In vitro studies of ulcerative colitis. II. Cytotoxic action of white blood cells from patients on human fetal colon cells

The search for the Holy Grail: autoantigenic targets in primary sclerosing cholangitis associated with disease phenotype and neoplasia

Unlike in other autoimmune liver diseases such as autoimmune hepatitis and primary biliary cholangitis, the role and nature of autoantigenic targets in primary sclerosing cholangitis (PSC), a progressive, chronic, immune-mediated, life threatening, genetically predisposed, cholestatic liver illness, is poorly elucidated. Although anti-neutrophil cytoplasmic antibodies (ANCA) have been associated with the occurrence of PSC, their corresponding targets have not yet been identified entirely. Genome-wide association studies revealed a significant number of immune-related and even disease-modifying susceptibility loci for PSC. However, these loci did not allow discerning a clear autoimmune pattern nor do the therapy options and the male gender preponderance in PSC support a pathogenic role of autoimmune responses. Nevertheless, PSC is characterized by the co-occurrence of inflammatory bowel diseases (IBD) demonstrating autoimmune responses. The identification of novel autoantigenic targets in IBD such as the major zymogen granule membrane glycoprotein 2 (GP2) or the appearance of proteinase 3 (PR3) autoantibodies (autoAbs) have refocused the interest on a putative association of loss of tolerance with the IBD phenotype and consequently with the PSC phenotype. Not surprisingly, the report of an association between GP2 IgA autoAbs and disease severity in patients with PSC gave a new impetus to autoAb research for autoimmune liver diseases. It might usher in a new era of serological research in this field. The mucosal loss of tolerance against the microbiota-sensing GP2 modulating innate and adaptive intestinal immunity and its putative role in the pathogenesis of PSC will be elaborated in this review. Furthermore, other potential PSC-related autoantigenic targets such as the neutrophil PR3 will be discussed. GP2 IgA may represent a group of new pathogenic antibodies, which share characteristics of both type 2 and 3 of antibody-mediated hypersensitive reactions according to Coombs and Gell.

QUANTITATIVE STUDIES ON THE BEHAVIOR OF SENSITIZED LYMPHOCYTES IN VITRO : I. RELATIONSHIP OF THE DEGREE OF DESTRUCTION OF HOMOLOGOUS TARGET CELLS TO THE NUMBER OF LYMPHOCYTES AND TO THE TIME OF CONTACT IN CULTURE AND CONSIDERATION OF THE EFFECTS OF ISOIMMUNE SERUM

When lymphoid cells, derived from rats immunized with respect to homologous skin, were cultured with target cells originally of donor origin, cytocidal and cytostatic activities of the attacking lymphocytes became evident. By application of a sensitive and reproducible quantitative assay system, various aspects of the mechanism of this destructive interaction between target cells and lymphocytes were examined with the following results. 1. The degree of survival of target cells was inversely related to the number of sensitized lymphocytes. Graphic plots of the data indicated that this relationship was an exponential one similar to "single-hit" inactivation phenomena. One interpretation which could be placed on these results is that a single lymphocyte, if immunologically active, was sufficient to destroy or at least have a detectably adverse effect on one target cell. Furthermore, from such a model it could be computed that, of the lymphocytes derived from an immunized animal, approximately 1 to 2 per cent of the cells were immunologically active; i.e., capable of demonstrable destructive activities against homologous target cells in vitro. 2. Morphological studies on the effect of sensitized lymphoid cells on homologous target cells, aftervarious lengths of time in culture, showed that by 7 hours of incubation, the attacking lymphocytes firmly adhered to the target cells. The cytotoxic effect of these lymphocytes generally occurred after the 20th hour. Quantitative studies supported this conclusion; the latent period, i.e., the time required for detectable degrees of target cell destruction to occur, was approximately 20 hours. 3. A consequence of the incubation of target cells with normal lymphoid cells or even with small numbers of sensitized lymphoid cells was an increase in the rate of division of the target cells. As might be expected, this was reflected in a shorter doubling time of these cells. 4. Extracts prepared from sonically disrupted sensitized lymphocytes proved to be no more deleterious to target cells than similar preparations from normal lymphoid cells. Furthermore, no evidence could be obtained that sensitized lymphoid cells, separated from target cells by a Millipore membrane, were cytocidally effective. These data indicated that if a cell-bound substance is involved in the destruction of homologous cells, either it is not toxic by itself, or it cannot be detached from the sensitized cells. In any case, close apposition of the lymphocytes to the target cells is apparently required for the destruction of the latter in vitro. 5. Serum obtained from immunized animals, if heat-inactivated, did not adversely affect homologous target cells; if employed fresh, slight degrees of toxicity resulted. Specific isoimmune sera did not impart any detectable degrees of immunological reactivity upon otherwise normal lymphoid cells. Immune sera, even in high concentrations, did not augment the effect of sensitized lymphoid cells upon homologous target cells; rather a slight inhibitory effect of these sera was detected. 6. Attempts to detect the presence of complement activity, which might have been provided by the lymphoid cells in culture, were unsuccessful. On the basis of these results, it was suggested that the destruction of homologous target cells by sensitized lymphoid cells occurs as a two step process. First, the attacking lymphocytes attach to their targets via a non-toxic cell-bound substance having an immunologic specificity, and then, destruction of the target cells follows the result of some process dependent on the metabolic activity of the attacking lymphoid cells.

