Cord blood contains cells secreting antibodies to nervous system components.

Umbilical cord blood of newborns and peripheral blood of healthy adults were investigated by an immunospot assay for cells secreting IgG, IgA and IgM antibodies against myelin basic protein (MBP), proteolipid protein (PLP), myelin-associated glycoprotein (MAG) and myelin oligodendrocyte glycoprotein (MOG) which represent putative antigens for an autoimmune attack in multiple sclerosis (MS) and against acetylcholine receptor (AChR) which is considered an important autoantigen in myasthenia gravis. Cells secreting antibodies against one or more of these autoantigens were detected in 18 out of 24 newborns, and in eight out of 20 adults. Eight of the cord blood samples contained cells secreting antibodies of IgG, IgA and/or IgM isotypes to one antigen, five to two antigens, two to three antigens, two to four antigens, and one to five antigens. Most prominent were anti-MBP IgG antibody secreting cells which were detected in 13 newborns at a mean number of 1/20,000 cord blood cells, and in six adults at a mean number of 1/10(5) peripheral blood cells. Anti-AChR IgG antibody secreting cells were detected in four out of 12 newborns versus four out of 14 peripheral blood specimens, at mean values of 1/10(5) cells in both instances. Cells secreting autoantibodies of IgA and IgM isotypes were less frequent both in cord blood and peripheral blood. The occurrence of nervous tissue autoantibody secreting cells in newborns must be related to a possible primary role of such autoantibodies in MS and myasthenia gravis.     

Patients with myasthenia gravis and thymoma have in their sera IgG autoantibodies against titin.

Patients with myasthenia gravis (MG) and thymoma have in their sera antibodies which react with non-receptor antigens from striated muscle. The purpose of this investigation was to characterize the antigen(s). Polypeptides in homogenates from rat skeletal muscle were separated by SDS-PAGE and trans-blotted to nitrocellulose. Sera from six patients with MG and thymoma stained a large (molecular weight greater than 500 kD) polypeptide, while no staining was observed with sera from 20 non-thymoma MG patients. Titin is one of the large (greater than 500 kD) polypeptides of striated muscle and the antibody containing MG sera have antibodies that bind to titin in a preparation of myofibrillary proteins from rabbit skeletal muscle. The staining pattern is identical to that obtained with antiserum to titin, showing that the antigen has the same electrophoretic mobility as titin. Antibodies from the sera of the patients with MG and thymoma, affinity-purified on the large polypeptide, reacted with skeletal muscle sections in a cross-striational pattern, near the A/I band junction but within the I band, corresponding to the localization of one of the epitopes of titin. Our findings therefore indicate that the muscle antibodies found in the sera from some MG patients with thymoma are directed against titin.     

Paraneoplastic IgG striational autoantibodies produced by clonal thymic B cells and in serum of patients with myasthenia gravis and thymoma react with titin.

Autoantibodies with heterogeneous specificities for contractile elements of striated muscle are found in 80 to 90% of patients who have myasthenia gravis (MG) with thymoma. The stimulus for production of these paraneoplastic striational autoantibodies (StrAb) is unknown. One approach to understanding their association with MG and thymoma is to define the antigenic specificities of monoclonal StrAb secreted by B cell lines established from patients who have MG and thymoma. Here, we report the isolation from a single patient of two independent thymic B cell clones secreting StrAb of IgG isotype. In immunoblots, both StrAb bound monospecifically to an antigen of human skeletal muscle that comigrated with the high molecular weight protein, titin. The pattern of immunofluorescence staining yielded by both antibodies in cultured human muscle cells was similar to that produced by rabbit polyclonal anti-titin antibodies. Each monoclonal antibody bound to a different region of the sarcomere in stretched myofibrils; these corresponded to sites previously reported to bind murine anti-titin monoclonal antibodies. The pattern of sarcomere immunostaining produced by combining the two human monoclonal antibodies was indistinguishable from that produced by serum IgG from the patient whose thymus yielded the B cell clones. Thus, the monoclonal antibodies appear to identify two epitopes of titin that are recognized by IgG StrAb in serum. The finding that IgG anti-titin autoantibodies are restricted to serum of MG patients who have thymoma suggests that titin is a major specificity of IgG StrAb. Our additional finding that anti-titin IgG binds to striated elements in medullary myoid cells of the human thymus supports the hypothesis that StrAb represent an intrathymic B cell immune response that is initiated by autoantigens that are rendered immunogenic for helper T cells in the course of noeplastic transformation to thymoma.     

