抗人淋巴细胞T8抗原样McAb的研制和初步鉴定

用杂交瘤技术,将经人外周血E花环阳性细胞免疫小鼠脾细胞与NS-1骨髓瘤细胞融合后,产生一分泌IgG_1亚型McAb杂交瘤株。其所分泌抗体经微量放射免疫测定及间接免疫荧光法分析,表明它只能与T细胞系、76％的胸腺细胞及22％的外周血T淋巴细胞反应,不与其它各种不同细胞反应。将此抗体所识别入外周血T淋巴细胞亚群与抗Leu-2a识别T8~+细胞、抗Leu-3a识别T4~+细胞比较,发现此抗体与抗Leu-2a识别同一群细胞。此抗体能从T细胞表面沉淀出30KD(还原条件)或78KD(非还原条件)分子,并完全阻断FITC标记抗Leu-2a与T细胞的结合,说明此抗体是识别T8抗原样的McAb。     

A monoclonal antibody (OPT1) to T cells which is available for paraffin-embedded materials

A monoclonal antibody (MAb), OPT1, reactive with T cells in formalin-fixed, paraffin-embedded tissue sections, has been identified through immunization with activated T cells from peripheral blood lymphocytes (PBL). The antibody is an IgG1 antibody as demonstrated by the Ouchterlony technique. By cytofluorometric analysis, almost all CD3+ lymphocytes and only a few CD20+ lymphocytes of peripheral blood expressed the OPT1 antigen. Nonhematolymphoid cell lines were negative for OPT1 by the immunoperoxidase staining using acetone-fixed cell lines. On the contrary, peripheral T cells, cells of two T cell lines out of four and a part of the cells of one B cell line out of two were positive for OPT1. The immunoperoxidase staining of paraffin-embedded tissue sections revealed that most of lymphocytes in T cell areas of lymph nodes expressed OPT1 antigen. Some lymphocytes in both cortex and medulla of the thymus and erythroid precursors of the bone marrow were OPT1+. In the malignant lymphoma series, approximately 90% of T cell lymphomas and 6% of B cell lymphomas reacted with OPT1. None of the Reed-Sternberg cells nor Hodgkin cells in Hodgkin's disease were positive. Consequently, OPT1 may be useful for the diagnosis and study of malignant lymphomas and other related lesions.     

CD3+ WT31- peripheral T lymphocytes lack T44 (CD28), a surface molecule involved in activation of T cells bearing the alpha/beta heterodimer

We have applied two-color fluorescence cytofluorometric techniques to the analysis of the distribution of T44 and CD3 antigens in peripheral blood human lymphocytes. While most CD3+ cells co-expressed T44 antigen, a small distinct subset was CD3+ T44- (2-10% of CD3+ cells). This cell subset also did not react with the WT31 monoclonal antibody (mAb), specific for an alpha/beta framework determinant of the T cell receptor (TCR). Lack of T44 antigen expression was also observed in purified CD3+ WT31- polyclonal populations that had been cultured in medium containing interleukin 2 (IL2) and as well as greater than 30 clones expressing the CD3+4-8-WT31- surface phenotype. Immunoprecipitation experiments confirmed that expression of T44 molecules was confined to CD3+ WT31+ peripheral blood T cells. While conventional CD3+ WT31+ cells produced IL2 in response to mAb directed to CD2, CD3 or T44 surface molecules, CD3+ WT31- cells did not respond to anti-T44 mAb but released IL2 following stimulation with anti-CD2 or anti-CD3 mAb. Therefore, assuming that anti-T44 mimicks the effect of a still undefined natural ligand our data suggest that T cells expressing the gamma-gene surface product may be signalled by stimuli which differ, at least in part, from those acting on CD3+ WT31+ T lymphocytes.     

Four distinct antigen systems on human thymus and T cells defined by monoclonal antibodies: immunohistological and immunochemical studies.