Patients with inflammatory bowel disease (IBD) reveal increased induction capacity of intracellular interferon-gamma (IFN-gamma) in peripheral CD8+ lymphocytes co-cultured with intestinal epithelial cells

Intestinal epithelial cells seem to play a key role during IBD. The network of cellular interactions between epithelial cells and lamina propria mononuclear cells is still incompletely understood. In the following co-culture model we investigated the influence of intestinal epithelial cells on cytokine expression of T cytotoxic and T helper cells from patients with IBD and healthy controls. Peripheral blood mononuclear cells (PBMC) were purified by a Ficoll-Hypaque gradient followed by co-incubation with epithelial cells in multiwell cell culture insert plates in direct contact as well as separated by transwell filters. We used Caco-2 cells as well as freshly isolated colonic epithelia obtained from surgical specimens. Three-colour immunofluorescence flow cytometry was performed after collection, stimulation and staining of PBMC with anti-CD4, anti-CD8, anti-IFN-gamma and anti-IL-4. Patients with IBD (Crohn's disease (CD), n = 12; ulcerative colitis (UC), n = 16) and healthy controls (n = 10) were included in the study. After 24 h of co-incubation with Caco-2 cells we found a significant increase of IFN-gamma-producing CD8+ lymphocytes in patients with IBD. In contrast, healthy controls did not respond to the epithelial stimulus. No significant differences could be found between CD and UC or active and inactive disease. A significant increase of IFN-gamma+/CD8+ lymphocytes in patients with UC was also seen after direct co-incubation with primary cultures of colonic crypt cells. The observed epithelial-lymphocyte interaction seems to be MHC I-restricted. No significant epithelial cell-mediated effects on cytokine expression were detected in the PBMC CD4+ subsets. Patients with IBD-even in an inactive state of disease-exert an increased capacity for IFN-gamma induction in CD8+ lymphocytes mediated by intestinal epithelial cells. This mechanism may be important during chronic intestinal inflammation, as in the case of altered mucosal barrier function epithelial cells may become targets for IFN-gamma-producing CD8+ lymphocytes.

ANTAGONISTIC EFFECTS OF HUMORAL ISOANTIBODIES ON THE IN VITRO CYTOTOXICITY OF IMMUNE LYMPHOID CELLS

The ability of specifically immunized lymphoid cells to kill H-2 incompatible target tumor cells in tissue culture was shown to depend on the source of the lymphoid tissue (spleen versus lymph nodes). Marked cytotoxic effects were obtained with regional lymph node cells 7 to 10 days after primary immunization, whereas spleen cells from the same animals had little or no effect. Hyperimmunization did not decrease the cytotoxic efficiency of lymph node cells. Experiments were performed to test the possibility that the weak effect of spleen cells is a result of humoral antibody production, antagonizing the cell-bound immunity. Humoral antibodies were cytotoxic in vitro in the presence of complement only. Their effect was manifested after 2 hours, whereas immune lymph node cells did not require complement and cytotoxicity was not expressed until 24 to 48 hours' incubation. Tumor cell cultures treated with specific humoral antibodies in the absence of complement became resistant to the cytotoxic effect of subsequently added immune lymph node cells, while no such protection was seen when normal serum was added. Thus, humoral antibodies led to an "efferent" inhibition of cell-bound immunity in vitro, in analogy with previous results in vivo.

T cell cytotoxicity of autologous and allogeneic lymphocytes in a patient with Crohn's disease

We report a 27-year-old male with Crohn's disease (CD) of the small and large intestine, whose peripheral blood lymphocytes (PBL) showed increased cell-mediated cytotoxicity (CTL). Autologous and allogeneic effector cells from PBL and intestinal lymph nodes (LN) were isolated on a Ficoll-Hypaque gradient. Colonic cells were prepared as the target and were incubated for 6h with effector cells, after being labeled with Na(2)51CrO4. The CTL activity [effector/target (E/T) ratio, 100:1] of PBL for autologous targets was increased by 38% compared with that in normal subjects (< 10%), while that shown by LN was not increased (14%). The CTL activity of allogeneic PBL prepared from three of four other CD patients was also increased. Anti-major histocompatibility (MHC) class I and II and CD4 and CD8 monoclonal antibodies (50 micrograms/ml) significantly inhibited CTL activity. Complement-mediated depletion of CD2+ cells significantly reduced CTL activity. These results suggest that MHC-restricted CTL may play a role in mucosal damage in some patients with Crohn's disease.

