In-vitro inhibition of leucocyte migration in Crohn's disease by a sarcoid spleen suspension

Leukocyte migration agarose test (LMAT) in sarcoidosis using Kveim test material

The two-stage leukocyte migration agarose test (indirect LMAT), shown to be a sensitive in vitro assay for cell-mediated immunity, was used to study Kveim reactivity in vitro in patients with sarcoidosis. No Kveim-induced inhibition of leukocyte migration in agarose or Kveim-induced lymphocyte transformation in vitro was found in 23 patients with sarcoidosis, suggesting that the Kveim reaction is not an expression of cell-mediated immunity.

[The leucocyte-migration-inhibition-test in the diagnostic of sarcoidosis (author's transl)]

The positive diagnosis of a sarcoidosis is often difficult since reliable laboratory and radiological parameters are not available. It is therefore often necessary to make the diagnosis with invasive methods. The Kveim skin test has many disadvantages, so that there have been many trials to facilitate the diagnosis by in vitro systems. With a modified and easy handable leucocyte migration technique in agarose (Clausen technique), 30 patients with certified sarcoidosis were tested. As controls served healthy volunteers and patients with various diseases such as Hodkins disease, Crohn's disease, tuberculosis etc. As antigene a Kveim suspension typ I was prepared according to Chase and was used in a concentration of 100 mug/ml. It could be shown, that leucocytes from patients with sarcoidosis demonstrated a significant inhibition of their migration in presence of Kveim antigene. Besides patients with Crohn's disease in no other group there was a migration inhibition. Therefore this in vitro system allows diagnostic differentiation and helps to find the diagnose which compares well to the results obtained with the Kveim skin test. Since the test is easy to perform and the results are available after 24 h the test is of diagnostic value for the clinical routine.

Comparative in vitro reactivities of leukocytes from sarcoids and normals to different Kveim preparations

Comparative studies of in vivo and in vitro reactivities to Kveim preparations have been carried out in 45 sarcoid and 30 normal subjects. Lymphocytes of 14 of 45 sarcoids and 4 of 30 normals proliferated significantly in response to at least 1 of the 4 Kveim suspensions used for in vitro studies. The prevalence of positive responses were significantly greater in sarcoids than normals in cultures containing Kveim-CSL and Kveim-Edinburgh. The Kveim-reactive cells were less stimulated by PHA, but no other significant alterations were found, including the presence or absence of in vivo Kveim reactivity in the cell donors. Reactivity to more than 1 Kveim preparation occurred in 9 of 14 cases. Kveim-induced leukocyte migration inhibition occurred more commonly in sarcoids than normals, but differences were not as striking. There was not a precise correlation between proliferative and migration-inhibition responses to Kveim.

Kinetics of monocyte receptor activity for immunoproteins in patients with sarcoidosis

Peripheral blood monocytes from patients with active sarcoidosis have increased ability to bind IgG-antibody-coated and C3-coated erythrocytes. Binding of monocytes from sarcoid patients is inhibited less than for normals with IgG1 and IgG3 in the fluid phase. Following phagocytosis of latex particles, monocytes from sarcoides patients retain the capacity to bind IgG-coated erythrocytes, whereas monocytes from normal individuals show disappearance of IgG receptors followed by recovery during a 6-8 hr period. Preliminary studies (8 patients) of monocytes from patients with Crohn's disease show some increase in binding of IgG-coated erythrocytes as compared with normals; this increase, however, is less than for sarcoidosis patients. Preliminary experiments with multistranded polynucleotides (poly I:C:U) show increased activity for normal monocytes and no detectable effect on IgG receptor activity for sarcoid monocytes. Thus peripheral blood monocytes of patients with sarcoidosis have increased IgG and C3 receptors sites, suggesting activation of monocytes in this disease and perhaps in other granulomatous disorders.

