Leukotactic dystunction in sarcoidosis

Indices of inflammatory cell activity and pulmonary function in different stages of sarcoidosis

The present study was carried out to compare radiological and physiological changes in sarcoidosis with biochemical markers for inflammatory cell populations. Of 53 patients with sarcoidosis, 28 had respiratory symptoms and 30 past or present bilateral hilar adenopathy without symptoms. A clinical score based on lung function tests and radiological findings correlated well with elevations of lysozyme and beta2-microglobulin in serum, indicating increased inflammatory cell activity in patients with more severe lung affection. A covariation between beta2-microglobulin and lysozyme was found, suggesting concomitant activation of macrophages and lymphocytes in sarcoidosis. Serum levels of lactoferrin were elevated in patients with a disease of short duration but did not correlate with the severity of the lung affection. The closing volume also seems to be abnormal in the early course of the disease, while elevated lysozyme and beta2-microglobulin levels rather seem to reflect the extent of the pulmonary affection.

Elevation of chemotactic factor inactivator in alcoholic liver disease

Defective regulation of neutrophil chemotaxis occurs in patients with alcoholic liver disease. One potent mediator of neutrophil chemotaxis is the complement-derived neutrophil chemoattractant, C5a, which can be inhibited by a serum protein, chemotactic factor inactivator. We hypothesized that chemotactic factor inactivator elevation might, in part, explain the defective neutrophil chemotaxis seen in patients with alcoholic hepatitis. To test this hypothesis, sera were collected from 22 patients with alcoholic hepatitis and 9 normal controls, and evaluated for the antigenic presence of chemotactic factor inactivator using an ELISA test. Chemotactic factor inactivator levels were found to be markedly elevated in patients with alcoholic hepatitis (162 +/- 24 micrograms per ml) compared to normals (60 +/- 3 micrograms per ml, p less than 0.01). Subdividing the hepatitis patients revealed that the elevation of chemotactic factor inactivator was found to be greatest in those patients with mild alcoholic hepatitis (prothrombin time within normal limits and bilirubin less than or equal to 5 mg per dl, 256 +/- 44 micrograms per ml, p less than 0.001), while the group with the severest hepatic dysfunction (prolonged prothrombin time and bilirubin greater than 5 mg per dl) did not differ significantly from controls (71 +/- 11 micrograms/ml, p less than 0.2). Importantly, the inhibition of C5a-induced chemotactic activity by partially purified chemotactic factor inactivator correlated with antigenic amounts of chemotactic factor inactivator in serum (r = 0.63, p less than 0.05). The C5a inhibitory activity in sera obtained from patients with alcoholic hepatitis coprecipitated with chemotactic factor inactivator when serum was precipitated by ammonium sulfate precipitation (45 to 64% saturation).(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of a protein in sera of normal humans that inhibits fibroblast chemotactic and random migration in vitro

Normal human serum contains a 230,000 Mr protein that inhibits fibroblast chemotactic and random migration. This serum inhibitor of fibroblast migration (SIFM) is a heat-stable, trypsin-sensitive protein with a pI of 4.8 that reversibly inhibits the random and chemotactic migration of fibroblasts in vitro. Although SIFM effectively inhibits the chemotaxis of fibroblasts to interstitial collagens, fibronectin, lymphocyte-derived chemotactic factor for fibroblasts, and serum-derived chemotactic factor, it does not alter the chemotactic migration of human peripheral blood neutrophils or monocytes, and does not act as a cytotoxin to human dermal fibroblasts. The SIFM appears to act through a cell-directed mechanism to alter the fibroblast's ability to migrate. Serum inhibitor of fibroblast migration may function in vivo to modulate fibroblast migration under physiologic and pathologic conditions.

Impaired neutrophil function in intestinal lymphangiectasia

Impaired neutrophil chemotaxis and phagocytosis were shown in three patients with intestinal lymphangiectasia. Abnormalities in cell associated and serum derived activity occurred, and possible mechanisms are suggested.

