Cell-mediated immune reactivity in liver disease

Myasthenia gravis and primary biliary cirrhosis. Common immunological features and rare coincidence

A 43-year-old woman with recently diagnosed primary biliary cirrhosis developed antibody-negative myasthenia gravis. She did not receive D-penicillamine therapy. Clinical and immunological features of this patient are discussed. In previous reports on an association between primary biliary cirrhosis and myasthenia D-penicillamine treatment was an obligate causal linkage between both disorders.

Cell-mediated immunity in liver disease

Four liver diseases in which cell-mediated immunity seems to be of major importance but in which the exact pathogenic event has been not fully clarified have been briefly discussed. More precise delineation of the phenotypes of mononuclear cells and the advent of in vitro techniques for the study of lymphocyte function and cytotoxicity have led to better understanding of the importance of cell-mediated immunity in some liver diseases. It seems that the liver itself may be variously affected by different immunologic reactions, not only in various diseases but also in different locations in the same disease.

T and B lymphocytes in patients with chronic active liver disease and in healthy HBsAg carriers

E-rosette and surface Ig tests were used to study circulating T and B lymphocytes in 65 patients with chronic active liver disease (CALD), 15 healthy HBsAg carriers and 30 healthy controls. No significant variation in B lymphocytes was observed in CALD and in healthy HBsAg carriers. On the other hand, the absolute number and the percentage of T lymphocytes were significantly decreased in CALD, especially in cases negative for HBV infection markers.

Cell-mediated immunity to liver antigen in toxic liver injury. I. Occurrence and specificity

To investigate the possible role of cell-mediated immunity in the pathogenesis of liver disease lymphocyte function was studied in CBA mice in which predictable sublethal liver necrosis had been included by the administration of the hepatotoxin carbon tetrachloride (CCl4). Non-specific lymphocyte function, as assessed by the response to the mitogen phytohaemagglutinin (PHA) was normal in over 90 percent of the animals. Forty-three per cent of the treated mice demonstrated specific lymphocyte sensitivity to liver antigen preparations. Such specific sensitivity was transient and apparent in only one case for more than 2 weeks after the CCl4 treatment. The lymphocyte sensitization was not reproduced by the addition of CCl4 to the lymphocyte cultures. There was no correlation between the severity of the liver disease and the detection of sensitized lymphocytes. Although these data may not be extrapolated directly to human liver disease, they demonstrate that cell-mediated immune reactivity to liver-derived antigens can occur as a result of non-immunological toxic liver injury.

An association between primary biliary cirrhosis and jejunal villous atrophy resembling celiac disease

A 76-year-old female presented with malabsorption and was subsequently shown to have jejunal villous atrophy. There was only partial clinical and histologic recovery with gluten withdrawal, but this was thought to be due to poor adherence to the diet. The findings were considered to be consistent with adult celiac disease. During the course of investigations, she was also found to have primary biliary cirrhosis. This is the fifth recorded instance of this association and the first from North America. Because these are uncommon conditions, it is postulated that this is unlikely to be a chance association. The recognition of this coexistence is of practical importance in the investigation and treatment of patients with primary biliary cirrhosis and celiac disease.

In vitro morphological studies on antibody-dependent nonimmune lymphocyte-mediated cytotoxicity in chronic active liver disease

Using an in vitro system of antibody-dependent cellular cytotoxicity (ADCC), the killing effect of chronic liver disease sera on target Chang cells, mediated by effector nonimmune lymphocytes (NLy), was studied. NLy destroyed Chang cells in monolayers pretreated with sera of patients with chronic active liver disease (CALD). Sera from these patients with CALD, after receiving steroid therapy, demonstrated a significant decrease of the cytotoxic action of NLy. The target cells treated with sera of normal subjects or patients with chronic persistent hepatitis were only minimally affected. Morphological observations of the cytotoxic action in a CALD serum-treated group showed intimate contact between NLy and the target cells in the areas of the plaques, where large numbers of the target Chang cells were injured and were closely associated with effector NLy. The Chang cells developed cytoplasmic swelling. The surface became ruffled, and intracytoplasmic organelles displayed vesicular degeneration. Thereafter, cell rupture, and fragmentation occurred. The sera in patients with CALD appear to possess a membrane reactive factor, presumably antibody, against the surface membrane of Chang cells. This immunological mode of reaction between the effectors and target cells (ADCC) may be important in the perpetuation and pathogenesis of hepatocyte death in CALD.

Immunological abnormalities associated with liver disease: cause or effect?