Histopathology of cell mediated immune reaction in mouse colon--allograft rejection

Grafts of mouse fetal colon, implanted beneath the renal capsule of adult hosts, have been used to study the growth and development of colonic isografts and the rejection of colonic allografts. Isografts grew normally and maintained a structure similar to normal colon. Grafts between strains with H2 histocompatibility differences were rejected by 13 days after transplantation. Early progressive infiltration of the grafts by lymphoid cells was followed by increasing damage to, and subsequent loss of, the epithelial cell layer and destruction of the underlying muscle, changes which parallel those seen in rejection of skin and small bowel. The increase in survival time which is seen in allografts between strains with H2 identity was longer in the colon than has been seen in the skin or small bowel; none of the allografts of colon were completely rejected before 30 days, and some remained viable at 50 days. Comparison of the appearances of rejection in the colon with those of ulcerative colitis and colonic Crohn's disease does not show the striking similarity which is seen between small bowel rejection and coeliac disease. Many of the individual features of these diseases are, however, present in the course of colonic rejection.

Leukocyte migration test in Crohn's disease, ulcerative colitis, and ankylosing spondylitis using Crohn's colon homogenate, mitochondrial, and microsomal fractions

Leukocytes from 33 patients with Crohn's disease, 20 patients with ulcerative colitis, and 20 patients with ankylosing spondylitis were tested for evidence of abnormal migration in the presence of preparations of colon from a patient with Crohn's disease. None of the patients was on treatment with immunosuppressive drugs. The test was also performed with leucocytes from 12 health subjects. Significant alteration was seen in the Crohn's disease group, particularly when the antigen used was mitochondrial or microsomal fraction of colon mucosa, whereas the patients in the ulcerative colitis group showed reactivity only with the whole colon homogenate and not with the subcellular fractions. The ankylosing spondylitis group showed no statistical difference from the normal controls with any of the antigens.

Inflammatory bowel disease: the surgical pathology of Crohn's disease and ulcerative colitis

Ulcerative colitis and granulomatous colitis are distinct entities, but up to 10 per cent of colectomy specimens remain unclassified. Ulcerative colitis is primarily a mucosal disease, and other changes appear to be secondary to this process. By contrast, Crohn's disease, or granulomatous colitis, involves the whole thickness of the bowel wall. About 20 per cent of the cases of Crohn's disease involve the small and large bowel, while another 20 per cent are restricted to the large bowel. Since granulomatous colitis is a patchy disease, and many of the changes are deep within the bowel wall, rectal biopsy may not be as helpful as in ulcerative colitis. Fully developed granulomas are present in only a small minority of cases, and a diagnostic report of granulomatous colitis may be given in the absence of granulomas. In biopsy material, the differentiation of inflammatory bowel disease from ischemic colitis and pseudomembranous colitis may be difficult. In the absence of specific demonstration of an organism it may also be impossible on rectal biopsy to distinguish amebic or bacillary dysentery from ulcerative colitis. Even by colectomy, 29 of 300 specimens were sufficiently atypical so as not to warrant a label of Crohn's disease, or ulcerative colitis. Cancer of the colon, which is common in ulcerative colitis, is rare in Crohn's disease, but may also represent a definite complication in the latter. Immunologic studies are still confusing, but it is suggested that patients with ulcerative colitis and Crohn's disease may have a state of altered immunologic reactivity.

A study of peripheral leucocyte migration in agarose medium in inflammatory bowel disease

THE MIGRATION OF PERIPHERAL LEUCOCYTES FROM PATIENTS WITH INFLAMMATORY BOWEL DISEASE WAS INVESTIGATED USING AN AGAROSE PLATE TECHNIQUE AND THREE ANTIGENIC MATERIALS: (1) the enterobacterial common antigen of Kunin; (2) extract from germ-free rat faeces; and (3) Kveim suspension from a sarcoid spleen K19. Inhibition of migration was obtained only with Kunin antigen. It was present in 11 out of 20 patients with ulcerative colitis and in four out of 20 patients with Crohn's disease but in only one out of 33 control subjects. These findings suggest the possibility that a state of cellular immunity to enterobacterial common antigen may exist in inflammatory bowel disease. Lack of cellular reactivity to extract from germ-free faeces and Kveim suspension is in contrast with the results obtained by others by means of the capillary tube method and requires further investigation.

Mixed-lymphocyte reaction as a measure of immunological competence of lymphocytes from patients with Crohn's disease

Peripheral blood lymphocytes from 12 patients with Crohn's disease and from a group of normal volunteers have been tested for transformation under stimulation of allogeneic cells in a mixed lymphocyte culture and by phytohaemagglutinin (PHA) in vitro. There was a significant depression of transformation in the mixed lymphocyte culture where lymphocytes from the Crohn's disease patients constituted the responding population. With PHA stimulation, no difference in transformation was seen between the patients and the control group. This is interpreted as indicating a depression in cellular immunity in Crohn's disease.