Human thymus and T cell antigens were identified by using four distinct monoclonal antibodies (MoAb), designated 2D5, 5B3, 7A5 and 9D4. 2D5 antibody reacted with most human thymocytes and a few peripheral lymphocytes as well as with a subpopulation (20%) of bone marrow cells, and precipitated a 45K molecular weight (mol. wt.) component from 125I-labelled thymus cell lysate. 7A5 antibody also reacted with the majority (80%) of thymocytes but neither with peripheral lymphocytes nor with bone marrow cells. The antigen detected by 7A5 was a glycoprotein consisting of 48K and 12K mol. wt. components, which were non-covalently associated with each other. 5B3 reacted with virtually all of human thymus and T cells but not with the majority of B cells and bone marrow cells. This reagent precipitated a 72K mol. wt. glycoprotein from thymus and T cells. An additional 65K mol. wt. glycoprotein was precipitated by 5B3 together with the 72K mol. wt. component, but with poor reproducibility. 9D4 antibody, on the other hand, reacted with a 200K mol. wt. component from thymus and T cells as well as 220K and 210K components from the non-T cell fraction of tonsil lymphocytes. Whereas antigens detected by 2D5 and 7A5 appeared to be highly expressed on cortical thymocytes, the antigen defined by 5B3 occurred much more abundantly on medullary thymocytes and peripheral T cells than on cortical thymocytes. Based on the data described above, it is suggested that 7A5, 5B3 and 9D4 MoAb recognize human homologues of mouse TL, Ly-1 and Ly-5 antigens, respectively, whereas 2D5 antibody seems to resemble OKT10, as described by others.     

Antigen Presenting Cells in Human Decidual Tissue: III. Role of Accessory Cells in the Activation of Suppressor Cells

ABSTRACT: Human decidual antigen presenting cells (DAPCs) exposed to fetal cells in vitro induce generation of suppressor T cells among a population of peripheral blood lymphocytes. Human lymphocyte antigen (HLA)-class II positive antigen presenting cells were isolated from early normal human decidual tissue and from peripheral blood (PAPCs) by adhering Ficoll-Pa-que separated cell suspensions to fibronectin. In contrast to PAPCs, DAPCs pulsed with fetal antigens induced a radio-sensitive, Leu 1,2-positive T suppressor cell population. A nylon wool adherent B cell population is required during the in vitro induction of the suppressor cells. These suppressor cells impair primary mitogen and mixed lymphocyte culture (MLC) responses, generation of anti-trinitrophe-nyl (TNP) cytotoxic T lymphocytes, and antibody response of autologous and allogeneic lymphocytes. Only intact viable embryonic cells can effectively confer upon DAPCs the ability to induce T suppressor cells. The T suppressor cell induction by DAPCs primed with fetal antigens is restricted by the major histocompatibility complex. Our results show that the HLA-DR molecules are the most prominent restriction elements.     

Accessory cell response to rye grass pollen extract in mice, guinea pigs and man

The ability of murine, guinea-pig and human accessory cells to function in antigen presentation has been assayed by a T-cell proliferative response to adherent cells pulsed with rye grass pollen extract. A population of phagocytic, esterase-positive, plastic-adherent splenocytes from non-immune Balb/c mice briefly incubated with solubilized rye antigen were capable of stimulating syngeneic T lymphocytes from immune mice in an antigen-specific manner. Accessory cell function was H-2 restricted and required Ia-positive cells. Treatment with a monoclonal anti-Ia antibody impaired proliferation, whereas the presence of polyclonal rabbit anti-rye antibody increased activity. Guinea-pig peritoneal and alveolar adherent cells pulsed with up to 1 mg/ml antigen increased the response of rye-immune lymph node T cells in vitro. Proliferation was dose-dependent, despite less than 0.1% of the available antigen being cell-associated, and could be inhibited by treating the accessory cells with trypsin, sodium iodoacetate and chloroquine. Adherent human peripheral blood cells treated with rye antigen supported the proliferation of non-adherent and nylon wool-enriched mononuclear cells obtained from both grass pollen-sensitive donors and from individuals lacking either detectable serum IgE antibody or a positive skin test to rye antigen.     