T helper type 17 cells expand in patients with myasthenia-associated thymoma

Myasthenia gravis (MG) is a prototypical CD4(+) T cell-dependent autoimmune disease mediated by anti-acetylcholine receptor autoantibodies (AChR-Abs). Certain subsets of helper T cells are suggested to be involved in the pathogenesis of MG, including Th1 and regulatory T cells (Treg). However, whether the recently identified Th17 cells play a role in the development of MG and its prognosis is still unknown. Here, we demonstrated that Th17 cells and their associated cytokines are increased, while the Treg cells are decreased in the peripheral blood mononuclear cells (PBMCs) from MG patients with thymomas (TM), but not from those with normal thymus (NT) or thymic hyperplasia (TH). Furthermore, the quantity of Th17 cells correlates with the quantitative myasthenia gravis (QMG) score in patients with TM. We also found a significant positive relationship between the frequency of Th17 cells (%) and the concentration of AChR antibodies in patients with MG. Therefore, the Th17/Treg imbalance in TM may suggest MG with certain pathological subtype, and the increase in Th17 cells may reveal the severity of the disease, which is valuable in the diagnosis and choice of therapeutic strategy for patients with MG.     

Monoclonal Antibodies to Acetylcholine Receptor Secreted by Human X Human Hybridomas Derived from Lymphocytes of a Patient with Myasthenia Gravis

Peripheral blood lymphocytes of a patient with myasthenia gravis (MG) were fused to the non-secreting human lymphoblastoid line HuNSI to produce human x human hybridomas that secrete monoclonal antibodies (mAb) to acetylcholine receptor (AChR). Screening of hybridomas for antibody production involved an enzyme-linked immunosorbent (ELISA) assay with AChR from Torpedo californica (TAChR). 25 of 302 wells tested (8.3%) were positive for anti-AChR antibody production and have been stable in their secretion of mAb for eleven months. Nine lines have been studied in detail. All produced IgM mAb, and most had greater activity against membrane-bound TAChR, than against solubilized TAChR. For anti-AChR clones, the mAb concentration in culture supernatants ranged from 2 to 33 ug/ml. Saturation curves of binding to TAChR performed on 4 lines demonstrated dissociation constants (Kds) estimated to range from 0.1-1.0 nM. The patient whose lymphocytes were used in this study had a serum anti-AChR antibody concentration of 243nM against human AChR and 15nM against AChR from T. californica. The results demonstrate the feasibility of producing stable human x human hybridomas secreting mAb to the autoantigen from the peripheral blood of patients with organ-specific autoimmune diseases. The mAb produced here may prove to be useful in analyzing, and possibly treating, the autoimmune phenomena in MG.     

T-cell recognition of acetylcholine receptor provides a reliable means for monitoring autoimmunity to acetylcholine receptor in antibody-negative myasthenia gravis patients

Myasthenia gravis (MG) is an autoimmune disease usually associated with autoantibodies (auto-Abs) against nicotinic acetylcholine receptor (AChR). Some MG patients appear negative for anti-AChR Abs (seronegative), and a fraction of these have auto-Abs against muscle-specific kinase. The remaining patients, although displaying MG symptoms, show no detectable auto-Abs. We describe here a possible association of a rare human leukocyte antigen (HLA)-DQ type and AChR Ab-negative MG. We also found that the majority of seronegative patients exhibit an anti-AChR autoimmune T lymphocyte response. We investigated the existence of AChR-reactive T cells in peripheral blood lymphocytes from seronegative patients by their proliferative responses against a mixture of 18 overlapping synthetic peptides encompassing the extracellular part of human AChR α-chain. Of the 10 samples, eight exhibited positive T-cell proliferative responses against the peptide mixtures. The proliferative assay was equally efficient using a mixture of eight peptides frequently recognized by MG T cells. This T-cell proliferative assay should provide a reliable method for monitoring seronegative MG patients.     

