Low-Salt Diet Attenuates B-Cell- and Myeloid-Cell-Driven Experimental Arthritides by Affecting Innate as Well as Adaptive Immune Mechanisms

A link between high sodium chloride (salt) intake and the development of autoimmune diseases was previously reported. These earlier studies demonstrated exacerbation of experimental autoimmune encephalomyelitis and colitis by excess salt intake associated with Th17- and macrophage-mediated mechanisms. Little is known about the impact of dietary salt intake on experimental arthritides. Here, we investigated if salt restriction can exert beneficial effects on collagen-induced arthritis (CIA) and K/BxN serum transfer-induced arthritis (STIA). CIA depends on both adaptive and innate immunity, while STIA predominantly mimics the innate immune cell-driven effector phase of arthritis. In both models, low salt (LS) diet significantly decreased arthritis severity compared to regular salt (RS) and high salt (HS) diet. We did not observe an aggravation of arthritis with HS diet compared to RS diet. Remarkably, in STIA, LS diet was as effective as IL-1 receptor blocking treatment. Complement-fixing anti-CII IgG2a antibodies are associated with inflammatory cell infiltration and cartilage destruction. LS diet reduced anti-CII IgG2a levels in CIA and decreased the anti-CII IgG2a/IgG1 ratios pointing toward a more Th2-like response. Significantly less inflammatory joint infiltrates and cartilage breakdown associated with reduced protein concentrations of IL-1 beta (CIA and STIA), IL-17 (CIA), and the monocyte chemoattractant protein-1 (MCP-1) (CIA) were detected in mice receiving LS diet compared to HS diet. However, we did not find a reduced IL-17A expression in CD4+ T cells upon salt restriction in CIA. Analysis of mRNA transcripts and immunoblots revealed a link between LS diet and inhibition of the p38 MAPK (mitogen-activated protein kinase)/NFAT5 (nuclear factor of activated T-cells 5) signaling axis in STIA. Further experiments indicated a decreased leukodiapedesis under LS conditions. In conclusion, dietary salt restriction ameliorates CIA and STIA, indicating a beneficial role of LS diet during both the immunization and effector phase of immune-mediated arthritides by predominantly modulating the humoral immunity and the activation status of myeloid lineage cells. Hence, salt restriction might represent a supportive dietary intervention not only to reduce cardiovascular risk, but also to improve human inflammatory joint diseases like rheumatoid arthritis.

Relevance of Receptor for Advanced Glycation end Products (RAGE) in Murine Antibody-Mediated Autoimmune Diseases

It is incompletely understood how self-antigens become targets of humoral immunity in antibody-mediated autoimmune diseases. In this context, alarmins are discussed as an important level of regulation. Alarmins are recognized by various receptors, such as receptor for advanced glycation end products (RAGE). As RAGE is upregulated under inflammatory conditions, strongly binds nucleic acids and mediates pro-inflammatory responses upon alarmin recognition, our aim was to examine its contribution to immune complex-mediated autoimmune diseases. This question was addressed employing RAGE−/− animals in murine models of pristane-induced lupus, collagen-induced, and serum-transfer arthritis. Autoantibodies were assessed by enzyme-linked immunosorbent assay, renal disease by quantification of proteinuria and histology, arthritis by scoring joint inflammation. The associated immune status was determined by flow cytometry. In both disease entities, we detected tendentiously decreased autoantibody levels in RAGE−/− mice, however no differences in clinical outcome. In accordance with autoantibody levels, a subgroup of the RAGE−/− animals showed a decrease in plasma cells, and germinal center B cells and an increase in follicular B cells. Based on our results, we suggest that RAGE deficiency alone does not significantly affect antibody-mediated autoimmunity. RAGE may rather exert its effects along with other receptors linking environmental factors to auto-reactive immune responses.

No association between systemic sclerosis and C77G polymorphism in the human PTPRC (CD45) gene

OBJECTIVE

The functional variant C77G (rs17612648) of PTPRC (CD45) was described to confer risk for systemic sclerosis (SSc) in German Caucasians. We analyzed this association in an independent, larger German cohort.