Leucocyte migration studies in Crohn's disease using Crohn's colon homogenate and mitochondrial and microsomal fractions

Leucocytes from 38 patients with Crohn's disease were tested for evidence of migration inhibition in the presence of preparations of colon from a patient with this disease. The occurrence of migration inhibition showed a positive correlation with clinically active disease and a negative correlation with immunosuppressive treatment. It was not seen with leucocytes from 12 healthy subjects.

The effect of gastric antigens on the in vitro migration of leucocytes from patients with atrophic gastritis and pernicious anaemia

A total of eighteen patients with pernicious anaemia (PA) ten patients with atrophic gastritis and achlorhydria but without PA, and fourteen control subjects were tested for delayed hypersensitivity to gastric antigens using the leucocyte migration test. The percentage of PAs showing inhibition of migration in the presence of a crude extract of gastric mucosa, liver mitochondria, stomach mitochondria and stomach microsomes was 50, 55, 50 and 50% respectively. The results in atrophic gastritis were 0, 20, 20 and 0% respectively and those in the fourteen control subjects were 0, 14, 7 and 14% respectively.

There was a significant difference between PA and controls with all four antigens. There was a significant difference using crude extract and stomach mitochondria and microsomes between PA and atrophic gastritis but not with liver mitochondria. There was no significant difference between atrophic gastritis and controls although the results tended to be midway between PA values and controls.

These results indicate that cell-mediated immunity is more strongly implicated in PA than it is in atrophic gastritis which has not progressed to PA.

Leucocyte migration studies with spleen preparations in Crohn's disease

Thirty-nine patients with Crohn's disease and 17 normal people were tested for hypersensitivity to sarcoid and normal spleen suspensions using the leucocyte migration test. In 26% of the Crohn's cases migration was inhibited, whereas inhibition was not significant in the control group. Migration inhibition did not appear to be related to duration or activity of the disease. Sixty-two percent of the Crohn's patients showed migration stimulation against normal spleen, a phenomenon that did not occur in the control group.

The effect of thyroid antigens on the in vitro migration of leucocytes from patients with Hashimoto thyroiditis

A total of fifty-two patients with Hashimoto thyroiditis were tested for delayed hypersensitivity to thyroid antigens using the leucocyte migration test. The percentage of patients showing abnormal migration in the presence of crude thyroid extract, thyroglobulin, thyroid mitochondria and thyroid microsomes was 75, 44, 54 and 34% respectively. Fifty-three control patients were studied concurrently with the same antigens and the percentage showing abnormal migration was 4, 6, 6 and 6% respectively. The antigenic activity of the mitochondrial fraction was not organ specific; both liver and kidney mitochondria interfered with the migration of leucocytes from patients with Hashimoto thyroiditis.

The Kmif (Kveim-induced macrophage migration inhibition factor) test in sarcoidosis

Circulating lymphocytes from 30 patients with sarcoidosis when stimulated in vitro with Kveim-induced macrophage migration factor, the Kmif test, produced a guinea-pig macrophage migration inhibition factor in 21 of 30 cases (70%). In those patients not on steroids the results showed a good correlation with the cutaneous Kveim test. One positive test was found in 16 normal subjects. Our results suggest that the Kmif test may prove a useful rapid alternative to the Kveim test.

Impaired lymphocyte reactivity against tumour cells in patients with Crohn's disease

Evidence is presented which indicates a possible reduction in recognition capacity for tumour cell antigens (EB(2) Burkitt lymphoma cell line) by lymphocytes from some patients with longstanding but inactive Crohn's disease. Three out of seven patients tested also showed diminished or absent lymphocytotoxicity when their cells were grown in mixed culture with chromium-labelled lymphoma cells and absent response has never been observed in a large series of controls similarly tested. In both test systems impaired reactivity appeared to be partly caused by a factor present in Crohn's disease serum. Increased tumour incidence in Crohn's disease may in part be attributable to defective immune surveillance and the histology of Crohn's disease could reflect an imbalance between the proliferative and the cytotoxic responses of lymphocytes to various antigens in the bowel lumen in this disease.

The problem of chronic inflammatory bowel disease

Images