Immunological abnormalities are demonstrable in patients with various types of liver damage. These may be (a) non-specific and unrelated to pathogenesis, e.g. auto-antibodies such as anti-nuclear factor; (b) specifically directed against liver antigens but not pathogenetic, e.g. cell mediated immune (CMI) reactions to liver antigen as seen in experimental carbon tetrachloride poisoning; (c) of such a nature as to modify the pathology produced by hepatotoxic agents, e.g. hepatitis B virus or alcohol; (d) primarily responsible for hepatic pathology, e.g. in idiopathic chronic active hepatitis. The latter two possibilities remain unproven although there is growing evidence that immune responses do play some role in the pathogenesis of acute and chronic hepatitis B and possibly also in the pathogenesis of alcoholic liver disease. It seems much less likely that primary abnormalities of the immune systems are responsible for any type of liver disease. In summary, therefore, the available evidence suggests that immune reactions could develop as a consequence of liver damage and only in certain circumstances do these reactions play a role in the development and continuation of hepatic pathology.

In vitro cell-mediated cytotoxicity in primary biliary cirrhosis and chronic hepatitis. Dysfunction of spontaneous cell-mediated cytotoxicity in primary biliary cirrhosis

The in vitro cytotoxic function and target cell specificity of peripheral blood lymphocytes from selected patients with primary biliary cirrhosis and hepatitis B surface antigen-negative chronic hepatitis were investigated using 51Cr-labeled human Chang and EL-4 mouse sarcoma cell targets in assays of spontaneous cell-mediated cytotoxicity (SCMC) and mitogen-induced cellular cytotoxicity (MICC). In addition, antibody-dependent cellular cytotoxicity (ADCC) against Chang cells was assessed. At an effector-to-target cell ration of 100:1, the mean SCMC against Chang cells was much less in patients with primary biliary cirrhosis than that in either the controls (P less than 0.001) or the patients with chronic hepatitis (P less than 0.005) whereas the value for patients with chronic hepatitis did not differ significantly from that of the controls. The mean SCMC against EL-4 mouse sarcoma cells was also less in patients with primary biliary cirrhosis than in controls (P less than 0.005) whereas the value for chronic hepatitis was not significantly different from that of the controls or patients with primary biliary cirrhosis. In contrast, MICC against both targets and ADCC against Chang cells were similar for each group. Comparison of SCMC and MICC against both target cells, measured simultaneously, showed similar cytotoxic potenital against both target cells for each group. Effector cells capable of mediating cytotoxicity in each assay were defined by testing the cytotoxic function of lymphocyte subpopulations isolated from two representative patients with each disease using techniques of immunoabsorbent affinity chromatography and Fc receptor binding to antigen-antibody complexes. In both primary biliary cirrhosis and chronic hepatitis SCMC and ADCC were mediated by a subpopulation of lymphocytes which lack surface immunoglobulin (sIg-) and bear Fc receptors (Fc+). In contrast, MICC was mediated by sIg- cells which lack Fc receptors. Lymphocytes bearing sIg- were not cytotoxic in any assay. These results establish a difference in cytotoxic function in primary biliary cirrhosis and chronic hepatitis by defining the presence of a defect in spontaneous cytotoxic function of sIg-, Fc+ lymphocytes against Chang cells in primary biliary cirrhosis.

T and B lymphocytes in patients with chronic active hepatitis (CAH)

Absolute numbers of T and B lymphocytes as well as active E rosette-forming cells were measured in twenty-seven patients with chronic active hepatitis (CAH), and in thirty control patients. In patients with CAH without cirrhosis, active E rosette-forming cells (a subpopulation of T lymphocytes considered to be actively involved in cell-mediated immune reactions) as well as lymphocytes with surface markers for IgA, IgM and IgG were increased. In patients with CAH and cirrhosis, total T lymphocytes were decreased. These results emphasize the significance of lymphocytes in CAH, and suggest the importance of monitoring T- and B-cell populations in patients with this disease.

Immunological studies in patients with chronic active hepatitis. Cytotoxic activity of lymphocytes to autochthonous liver cells grown in tissue culture

The cytotoxic activity of lymphocytes against autochthonous liver cells was studied in patients with chronic liver diseases and in controls. Cytotoxicity of lymphocytes was observed in eight of ten patients with chronic active hepatitis, two patients with chronic persistent hepatitis, one patient with primary biliary cirrhosis, one patient with alcoholic hepatitis and carcinoma of the pancreas, and in three of five patients with acute viral hepatitis, but not in seven patients without liver alteration or with miscellaneous liver diseases. Serum was not cytotoxic, but in three patients it decreased the cytotoxicity of lymphocytes. Cytotoxicity was seen in both HBAg-positive and HBAg-negative patients, appears to be influenced by therapy, and does not correlate with autoantibodies. These data support the hypothesis of an aggressive activity of lymphocytes in certain liver diseases.

Cell-mediated immunity in Sjögren's syndrome

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