METHODS

We genotyped 171 cases and 179 controls. Cases were subgrouped according to sex, autoantibody profiles, or clinical subsets.

RESULTS

No association of SSc with C77G was detected in the whole dataset, in subgroups, or in combined analyses with a previous study.

CONCLUSION

The results do not confirm PTPRC C77G as a general and independent risk factor for development of SSc.

Sequence Analysis of TNFRSF13b, Encoding TACI, in Patients with Systemic Lupus Erythematosus

B cell activating factor belonging to the TNF family (BAFF) and a proliferation inducing ligand (APRIL), and their receptors BAFF receptor (BAFFR), B cell maturation antigen (BCMA), and transmembrane activator and CAML interactor (TACI) are involved in the regulation of B cell homeostasis and differentiation. BAFF overexpression leads to systemic lupus erythematosus (SLE) in mice and elevated BAFF levels have been observed in human SLE and mouse models for SLE. Furthermore, genetic inactivation of TACI in mice results in a SLE-like phenotype. Based on our recent finding that TACI is mutated in patients with common variable immunodeficiency, of whom more than 30% suffer from autoimmune conditions, we analyzed TACI in humans with SLE. Sequence analysis of TNFRSF13b/TACI in 119 unrelated SLE patients revealed four variants: R20C in exon 1, R72H in exon 3, the silent variation c.327 G > A in exon 3, and A181E in exon 4. No significant association with any of these variants was found, when compared to the frequencies of the variants in a healthy control cohort. Furthermore, the mutated alleles R20C and R72H did not segregate with the SLE phenotype in familial cases of SLE. Thus, our evaluation of the coding region of TNFRSF13b/TACI did not reveal any deleterious or disease-associated mutations.

The activity of erythrocyte sodium-proton exchanger in women with pregnancy- induced hypertension

BACKGROUND

Hypertension that develops after 20 gestational weeks and is defined as pregnancy-induced hypertension (PIH). The main cause of PIH is vasoconstriction and the thickening of vascular media, which decreases vascular capacity and increases peripheral resistance. One of the theories postulated to explain this phenomenon is that a transmembrane sodium transport disorder causes an increase in intracellular sodium concentration. In the latest literature, special attention is paid to the role of the increased intracellular sodium concentration in the pathogenesis of essential hypertension (EH). One of the best documented phenotypes for EH is the increased activity of the sodium-proton exchanger (NHE). The aim of this study was to assess if increased NHE activity could be the mechanism responsible for the development of PIH.

SUBJECTS AND METHODS

The study included 30 women: 10 pregnant women with PIH after gestational week 30, 10 women with physiological pregnancy after 30 gestational weeks, and 10 healthy non-pregnant women. NHE activity was determined according to Orlov's method as amiloride-sensitive H(+) efflux from acid-loaded cells.

RESULTS

The NHE activity in the group of women with PIH was significantly higher than that in women with physiological pregnancy: 10.09 +/- 1.65 vs. 6.81 +/- 2.3 mmol/L RBC/h (p < 0.049) and in the group of non-pregnant women: 10.09 +/- 1.65 vs. 7.56 +/- 1.66 mmol/L RBC/h (p < 0.029). Erythrocyte NHE activity did not differ in the group of women with physiological pregnancy and in the group of non-pregnant women.

CONCLUSION

These results seem to suggest that erythrocyte NHE activity is elevated in PIH pregnancies.

Continuous enhanced expression of Hsc70 but not Hsp70 in rheumatoid arthritis synovial tissue

OBJECTIVE

To investigate the expression of constitutive and inducible members of the Hsp70 protein family in synovial tissue of patients with rheumatoid arthritis (RA) or osteoarthritis (OA).

METHODS

Frozen sections of synovial tissue and isolated synovial adherent cells obtained from 17 RA patients, 5 OA patients, and 1 patient with carpal tunnel syndrome (CTS) were analyzed with specific monoclonal antibodies, by immunohistochemistry, immunocytochemistry, and immunoblotting.