Change of Th0 to Th1 cell-cytokine profile following tuberculosis chemotherapy

T cells mediate protection against tuberculosis, but little is known about their role during chemotherapy of patients with active disease. Here we examined the cytokine profile of CD4 T cells before and after four months of chemotherapy in six initial skin test anergic cases. Purified protein derivative (PPD) and 16-kDa antigen-reactive CD4 T-cell clones prior to therapy resided mostly in disease-associated body fluids and were of the Th0 (interferon (IFN)-γ + interleukin (IL)-4) secreting profile. In contrast, the majority of postchemotherapy CD4 T-cell clones originated from blood and were of the IFN-γ secreting Th1 type. However, the recognition of several peptides derived from the 16-kDa antigen was not significantly different between the Th1 and Th0 clones. We conclude that chemotherapy shifts CD4 T cells from the affected body fluids to the blood circulation, accompanied by a change from Th0 to Th1 cytokine profile.     

An enzyme-linked immunosorbent assay for antibodies against saline-soluble muscle components in myasthenia gravis

An enzyme-linked immunosorbent assay (ELISA) system has been developed for measuring antibodies against rat skeletal muscle components solubilized with phosphate-buffered saline. With this assay, 53.8% (50/93) of sera from patients with myasthenia gravis (MG) was positive (the values over the mean plus 3 SD of 256 healthy individuals were considered significant). No sera from patients with neurological disorders other than MG gave positive values (0%; 0/60). No correlation between titers of antibody against the muscle components and those of anti-acetylcholine receptor antibody (r = 0.01) was found. These results indicate that our ELISA system is useful for diagnosing myasthenia gravis.     

Serological diagnostics in myasthenia gravis based on novel assays and recently identified antigens

Myasthenia gravis (MG) is the most common immune-mediated disorder of the neuromuscular junction with a prevalence of 200–300/million population and its study has established paradigms for exploring other antibody-mediated diseases. Most MG patients (~ 85%) have autoantibodies against the muscle acetylcholine receptor (AChR-MG), whereas about 6% of MG patients have autoantibodies against the muscle specific kinase (MuSK-MG). Until recently no autoantibodies could be detected in the remaining patients (seronegative MG). Probably, the most sensitive assays for the detection of the autoantibodies in MG sera have been the radioimmunoprecipitation assays (RIPA) for both types of MG. However, with recent novel methods, not yet used routinely, it has been shown that the “seronegative” MG group includes patients with low levels of autoantibodies or of low affinity, against the known autoantigens, or even with antibodies to recently identified autoantigens.Since MG is heterogeneous in terms of pathophysiology, depending on the autoantigen targeted and on other factors (e.g. presence of thymoma), the serological tests are crucial in verifying the initial clinical diagnosis, whereas frequent measurement of autoantibody levels is important in monitoring the course of the disease and the efficacy of treatment. In addition, in AChR-MG, autoantibodies against the muscle proteins titin and ryanodin receptor have been identified; these antibodies are useful for the classification of MG, indicating the concomitant presence of thymoma, and as prognostic markers.     