A unique case of sarcoidosis with coexistent collagen vascular disease. Possible result of a compatible disease-sustaining immunologic environment

A patient presented with dysphagia, arthralgias, and a peculiar skin eruption characterized by histopathologic features of sarcoidal granulomas and lupus erythematosus occurring in the same lesion. Sarcoidal granulomas were also found in skeletal muscle. The unique histopathologic features of this case suggest that coexistence of sarcoidosis with autoimmune collagen vascular diseases may be more than coincidence. A review of the immunologic status of patients with sarcoidosis and autoimmune collagen vascular disorders is presented with speculations on the relevance of potential disease-sustaining immunologic patterns of both groups of diseases.

The cellular host response in juvenile periodontitis. A review

The current knowledge on the cellular, host-response features in juvenile periodontitis (JP) has been reviewed. The chemotaxis of the polymorphonuclear leukocytes (PMNs), known to be defective in JP, is modulated by serum factors and bacteria. The interactions of the putative etiologic pathogen Actinobacillus actinomycetemcomitans (A.a.) and the enzyme lysozyme with PMNs modify the host defense. Data on the phagocytic capacity of the peripheral blood and gingival crevice PMNs in JP are still controversial. The monocytes exhibit similar alterations as PMNs in interaction with A.a., but the reports on defective monocyte chemotaxis are conflicting. Both bacterial challenge and genetic factors may regulate the lymphocyte response in JP.

Neutrophil function and oral disease

The pathologic sequela of reduced neutrophil function have been reviewed. In each case, the mechanism for the reduction in function has been elaborated when known. Special emphasis has been placed upon the pathologic changes in the oral cavity as a result of neutrophil dysfunction. Numerous examples have been given, and the overriding conclusion must be that any impairment of neutrophil function will lead to some degree of increased susceptibility to infection. Perhaps the tissue most sensitive to pathologic changes in the oral cavity is the periodontium. In cases of severe neutrophil dysfunction there is severe periodontal breakdown. But also in cases of "mild" neutrophil dysfunction, where there is no other infection, such as in individuals with LJP, there is severe periodontal breakdown. The molecular basis of neutrophil dysfunction is beginning to be understood in individuals with LJP. It is our hope that further research in this area will help to delineate the pathogenesis of periodontal diseases.

Sarcoidosis. An updated review

Sarcoidosis, a multisystem disease of unknown cause characterized by the formation of noncaseating granulomas, may involve any organ of the body, but the commonest sites of predilection are the lungs, lymph nodes, skin, and eyes. Sarcoidosis can be associated with polyclonal hyperglobulinemia, hypercalcemia, hypercalciuria, circulating immune complexes, cutaneous anergy, and in vitro depressed cell-mediated immunity. Recent studies of the cellular composition and cellular interactions of sarcoid-involved tissue have resulted in some insight into the pathophysiology of the disease. In early stages the predominance of activated T-helper cells in affected sites may account for many of the immunologic aberrations. The production of macrophage chemotactic substances by these cells may be the initial stimulus for the formation of the granuloma. The natural history of the disease is highly variable; the acute forms tend to resolve spontaneously, whereas the chronic forms rarely involute. Although multiple therapeutic modalities have been used and some have reportedly been effective, systemic corticosteroids remain the most effective available therapeutic agents.

Impaired polymorphonuclear leucocyte chemotaxis in rheumatoid arthritis

This study has investigated the chemotactic activity of polymorphonuclear cells (PMNs) isolated from the blood of patients with either articular rheumatoid arthritis (RA) or RA with extra-articular manifestations. A double fluorochrome immunofluorescent staining test has been employed to identify cell-associated immunoglobulins, probably immune complexes. The results suggest an inverse relationship between PMN chemotaxis and staining for cell-associated immunoglobulins, either surface bound or internalised. PMNs from RA patients showed reduced chemotaxis, and this was further reduced when RA PMNs were incubated for 30 minutes in autologous serum. A similar reduction in chemotaxis of normal PMNs occurred after incubation in RA sera. Preincubation of both RA and normal PMNs in RA serum (but not normal serum) resulted in an increase in the number of cells in which cell-associated immunoglobulins were demonstrable. This further reduction in RA PMN chemotaxis after exposure to autologous serum, together with an increase in immunoglobulin staining, may indicate selection of certain PMNs at the time of venepuncture due to cell margination. Such a selection process would call for a re-evaluation of previous studies of RA PMN function in relation to the disease process.