Both Fc receptors and lymphocyte-function-associated antigen 1 on human Tγ lymphocytes are required for antibody-dependent cellular cytotoxicity (killer cell activity)

A monoclonal antibody, designated CLB-LFA-1/1, directed to the human lymphocyte-function-associated antigen 1 (LFA-1) was raised by immunization of mice with the peripheral blood lymphocytes of a Tγ lymphocytosis patient. The monoclonal antibody was selected by inhibition of the natural killer cell and the antibody-dependent killer cell activity of the patient's Tγ lymphocytes. In addition, the monoclonal antibody was shown to inhibit the cytotoxic activity of T cell clones specific for either class I or class II HLA molecules. The antigen recognized by CLB-LFA-1/1 consisted of three polypeptide chains with molecular weights of 180000 (α), 155000 and 94000 (β). The antibody reacted with T cells, B cells, monocytes and granulocytes, and stained normal Tγ cells and Tγ cells of patients with Tγ lymphocytosis two- to threefold stronger than normal T cells. It was shown that LFA-1 and the Fc receptor on Tγ cells did not comodulate and it is therefore concluded that Fc receptors and LFA-1 are independent membrane structures, both required for the killer cell activity of Tγ cells.     

Identification of an Anti-Human Osteogenic Sarcoma Monoclonal-Antibody-Defined Antigen on Mitogen-Stimulated Peripheral Blood Mononuclear Cells

An anti-human osteogenic sarcoma monoclonal antibody (mouse IgG2b) termed 791T/36 was found to exert complement-dependent cytotoxicity against phytohaemagglutinin (PHA)-stimulated peripheral blood mononuclear (PBMN) cells. This reaction was examined by flow cytofluorimetry using indirect membrane immunofluorescence to detect cell-bound antibody and by measurement of the binding of fluorescein-isothiocyanate-conjugated 791T/36 antibody to cells. The antibody reacted strongly with peripheral blood blast cells induced by PHA, and there was negligible reactivity with resting lymphocytes. Maximum binding was observed after 3 days' culture with PHA, coinciding with maximum DNA synthesis, and this represented of the order of 2 X 10(5) antibody molecules bound per cell. After cell surface radioiodination of PHA-stimulated PBMN cells, detergent lysis and immunoprecipitation of antigen with 791T/36 antibody and Sepharose-protein A, the apparent molecular weight of this antigen was determined to be 72,000 by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. This is identical to that of the 791T/36-defined antigen expressed on various osteogenic sarcoma cell lines [3, 17], and by this criterion the antigen is distinguishable from other cell surface markers of activated human lymphocytes.     

Monocyte-regulated Hyporesponsiveness of Human Cord Blood Lymphocytes to OKT3-monoclonal-antibody-induced Mitogenesis

OKT3 monoclonal antibody recognizes surface antigenic structures present on all human mature T lymphocytes and is mitogenic for resting peripheral T cells. Recent reports suggest that these structures are linked to the specific antigen receptor of the T cells and play an important role in T-cell activation. We have tested the mitogenic action of OKT3 on resting lymphocytes from human newborns, their mothers, and unrelated adults. We found that the proliferative response of cord T cells to OKT3 is significantly lower than the response of maternal and adult cells at all doses of the antibody tested (5-1000 ng/ml). This difference was not dependent on culture conditions (source of serum, kinetics induced by the OKT3 antibody, or different proportions of adherent cells in peripheral blood mononuclear leukocytes), and could only to some extent be accounted for by differences in the proportions of OKT3-binding cells between these populations. Removal of adherent monocytes largely diminished the OKT3-induced proliferation of maternal and adult cells, by an average of 70-80%. In contrast, it significantly enhanced the proliferation of cord cells. The proliferative response of cord T lymphocytes to the two polyclonal T-cell activators phytohaemagglutinin and concanavalin A was similar to or greater than that of mothers and other adults.     

Early events during primary activation of T cells: antigen receptor cross-linking and interleukin 1 initiate proliferative response of human T cells

To study early events during primary activation of human T cells, a simple method was developed which simultaneously allows positive selection of T cells from peripheral blood lymphocytes (PBL) and their polyclonal, antigen receptor-mediated stimulation with anti-T3 monoclonal antibodies. In the absence of accessory cells, T cells activated with matrix-bound OKT3 express high levels of the Tac antigen within 15 h and produce interleukin 2 (IL2). Tac expression was further enhanced by addition of exogenous IL2. However, under these conditions purified T cells were unable to mount a proliferative response, whereas unfractionated PBL proliferated already after 24 h of culture. This unresponsiveness of purified T cells could be overcome by either re-addition of low numbers of autologous accessory cells or semipurified human IL1. As IL1 had no significant effect on Tac expression of T3-stimulated T cells, we conclude from these data that IL1 exerts in addition to its influence on IL2 production an effect, which allows antigen receptor-triggered T cells to enter the cell cycle.     