Activation of the receptor for advanced glycation end products (RAGE) exacerbates experimental autoimmune myasthenia gravis symptoms

RAGE belongs to immunoglobulin superfamily and serves as a ligand for various immunoregulatory molecules including S100B that has been demonstrated important to T cell mediated autoimmune diseases. In this context, we hypothesized that RAGE could also impact B cell mediated, T cell-dependent autoimmune diseases. This was tested using myasthenia gravis (MG) animal model, EAMG. We show that expression of both RAGE and S100B are increased during EAMG and the interaction between RAGE and S100B affected the Th1/Th2/Th17/Treg cell equilibrium, up-regulate AChR-specific T cell proliferation. Furthermore, addition of S100B in vitro stimulated splenocyte activity linked to COX-2 up-regulation. NS-398, a selective COX-2 inhibitor, effectively diminished S100B mediated activity of AChR-specific antibody secreting splenocytes. These findings suggested that a reciprocal relationship between RAGE and S100B promoted the development of EAMG, highlighting the importance of understanding the mechanisms of EAMG disease as a means of developing new therapies for the treatment of MG.     

Disruption of the IL-1beta gene diminishes acetylcholine receptor-induced immune responses in a murine model of myasthenia gravis

Human autoimmune myasthenia gravis (MG) is associated with the IL-1beta TaqI RFLP allele 2. Individuals positive for this allele have high levels of inducible IL-1beta in their peripheral blood. Here, we have characterized MG induction and the immune response elicited by Torpedo acetylcholine receptor (AChR) immunization in wild-type and IL-1beta deficient (-/-) mice. Compared with wild-type mice, IL-1beta-/- mice were relatively resistant to induction of clinical experimental autoimmune myasthenia gravis (EAMG). Draining lymph node cells from IL-1beta-/- mice showed poor proliferative capacity upon AChR stimulation in vitro. Both Th1 (IFN-gamma, IL-2) and Th2 (IL-4) cytokine responses were reduced and levels of serum anti-AChR antibodies decreased in IL-1beta-/- mice compared to wild-type mice. Taken together, these results reveal a critical role for IL-1beta in the induction of MG in mice, and support a role for IL-1beta in the pathogenesis of MG in man.     

IMMUNOPATHOLOGICAL STUDY RELATED TO MYOGLOBIN IN MYASTHENIC AND NON-MYASTHENIC THYMUSES

Twelve biopsied thymuses taken from 4 cases with myasthenia gravis (MG group) and 8 cases without myasthenia gravis (control group) including 2 thymoma cases in each group were immunopathologically investgated in relation to myoglobin (Mb). Mb positive cells of various degrees were detected in all thymuses of both groups, and immunoelectron microscopical examination disclosed that Mb positive cells corresponded to interdigitating reticulum cells and myoid cells in non-neoplastic thymuses, and neoplastic epithelial reticular cells in thymomas. Anti-Mb antibody staining by direct immunoperoxidase technique revealed positive localization to the lymphoid cells in the thymuses of 2 cases of MG group with thymoma. In addition, indirect immunofluorescent study with the serum of each case which was applied to the normal human skeletal muscle, showed positive staining of the sarcoplasm in 3 cases of MG group, including 2 thymoma cases, and using peroxidase labeled serum IgG F(ab')₂ of the same patients this anti-muscle antibodies were proved to be against both postsynaptic cytosol and sarcoplasm of the extraocular muscle of the guinea pig. From these results, it was suggested that Mb may conduct itself as a homologous antigen between the thymus and the skeletal muscle in the myasthenic patient with thymoma, and in the thymus the interdigitating reticulum cell, the myoid cell, or the neoplastic epithelial reticular cell may retain or produce Mb as an antigen-presenting cell.     

Immunopathological study related to myoglobin in myasthenic and non-myasthenic thymuses