Mechanisms of leukocyte regulation by complement-derived factors

Progress over the past five years has drawn attention to the fact that the anaplylatoxins are important factors in both leukocyte activation and regulation events. The C5 anaphylatoxin has been proposed to play major role in leukocyte aggregation and adherence phenomenon. Influences of C5a on the leukocyte may lead to clinical manifestations such as respiratory distress syndrome after trauma or postpump syndrome after cardiopulmonary bypass, both effects derived from leukocyte sequestration. Many other clinical conditions involving repeated transient sequestration of leukocytes, particularly in the pulmonary vasculature, may eventually be recognized as a complication of systemic complement activation. Dramatic pathologic changes observed in the lungs of animals exposed to either C3a or C5a emphasizes the potential damage that these factors may exert via cellular activation mechanisms (Huey et al., 1983). More recent evidence that the anaphylatoxins are potent immunoregulatory factors under in vitro conditions suggests a physiologic role for these humoral factors in nonspecific modulation of the immune response. It is an attractive hypothesis to suggest that once activated, complement is capable of relaying information to the cellular immune system via the anaphylatoxins. Other components of the complement system have long been known to exert regulatory influences on the immune system, and perhaps molecular description of such entities as the C3d-K fragment will serve to unravel this seemingly more complex effector system. In any case, as our understanding of both the chemical and biologic nature of factors derived from blood complement components advances, it has become apparent that a major function of complement may be to modulate the immune response. We have already demonstrated that these factors are selective both for cell type and for eliciting a variety of cellular responses. From this, one can infer that manipulation of the cellular events will eventually be possible. Hence a therapeutic value may be realized once involvement of these complement factors under in vivo conditions is better characterized.

Biologically active complement (C5)-derived peptides and their relevance to disease

In man and in most mammals, activation of the complement system via either the classical or the alternative pathway results in the generation of biologically active peptides. The most active peptides are C5a and C5a des Arg generated by cleavage of the alpha-chain of native C5. C5a is a potent anaphylatoxin and can induce human polymorphonuclear leukocytes to migrate in a directed fashion, to degranulate, to undergo a burst of oxidative metabolism and to aggregate. Upon generation C5a is converted in serum and plasma to C5a des Arg with loss of the noxious anaphylatoxin activity. C5a/C5a des Arg play important roles in host defenses against bacterial infections and possibly in the mediation of some pathologic lesions such as the leukocyte infiltration seen in the lungs during acute respiratory distress syndrome.

Chemotaxis: basic aspects of methodology, mechanisms and pathology

This review is an attempt to discuss the basic conceptual tools that are a prerequisite for any clinical study of chemotactic defects. They include familiarity with definitions of common terms and with the merits and drawbacks of the several possible in vivo and in vitro assay methods. Cellular mechanisms involved in locomotion are complex. They include basic requirements for cell metabolism as well as receptor recognition, attachment to surfaces and contraction of the cytoskeleton of the cell. Of the many chemotactic factors reported, few are well characterized and universally agreed upon. Similarly, with the use of more stringent criteria, a number of clinical defects of chemotaxis have proven transitory or even artifactual.

Rapidly advancing periodontitis in a patient with sarcoidosis. A case report

A brief review of sarcoidosis is presented. It is a multisystem granulomatous disease of unknown etiology. Typically the sarcoidosis patient manifests depressed T-cell function but has hyperactive B-cells. This case report deals with a 27-year old black female who was diagnosed as having sarcoidosis. Prior to the onset of the disease, radiographs taken of her periodontium revealed incipient alveolar bone loss. Two years after the apparent onset of the sarcoidosis, periapical radiographs manifested advanced destruction of the alveolar bone. In addition to the usual clinical indices, the effect of the patient's serum on cultures of normal PMNs and Actinobacillus actinomycetemcomitans (A. a.) was studied. The serum from this patient inhibited the leukotoxic effect of the (A. a.) organism. A similar effect has been observed in juvenile patients with rapidly advancing periodontitis.