RESULTS

Expression of the constitutive chaperone Hsc70 was increased in synovial tissue from 9 of 9 patients with RA, but was faint or undetectable in 3 of 3 samples from patients with OA. In RA samples, cells mainly of the synovial lining stained intensely for Hsc70 as well as for HLA-DR, CD14, and CD68. Also, in vitro-cultured synovial adherent cells from 8 of 9 RA patients overexpressed Hsc70 (specimens from 1 RA patient were used in both the immunochemistry and the in vitro culture studies). On immunoblots of protein extracts, the synovial and HeLa cell molecules appeared identical in size. The inducible chaperone Hsp70 was not detected in samples from any of the same 17 RA patients, except for rare, isolated cells in 3. Samples from 4 of 5 OA patients also were negative for the inducible chaperone Hsp70, and the fifth was very weakly positive. In addition, tissue from 1 patient with CTS was analyzed 10 months before diagnosis of RA. Synovial tissue from this patient showed extreme overexpression of both Hsc70 and Hsp70.

CONCLUSION

In RA, synovial lining cells continuously overexpress Hsc70 but not Hsp70. Hsc70 may be up-regulated due to the high activity of these cells in several respects, including antigen processing and presentation.

Major differences in antigen-processing correlate with a single Arg71<-->Lys substitution in HLA-DR molecules predisposing to rheumatoid arthritis and with their selective interactions with 70-kDa heat shock protein chaperones

Several HLA-DR alleles are genetically associated with rheumatoid arthritis. DRB1*0401 predominates in Northern Europe and has a characteristic (70)QKRAA motif. This sequence contacts bound peptides and the TCR. Further interactions have been suggested with additional proteins during Ag loading. We explored the much stronger processing/presentation of full-length recombinant human acetylcholine receptor alpha subunit to a specific T cell clone by APC from DRB1*0401+ than *0408+ donors. Using DR*04 transfectants, we show that this difference results largely from the single Lys71<-->Arg interchange (0401<-->0408), which scarcely affects epitope binding, rather than from any other associated polymorphism. Furthermore, we proved our recombinant polypeptides to contain the Escherichia coli 70-kDa heat shock protein molecule DnaK and its requirement for efficient processing and presentation of the epitope by DRB1*0401+ cells. According to a recent report, 70-kDa heat shock protein chaperones preferentially bind to the QKRAA, rather than the QRRAA, motif. Variations between the shared epitope motifs QKRAA and QRRAA are emphasized by underlining. We propose that such interactions enhance the intracellular epitope loading of *0401 molecules. They may thus broaden immune responses to pathogens and at least partially explain the distinct contributions of DRB1*0401 and other alleles to disease predisposition.

Monoclonal autoantibodies from patients with autoimmune diseases: specificity, affinity and crossreactivity of MAbs binding to cytoskeletal and nucleolar epitopes, cartilage antigens and mycobacterial heat-shock protein 60

Serum autoantibodies produce typical immunofluorescence staining patterns on HEp-2 cells, which are frequently used for diagnostic purposes. These include antibodies recognizing cytoskeletal and nuclear epitopes. The detailed analysis of human monoclonal antibodies (MAbs) should help to understand which antigens or autoantigens were involved in the generation of these immune responses. Here, three MAbs are described staining HEp-2 cells in a characteristic pattern. They were derived from peripheral blood B cells of two patients with rheumatic diseases (rheumatoid arthritis and relapsing polychondritis). Their binding reactivities were characterized in detail in several assay systems and their affinities measured. Although the antibodies differed in their fine specificity and crossreactivity, all three MAbs (2 IgM, 1 IgA) bound to purified cytoskeletal antigens (desmin) and, in addition, to cartilage antigens (human collagen type II, proteoglycans). The binding to HEp-2 cells could be inhibited specifically with soluble antigens as shown by intracellular flow cytometry. The affinities for both groups of antigens were relatively high (examples: K(D) (desmin) = 0.1 x 10(-7) M; K(D) (collagen) = 3.5 x 10(-7) M). Two of the MAbs also bound to heat-shock protein 60 (HSP60) derived from Mycobacterium tuberculosis. The results prove that antibodies and B cells with reactivity to both intracellular cytoskeletal and nuclear antigens and exogenous antigens (e. g. HSP60) exist in patients with rheumatic diseases. Similar to an animal model such human B cells may be induced by the exogenous antigen (HSP60) and crossreact with local auto-antigens related to the disease (cartilage). In this way they might contribute to pathogenic processes. Due to their additional crossreactivity with intracellular cytoskeletal and nuclear antigens, these antibodies simultaneously can be detected in the HEp-2 immunofluorescence assay.