Major histocompatibility antigen-restricted cytotoxicity in inflammatory bowel disease

BACKGROUND

The role of cytotoxicity mediated by peripheral blood mononuclear cells for colonic epithelial cells in inflammatory bowel disease (IBD) is still controversial. To clarify it, we studied major histocompatibility antigen (MHC)-restricted T cell-mediated cytotoxicity (CTL).

METHODS

Cytotoxicity was measured by 51Cr release from colonic cells after the 6-hour incubation with peripheral blood mononuclear cells in 11 IBD patients (6 with Crohn's disease and 5 with ulcerative colitis).

RESULTS

CTL activity (E/T ratio = 200:1 or 100:1) for autologous target cells was significantly increased (22%-40%) in 5 of 6 CD and 4 of 5 UC patients (22%-64%) compared with that for allogeneic target cells. The increase in CTL activity was mainly inhibited by anti-MHC class I and CD8 monoclonal antibodies (50 micrograms/mL), while it was partially inhibited by anti-MHC class II or CD4 antibodies in some patients. Complement-mediated depletion of CD2+ cells also significantly decreased CTL activity.

CONCLUSIONS

The results indicate that MHC-restricted T cell cytotoxicity may play a role in mucosal damage in some patients of IBD.

The presence in experimental animals of a colon specific Mr 40,000 protein(s) with relevance to ulcerative colitis

In patients with ulcerative colitis a colon tissue bound IgG and serum antibodies against an Mr 40,000 colonic protein(s) has been identified. Using an anti-Mr 40,000 protein monoclonal antibody, 7E12H12, by an immunocytochemical method, the protein was localised in human tissue exclusively to colonic epithelial cells. In this study the presence of the Mr 40,000 protein was assessed in experimental animals by the direct and inhibition enzyme linked immunosorbent assays (ELISAs) using the anti-Mr 40,000 protein monoclonal antibody, 7E12H12 (IgM isotype). In addition, a total of 129 specimens including colon, small intestine, gall bladder, biliary tract, and kidney from nine strains of rats and mice, and from human tissue were studied by the immunocytochemical method using 7E12H12. All colon specimens from both humans and animals reacted with 7E12H12 in the immunocytochemical and ELISA assays. None of the non-colonic organs reacted with 7E12H12. While in human colon 7E12H12 recognised the absorptive epithelial cells, in all the animals it recognised mainly the colonic goblet cells. Extracts of animal colon but not of small intestine inhibited the binding of 7E12H12 to the human colon extract. This study shows the presence of an organ specific Mr 40,000 colonic epithelial protein(s) in humans and experimental animals. A differing cellular localisation of the Mr 40,000 protein(s) in human v animal tissue was also shown. Further characterisation of the Mr 40,000 protein(s) may provide important clues regarding the autoimmune mechanisms in ulcerative colitis.

Lack of induction of suppressor T cells by intestinal epithelial cells from patients with inflammatory bowel disease

The mechanisms underlying the chronic unrelenting inflammatory response seen in inflammatory bowel disease (IBD) are poorly understood. We have recently proposed a novel role for the normal intestinal enterocyte, that of antigen presenting cell. However, in contrast to conventional antigen presenting cells, normal enterocytes appear to selectively activate CD8+ antigen nonspecific suppressor T cells. To determine whether failure of this process may be occurring in inflammatory bowel disease, freshly isolated enterocytes from small and large bowel from normal patients, patients with Crohn's disease, ulcerative colitis, and inflammatory (diverticulitis, ischemic colitis, and gold induced colitis) controls were co-cultured with allogeneic T cells in a modified mixed lymphocyte reaction. In contrast to normal enterocytes, 42/42 Crohn's and 35/38 ulcerative colitis-derived epithelial cells stimulated CD4+ T cells, whereas 65/66 and 9/9 normal and inflammatory control enterocytes, respectively, stimulated CD8+ T cells (as previously described), suggesting that the results seen were not just a reflection of underlying inflammation. Furthermore, IBD enterocytes from both histologically involved and uninvolved tissue were similar in their ability to selectively activate CD4+ T cells, speaking for a more global defect in epithelial cells in IBD. Finally, activated T cells from IBD epithelial cell-stimulated mixed lymphocyte cultures displayed potent T helper activity in an antigen nonspecific fashion. Taken together, these data suggest that there may be an intrinsic defect in epithelial cells from patients with IBD, resulting in the inability to normally stimulate suppressor T cells in an antigen overloaded environment.

Autoantibodies to colonic cells and subcellular fractions in inflammatory bowel disease: do they exist?

