Changes in leucocyte migration after renal transplantation

Ovine hydatidosis: some immunological characteristics of the seronegative host

The immune status of a group of sheep naturally infected with hydatid cysts was investigated. Low specific anti-hydatid antibody (Sab) titres and negative results in intradermal and leucocyte migration tests occurred in hosts with high hydatid antigen-stimulated lymphocyte transformation (LT). Total (non-specific) IgG was elevated in infected sheep and was positively correlated with LT. Circulating hydatid antigen (cAg) was detectable in some infected sheep, but not in all of those with low Sab. Relationships between cAg, Sab and immune complex levels suggest that most cAg is present in immune complexes.

Migration inhibition of sensitized mouse spleen cells by cell-associated transplantation antigens: effect of method of antigen presentation

The migration of specifically sensitized mouse spleen cells following exposure to allogeneic cells (antigen) in vitro was studied. The migration inhibition recorded when sensitized cells were admixed with allogeneic cells in capillary tubes (mix method) was compared to the inhibition observed when allogeneic cells were suspended in the culture chamber media (non-mix method). Specificity as well as a higher degree of migration inhibition were obtained using the mix method, suggesting that this method is superior to the nom-mix method.

[Active enhancement of canine liver allograft by pretreatment with polyspecific spleen alloantigen (author's transl)]

Because it is not possible to use donor specific antigens for the induction of immunological enhancement in cadaveric organtransplantation, attempts were made to use polyspecific antigens in the enhancement of orthotopic canine liver allotransplants. Of 34 mongrel recipients, 17 controls survived for 6.9 +/- 1.5 days. Six recipients (group 3) were given 750 mg/kg polyspecific, semisoluble antigen prepared from 20 spleens (PSEA 20) together with 10 mg/kg prednisolone on days 15, 8 and 1 before transplantation. The mean survival time of this group was 10.1 +/- 2.0 days (P less than 0.01 compared with the control group). Six other recipients (group 4) were treated similiarly, except that the antigen had been prepared from a pool of 70 spleens (PSEA 70). Survival was variable here: 3 survived for more than 3 weeks and the other 3 died on days 1, 7 and 8 post-operatively, with signs of accelerated rejection. Donors and recipients were not identical for LD determinants, but one donor recipient pair with near identity showed a higher degree of enhancement. The recipients displaying accelerated rejection had markedly higher lymphocytotoxic and haemagglutinating antibodies. Animals surviving for longer periods had low antibody titres. In addition, all recipients progressive rejection were found to show inhibition of leucocyte migration. After three antigen doses rosette-forming lymphocytes were present in increased numbers in peripheral blood, and remained unchanged thereafter.

E-rosette forming cell numbers in the blood of human renal allograft recipients

The incidence of circulating T lymphocytes (ET-RFC) and a sub-population of T lymphocytes (EE-RFC) were monitored in the blood of seventy-one cadaver renal allograft recipients for the first 2 months after transplantation. In patients with uneventful post-operative courses, the incidence of both ET-RFC and EE-RFC fell promptly upon initiation of immunosuppression returning approximately to pre-operative levels 3-5 weeks after operation; the fall in cell numbers was greatest in those patients receiving adjunct ALG therapy. With the onset of an acute rejection episode, the EE-RFC level rose quickly eventually exceeding the pre-operative level; in 88% (thirty episodes) of cases this rise occurred 1-6 days before clinical diagnosis of rejection and in 12% of cases on the same day as clinical diagnosis. The incidence of ET-RFC rose in conjunction with some cases of acute rejection but remained unchanged in other cases. It is suggested that measurement of the incidence of EE-RFC in blood is valuable in predicting the onset of acute rejection and for the differential diagnosis of acute rejection and ischaemic renal damage.

Human leucocyte migration inhibition

Within the last decade a variety of techniques have been developed and used for the detection of cell-mediated immunity in man by means of leucocyte migration inhibition in vitro. A detailed description of the leucocyte migration capillary tube technique (LMCT) and the leucocyte migration agarose technique (LMAT) is given. The procedure for selecting and using the proper antigen concentration is described. A description is also given of the indirect LMAT and the technique for determination of concanavalin A-induced lymphocyte release of leucocyte migration inhibition factor. Applications of these techniques are mainly intended for the exploration of the immunobiology of lymphocytes and cellular interactions associated with the immune response and the investigation of clinical conditions in man, i.e. infectious diseases, autoimmune diseases, transplantation states, tumour diseases, contact hypersensitivity and immunological deficiency states. Selection and adaptation to suit the experimental aim is necessary to obtain optimal results with these techniques. Their usefulness may be increased through more extensive use of purified antigens and indirect assays.