[Clinical analysis of preterm labor]

576 patients with preterm deliveries that occurred between the 22nd to 37th gestation weeks were undergone clinical analysis. The material was collected in the years 1995 to 1999 at Clinic of Obstetric and Perinatology of Pomeranian Academy of Medicine in Szczecin. In our study the rate of preterm delivery was 10.5%. Special attention was paid to mother's age, obstetrics history, socioeconomic, medical and psychogenic conditions of pregnant women, condition of infants, infant mortality and their birth-weight. The rate of premature preterm rupture of fetal membranes was 52.7%. The frequency of caesarean sections in our study in preterm births was about 50% like in other publications and the most important indication for them was amnionitis. In almost 40% the general state of infants was poor and medium. Almost 25% of preterm deliveries is connected with other systemic diseases during pregnancy.

Monoclonal autoantibodies from patients with autoimmune diseases: synovial fluid B lymphocytes of a patient with rheumatoid arthritis produced an IgG lambda antibody recognizing J-sequences of Ig kappa chains in a conformation-dependent way

Synovial fluid B cells from a patient with seronegative rheumatoid arthritis were immortalized by electrofusion. The specificity of clone FKN-E12 (IgG1 lambda) was analysed by screening a phage display random peptide library. One heptamer sequence was identified (RASFp1 = HLTFGPG). Three human IgG kappa antibodies contained a highly homologous sequence (xLTFGPG) at the junction of V- and J-regions. Homologies were also found in distinct humans (J kappa 3, J kappa 4) and murine (J kappa 5) J kappa-sequences (TFGPG, LTFGxG), and to a lower degree in all remaining J kappa-sequences (TFGxG). Binding and binding inhibition assays showed that FKN-E12 bound to kappa light chains tested in a conformation-dependent way: it reacted only with IgG kappa or IgA kappa chains adhered to a plastic surface, but not in soluble form. In conclusion, FKN-E12 detects a conformational epitope on probably all kappa light chains, which could be definded by screening a phage library displaying linear epitopes.

Overexpression of human homologs of the bacterial DnaJ chaperone in the synovial tissue of patients with rheumatoid arthritis

OBJECTIVE

To study the expression of the chaperone family of J proteins in the synovial tissue of patients with rheumatoid arthritis (RA) or osteoarthritis.

METHODS

Rabbit antibodies specific for a synthetic peptide (pHSJ1: EAYEVLSDKHKREIYD), representing the most conserved part of all J domains thus far identified--among them the Drosophila tumor suppressor Tid56--were used in immunohistochemical analyses of frozen sections of synovial tissue and immunoblotting of protein extracts of adherent synovial cells. IgG specific for Tid56 was also used.

RESULTS

Both antisera predominantly and intensely stained synovial lining cells from RA patients; other cells did not stain or stained only faintly. In immunoblots, anti-pHSJ1 specifically detected several bands with molecular weights of >74 kd (type I), 57-64 kd (type II), 41-48 kd (type III), and < or =36 kd (type IV). The strongest band detected in RA adherent synovial cells was the type II band, whereas in a B cell line, a type I band was prominent.

CONCLUSION

Several potentially new members of the J family are described. The type II band represents the human homolog of the Drosophila Tid56 protein and is strongly expressed in RA synovial tissue.

The B cell repertoire of patients with rheumatoid arthritis. II. Increased frequencies of IgG+ and IgA+ B cells specific for mycobacterial heat-shock protein 60 or human type II collagen in synovial fluid and tissue

OBJECTIVE

A qualitative and quantitative analysis of the functional, antigen-specific B cell receptor repertoire of patients with rheumatoid arthritis (RA) in synovial and peripheral compartments.

METHODS

B cells were activated to grow and differentiate at high efficiency in vitro under limiting-dilution conditions. Isotype and specificity of the secreted Ig were tested by enzyme-linked immunosorbent assay.