Previous observations have purported to demonstrate circulating antibodies which bind to colon epithelial cells. However, the significance and reproducibility of such observations has been difficult and the data often phenomenological. To further our understanding of such autoreactivity, we studied sera and purified serum immunoglobulins from patients with ulcerative colitis, Crohn's colitis and other inflammatory diseases, as well as normal volunteers using as a target, well-defined epithelial cell preparations from normal and diseased colon and small bowel including crude suspensions of homogenized cells, purified and characterized brush border membranes, basolateral membranes and a DEAE cellulose column purified protein fraction. Homogenates of normal liver, lung, kidney, thymus, pancreas, stomach and small and large intestine, obtained at surgery, were also included. The purified preparations were characterized by enzyme activity and were electrophoresed on SDS-polyacrylamide gels for immunoblotting. Additional studies were carried out comparing these findings with those of a previously published and described 'positive' colon target preparation and polyclonal antibody. There was no convincing demonstration of circulating autoantibodies in patients with ulcerative colitis. Our data, using well-defined and characterized tissue preparations, raises doubts regarding the presumptive demonstration of autoantibodies in ulcerative colitis.

Immune events associated with inflammatory bowel disease

Immunologic abnormalities have been implicated in the etiology of inflammatory bowel disease (IBD). Defects of systemic immunity and of local (intestinal) immunity have been studied. The numbers of T and B lymphocytes and their characteristics seem to vary with the disease, but no cause-and-effect relationship has been established. The presence of anticolon antibodies in patients with ulcerative colitis suggests that these antibodies could be involved in IBD, but they have also been found in other conditions. In the peripheral blood, abnormalities of cell-mediated immunity are inconsistent and suggest that they are not fundamental defects of the disease. The hypothesis that the inflammatory process is a result of immune-mediated intestinal tissue damage is being extensively studied. The high familial incidence of the disease suggests a role of histocompatibility locus antigens, but no reproducible association can be established. In vivo and in vitro studies of mucosal mononuclear cells have revealed abnormalities of immunoglobulin production, some types of cytotoxicity against gut-derived antigens, and altered lymphokine production associated with the disease. Further studies of the intestinal immune system would seem to be the most fruitful line of research.

Lysis of colonic epithelial cells by allogeneic mononuclear and lymphokine activated killer cells derived from peripheral blood and intestinal mucosa: evidence against a pathogenic role in inflammatory bowel disease

A sensitive 4 h 51Cr-release cytotoxicity assay has been developed using as targets colonic epithelial cells obtained by Dispase-collagenase digestion of resected mucosa or colonoscopic biopsies. Peripheral blood mononuclear cells (MNC) from most healthy donors showed low, but significant levels of cytotoxicity for normal epithelial cell target cells of 8.7 (4.4) % (mean (SD] and similar levels were found in 14 ulcerative colitis (6.5 (4.4) %) and 16 Crohn's disease (6.2 (5.2) %) patients. Neither drug therapy nor disease activity influenced the results. The sensitivity of colonic epithelial cells isolated from inflamed and histologically normal mucosa to lysis by peripheral blood MNC from a single donor was not affected by the underlying disease. Anti-epithelial cell activity did not correlate with anti-K562 activity and the cytotoxic cell was plastic non-adherent and Leu-11b-. None of 15 MNC populations isolated from mucosa of normal, tumour bearing, or chronically inflamed intestine exhibited significant lysis of colonic epithelial cells despite killing of K562 target cells in 10. Lymphokine activated killer (LAK) cells, generated by interleukin-2 stimulation in vitro of nine intestinal and seven peripheral blood MNC populations, exhibited high levels of lysis of K562 cells but, on every occasion, failed to lyse colonic epithelial cells. These data indicate that spontaneously cytotoxic or LAK cells are unlikely to play a role in the generation of colonic epithelial cell injury by direct cytotoxicity in inflammatory bowel disease.

What sequence of pathogenetic events leads to acute ulcerative colitis?

The etiology of ulcerative colitis remains unresolved despite new immunologic, biochemical, and microbiologic observations made in this disease. A sequence of pathogenetic events has been adduced from abnormalities reported from human and experimental colitis with the express purpose of establishing priority of factors that may lead to an attack of acute ulcerative colitis. The presence of undefined bacterial metabolites in the colonic lumen causing specific breakdown of fatty acid oxidation in colonic epithelial cells is proposed to be the initiating event of the disease process that leads to an immune response and eicosanoid response perpetuating epithelial cell damage. The proposals embody the thesis that primary metabolic damage to colonocytes determines the clinical and pathologic manifestations of ulcerative colitis.

Cutaneous delayed hypersensitivity in Crohn's disease and ulcerative colitis. Application of multi-test

In this study the Multi-Test was applied in 48 patients with inflammatory bowel disease and in 25 normal controls. A significant difference between normal controls and patients with Crohn's disease but not between normal controls and patients with ulcerative colitis was found with regard to anergic status, frequency of positive skin reactions, and size of skin infiltration. The authors conclude that in patients with Crohn's disease a defect exists in the cellular immunity.