Polymorphonuclear and mononuclear leucocyte function in necrobiosis lipoidica and granuloma annulare

Neutrophils and monocytes from patients with necrobiosis lipoidica (NL) and granuloma annulare (GA) were studied in vitro in order to detect functional abnormality. Phagocytosis of latex particles and zymosan-induced release of beta-glucuronidase were similar in patients and controls. Plasma from these patients did not enhance or inhibit phagocytosis or enzyme release from normal cells. Our studies suggest that peripheral blood leucocyte function in patients with GA and NL is normal, but this does not exclude a functional abnormality in the lesions.

Bactericidal activity and chemotaxis in pemphigus vulgaris and bullous pemphigoid

Host defense mechanisms were studied in six patients with pemphigus vulgaris (PV) and six patients with bullous pemphigoid (BP). Polymorphonuclear (PMN) leukocyte killing of Staphylococcus organisms was evaluated, and chemotaxis of PMN and mononuclear (MN) leukocytes in patients was compared with that in twenty age- and sex-matched controls. All patients had extensive widespread disease with the clinical diagnosis confirmed by immunopathologic studies. No statistically significant differences were observed in the PMN leukocyte bactericidal activity between PV patients and controls. In BP patients, PMN leukocyte bactericidal activity was very slightly reduced when normal cells and patient serum were used, but activity was normal when patient cells and patient serum were used. PMN leukocyte chemotaxis was normal in PV and BP patients. MN leukocyte chemotaxis was normal in PV patients and increased in BP patients when compared with that in controls. This study indicated that in spite of very severe and extensive disease, patients with PV and BP have intact neutrophil and monocyte functions. Drugs that compromise the patient's ability to fight infections should be used cautiously and judiciously.

Identification of a chemokinetic inhibitor in serum from patients with chronic lymphocytic leukaemia

The effects of serum from patients with chronic lymphocytic leukaemia (CCL) on normal polymorphonuclear leucocyte migration (PMN) were examined by means of the leading front technique, using a modified Boyden chamber. 18 randomly selected patients were studied. 13 patients had a reduced chemokinetic activity. The defective migration was explained by the finding in serum from these patients of cell-directed inhibitory activity which was destroyed by heating (56 degrees C, 30 min). The B-lymphocytes as the origin of the inhibitory activity was suggested by the presence of a similar activity in supernatants from cultured tumour cells. 6 of the 18 patients had the combination of a defective chemokinetic activity and low levels of immunoglobulins. These 6 patients had an increased tendency towards infections.

Monocyte count, monocyte chemotaxis and chemotactic factor inactivator in gastric cancer patients

The monocyte count in the peripheral blood, chemotactic responsiveness (MCR) and chemotactic factor inactivator (CFI) were measured in 66 patients with gastric cancer. Monocyte counts in advanced gastric cancer patients were significantly increased. MCR was significantly depressed in gastric cancer patients in the advanced stage of the disease, as compared with findings in the control groups. Sixty-seven percent of the patients with stage IV carcinoma had abnormally depressed responses. The CFIs were significantly higher in gastric cancer patients than in the control groups, and there was a positive correlation between the degree of inhibition and extent of cancer progress. These data support the hypothesis that qualitative and quantitative abnormalities of circulating monocytes, as macrophage precursors, may hinder immunological host defense mechanisms.

Enhanced polymorphonuclear chemotaxis - a common feature of diseases responsive to colchicine

Increased chemotactic activity of peripheral polymorphonuclear (PMN) cells has been described in disease states of different etiology and may represent a common pathway in the generation of an inflammatory reaction. The suppressive effect of colchicine on PMN chemotaxis may explain its effect in apparently unrelated disorders.

Neutrophil dysfunction associated with states of chronic and recurrent infection

Infants, children, and young adults who suffer chronic and recurrent bacterial or fungal infection despite adequate numbers of circulating granulocytes and normal or elevated levels of immunoglobulins should be suspected of having fundamental defects in granulocyte functioning. This article considers clinical disorders for which there is evidence for associated defects of polymorphonuclear leukocytes.