Studies on the immunoregulation of thyroid autoantibody production in vitro.

The spontaneous production (without mitogen or antigen) of antithyroglobulin and antimicrosomal antibodies by peripheral (PBL) and thyroid-derived lymphocytes from patients with Hashimoto's thyroiditis (HT) has been studied with particular emphasis on the regulation of this phenomenon. Based on studies of DNA and protein synthesis, kinetic studies and B/T reconstitution experiments, in most HT patients, spontaneous production by PBL is accounted for by secretion of preformed antithyroglobulin (termed Type 1 patients), whereas active production is observed in a small minority (termed Type 2). In none of 24 HT patients could active antimicrosomal antibody production by PBL be detected. Conversely, thyroid-derived lymphocytes produced both autoantibodies by an active process. Pokeweed mitogen (PWM) stimulation enhanced antibody production by PBL in the Type 1 group but not in Type 2 or thyroid-derived lymphocytes. T lymphocytes were required for antibody synthesis in both thyroid antigen-driven and peripheral PWM-driven cultures. By separating T lymphocytes into T4+ (helper) and T8+ (suppressor) subsets with monoclonal antibodies, T-cell modulation of autoantibody production in both systems was studied. In a PWM-induced system, both thyroid and peripheral T-cell subsets were capable of modulating peripheral antibody production. In the thyroid lymphocyte antigen-specific system, further addition of thyroid derived T8+ cells alone caused partial suppression of antibody production but not with peripheral T8+ cells. Of interest was the partial decrease of antibody production by the thyroid lymphocytes by added peripheral T4+ cells. The fact that the production of thyroid autoantibodies by thyroid-derived mononuclear cells (which included T suppressor, T helper and B lymphocytes) could be reduced by the addition of more suppressor T lymphocytes suggests that an antigen-specific defect in the T4+/T8+ thyroid cell balance may account for the in vivo production of these antibodies in patients with Hashimoto's thyroiditis.     

MLR3 molecule is an activation antigen shared by human B, T lymphocytes and T cell precursors

MLR3 molecule is a membrane glycoprotein (mol. mass range 28-34 kDa) present on activated, but not resting human peripheral T cells, B cells and thymocytes. Its kinetics of appearance on the cell surface (3 h after the addition of the inductive signal to the cells) suggests that it is an early activation antigen. The proliferative response of cultured T and B lymphocytes and thymocytes to different activation signals is inhibited by the addition of MLR3 monoclonal antibody. Moreover the antibody in combination with non-mitogenic doses of phorbol myristate acetate leads to proliferation of thymocytes and resting B and T lymphocytes. In the latter, synthesis of interleukin 2 is also induced. Biochemical analysis of MLR3 antigen indicates that it is a phosphorylated protein with N-linked sugar moieties. Together these data suggest a role for MLR3 antigen in the signal transduction process during activation, both for mature lymphocytes and for T cell precursors.     

Two monoclonal anti-CD3 antibodies can induce different events in human T lymphocyte activation

Two monoclonal antibodies, WT32 and CLB-T3/4.2a, directed against the CD3 complex were used to study the mechanism of activation of human peripheral T lymphocytes. WT32, a mouse monoclonal IgG2a antibody with a low avidity (much less than OKT3) for the CD3 complex, effectively induces mitogenesis of purified T lymphocytes when used in the 1 ng-10 micrograms range in the presence of monocytes or recombinant interleukin 2 (IL2). In contrast, CLB-T3/4.2a, a mouse monoclonal antibody of the same isotype with a high avidity (much greater than OKT3) for the CD3 complex, induces IL2 receptor expression and IL2 responsiveness only at very low concentrations (less than 5 ng/ml), yet in the presence of monocytes this antibody induces proliferation within a similar dose range as WT32. Apparently, in the absence of accessory cells which can cross-link the antibody CD3 complexes, the binding properties (avidity) of an antibody and thereby the number of receptors that are occupied are important parameters for induction of IL2 responsiveness. Furthermore, we show that Ca2+ mobilization only occurs when the cells are stimulated by saturating amounts of antibody, so that, when the conditions are optimal for the induction of IL2 responsiveness, no Ca2+ mobilization will be detected.     