Sensitization to epithelial antigens in chronic mucosal inflammatory disease. III. Serum factor modulates circulating and mucosal mononuclear-cell reactivity to epithelial cell-associated components of colon (ECAC-C)

A prior report indicated that sera together with peripheral blood mononuclear cells from patients with Crohn's disease were reactive with epithelial cell-associated components derived from small bowel (ECAC-SB). In the present study, we sought to determine whether similar components (designated ECAC-C) from everted, inflated loops of murine colon could be purified to homogeneity in aqueous soluble form and physiochemically characterized; if sera and/or peripheral mononuclear cells from patients with a chronic idiopathic inflammatory disorder of intestinal mucosa were specifically reactive with ECAC-C; whether immunoglobulin was the factor conferring specificity to the anti-ECAC-C response; and if this immunoglobulin was actively synthesized by human lamina propria B lymphocytes isolated from disease-involved intestinal mucosa. Preparative polyacrylamide gel electrophoresis followed by elution of specific bands resulted in the isolation of three major proteins in homogeneous form. Each was a distinctive macromolecule by molecular weight (39,000, 63,000, 148,000), carbohydrate/protein content, and serologically detectable determinants as assessed by quantitative hemagglutination inhibition. By a 51Cr release microcytotoxicity assay, ECAC-C-labeled indicator cells were specifically lysed by sera and peripheral blood mononuclear cells from patients with ulcerative colitis (8.0 +/- 6.8%) and Crohn's disease (13.2 +/- 4.7%), compared with age-/sex-matched controls (0.6 +/- 0.9 and 0.2 +/- 0.4%, respectively). That the factor conferring ECAC-C specificity was immunoglobulin was demonstrated by the retention of ECAC-C-specific reactivity of patient sera in the presence of normal peripheral blood mononuclear cells, the ability of patient sera (without cells) to effect complement-mediated lysis against erythrocytes labeled with ECAC-C (8.0 +/- 6.7%) but not with control kidney antigen (0.7 +/- 0.7%), and the fact that purified immunoglobulin from patient sera could substitute for the latter in an ECAC-C-specific antibody-dependent cellular cytotoxicity assay. Unique aspects of this ECAC-C reactivity included its absence from sera in other disorders with a known or presumed autoimmune basis (systemic lupus erythematosus, chronic active hepatitis) and the lack of simultaneous reactivity directed toward control antigens, isolated from kidney in a manner analogous to that used for ECAC-C. The importance of ECAC-C-specific immune responses at the mucosal level was also examined using mononuclear cells isolated from disease and control intestinal lamina propria (LPMC).(ABSTRACT TRUNCATED AT 400 WORDS)

Antigen presentation by epithelial cells of the rat small intestine. II. Selective induction of suppressor T cells

Columnar epithelial cells (EC) isolated from the rat small intestine can present protein antigen in vitro, inducing proliferation of primed T cells. This system was used to examine the immunoregulatory function of T cells activated by presentation of ovalbumin (OVA) by EC. Rat lymph node T cells, sensitized to OVA in vivo and exposed to EC and OVA in vitro, suppressed the in vitro proliferative response of primed T cells to OVA. The suppression mediated by these modulated T cells (Tmod) was antigen-specific, was restricted during the induction phase by Ia antigens on the EC accessory cells, and was not affected by irradiation of Tmod. The generation of suppressor activity in Tmod was accompanied by an increase in expression of suppressor phenotype. It is suggested that a possible in vivo correlate of this phenomenon may play a role in the induction of suppressor T cells mediating systemic tolerance to dietary antigens.

Inhibition of cytotoxicity by sulfasalazine. I. Sulfasalazine inhibits spontaneous cell-mediated cytotoxicity by peripheral blood and intestinal mononuclear cells from control and inflammatory bowel disease patients

We have studied the effects of sulfasalazine and its metabolites on cell-mediated cytotoxicity by peripheral blood and intestinal mononuclear cells from both control and inflammatory bowel disease (IBD) patients. Sulfasalazine and sulfapyridine, as well as hydrocortisone and nordihydroguaiaretic acid inhibited spontaneous cell-mediated cytotoxicity by control and IBD peripheral blood cells. Sulfasalazine and nordihydroguaiaretic acid inhibited spontaneous cell-mediated cytotoxicity by control and IBD intestinal mononuclear cells cultured for 72 h in media alone. In contrast, 5-aminosalicylate, indomethacin and benzylimidazole had no effect on cytotoxicity by any cell population. Lectin-induced, antibody-dependent and interleukin-2-induced cell-mediated cytotoxicity, as well as lymphokine-activated killing were not inhibited by the drugs: inhibitory effects in these assays were primarily upon the underlying spontaneous cell-mediated cytotoxicity. The inhibition induced by sulfasalazine, sulfapyridine and nordihydroguaiaretic acid could not be reversed by adding the lipoxygenase metabolites leukotriene B4 or 12-hydroxyeicosatetraenoic acid. These findings demonstrate that spontaneous cell-mediated cytotoxicity by control and IBD mononuclear cells can be inhibited by sulfasalazine.