Twelve biopsied thymuses taken from 4 cases with myasthenia gravis (MG group) and 8 cases without myasthenia gravis (control group) including 2 thymoma cases in each group were immunopathologically investigated in relation to myoglobin (Mb). Mb positive cells of various degrees were detected in all thymuses of both groups, and immunoelectron microscopical examination disclosed that Mb positive cells corresponded to interdigitating reticulum cells and myoid cells in non-neoplastic thymuses, and neoplastic epithelial reticular cells in thymomas. Anti-Mb antibody staining by direct immunoperoxidase technique revealed positive localization to the lymphoid cells in the thymuses of 2 cases of MG group with thymoma. In addition, indirect immunofluorescent study with the serum of each case which was applied to the normal human skeletal muscle, showed positive staining of the sarcoplasm in 3 cases of MG group, including 2 thymoma cases, and using peroxidase labeled serum IgG F (ab')2 of the same patients this anti-muscle antibodies were proved to be against both postsynaptic cytosol and sarcoplasm of the extraocular muscle of the guinea pig. From these results, it was suggested that Mb may conduct itself as a homologous antigen between the thymus and the skeletal muscle in the myasthenic patient with thymoma, and in the thymus the interdigitating reticulum cell, the myoid cell, or the neoplastic epithelial reticular cell may retain or produce Mb as an antigen-presenting cell.     

重症肌无力中白介素4、15、18与端粒酶活性的相关性研究

目的:探讨IL-4、IL-15、IL-18在重症肌无力(MG)中的表达及其与CD4~+T淋巴细胞端粒酶活性的相关关系.方法:应用ELISA及重复扩增-酶联免疫吸附实验(PCR-ELISA)检测30例MG患者(MG组)和30例健康对照者(NC组)血清中的IL-4、IL-15、IL-18水平和CD4~+T淋巴细胞端粒酶活性.结果:MG组血清IL-4、IL-15、IL-18水平及CD4~+T淋巴细胞端粒酶活性显著高于NC组,差异具有统计学意义(P<0.01); MG组CD4~+T淋巴细胞端粒酶活性与血清IL-4、IL-15、IL-18水平均存在正相关关系(P<0.01).结论:IL-4、IL-15、IL-18及CD4~+T淋巴细胞端粒酶均参与了MG的发病过程;MG中IL-4、IL-15及IL-18有可能通过各种途径直接或间接的上调CD4~+T淋巴细胞的端粒酶的活性.     

Phenotypic changes of the subseptal thymic epithelium in myasthenia gravis

We studied the phenotype of thymic epithelial cells of hyperplastic thymuses from myasthenia gravis, (MG) patients, in respect to the expression of a 64 Kd protein defined by the monoclonal antibody T2/30 and normally present in the whole cortical epithelium. In hyperplastic thymuses, epithelial cells bordering the basement membrane (subseptal epithelial layer) were consistently T2/30-negative whereas other cortical epithelial cells did bind the monoclonal antibody. These results clearly demonstrate a phenotypic change in hyperplastic thymus of MG patients. Such change might be correlated with the damage of basement membrane previously reported in myasthenia gravis hyperplastic thymuses, and eventually with an invasion of B cells into the parenchyma of the organ.     

Clonal expansions of CD4+ B helper T cells in autoimmune myasthenia gravis

The weakness in myasthenia gravis (MG) is mediated by T helper cell (Th)-dependent autoantibodies against neuromuscular epitopes. So far, analyzing Th phenotypes or antigen specificities has yielded very few clues to pathogenesis. Here we adopt an alternative antigen-independent approach, analyzing T cell receptor (TCR) Vbeta usage/expansions in blood from 118 MG patients. We found major expansions (>or= five standard deviations above the mean of 118 healthy, individually age- and sex-matched controls) in diverse Vbeta in 21 patients (17.6%, p<0.001) among CD4+ T cells, and in 45 patients (38.1%, p<0.001) among CD8+ T cells. In informative probands, the expanded CD4+ cells consistently showed a Th cell phenotype (CD57+CXCR5+) and expressed Th1 cytokines. Furthermore, their expression of markers for activation, lymphocyte trafficking and B cell-activating ability persisted for >or=3 years. Surprisingly, we noted a selective decline in the expansions/their CD57 positivity while the probands' MG was improving. CDR3 spectratyping suggested mono- or oligoclonal origins, which were confirmed by the prevalent TCR Vbeta CDR3 sequences of Th cells cloned from repeat bleeds. Thus, our data provide evidence for persistent clonally expanded CD4+ B helper T cell populations in the blood of MG patients. These unexpected CD4+ expansions might hold valuable clues to MG immunopathogenesis.     