[Lymphokine activity in mercury stimulated leucocyte cultures (author's transl)]

Blood-lymphocytes from 42 persons reacted, as expected, in the leucocyte-culture with an increased DNA-synthesis, measured by the uptake of tritiated thymidine during the last 16 h of a five days culture, if mercurybichloride was added at the onset of culture. The logarithms of the activity-indices were nearly symmetrically distributed. When the lymphokine-activity in the culture supernatants was studied with the indirect leucocyte-migration-test, using autologues leucocytes, there was a bimodal distribution of the logarithmic migrationindices with a high top in the negative area (migration-inhibition) and a lower one in the positive area (migration-stimulation). These phenomena had no detectable correlations to sex, age, or dermatosis of the patients.

Cell-mediated immunity to a serologically defined (SD) HL-A antigen panel in kidney-transplanted patients

The graft-directed, cell-mediated immunity in kidney-allografted patients was examined with a seriologically defined (SD), donor-unrelated panel of antigenic material in clinical steady state, soon after transplantation, and during acute rejection episodes. The SD antigens were selected from the panel on the basis of predictions hypothesized from the SD match of donor and recipient. The cell-mediated immunity was measured by the direct leukocyte migration agarose test (LMAT). Positive reactions in kidney-transplanted patients were induced particularly by one preparation (antigen 52) and were unpredictable on the basis of SD classification. The investigation shows that other antigenic determinants, different from SD antigens, probably play an important role as inducers of cell-mediated, graft-associated immunity in kidney-transplanted patients.

The leucocyte migration technique as an assay of presensitization to human transplantation antigens

An assay of cell-mediated immunity, the leucocyte migration technique (LMT), has been compared with the commonly used assay of humoral immunity to transplantation antigens, the microlymphocytotoxicity test. Five recently multiply transfused patients and nineteen haemodialysis patients who had been potentially immunized against transplantation antigens were studied by both tests. All five transfused patients gave positive LMT results while only two gave a positive serological test. Sixteen out of nineteen dialysis patients gave positive LMT results compared with nine with known anti-HL-A antibodies and four showing positive serological direct cross-matches. There was no correlation between cell-mediated and humoral immunity as detected by these methods, although there was a tendency, which was not absolute, for positive direct cross-matches between patients' sera and the panel's lymphocytes, to be associated with positive LMT results. There was a significant correlation (P less than 0-05) between the number of blood transfusions received by the dialysis patients and the detection of cytotoxic antibodies but not with the LMT results. It is felt that some of these positive LMT results are due to reactivity with non-HL-A antigens, and that false negative results also occur. For this reason the technique is not of great value in determining presensitization against HL-A before transplantation.

Inhibition of leucocyte migration as an index of rejection in renal transplant recipients

In a blind study, the peripheral blood leucocytes of fifteen recipients of cadaver kidney homografts have been checked at regular intervals for migration inhibition in the presence of antigen derived from donor spleen. Six of seven episodes of definite acute rejection were preceded or accompanied by migration inhibition, and four of seven probable acute rejection crisis were similarly accompanied by inhibition. No false positive tests were observed. The technique may be a useful adjunct to present methods of diagnosing acute homograft rejection.

Cellular immunity to breast carcinoma and malignant melanoma

We have examined the effect of extracts of benign and malignant tumours on the migration of leucocytes from the peripheral blood of 55 melanoma patients, 73 breast carcinoma patients and 162 control donors in the leucocyte migration test. The leucocytes from a majority of tumour bearing patients were inhibited on contact with extracts of histogenetically similar tumours but only occasionally by extracts of dissimilar tumours and preparations from non-neoplastic breast tissue. Control donor's leucocytes were rarely inhibited by any of the tissue extracts. In both patients with malignant melanoma and those with breast carcinoma there was a striking decline in the frequency of tumour extract mediated leucocyte migration inhibition in patients with metastases.

Assessment of the cellular immune response to HL-A antigens in human renal allograft recipients

The cellular response to HL-A antigens has been studied in thirty-one patients who had received a renal allograft from either a cadaveric or living donor, utilizing the leucocyte migration technique. The results indicate that inhibition of migration develops prior to or during the onset of a clinical rejection episode. This inhibition of migration reverts to non-inhibition in autologous serum when the rejection crisis is reversed. Inhibition of migration is still noted in allogeneic serum following this clinical reversal, but after varying time intervals the inhibition reaction also decreases in this serum. The abrogation of inhibition in autologous serum is specific to the HL-A antigens of the donor. These observations suggest that survival of human renal allografts depends on a blocking substance in the serum initially; subsequently, the loss of inhibition of migration with HL-A antigens in both autologous and allogeneic serum suggests an inactivation of specific antigen sensitive cells to the histocompatibility antigens of the donor.

