Studies in the rat of antibody-coated and N-ethylmaleimide-treated erythrocyte clearance by the spleen. II. Effects of immune complex infusion.

The effects of immune complex infusion on the clearance of antibody (R3/13)-coated and NEM-treated rat erythrocytes by the splenic component of the rat mononuclear phagocyte system (MPS) were investigated. Equivalence complexes of BSA-anti-BSA produced a significant delay in the clearance of the NEM cells (pre-infusion T1/2 19.7 +/- 3.9 min, post-infusion T1/2 26.5 +/- 3.8 min, mean +/- SE, n = 6, P less than 0.01), but this effect could be abolished by agents that prevented the changes in the splenic blood flow that followed complement activation. The immune complexes formed in 10-fold antigen excess (mean size 15S) did not delay the clearance of the NEM cells. Clearance of R3/13-coated cells was impaired by the infusion of immune complexes prepared at equivalence. 10-fold antigen excess or complexes prepared with F(ab')2 fragments of rabbit anti-BSA antibody. The inhibition of red cell clearance was independent of changes in blood flow, but the degree of inhibition produced did not correlate well with the dose of immune complex injected.     

Studies of mononuclear phagocyte function in the rat. I. Saturation and recovery following intravenous administration of soluble human serum albumin (HSA)--anti-HSA complexes.

We have attempted to demonstrate saturation of the mononuclear phagocyte system (MPS) in the Long Evans rat following intravenous administration of increasing doses of soluble HSA--125I-anti-HSA complexes. The fate of large (greater than 11S) complexes was followed by sucrose density gradient ultracentrifugation of serial serum samples in rats receiving 0.005-0.16 mg anti-HSA/g body weight. Administration of complexes provoked a rapid and profound increase in vascular permeability. Under these conditions no steady state clearance velocity for greater than 11S complexes could be established. The quantity of greater than 11S complexes removed from the circulation in the 1st hr never became independent of the initial dose. Specific immune complex uptake by the liver reached a maximum in rats receiving 0.09 mg anti-HSA/g body weight. Above this dose specific uptake decreased. Clearance of a tracer dose of complexes in rats pre-loaded with complexes containing 0.06 mg anti-HSA/g body weight was delayed for more than 3 hr. This was cautiously interpreted to indicate the period required for MPS recovery. The pattern of immune complex clearance in the context of marked changes in vascular permeability raised the possibility that maximum uptake was determined not by saturation of the mononuclear phagocyte system but by impaired hepatic perfusion.     

Reduced erythrocyte CR1 levels in patients with pulmonary tuberculosis is an acquired phenomenon

Complement receptor 1 expressed on erythrocytes is involved in the transport of circulating immune complexes from the circulation to the mononuclear phagocyte system for safe disposal. The prevalence of complement receptor 1 genotypes and the association between circulating immune complexes and expression of complement receptor 1 on erythrocytes in pulmonary tuberculosis are not fully understood. Observations from this study showed increased occurrence of HH genotype in patients with pulmonary tuberculosis. Patients with tuberculosis had decreased erythrocyte complement receptor 1 and increased immune complex levels compared to healthy controls which also correlated with increasing severity of the disease. In addition, the expression of complement receptor 1 on erythrocytes correlated inversely with the levels of circulating immune complexes. This study suggests that the presence of HH genotype is high in pulmonary tuberculosis patients and the reduced complement receptor 1 in patients may be an acquired phenomenon related to disease pathogenesis.     

Identification and quantitation of cells that process immune complexes in nephritic rats induced with bovine serum albumin

A light microscopic autoradiography was used to determine which cell types positively disposed of the daily circulating immune complexes produced in rats with experimental immune complex glomerulonephritis. Our results indicated that polymorphonuclear leucocytes (PMNs) remove large quantities of immune complexes in the livers, spleens, and lungs of these rats. Semiquantitative autoradiography indicated further that the function of mononuclear phagocyte system decreased late in the course of glomerulonephritis; whereas, in compensation, the role of PMNs appeared to increase. Our data uncovered a significant role for PMNs in the disposition of immune complexes during the induction of experimental immune complex nephritis.     