Characterization of two sheep lymphocyte differentiation antigens, SBU-T1 and SBU-T6

The monoclonal antibodies 25.91 and 20.27 define two lymphocyte cell surface antigens of sheep. 25.91 is reactive with 60-80% of lymphocytes and 98% of thymocytes, and only stains surface immunoglobulin-negative peripheral lymphocytes. 25.91 immuno-precipitates a 67,000 MW protein from lymphocyte lysates under both reducing and non-reducing conditions, whereas immunoprecipitation of thymocyte lysates reveals a 67,000, 62,000 MW complex. The tissue distribution and molecular weight analysis reported here for the antigen recognized by 25.91 indicate that this antigen is the sheep homologue of the human T1 and mouse Ly 1 antigens. The monoclonal antibody 20.27 is reactive with 80% of thymocytes and the majority of cell surface immunoglobulin-positive peripheral blood lymphocytes (B cells), but is unreactive with peripheral blood T cells. 20-27 also stains Langerhans cells in skin tissue sections and large dendritic-like cells in the paracortex sections and large dendritic-like cells in the paracortex of lymph node tissue sections. Immunoperoxidase staining of thymus tissue sections with 20.27 shows intense staining of cortical thymocytes and an absence of staining within the medulla. Molecular weight analysis of the 20.27 antigen reveals two major bands of 46,000 and 12,000 MW under both reducing and non-reducing conditions. The 20.27 antigen has properties resembling MHC class I-like antigens such as T6 in the human and TL in the mouse.     

Monoclonal antibody against human macrophages/monocytes and granulocytes

A monoclonal antibody of the IgG2a isotype directed against lymphokine-activated human macrophage cell line (U937) was produced and characterized. By indirect immunofluorescence microscopy or binding assay, this antibody (MaG-1) reacted with human peripheral monocytes, peritoneal macrophages, alveolar macrophages, and peripheral granulocytes but not with lymphocytes, erythrocytes, and platelets. MaG-1 antigen was also expressed by 34% of bone-marrow cells which includes monocytic and granulocytic precursors, whereas lymphoid and erythroid precursor cells were found on MaG-1 negative population. Immunoprecipitation of 125I-labeled U937 cell extract with the Mag-1 antibody under nonreducing and reducing conditions yielded a specific band of 66 kD. Thus, this antibody defines a new human macrophage/monocyte and granulocyte-specific antigen and may be useful for studying differentiation of human macrophages/monocytes.     

The expression of IgE Fc receptors on lymphocytes of allergic patients

Peripheral blood lymphocytes from nonatopic subjects and atopic patients were analyzed for cells expressing Fc receptors for IgE (Fc epsilon R). Nonatopic humans and atopic patients in remission had approximately 1 percent of Fc epsilon R+ peripheral blood lymphocytes. Usually greater than 99 percent of these cells were mIgM+/mIgD+ B cells. However, in approximately 10 percent of nonatopic and atopic subjects a transient increase of Fc epsilon R+ lymphocytes to 3-6 percent was observed in the absence of any disease manifestations and measurable changes in the serum IgE level. At times of increased numbers of peripheral blood Fc epsilon R+ lymphocytes, up to 1 percent Fc epsilon R+ positive cells were detected in isolated T cell preparations. The Fc epsilon R+ T cells reacted with the monoclonal antibody Lyt 3 to the sheep erythrocyte receptor of human T cells but not the anti-T cell antibody OKT3, and fractions also with the monoclonal antibodies OKT8 (cytotoxic and suppressor T cells) and OKM1, which binds to an antigen present on monocytes and a subpopulation of T cells and large granular lymphocytes. No OKT4+ (helper T cells) Fc epsilon R+ cells were detected. The reactivity with monoclonal antibodies to T cell subsets of the Fc epsilon R+ T cells paralleled the reactivity of the IgG Fc receptor positive T cells. In contrast to patients with allergic rhinitis and asthma, patients with severe atopic dermatitis or the Hyper IgE Syndrome always had significantly elevated percentage of Fc epsilon R+ lymphocytes (4-10 percent), which were almost entirely B cells since less than 0.1 percent Fc epsilon R+ T cells were detected in these patients. Atopic dermatitis patients receiving systemic corticosteroid treatment had only 0.2 percent Fc epsilon R+ lymphocytes which was significantly less than the 1 percent of the nonatopic control donors. Attempts to define the function of Fc epsilon R on human B and T lymphocytes have been unsuccessful thus far; however, the increase of Fc epsilon R+ cells associated with atopic disease in man and parasitic infections in rats and mice suggest that Fc epsilon R+ lymphocyte may be involved in the IgE isotype regulation.     