Deficient cell-mediated cytotoxicity and hyporesponsiveness to interferon and mitogenic lectin activation by inflammatory bowel disease peripheral blood and intestinal mononuclear cells

Intestinal mononuclear cells are poor mediators of spontaneous and antibody-dependent cellular cytotoxicity. In this study, we found that both interferon and mitogenic lectins were able to induce increased levels of cell-mediated cytotoxicity by intestinal mononuclear cells. Intestinal mononuclear cells from patients with inflammatory bowel disease exhibited hyporesponsiveness to cytotoxic activation by interferon or lectins compared with control intestinal mononuclear cells. Peripheral blood mononuclear cells from patients with Crohn's disease exhibited deficient spontaneous and antibody-dependent cytotoxicity that could be partially reversed by interferon or mitogenic lectins. These studies demonstrate that exogenous agents or endogenous factors can induce deficient intestinal and peripheral blood cytotoxic effector cells from inflammatory bowel disease patients to become active. In comparison with control cells, however, intestinal and peripheral blood mononuclear cells from inflammatory bowel disease patients are not only deficient in cytotoxic capabilities but also are hyporesponsive to interferon and lectin activation.

Isolation and characterization of a colonic autoantigen specifically recognized by colon tissue-bound immunoglobulin G from idiopathic ulcerative colitis

Patients with idiopathic ulcerative colitis (UC) have a colonbound antibody (CCA-IgG) that reacts with colon tissue extracts. We have partially characterized a colonic protein that is specifically recognized by CCA-IgG. CCA-IgG was eluted from operative colon specimens from 10 patients with UC. A colon tissue-bound IgG was similarly eluted from six patients with Crohn's colitis, two with ischemic colitis, and one with diverticulitis. Purified serum IgG from patients with Crohn's disease, from normal subjects and a patient with myeloma were also used as additional controls. For detection of antigen(s), tissue extracts were prepared from 26 specimens of colon (UC, 12; Crohn's disease, 6; normal, 4; other controls, 4), 8 specimens of human normal stomach, duodenum, ileum, and liver (2 each). Tissue extracts were also prepared from rats and mice, including germ-free rat colons and rat's fetal colons. Immunorecognition of CCA-IgG to the tissue extracts was examined by affinity-column chromatography and by transblot analysis. Tissue-extracted proteins were electrophoresed in SDS-polyacrylamide gel, transferred to nitrocellulose sheet, and probed with iodinated CCA-IgG, colonic IgG from other inflammatory bowel disease patients, UC serum IgG, and control serum IgG. Although many proteins were present in colon tissue extracts, 9 of 10 CCA-IgG consistently recognized a protein of 40 kD. None of the nine IgG preparations from colon specimens of patients with Crohn's colitis and other colonic inflammatory diseases reacted with the 40-kD protein. Five of six symptomatic UC serum IgG and none of eight control serum IgG reacted with the 40-kD protein. The 40-kD protein was present in all colon specimens and it appeared to be organ specific. It was absent in mouse and rat tissues, including colon. The 40-kD protein is not actin and nor a part of the Ig molecule. These results suggest that the 40-kD protein is a colonic "autoantigen" that may initiate a specific IgG antibody response in UC.

Peripolesis followed by cytotoxicity in chronic idiopathic inflammatory bowel disease

Antigen presenting veiled cells have recently been described in cell suspensions prepared from the gut wall of patients with chronic idiopathic inflammatory bowel disease (CIBD). The normal gut wall is virtually devoid of these cells. In this report we describe a phenomenon known as peripolesis studied by phase contrast cinematography. This is a process in which lymphocytes are seen to wander around larger target cells. These could be identified ultrastructurally as Ia positive veiled cells. In most cases peripolesis was followed by lysis of the target cell. Peripolesis was recorded in cell suspensions of three out of seven patients with ulcerative colitis and in three out of nine patients with Crohn's disease; furthermore peripolesis was observed in one out of two patients with non-classifiable CIBD. In four cell suspensions showing peripolesis, cell lysis could be recorded and was especially striking in ulcerative colitis. Peripolesis involving veiled cells was previously described in delayed hypersensitivity reactions. This study lends support to the concept that delayed allergic reactivity plays a part in chronic inflammatory bowel disease. The antigens involved are, however, completely unknown.