Dynamics of mononuclear phagocyte system Fc receptor function in systemic lupus erythematosus. Relation to disease activity and circulating immune complexes

Seventeen pairs of longitudinal studies of mononuclear phagocyte system (MPS) Fc receptor function in 15 patients with systemic lupus were performed to explore the dynamic range of Fc receptor dysfunction in lupus and to establish the relationships between MPS function, clinical disease activity and circulating immune complexes (CIC). Fc receptor function was measured by the clearance of IgG sensitized autologous erythrocytes. At the time of first study the degree of MPS dysfunction was correlated with both clinical activity (P less than 0.05) and CIC (P less than 0.05). At follow-up patients with a change in clinical status show significantly larger changes in clearance function compared to clinically stable patients (206 min vs 7 min; P less than 0.001). MPS function changed concordantly with a change in clinical status in all cases (P = 0.002). Longitudinal assessments did not demonstrate concordance of changes in MPS function and CIC, measured by three different assays. The MPS Fc receptor defect in systemic lupus is dynamic and closely associated with disease activity. The lack of concordance of the defect with changes in CIC suggests that either CIC does not adequately reflect receptor site saturation or that other factors may also contribute to the magnitude of MPS dysfunction.     

Evaluation of aggregated IgG in mice as an Fc receptor specific probe of the hepatic mononuclear phagocyte system.

In experimental models of immune complex diseases the hepatic mononuclear phagocyte system removes circulating immune complexes (CIC) by interaction with Fc receptors, and the spleen has a relatively insignificant role in this function. We have used heat-aggregated human IgG (AHGG) to detect altered hepatic mononuclear phagocyte system activity in an acute immune complex model in mice in order to evaluate its suitability for possible use in humans. Immune complexes inhibited the clearance of AHGG, as a function of the dose and of the time after injection of complexes. The delayed clearance resulted from decreased hepatic uptake of the AHGG. Alterations in the comparatively small splenic uptake of AHGG did not correlate with changes in the clearance or the hepatic uptake that were produced by the complexes. Studies with Rose Bengal showed that the complexes caused a small but definite decrease in hepatic blood flow. Immune complexes also inhibited the clearance and hepatic uptake of aggregated mouse albumin and aggregated ovalbumin. The aggregated albumins, however, were cleared very rapidly, indicating high extraction ratios, so their clearance was more affected by the decreased blood flow than the clearance of AHGG. We conclude that a small dose of AHGG is a sensitive probe for hepatic Fc receptor function and has potential for human use.     

Mononuclear phagocyte system Fc-receptor function in patients with seropositive rheumatoid arthritis.

Mononuclear phagocyte system (MPS) Fc-receptor function in 20 patients with seropositive rheumatoid arthritis (RA) was investigated using radiolabelled autologous erythrocytes coated with an average of 5,800 molecules of anti-rhesus IgG (E. IgG). Although clearance times (T1/2) of E. IgG tended to be longer in RA patients than those in healthy controls (46 +/- 6 min vs 38 +/- 5 min, mean +/- s.e.m., P = 0.38), this did not reach statistical significance. Liver spleen uptake ratios (LS ratios) were increased in patients with RA (13/100 +/- 1/100 vs 7/100 +/- 1/100, P less than 0.05). There was no correlation of T1/2 or LS ratios with articular disease activity, vasculitis, ESR, IgM containing immune complex levels or Clq-binding immune complex levels. Although Clq-binding immune complex levels were significantly higher in patients with vasculitis than in those without (P less than 0.01), T1/2 and LS ratios did not differ in these two groups of patients. The T1/2 and LS ratios of E.IgG did not reveal a defect in MPS Fc-receptor function and did not correlate with one of the above-mentioned clinical and immunological parameters. We suggest that in order to establish a possible defect in Fc-receptor function correlating with disease activity and immune complex levels in RA patients, soluble immune complexes or immune complex-like material should be used as probes.     

Macrophage interactions with antibodies and soluble immune complexes

In vitro studies aimed at characterising (1) the binding of monomeric immunoglobulins from a variety of animal species to homologous mononuclear phagocytes, (2) the enhancement in phagocyte binding when antibodies are reacted with soluble antigens to form complexes of defined size, (3) the kinetics of complex ingestion and catabolism by macrophages and the biochemical mechanisms involved, (4) the role of complement in soluble complex catabolism and (5) the stimulatory effects of soluble complexes on phagocyte activity are reviewed. Insights gained from these studies into the in vivo clearance of soluble complexes and into the part played by circulating immune complexes in disease are discussed.     