RESULTS

In contrast to peripheral B cells, most synovial B cells had already switched to IgG/IgA in vivo. The frequencies of B cells specifically recognizing foreign antigens were decreased within the synovial population, whereas the frequencies of B cells specific for type II collagen, mycobacterial heat-shock protein 60 (hsp60), or IgG Fc fragments were significantly increased, revealing a negative correlation in terms of frequencies.

CONCLUSION

B cells specific for human type II collagen, hsp60, and IgG Fc fragments are produced and/or expanded locally within the affected joints of RA patients. Thus, the specific immune system is definitely involved in the local inflammatory and destructive processes.

Identification of two nuclear protein binding sites and their role in the regulation of the murine multidrug resistance mdr1a promoter

Multidrug resistance genes (mdr) that encode P-glycoproteins (P-gp) are transcriptionally regulated in normal tissues and in some multidrug-resistant (MDR) cells. Several lines of evidence suggest that regulation of P-gp overexpression at the transcriptional level is also important in human tumors. In murine MDR cells, mdr1a and/or mdr1b genes are overexpressed and P-gp isoforms are overproduced. To identify the mdr1a promoter regions that are required for transcription, the promoter has been linked to the chloramphenicol acetyltransferase (CAT) gene in transient expression vectors. 5'-Deletions of the promoter sequences have demonstrated that the region between -155 to +89 bp is crucial for basal activity of the mdr1a gene. DNase I footprinting, methylation interference, and gel retardation assays identified two nuclear protein binding sites within these sequences. One of the nuclear protein binding sites contains an 11-bp DNA sequence that interacts with nuclear protein(s) and is conserved in the promoters of the murine mdr1a and mdr1b, hamster pgp1, and human MDR1 genes. The conserved SP1 site (5'-GGGCGGG-3') that is present further downstream was shown to interact with its nuclear factor. These observations suggest that at least part of mdr gene transcriptional regulation is mediated by conserved mdr cis-regulatory elements and common nuclear factors.

Plasticity of T-cell function. II. Transient induction of CD8 (Ly-2) expression in cloned EL-4 lymphoma cells depending on cell density

EL-4 lymphoma cells are able to suppress the primary humoral immune response of spleen cells to sheep erythrocytes or 4-hydroxy-3-iodo-5-nitrophenylacetyl-keyhole limpet haemocyanin (NIP-KLH) in vitro. Typically, the cells suppress very efficiently in small numbers, but lose this capacity as the numbers increase. Three clones were analysed and this fluctuation in function was paralleled by a fluctuation in the expression of CD8 (Ly-2). Clones were incubated for 2 days, starting from different seeding concentrations, and analysed with cytofluorography. Neither Thy-1 nor CD5 (Ly-1), H-2 K, H-2 D, LFA-1 (all positive) nor CD4 (L3T4) or MEL-14 (both negative) were influenced by this treatment. In contrast, cells were CD8- at high seeding concentrations, and CD8+ at low seeding concentrations. When cell cultures grew to higher densities, the cells again lost the capacity to express CD8. Experiments testing the suppressive capacity of individual EL-4 clones after preculture at different densities or in the presence of antibodies against CD8 suggest that the efficiency of suppression may well be correlated to the amount of CD8 expressed.

Frequencies and interactions of regulatory T cells. I. The balance between help and suppression regulates the primary immune response to keyhole limpet hemocyanin in vitro