Isolation of spontaneous and interferon inducible natural killer like cells from human colonic mucosa: lysis of lymphoid and autologous epithelial target cells

Viable mononuclear and epithelial cells were dispersed from human colonic tissue by treatment with collagenase and ethylene diamino-tetra acetate (EDTA) and separated by centrifugal elutriation. Using a single cell cytotoxic assay, functional endogenous and interferon responsive mononuclear cytotoxic cells were detected. Compared to peripheral blood lymphocyte associated killer cells that had been exposed to similar treatment, these colonic killer cells demonstrated lower efficiency cytotoxicity of Molt-4 target cells. Furthermore, inefficient, but interferon responsive cytotoxic cells were present which bound and lysed freshly isolated autologous epithelial cells. The cytotoxicity of these colonic mononuclear natural killer (NK) like cells appeared specific in that cells bound but did not lyse NK resistant Raji cells, even after interferon activation.

Bullous pemphigoid and ulcerative colitis

A 21-year-old white woman, who had ulcerative colitis for 14 years, developed generalized severe bullous pemphigoid. Following the resection of her colon, her skin showed marked clinical improvement, but this was only temporary. Direct immunofluorescence was performed on the surgical specimen and no antibodies (BMZ) to colonic mucosal cells were evident. Anti-basement membrane zone antibodies were found on direct and indirect immunofluorescent studies and have persisted. Sera from 15 patients with ulcerative colitis and 11 patients with Crohn's disease, evaluated for the presence of an anti-basement membrane zone antibody did not contain any demonstrable levels of anti-BMZ antibodies. The co-existence of ulcerative colitis and bullous pemphigoid is more likely incidental rather than etiopathologic.

Inhibition of spontaneous but not antibody-dependent cell-mediated cytotoxicity by simple sugars: evidence that endogenous lectins may mediate spontaneous cell-mediated cytotoxicity

Using Chang and K-562 cell line cells as targets, we have observed that a number of sugars are capable of inhibiting spontaneous cell-mediated cytotoxicity (SCMC) but not antibody-dependent cell-mediated cytotoxicity (ADCC). The sugars D(-)ribose, beta-gentiobiose, N-acetyl-D-galatosamine, and alpha-lactose all significantly inhibited SCMC of Chang and K-562 cell line cells. Because these same sugars caused no inhibition of ADCC against either Chang or K-562 cell line cells in assays run simultaneously, the results do not appear to be due to a non-specific toxic effect of the sugars against the effector cells. These studies add to the evidence that ADCC and SCMC are mediated by separate receptors. Furthermore, they provide evidence that endogenous lectin receptors or lectin-like molecules may be involved in the recognition and/or effector stages leading to SCMC. Thus, NK cells may recognize targets by virtue of receptors capable of interacting with monosaccharide, disaccharide, or oligosaccharide sequences present alone, as glycolipids, and/or as glycoproteins on the target cell surface.

Immune regulation in inflammatory bowel disease: absence of a serum inhibitor of suppressor cell function

Suppressor cell function of normal peripheral blood mononuclear cells was unaltered by preincubation with sera from patients with severe inflammatory bowel disease (IBD). These results suggest that, in contrast to juvenile rheumatoid arthritis and systemic lupus erythematosus, the decreased suppressor cell activity in IBD is not mediated by anti-suppressor cell antibodies.

Inflammatory bowel disease: study of cell mediated cytotoxicity for isolated human colonic epithelial cells

A better understanding of the mechanism(s) of cell mediated toxicity for colon cells in vitro may help clarify the pathogenesis of inflammatory bowel disease (IBD). We have examined both the cytotoxicity of IBD peripheral blood mononuclear cells and the kinetics of induction of such toxicity by soluble plasma factors. Peripheral blood mononuclear cells from IBD patients were found to be cytotoxic for the colon cells. With the use of Chang cells, this cytotoxicity was shown not to be due to an increase in spontaneous cell mediated cytotoxicity. Colon cell toxicity in vitro did not correlate with site of disease or severity, but decreased toxicity appeared to be associated with in vivo steroid administration. Plasma from some IBD patients was capable of inducing normal peripheral blood mononuclear cells to be toxic to colon cells. This ability was not affected by steroid therapy. The induction capacity of IBD plasma was not associated with the presence of circulating immune complexes, as measured by Raji RIA, suggesting that large complement fixing complexes are not the inducing and directing factors. Unlike findings in other systems, induction could be demonstrated after a one hour preincubation of mononuclear cells with IBD plasma. The kinetics of induction are consistent with the hypothesis that either cytophilic antibody or small circulating immune complexes arm K cells for specific colon cell lysis.

Systemic manifestations of chronic ulcerative colitis refractory to colectomy

In this paper, two cases of chronic ulcerative colitis displaying systemic manifestations are discussed. Each case illustrates the refractoriness of the systemic manifestations to colectomy and the total resolution of the manifestations by additional proctectomy. The implications of these clinical observations in relationship to the aetiology and therapy of ulcerative colitis are discussed.