Prolonged circulation of immune complexes due to various altered immune functions contributes to nephritis in MRL/lpr mice.

To gain some insight into the pathogenesis of proliferative lupus nephritis in MRL/lpr mice we investigated the kinetics of removal of immune complexes from the circulation, the carrier state of blood cells, the uptake of complexes by the mononuclear phagocyte system, and the localization of complexes in kidneys. In nephritic MRL/lpr mice challenged with a subsaturating dose of radiolabelled complexes (2.5 mg bovine serum albumin-anti-bovine serum albumin) liver uptake was profoundly decreased, removal of circulating complexes was delayed, and 12-h kidney localization of complexes was enhanced 7.3-fold, in comparison to control mice. The findings were not encumbered by differences in complement concentration and most likely are attributable to various altered immune functions: spontaneous polyclonal activation of B cells, enhanced production of endogenous immune complexes, delayed removal of complexes from the circulation, and decreased uptake of complexes by the mononuclear phagocyte system. In concert, such altered functions contribute to prolonged circulation of complexes to result in their enhanced deposition in the microcirculation.     

Abnormal clearance of soluble aggregates of human immunoglobulin G in patients with systemic lupus erythematosus.

In the present study, we tested mononuclear phagocyte system function in nine healthy controls and 15 SLE patients with complement activating 123I-labelled aggregates of human IgG (AIgG). Clearance half-time of AIgG was 26 +/- 8 min in controls, compared to 58 +/- 27 min in patients (P less than 0.005). Binding of AIgG to erythrocytes was significantly lower in patients, 9.3 +/- 8.1 vs 24 +/- 20% (P less than 0.05). The increase of C3a-levels in plasma was significantly lower in patients than in controls (P less than 0.05 at 3 and 8 min), suggesting less complement activation. Liver and spleen uptake of 123I-AIgG was measured with a gamma camera and expressed as liver/spleen uptake ratios. In patients, the liver/spleen uptake ratios were significantly higher than in controls at 15 min, 3.8 +/- 2.0 vs 2.31 +/- 0.7 (P less than 0.05), due to less splenic uptake of AIgG. Correlations between clearance half-time or liver/spleen uptake ratios and immune complex levels or disease activity were not found. This study indicates that clearance of soluble AIgG is abnormal in patients with SLE, due to decreased splenic uptake of AIgG.     

Spontaneous suppressor cell activity in the peripheral blood of patients with malignant and chronic inflammatory bowel diseases.

Fifteen patients with colorectal tumours, 15 patients with Crohn's disease (CD) and two groups of normal controls were investigated for the presence of spontaneous suppressor cell activity (SSCA) in peripheral blood mononuclear cells (PBMC). In comparison to the age and sex matched controls patients with colorectal carcinoma exhibited a significant increase in SSCA (P less than 0.01). No evidence could be obtained that the suppressive effect was due to a soluble factor such as prostaglandins. In contrast, patients suffering from CD presented a decreased SSCA. No correlation was obtained between the enhanced SSCA in tumour patients and the clinical stage of the disease, levels of oncofetal antigens or serum immune complexes. Likewise in patients with CD no correlation was found between decreased SSCA and CD index or different serum parameters. When PBMC of the different test groups were incubated with histamine or cimetidine before they were added to the indicator system the suppressive activity remained unchanged. Also pre-incubation of normal PBMC with alpha-fetoprotein or carcinoembryonic antigen did not change the spontaneous suppressor cell activity. Whether the significantly enhanced in vivo activity of spontaneous suppressor cells in patients with colorectal carcinoma is one of the multifactorial mechanisms leading to the establishment of cancer or whether it rather represents a reflection of the immune system on colorectal tumour antigens remains unsolved.     