Maintenance of granuloma formation in pulmonary sarcoidosis by T lymphocytes within the lung

Pulmonary granulomata of sarcoidosis are composed primarily of mononuclear phagocytic cells that are probably derived from blood monocytes. To evaluate the concept that recruitment of blood monocytes to the sarcoid lung is mediated by chemoattractants produced by immune effector cells within the lung, we obtained mononuclear cells from lung and blood of six patients with active pulmonary sarcoidosis, six normal subjects, and six patients with active idiopathic pulmonary fibrosis and studied their ability to secrete a chemotactic factor for monocytes. Lung T lymphocytes from all sarcoidosis patients, but not from normal subjects or patients with idiopathic pulmonary fibrosis, spontaneously secreted such a mediator. Lung T lymphocytes from patients with sarcoidosis secreted more monocyte chemotactic factor than did blood T lymphocytes from the same patients. The accumulation of monocytes in the lung in patients with pulmonary sarcoidosis may be mediated by local production of monocyte chemotactic factor by lung T lymphocytes.

Defective polymorphonuclear leucocyte chemotaxis in rheumatoid arthritis associated with a serum inhibitor

Cellular and/or serum components of polymorphonuclear leucocyte chemotaxis were assessed in 21 patients with rheumatoid arthritis. No difference in the chemotactic migration of control and patient cells in response to a number of chemotactic solutions could be detected (P = 0.38). Deficient generation of chemotactic activity in patient sera (P = 0.58) as compared to control sera (P = 0.014) after incubation of the sera with Escherichia coli lipopolysaccharide, resulted in a significant difference in the chemotactic activity of the control and rheumatoid serum preparations for polymorphonuclear leucocytes (P = 0.0012). This defect was associated with the presence of a serum inhibitor of chemotaxis, the potency of which was inversely correlated with the level of chemotactic activity generated in the rheumatoid sera (r = -0.941, P less than 0.001).

Infection in patients with systemic lupus erythematosus. Association with a serum inhibitor of complement-derived chemotactic activity

We have found subnormal amounts of chemotactic activity in zymosan-treated sera from 13 of 29 patients with systemic lupus erythematosus (SLE). As an explanation for this abnormality, the presence of a uniquely specific, heat-stable inhibitor of complement (C5)-derived chemotactic activity has been documented in sera from 11 of these patients. Sera from 2 other patients contained elevated levels of nonspecific, heat-labile chemotactic factor inactivator (CFI) activity. The serum from 1 patient contained the heat-stable inhibitor as well as elevated levels of CFI. Patients with SLE whose sera contained the heat-stable inhibitor had more active disease clinically, but otherwise they were indistinguishable from patients without the inhibitor. When patients with the heat-stable inhibitor improved clinically, this usually was accompanied by a decrease in serum inhibitory activity. Only one episode of bacterial infection was observed among 16 patients with SLE whose sera yielded normal amounts of chemotactic activity after treatment with zymosan. In contrast, 7 of 11 patients with SLE whose sera contained the heat-stable inhibitor suffered serious bacterial infections. The presence of this heat-stable inhibitor in sera from some patients with SLE may contribute, in part, to their increased susceptibility to infection.

Directed migration of circulating polymorphonuclear leucocytes in patients with rheumatoid arthritis: a defect in the plasma

The migration of peripheral polymorphonuclear leucocytes (PMNs) of patients with rheumatoid arthritis has been studied both in vivo and in vitro. A significant reduction in the accumulation of PMNs in skin chambers in patients with rheumatoid arthritis compared to controls was observed but no defect in cell movement was detected when the isolated PMNs from the patients were exposed to activated control plasma. However, when PMNs from the control group were tested against activated plasma from patients with rheumatoid arthritis there was a significant decrease in their chemotactic response. It is proposed that there is a humoral defect in the plasma of the patients.