Recognition of a human T-lymphocyte differentiation antigen by an IgM monoclonal antibody.

A monoclonal antibody directed at a determinant on human T cells was produced and characterized. This IgM antibody, MBG6, bound to human peripheral blood T lymphocytes and to medullary thymocytes. It was unreactive with normal B cells, B-cell lines and granulocytes. Apart from T lymphocytes, bone marrow cells (including cells positive for the terminal transferase marker, myeloid colony-forming cells, myeloblasts, and differentiating myeloid and erythroid cells) were negative. Peripheral blood cells that were treated with MBG6 and rabbit complement were no longer capable of proliferating in response to phytohaemagglutinin or concanavalin A; MBG6 did not have any direct mitogenic action on T lymphocytes. Double immunofluorescence studies using IgM MBG6 and OKT3, and IgG2a monoclonal antibody that recognizes all peripheral T cells, showed that these two antibodies identified exactly the same cell populations. Competitive binding studies, however, indicated that MBG6 and OKT3 recognized different epitopes. The antibody may have clinical applications in bone marrow transplantation.     

Differences in the stimulating capacity of immobilized anti-CD3 monoclonal antibodies: variable dependence on interleukin-1 as a helper signal for T-cell activation.

Monoclonal antibodies to the CD3 antigen on human T lymphocytes have been shown to induce accessory cell-dependent T-cell activation. One function of the accessory cells is cross-linking of CD3 by Fc receptor-binding of the anti-CD3 antibodies. Whether additional accessory signals are still required when anti-CD3 is presented in immobilized form is controversial. In the present study we stimulated purified human T cells with several anti-CD3 monoclonal antibodies, which were immobilized by coating the culture wells with goat anti-mouse IgG. A first group of immobilized anti-CD3 antibodies (anti-Leu-4, UCHT1, anti-T3, WT32 and 64.1) induced vigorous T-cell proliferation in the complete absence of monocytes, even when anti-interleukin-1 beta antiserum was added to the cultures. Other immobilized anti-CD3 antibodies (OKT3, WT31) required interleukin-1 beta in order to induce T-cell proliferation. However, when OKT3 was immobilized by direct coating of the culture wells with OKT3, it was also able to induce accessory cell-independent production of interleukin-2 and T-cell proliferation. Interleukin-1 beta further enhanced the interleukin-2-dependent proliferative response and it could provide help to induce proliferation at doses of immobilized OKT3 which, by themselves, were insufficient for full T-cell activation. We conclude that the requirement for interleukin-1 beta to induce interleukin-2-dependent proliferation of T cells when stimulated with anti-CD3 antibodies is not absolute, but depends on the CD3 epitope recognized, on the way of antibody presentation, on the antibody concentration and on other, still undefined, characteristics of the monoclonal antibodies used.     

A subset of gamma delta lymphocytes is increased during HIV-1 infection.

The gamma delta T cell receptor (TcR) lymphocytes constitute 3-10% of human peripheral blood lymphocytes. Only a very small fraction of these cells is recognized by the delta TCS1 monoclonal antibody, directed against the V delta 1 chain of the receptor. We describe the immunological, virological and clinical data of a small group of seropositive subjects having high levels of gamma delta TcR T cells in the peripheral blood. Our flow cytometric studies show that most of these cells belong to the delta TCS1+ (V delta 1+), CD8 +/- (dim staining) subset. Patients with high gamma delta TcR T cell numbers were not characterized by the presence of an acute (IgM positive) or reactivated (as defined by high IgG titres against early antigen or IgA titres against viral capsidic antigen) Epstein-Barr virus infection. Cytomegalovirus infection was excluded by serological assays, and other herpes viral infections were not found after clinical examination. HIV p24 antigenaemia was present in two out of 11 subjects. AIDS patients had very high percentages of gamma delta TcR T cells. Altogether these data show that the selective expansion of delta TCS1+ cells in HIV1 seropositive subjects is not related to some exogenous antigen stimulation, but may be related to peculiar pathologic processes involving the immune system.