K-Cell activity in lamina proprial lymphocytes from the human colon

Using an enzymatic method for their isolation, it has been shown that human colonic lamina proprial lymphocytes, isolated from patients with various colonic diseases and depleted of polymorphonuclear leukocytes and macrophages, demonstrated K-cell activity in two antibody-dependent cell-mediated cytotoxicity assays in vitro. No differences were found between the activities of lamina proprial lymphocytes isolated from colonic specimens involved by Crohn's disease, chronic ulcerative colitis, or colonorectal carcinoma. K-cell activity was demonstrable using lymphoid cells isolated from the colons of patients receiving steroid therapy at the time of the therapeutic resections. These findings indicate the need for further investigation of possible roles for K-cells in local immune responses in the human bowel mucosa in inflammatory and neoplastic diseases.

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

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

Characteristics of complexes for arming and inhibiting effector cells for antibody-dependent cell-mediated cytotoxicity

The size of IgG aggregate effective in the inhibition or arming of human effector cells for antibody-dependent cell-mediated cytotoxicity (ADCC) was investigated using heat- and alkalipolymerized rabbit IgG or purified antibody fractionated by gel filtration. In contrast to the inhibition of ADCC against chicken erythrocytes, which was marked when effector cell were pre-incubated with high molecular weight aggregates (19S or greater), small polymers were most effective in arming for cytotoxicity against antigen-coated chicken red cells. Our data also demonstrate that while the cytotoxic potential of armed cells is short-lived and rapidly lost during culture at 37 degrees C but not 4 degrees C, the reduced capacity of these cells to kill antibody-coated targets is not altered by similar incubation at 37 degrees C. The differences in the size of aggregate active in arming and inhibition, and the stability of the two phenomena are compatible with the hypothesis that large aggregates may cause more cross-linking and redistribution of effector cell Fc receptors than small polymers of IgG.

Decreased suppressor cell activity in inflammatory bowel disease

Studies were performed on eleven patients with inflammatory bowel disease to determine if there was an alteration in concanavalin A (Con A) induced suppressor cell activity. Similar investigations were also performed on twenty-one control subjects and five patients with other inflammatory conditions. Supressor cells were generated by pre-incubation of peripheral blood mononuclear cells with a mitogenic concentration of Con A, followed by treatment with mitomycin C and alpha-methyl mannoside. Under these conditions, cells obtained from normal individuals are then capable of suppressing the Con A-stimulated blast transformation responses of fresh allogeneic lymphocytes in new cultures. We found that in twenty out of twenty-one control subjects, and all five patients with other inflammatory disorders, Con A-stimulated suppressor cell activity was demonstrable. Four patients with inflammatory bowel disease, whose disease was mildly active or was in clinical remission, had elicitable suppressor cell activity which fell within the normal range. In contrast, suppressor cell activity was markedly diminished or absent in seven patients with severe and active inflammatory bowel disease. These studies suggest that an alternation in Con A-stimulated suppressor cells exists in patients with active inflammatory bowel disease, which may contribute, in part, to the persistent inflammation in the gastrointestinal tract.

Studies on the subpopulation and function of peripheral lymphocytes, and lymphocyte reactivity to colonic mucosal antigen and bacterial antigen in patients with ulcerative colitis and Crohn's disease

Immunological studies were carried out in fifteen cases of ulcerative colitis, three cases of tuberculous colitis, four cases of Crohn's disease and one case of Behcet's disease diagnosed by X-ray, endoscopy or biopsy mainly from the standpoint of cellular immunity. In patients with ulcerative colitis the T-cell population and PHA responsiveness of peripheral lymphocytes were both depressed more than in the control group. At different stages of the disease, the deviation of the values of PHA responsiveness of lymphocytes showed a rather wide range in the active stage and there was also immunological instability. However, when the disease entered remission, the immunological conditions settled down and the pathological condition appeared stable. In contrast to the nonspecific immunological conditions mentioned above, characteristically, there were many examples of a positive lymphocyte response to colonic mucosal and bacterial antigens. In all cases of Crohn's disease the lesions are in the small intestine and there was a reduced response to PHA lymphocytic stimulation which was more pronounced than that in patients with ulcerative colitis. PHA response was also high in tuberculous colitis cases.

Immune-complex mediated colitis in rabbits. An experimental model

An experimental colitis in rabbits is described, following the intravenous injection of preformed immune complexes of human serum albumin (HSA) and anti-HSA into non-sensitised rabbits. Tissue damage was localised to the colon by the Auer technique of inducing local non-specific inflammation, by the rectal instillation of dilute formalin. Formalin alone gave transient changes that reverted to normal within 24 hours. In rabbits given intravenous immune complexes formed in antigen-excess, a severe colitis was initiated, with histological features including mucosal ulceration, mixed inflammatory cell infiltration in the lamina propria, and crypt abscess formation. It is possible that immune-complex damage may be one of the pathogenic mechanisms involved in human ulcerative colitis.