A specific inhibitor of complement (C5)-derived chemotactic activity in serum from patients with systemic lupus erythematosus

In the course of examining polymorphonuclear leukocyte (PMN) chemotaxis in patients with systemic lupus erythematosus (SLE), we have found a previously undescribed serum inhibitor of complement (C5)-derived chemotactic activity. Serum from a 25-yr-old Black female with untreated SLE, when activated with zymosan, failed completely to attract either her own or normal PMN. Incubation of normal PMN with the patient's serum did not affect their subsequent random motility or chemotactic response toward normal zymosan-treated serum (ZTS). The patient's serum, however, did inhibit the chemotactic activity of normal ZTS and of column-purified C5-derived peptide(s), but had no effect on the chemotactic activity of either the synthetic peptide, N-formylmethionyl leucyl-phenylalanine or a filtrate prepared from a culture of Escherichia coli (bacterial chemotactic factor). The inhibitory activity in the patient's serum resisted heating at 56 degrees C for 30 min and could be separated from C5-derived chemotactic activity in the patient's ZTS (or normal ZTS that had been incubated with the patient's serum) by chromatography on Sephadex G-75. Despite its effect on C5-derived chemotactic activity, the patient's serum did not influence two other C5-derived biologic activities: PMN lysosomal enzyme-releasing activity and PMN-aggregating activity. Chromatography of the patient's serum (65% ammonium sulfate pellet) on Sephadex G-200 yielded three distinct peaks of inhibitory activity. Two were heat labile and exhibited other properties of the previously described chemotactic factor inactivators of normal human serum. The third and most active peak, however, resisted heating at 56 degrees C for 30 min, eluted with an apparent mol wt of 50,000-60,000, and acted specifically on C5-derived chemotactic activity. This uniquely specific, heat-stable inhibitor of C5-derived chemotactic activity has been found thus far in serum from 4 of 11 patients with active SLE and may account, in part, for altered host defenses against infections caused by pyogenic microorganisms.

A qualitative and quantitative study of monocytes in patients with malignant solid tumors

Monocytes from 21 patients with cancer of the lung and cancer of the prostate were studied prior to treatment. The absolute circulating monocyte count, serum lysozyme levels and monocyte IgG surface receptors were normal at all stages of the disease. Monocyte chemotaxis was defective in 45% of the patients. Serum chemotatic factor inactivator(s) that inhibit chemotaxis of normal monocytes were detected in 90% of the patients. In two of four patients the chemotactic factor(s) disappeared following surgical removal of localized tumors. The results of the chemotaxis studies may explain the data of defective delayed hypersensitivity reactions frequently seen in patients with malignancies. The defective chemotaxis and the presence of chemotatic factor inactivator(s) may interfere with the ability of monocytes to accumulate as macrophages in tumor sites.

An acquired cell-directed inhibitor of neutrophil chemotaxis and hypogammaglobulinemia

An unusual combination of host defense abnormalities was demonstrated in an adult male with recurrent pulmonary infections due to a variety of microorganisms. Polymorphonuclear neutrophil chemotaxis was defective. Other neutrophil and T-lymphocyte function tests were normal. The patient's serum also showed a severe deficiency of IgG, no detectable IgA, IgM, or IgD, and increased IgE. The chemotactic defect was shown to be due to a cell-directed inhibitor in the patient's serum. The effect of the inhibitor on chemotaxis could be antagonized by factors in normal serum. The chemotaxis defect persisted for several months, but eventually returned to normal.

Disorders of leukocyte chemotaxis

The rapid accumulation of inflammatory cells at sites of microbial invasion or neoplastic transformation is a central event in immunologically-mediated host defense. The availability of methodology to accurately quantify leukocyte migration in vitro has allowed the disclosure of previously unrecognized clinical disorders, namely leukocyte dysmotility syndromes. Although this area of clinical investigation is in its infancy, one can identify several processes associated with abnormal leukocyte accumulation. Abnormalities of immune recognition, chemotactic factor production, cellular motility or inhibitors of chemotaxis have been identified in different human diseases. In the upcoming years, pharmacological intervention directed at correcting specific causes of leukocyte dysmotility may well enhance our ability to treat certain infectious, inflammatory, and neoplastic diseases.