Estimation of lymphocyte subpopulations in the peripheral blood of patients with sarcoidosis

Neutrophil and lymphocyte function in patients with diabetes mellitus

Neutrophil granulocyte chemotaxis and intraneutrophilic and plasma levels of lysozyme as well as the number of T and B lymphocytes and lymphocyte transformation in vitro on stimulation with mitogens and microbial antigens were studied in four groups of patients with diabetes mellitus (DM). Twelve patients with insulin-dependent diabetes mellitus (IDDM) and ketoacidosis and 4 patients with non-insulin-dependent diabetes mellitus were studied at the time of diagnosis and before and after start of treatment. Ten patients with IDDM of less than 10 years' duration which had been difficult to regulate well and 10 patients with IDDM well regulated for more than 20 years were studied at their regular outpatient visits. Apart from a slight increase in plasma lysozyme in group 1 from the first to the second examination, we found no differences between diabetics and healthy control persons. It is concluded that if patients with DM are more susceptible to infections, it is probably caused by elements of neutrophil or lymphocyte function not examined in this study or by factors unrelated to immunity.

Prognostic significance of lymphopenia in sarcoidosis

During 1959--67, sarcoidosis were diagnosed in a series of 140 patients. All were followed up and 22 developed chronic sarcoidosis. In 134 patients (20 with chronic course) the initial granulocyte, monocyte and lymphocyte counts were known. No differences in granulocyte values were seen between different groups of sarcoidosis patients. Patients with erythema nodosum had significantly increased monocyte levels. Lymphopenia below 1 000/microliter was seen in only 7.5% of the patients. Lymphocyte counts below 1 500 microliter were a common finding, especially in patients developing chronic sarcoidosis. Significantly decreased lymphocyte values were also seen in patients older than 40 years at the time of diagnosis, in patients negative to 10 TU of PPD and in those with a disease requiring treatment with corticosteroids. A correlation was found between initial lymphopenia and less favourable prognosis, 85% of the patients having a very good prognosis. Patients with initial lymphopenia must be carefully followed up. The initial presence of erythema nodosum does not always guarantee a good prognosis.

Lymphocyte subpopulations in bronchoalveolar lavages of patients with sarcoidosis and hypersensitivity pneumonitis

Sarcoidosis and hypersensitivity pneumonitis (HP) are two granulomatous pulmonary diseases, the former of unknown cause and the latter with known etiology. To compare these diseases, we practiced bronchoalveolar lavage on 16 patients with sarcoidosis, 6 with HP, 10 healthy nonsmokers, and 10 smokers with chronic bronchitis. Lymphocyte subpopulations were evaluated by four membrane markers: (1) The total cell count was very high in patients with HP compared with those with sarcoidosis and with healthy subjects. (2) The proportion of lymphocytes was higher in patients with HP than in those with sarcoidosis (P less than 0.02) and also higher in patients with sarcoidosis than in healthy subjects (P less than 0.001). (3) There were only a small number of B cells and of Fc-receptor bearing cells. (4) The lymphocytes identified by our techniques were mainly T cells in sarcoidosis and HP (68.4 +/- 3.5 percent and 76.8 +/- 3.6 percent, respectively), but the proportion of "active" E-rosette-forming cells was higher in sarcoidosis than in HP (28.1 +/- 2.5 percent vs 9.8 +/- 1.5 percent) and higher in patients with HP than in healthy subjects. These studies suggest that: (1) these two granulomatoses may be differentiated by this method, which might also be used for other pulmonary angiitis and granulomas; (2) cell-mediated immune phenomena play a major role in the pathogenesis of sarcoidosis, and conversely the finding of low active E-rosette proportions in HP limits the role of delayed-type hypersensitivity; and (3) the exact role of immunologic activation of bronchopulmonary macrophages, "presenting" antigen to T cells, for instance, must be evaluated.