Immunological abnormalities in massive cutaneous hyalinosis

Immunological studies in a patient with massive cutaneous hyalinosis, a disease characterized by principally dermal and subcutaneous accumulations of monoclonal kappa light chains and a gliadin-binding mannose-rich 90 kD glycoprotein, show that the ratio of helper to suppressor T cells is decreased and the proliferative responses of the peripheral mononuclear cells to T cell and T cell-dependent B cell mitogens are depressed. High levels of circulating immune complexes were demonstrated by C1q-binding and rheumatoid factor enzyme linked immunoassays. IgM and IgA class antibodies against the hyalin components, the mannosyl-90 kD glycoprotein and type I collagen, and against keratin and gluten were present in high titres. The reactivity of mononuclear cells to phytohemagglutinin normalized and the antibody levels to hyalin proteins, keratin and gluten fell during low-dose steroid therapy. However, the concanavalin A response was not reversed, neither did the levels of circulating immune complexes and anti-intercellular substance antibodies decrease. The results demonstrate a very complex dysfunction of the immune system in massive cutaneous hyalinosis.     

Demonstration of hepatic Fc receptor function in vivo

We describe an investigation of the Fc-receptor dependent function of the hepatic component of the mononuclear phagocyte system (MPS) in rats. Erythrocytes sensitized with the rat IgG2b monoclonal antibody (JY1/98) were cleared by the liver in decomplemented splenectomized rats. This immune clearance was Fc-receptor dependent since it was effectively inhibited by immune complexes of bovine serum albumin (BSA) and rabbit-anti-BSA antibody formed either in vivo or in vitro. Immune complexes formed with F (ab')2 fragment of the rabbit anti-BSA antibody had no effect. Heat-aggregated human gamma globulin was virtually without any competitive activity in the Fc-mediated clearance system. Immune complexes inhibited the hepatic clearance of antibody-sensitized erythrocytes but did not have a significant effect on the early rapid removal of erythrocytes pre-coated with antibody and complement.     

Defects in mononuclear phagocytic system (MPS) function in autoimmune MRL-lpr/lpr mice

MRL-lpr/lpr mice develop an autoimmune disease similar to systemic lupus erythematosus. To determine whether mice of this strain develop defects in mononuclear phagocyte system (MPS) function similar to those observed in patients, the pattern of sequestration of labeled immune complexes was compared 90 min after infusion into MRL-lpr/lpr and into normal B6D2 mice. The amount of complexes persisting in the blood was increased, and the amount sequestered in the liver was significantly reduced in MRL-lpr/lpr mice in comparison to normal B6D2 controls. This defect was most evident in MRL-lpr/lpr mice of the ages of 25-26 weeks; mice of this age also demonstrated the greatest elevation of anti-DNA antibody levels. The role of the MRL strain background and of the lpr gene in determining this defect was investigated by analysis of MRL-+/-/+/- and of other lpr congenic strains (B6-lpr/lpr, AKR-lpr/lpr, and C3H-lpr/lpr). Both MRL-+/-/+/- and congenic lpr animals showed similar defects, although to a lesser degree than MRL-lpr/lpr mice. In contrast, MRL-lpr/lpr mice demonstrated normal clearance of heat-damaged red blood cells and heat-aggregated albumin. Thus MRL-lpr/lpr mice display a selective defect in MPS Fc receptor function and may provide a valuable model for elucidating the etiology and importance of MPS dysfunction in immune complex deposition disease.     

Effects of mononuclear phagocyte system modulating agents on Fc and C3 receptors of adherent cells.

Agents which modulate the mononuclear phagocyte system (MPS) were examined for their effects on Fc and C3 receptors of adherent cells (A-cells) as judged by rosette formation. Dextran sulphate, carrageenan, and immune complexes, known as MPS suppressants, reduced the percentage of receptor-positive A-cells, while levamisole, known as a MPS-activator, increased the percentage in vitro. The changes in the percentage of Fc receptor were parallel to those of the C3 receptor in vitro. The effects of these agents were also examined in vivo.     

Effects of mononuclear phagocyte system modulating agents on Fc and C3 receptors of adherent cells

Agents which modulate the mononuclear phagocyte system (MPS) were examined for their effects on Fc and C3 receptors of adherent cells (A-cells) as judged by rosette formation. Dextran sulphate, carrageenan, and immune complexes, known as MPS suppressants, reduced the percentage of receptor-positive A-cells, while levamisole, known as a MPS-activator, increased the percentage in vitro. The changes in the percentage of Fc receptor were parallel to those of the C3 receptor in vitro. The effects of these agents were also examined in vivo.     