Frequencies and efficiencies of regulatory T cells from non-immunized mice were estimated in several assay systems differing from each other in cellular composition and antigen dose (NIP-KLH). The NIP-specific and total IgM responses were quantified. Using 10(4) syngeneic B cells and 50 micrograms/ml NIP-KLH, helper (Th) cells from 5 day immune donors were detected in frequencies of 1:3000-1:4000 in lymphnode and spleen T cells, with an efficiency of 70-90 ng IgM/Th cell in C57B1/6 mice. In non-immune spleen T cells, Th cells were observed in frequencies of 1:16,000-1:38,000, with comparable efficiency, but these Th cells appeared suppressed at increased T cell doses. Polyclonal activation led to the appearance of multiple independently regulated populations of Th cells with similar efficiencies. In the presence of 10(5) syngeneic spleen cells, treated once with anti-Thy-1 antibody and complement and 50 micrograms/ml NIP-KLH, suppressor activity was observed in the same T cell population. Similar to help, suppression fluctuated with increasing T cell numbers. Using 1 x 10(6) spleen cells and 50 micrograms/ml NIP-KLH as assay system, T cells enhanced the responses. Again, several independently regulated populations were observed, with efficiencies slightly higher than those of the above-described Th cells. By maintaining the cellular components of the assay system constant (10(4) B cells) and titrating the antigen, Th cell frequencies showed little variation up to 100 micrograms/ml NIP-KLH and were always suppressed at higher T cell numbers. At 200 micrograms/ml NIP-KLH, the frequency was increased to approximately 1:2000, and not suppressed, i.e., was identical to the frequency observed in mice immunized 5 days previously. Efficiencies increased with increasing doses of antigen. The results strongly indicate that regulatory T cell function shows "plasticity", in the sense that the appearance and the frequencies of helping and suppressing T cell populations highly depend on the micro-environment present in culture.

Plasticity of T cell function. Cloned EL-4 lymphoma cells may help or suppress a primary antibody response depending on their own concentration and the assay system

Cloned EL-4 lymphoma T cells were tested in limiting dilution experiments for their capacity to suppress or to help the primary humoral immune response of spleen cells (or T cell-depleted spleen cells) to the Ag SRBC and 4-hydroxy-3-iodo-5-nitro-phenyl-keyhole limpet hemocyanin. EL-4 clones are able to suppress up to 80% of the total IgM responses in both systems, as well as to help. Suppression and help fluctuate between high and low levels with the numbers of EL-4 cells placed into tissue cultures. In Poisson plots, this is reflected as a "typical curve": usually one or two frequencies are estimated (e.g., integral of 1/4 and approximately 1/1000 for suppression and approximately 1/6 and approximately 1/200 for help), which appear regulated with increasing numbers of cells seeded. Control experiments showed that EL-4 cells need to be alive to exert the effects. EL-4 cells do not serve as additional antigen, do not induce an isotype switch and are not cytotoxic. Help and suppression are not restricted by the MHC. Help requires the presence of a small number of normal T cells in the assay system, indicating that EL-4 cells do not replace specific helper T cells. When a number of control cell lines were analyzed under identical circumstances, similar effects were observed with most long term T cell lines or clones expressing a T cell receptor, whereas cells of non-T lineages and T cells not expressing a T cell receptor did not show the phenomena. The results suggest a functional plasticity of T cells, dependent on cell numbers and the assay system used, and expressed via T cell communication.

Plasticity of T cell function. Cloned EL-4 lymphoma cells may help or suppress a primary antibody response depending on their own concentration and the assay system

Cloned EL-4 lymphoma T cells were tested in limiting dilution experiments for their capacity to suppress or to help the primary humoral immune response of spleen cells (or T cell-depleted spleen cells) to the Ag SRBC and 4-hydroxy-3-iodo-5-nitro-phenyl-keyhole limpet hemocyanin. EL-4 clones are able to suppress up to 80% of the total IgM responses in both systems, as well as to help. Suppression and help fluctuate between high and low levels with the numbers of EL-4 cells placed into tissue cultures. In Poisson plots, this is reflected as a "typical curve": usually one or two frequencies are estimated (e.g., integral of 1/4 and approximately 1/1000 for suppression and approximately 1/6 and approximately 1/200 for help), which appear regulated with increasing numbers of cells seeded. Control experiments showed that EL-4 cells need to be alive to exert the effects. EL-4 cells do not serve as additional antigen, do not induce an isotype switch and are not cytotoxic. Help and suppression are not restricted by the MHC. Help requires the presence of a small number of normal T cells in the assay system, indicating that EL-4 cells do not replace specific helper T cells. When a number of control cell lines were analyzed under identical circumstances, similar effects were observed with most long term T cell lines or clones expressing a T cell receptor, whereas cells of non-T lineages and T cells not expressing a T cell receptor did not show the phenomena. The results suggest a functional plasticity of T cells, dependent on cell numbers and the assay system used, and expressed via T cell communication.