Distinct Th1- and Th2-Type prenatal cytokine responses to Plasmodium falciparum erythrocyte invasion ligands

Prenatal immunity to Plasmodium falciparum merozoite proteins involved in erythrocyte invasion may contribute to the partial protection against malaria that is acquired during infancy in areas of stable malaria transmission. We examined newborn and maternal cytokine and antibody responses to merozoite surface protein-1 (MSP-1), ribosomal phosphoprotein P0 (PfP0), and region II of erythrocyte binding antigen-175 (EBA-175) in infant-mother pairs in Kenya. Overall, 82 of 167 (50%), 106 of 176 (60%), and 38 of 84 (45%) cord blood lymphocytes (CBL) from newborns produced one or more cytokines in response to MSP-1, PfP0, and EBA-175, respectively. Newborns of primigravid and/or malaria-infected women were more likely to have antigen-responsive CBL than were newborns of multigravid and/or uninfected women at delivery. Newborn cytokine responses did not match those of their mothers and fell into three distinct categories, Th1 (21 of 55 CBL donors produced only gamma interferon and/or interleukin 2 [IL-2]), Th2 (21 of 55 produced only IL-5 and/or IL-13), and mixed Th1/Th2 (13 of 55). Newborns produced more IL-10 than adults. High and low levels of cord blood IL-12 p70 production induced by anti-CD40 activation were associated with malaria-specific Th1 and Th2 responses, respectively. Antigen-responsive CBL in some newborns were detected only after depletion of IL-10-secreting CD8 cells with enrichment for CD4 cells. These data indicate that prenatal sensitization to blood-stage Plasmodium falciparum occurs frequently in areas where malaria is holoendemic. Modulation of this immunity, possibly by maternal parity and malaria, may affect the acquisition of protective immunity against malaria during infancy.     

CD4~+效应T细胞在自身免疫性溶血性贫血患者外周血的变化研究

目的研究自身免疫性溶血性贫血(AIHA)患者外周血中效应T细胞亚群Th1和Th17数量和比例的变化,探讨其在AIHA发病中的作用。方法选择30例AIHA患者,分离外周血单核细胞(PBMC),采用流式细胞术检测Th1和Th17细胞频率,用ELISA测定培养上清中IFN-γ和IL-17水平,并与健康对照组比较。结果 AIHA患者PBMC中IFN-γ+Th1和IL-17+Th17细胞频率均显著高于健康对照组(P<0.01);而且,AIHA患者外周血IL-17水平明显高于健康对照组(P<0.05),但IFN-γ水平在患者和正常人之间差异不显著。结论Th17与Th1细胞亚群可能参与AIHA患者的免疫学发病机制。     

Immunological heterogeneity of autoreactive T lymphocytes against the nicotinic acetylcholine receptor in myasthenic patients

The response of human T lymphocytes against the nicotinic acetylcholine receptor (AChR) was studied in five patients with myasthenia gravis (MG) and in six healthy donors using either native Torpedo AChR or recombinant protein derived from the mammalian AChR α subunit (X4, residues 6–216 of mouse AChR α subunit). The present study demonstrates that (a) AChR-specific T helper cell lines can be generated from MG patients [either from peripheral blood lymphocytes (PBL) or from thymocytes] as well as from PBL of normal controls, (b) lymphocytes from MG patients, but not from controls, recognize the mammalian AChR but not the Torpedo receptor, (c) in humans, the HLA-DR2-associated T cell epitope is probably located in the region of residues 162–216 of the AChR α subunit and (d) there is a considerable heterogeneity of autoreactive T cell responses: (i) Tcell lines from different HLA-type donors have distinct epitope profiles; (ii) the epitope specificity of the PBL-derived T cell line is different from that of the thymocyte-derived line; (iii) the epitope specificities of patient-derived T cell lines are different from those generated from normal controls who share the same HLA phenotype.