Studies in cobra venom factor treated rats of antibody coated erythrocyte clearance by the spleen: differential influence of red blood cell antigen number on the inhibitory effects of immune complexes on Fc dependent clearance

The splenic component of the mononuclear phagocyte system (MPS) was investigated in decomplemented rats by determining the clearance from the blood of erythrocytes coated with a monoclonal antibody (R3/13). The infusion of immune complexes (IC), prepared at 10-fold antigen excess, at an appropriate time during the erythrocyte clearance produced a significant increase in the T1/2 of the antibody coated cells. Immune complexes formed with the F(ab')2 fragment of the rabbit antibody did not have any significant effect. A positive correlation was seen between the dose of immune complex infused and the degree of inhibition of erythrocyte clearance. The influence of red cell antigen number on the behaviour of erythrocytes sensitized with R3/13 was studied by comparing the clearance of DA and (DA X PVG) F1 erythrocytes. F1 erythrocytes, with only half the number of specific antigens on their surface that bind R3/13 antibody were cleared much more slowly (82 +/- 2.6 min, mean +/- s.e.) by the spleen than the DA erythrocytes (44 +/- 1.5 min P less than 0.001). Both cell suspensions were equally susceptible to inhibition by soluble IC. These studies show that the number of specific antigens on the red cell surface influences the rate at which sensitized cells are removed by splenic macrophage Fc receptors but not their susceptibility to inhibition by IC. Our results draw attention to a major defect in the use of autologous erythrocytes coated with anti-rhesus (D) immunoglobulin to assess macrophage Fc receptor function in man.     

Circulating immune complexes in infected ventriculoatrial and ventriculoperitoneal shunts

Distinguishing infected from noninfected ventriculoatrial (VA) or ventriculoperitoneal (VP) shunts is prognostically and therapeutically important. Eighty-seven serum samples from twenty-seven patients with VA or VP shunts were studied for the presence and quantification of circulating immune complexes. Eighty-three percent of the samples from infected shunts presented circulating immune complexes. Mean values of immune complexes in patients with infected shunts were significantly higher than in those without infection. In febrile, septicemic patients with few clinical symptoms, immune complexes were present, and their measurement in serial serum samples was a significant diagnostic aid. If circulating immune complex levels are not detectable, a shunt infection is less likely to be present.     

Studies on immune adherence (C3b) receptor activity of human erythrocytes: relationship between receptor activity and presence of immune complexes in serum.

Human erythrocytes (E) have surface receptors for the third component of complement (C3b-IA receptors) which mediate immune adherence haemagglutination (IAHA). We have observed that E from patients with systemic lupus erythematosus had imparied or defective C3b receptor (C3b-R) activity when circulating immune complexes (CIC) were found in serum. This phenomenon has been investigated by a newly developed method involving competitive inhibition of IAHA in patients with immune complex diseases. IAHA involving sheep E coated with antibody and complement (EAC), and indicator human E was inhibited by lysates of E with normal C3b-R activity from healthy donors and a monkey. In contrast, the lysates of E from 95% of patients bearing CIC did not inhibit IAHA, which indicated such E had defective or impaired C3b-R activity. This phenomenon was supported by control studies in which IAHA was not inhibited by lysates of E with absent, inactivated or occupied C3b-R. In those patients, in whom CIC disappeared during immunosuppressive therapy, C3b-R activity slowly returned to normal levels. Moreover, it was observed that C3b-R activity of patients' E decreased with the reappearance of CIC during exacerbations of disease. These observations suggest that CIC are carried in vivo by the C3b-R of E as well as those of the mononuclear phagocyte system, and that the E C3b-R may also contribute to the clearance of CIC.     

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases.

The neuroendocrine polypeptide hormone beta-endorphin (beta-END), which is released from various tissues including the anterior pituitary gland and cells of the immune system, has recently been implicated as having an immunoregulatory role. We used a radioimmunoassay to measure beta-END levels in circulating mononuclear leucocytes from normal subjects and patients with various rheumatic diseases. Levels of beta-END in leucocytes from patients were lower than in leucocytes from healthy subjects (P less than 0.001). Whereas levels of beta-END in leucocytes from patients with the various rheumatic disorders were not significantly different, an inverse correlation was found between beta-END levels in leucocytes and expression of rheumatoid factor (P less than 0.025) and erythrocyte sedimentation rate (P less than 0.025). This study demonstrates decreased content of beta-END in cells of the immune system related to parameters of inflammatory activity in rheumatic diseases.