Viral infection and renal transplant rejection

The occurrence of an outbreak of influenza in a renal transplant unit is described. Five patients had a proved episode of infection, confirmed by a rise in the complement fixation titre to influenza virus A, and this coincided in three of the patients with episodes of acute rejection. It seems likely that the virus infection was responsible for the rejection, possibly through a stimulating effect of the virus on the host's immune response.

Leucocyte migration and cell-mediated immunity in syphilis

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Further assessment of rosette inhibition test in clinical organ transplantation

The rosette inhibition test was used in the clinical management of organ allografts to estimate the amount of immunosuppressive drugs necessary to prevent rejection. In patients surviving more than three months renal function appeared to be better than in a similar group of patients managed without the test. It is suggested that this was due to a reduction in the number of clinical or subclinical rejection episodes. On the other hand, the test indicates that in many cases the level of immunosuppression should be much higher, and if this advice is followed the patients become increasingly exposed to the risk of infection. In other words, those patients with good renal function remained well, whereas those who might otherwise have rejected their kidney and survived had in fact died of sepsis.

Evaluation of the leucocyte migration test as a measure of delayed hypersensitivty in man. Suppression of migration inhibition by puromycin

The response of peripheral blood leucocytes to PPD was studied in vitro by means of the leucocyte migration test, using Mantoux-positive and -negative subjects. The migration of leucocytes from 83% of the positive subjects was significantly inhibited when a concentration of 100 μg PPD/ml was used in the chambers. Leucocytes from the majority of these subjects were also inhibited at a lower concentration of 50 μg PPD/ml and one strongly positive subject showed inhibition at all concentrations tested, down to 1 μg PPD/ml. Stimulation of migration was not observed with leucocytes from any of the positive subjects even when the lowest concentration of PPD was used. Inhibition of migration with PPD was prevented by the addition of puromycin, suggesting that the response is dependent on protein synthesis and may be mediated by a soluble factor produced by sensitized lymphocytes.

An in vitro study of renal allograft recipients for cellular delayed type hypersensitivity to glomerular basement membrane and disrupted spleen cells

An in vitro study of delayed hypersensitivity by leucocyte migration inhibition using disrupted spleen cells as a source of transplantation antigens, and soluble glomerular basement membrane (GBM) antigen, was made on the peripheral blood leucocytes of six normal subjects and eleven renal allograft recipients.

There was no inhibition of migration in the control group. The cells of one allograft recipient were inhibited by disrupted spleen cells and the cells of four other recipients were inhibited by soluble GBM antigen. Three of the latter had underlying glomerulonephritis and the fourth recipient only showed inhibition after infarction of the graft and its removal. These observations suggest that the immunosuppressed transplant recipients develop hypersensitivity to GBM antigen although there is no evidence of deteriorating renal function.

A micro-method for peripheral leucocyte migration in tuberculin sensitivity

Inhibition of buffy layer peripheral leucocyte migration by tuberculin purified protein derivative (PPD) from micro-capillaries mounted in small tissue culture chambers correlates in all cases with a positive Mantoux test. This quick and reproducible test of cellular hypersensitivity in man requires only 5-15 ml of blood and is applicable for study in children and in clinical situations where repeated monitoring of cellular immunity may be required.

Clinical evaluation of a rosette inhibition test in renal allotransplantation

The formation of spontaneous rosettes by peripheral blood or spleen mononuclear cells when incubated with sheep red blood cells has proved a useful way of assessing the potency of immunosuppressive drugs and antilymphocyte sera in vitro. A test employing the inhibition by antilymphocyte globulin (A.L.G.) of spontaneous rosette formation around peripheral blood mononuclear cells is described. This has been used to assess the degree of immunosuppression in patients with renal allografts and uraemic patients on regular haemodialysis.Twenty-three patients with renal allografts had 21 clinically diagnosed episodes of rejection. In none of these rejection episodes was the minimal inhibitory concentration (M.I.C.) of A.L.G. (that necessary to reduce the spontaneous rosette formation of peripheral cells by 75%) less than 1/50,000. Nineteen patients had no rejection episodes during 57 patient/months of continuous observation while the M.I.C. was at a greater dilution than 1/50,000. The test has therefore been of great value in suggesting when an individual is capable of rejecting his graft, and allows the dose of immunosuppressive drugs to be adjusted to a minimum in a controlled fashion. It has been of use in diagnosing rejection in the anuric patient, when the distinction between rejection, urinary tract obstruction, and infection is particularly difficult.Fifteen patients maintained on regular haemodialysis for more than a year had, as judged by this technique, less reactive lymphocytes than normal healthy controls. The degree of immunosuppression was not as great as in the patients on full immunosuppressive regimens.