T Lymphocytes and mononuclear phagocytes in the skin infiltrate of systemic and discoid lupus erythematosus and Jessner's lymphocytic infiltrate

T Lymphocytes and mononuclear phagocytes were measured quantitatively with the histochemical acid α-naphthyl acetate esterase (ANAE) method from paraffin sections of skin affected by systemic and discoid lupus erythematosus and by Jessner's lymphocytic infiltrate. The composition of the patchy cutaneous mononuclear cell infiltrates was similar in these three disorders.     

Serological Evidence for the Role of Bacterial Infections in the Pathogenesis of Thyroid Diseases

ABSTRACT. Subacute thyroiditis is generally believed to be of viral origin, and infection is also suspected of playing a role as a triggering factor in the pathogenesis of autoimmune thyroid diseases. We have measured a broad spectrum of bacterial and viral antibodies in paired sera of 32 patients with thyroid disease of recent onset. The data indicate a preceding infection in 14 (44%) of the patients, enterobacterial in 5, streptococcal in 4 and staphylococcal in 2. A viral infection was suggested in 6 patients, in each case caused by different agents; 3 of them also showed evidence of a bacterial infection. Patients with positive microbial serology were found in all diagnostic groups, including subacute thyroiditis, Graves' disease and Hashimoto's disease. These results suggest an association between a preceding bacterial infection and the development of thyroid disease in some patients.     

Distribution of natural killer cells and lymphocyte subclasses in Jessner's lymphocytic infiltration of the skin and in cutaneous lesions of discoid and systemic lupus erythematosus

We studied the cell infiltrates in biopsies from lymphocytic infiltration of the skin (LIS), with six monoclonal T cell antigen-specific antibodies and compared the reactivity pattern with those in biopsies from discoid and systemic lupus erythematosus skin lesions and allergic contact skin reactions. A newly described antibody (NK₉) recognizing natural killer (NK) cells and activated cytotoxic T lymphocytes was included, and the numbers and activity of circulating NK cells was determined. Immunohistochemical staining revealed that the numbers of NK₉-positive cells were highest in LIS. The distribution of T lymphocytes (OKTii + ve), helper T cells (OKT₄+ ve), suppressor T celts (OKT8 + ve), Langerhans cells (OKT6 + ve) and activated T cells (anti-Tac + ve) in LIS differed from those in DLE, SLE and allergic contact reactions. However, the number of circulating NK cells (large granular lymphocytes) and the NK activity in peripheral blood were normal in LIS. We conclude that in LIS a distinct type of T cell activation occurs; the cause of this remains to be determined.     

The relation of different inflammatory cell types to the various parenchymal components of rejecting kidney allografts

Histochemical and immunoperoxidase techniques were used to characterize the spatial relationships of various inflammatory cell types to the different transplant structures in human renal allograft rejection. T lymphocytes were identified by acid α-naphthyl acetate esterase (ANAE) staining, plasma cells by intracyto-plasmic immunoglobulin, mononuclear phagocytes by intracytoplasmic 'dispersed' ANAE reaction and/or lysozyme staining and granulocytes by intra-cellular lactoferrin. In the two cases of acute rejection the infiltrate around the blood vessels consisted mainly of lymphocytes, whereas the infiltrate around the tubules and within the glomerular tufts consisted mainly of mononuclear phagocytes. In acute rejection only a few plasma cells and granulocytes were seen. In the single case of chronic rejection studied, the lymphocytes were no longer concentrated exclusively around the blood vessels, but diffusely distributed throughout the kidney parenchyma. The different distribution of various inflammatory cells may reflect differences in the functions of these cell types in graft destruction.     

Photosensitivity in lupus erythematosus, UV photoprovocation results compared with history of photosensitivity and clinical findings

Photosensitivity, one of the presenting symptoms in lupus erythematosus (LE), is still poorly defined and varying prevalence figures have been reported. The possibility of a coexisting photodermatosis, especially polymorphous light eruption (PLE), has often not been taken into account. We report the results of ultraviolet A (UVA) and B (UVB) photoprovocation tests in 67 clinically photosensitive patients who had confirmed discoid LE (DLE), systemic LE (SLE) or subacute cutaneous LE (SCLE). The results are compared with a detailed history of photosensitivity and with clinical and serological findings. A pathological photoprovocation reaction, graded as weak, moderate or strong, was induced with either UVA or UVB in 69% of patients with LE, in 100% of those with SCLE, in 70% of those with SLE and in 64% of those with DLE, but in none of 14 controls. Only 16% of the pathological reactions were strong and long-lasting, resembling LE lesions, while 48% were moderate or weak and transient, clinically like PLE. Fifty-three per cent of the provocation reactions which were biopsied showed a PLE-like histology or a non-specific inflammatory reaction, and most of them were clinically moderate or weak reactions of short duration. In the remaining, mostly clinically strong or long-lasting reactions, the histology was consistent with LE. A history of sunlight sensitivity did not predict a pathological photoprovocation result but a positive association between the presence of SSA/Ro or SSB/La antibodies and a pathological photoprovocation reaction was found. We have shown that PLE coexists with LE and that both PLE- and LE-like lesions can be induced with UV radiation in LE patients.     

Occurrence of polymorphous light eruption in lupus erythematosus

Photosensitivity is a well–known manifestation of lupus erythematosus (LE). Since there are no strict criteria for photosensitivity, varying prevalence figures have been reported. Also, distinction from polymorphous light eruption (PLE) can be difficult. The purpose of this study was to characterize photosensitivity in more detail and to determine the occurrence of PLE in a series of well–documented LE patients. A questionnaire was answered by 337 LE patients seen at dermatology departments in Finland and Sweden, and 63 of the patients were invited for interview. According to the questionnaire. LE lesions were made worse by sunlight in 242 (72%) patients. Symptoms consistent with PLE were reported by 165 (49%) patients. Detailed personal interviews supported the results from the questionnaire, and revealed that PLE had started 2–45 years before the onset of LE in 23 of 37 patients with both diagnoses, and more than 7 years before in 18 of 37 (49%). PLE proved to be common in patients with both systemic and cutaneous LE. The two conditions may often coexist and, in about half of the cases, PLE preceded LE. These two diseases may share pathogenic factors, PLE might predispose to LE in a subgroup of PLE patients.     

Expression of the Acid α-Naphthyl Acetate Esterase Marker by Activated and Secondary T Lymphocytes in Man

Acid alpha-naphthyl acetate esterase (ANAE) activity is characteristic of resting human T lymphocytes. The expression of the ANAE marker by activated human T and B lymphocytes (blasts) and by corresponding 'secondary' lymphocytes has been investigated. Human blood lymphocytes were stimulated by selective T-cell (phytohemagglutinin (PHA) and concanavalin A (Con A)) or B-cell (Staphylococcus aureus strain Cowan 1) mitogens or in the mixed lymphocyte culture (MLC), and the percentage of blasts expressing the marker was quantiated. Whereas 95% of Con-A-activated blasts expressed the marker, approximately 25%-30% of MLC-activated blasts and only 10%-25% of PHA-activated blasts were ANAE-positive. After reversion to secondary lymphocytes, the PHA- and MLC-activated cells regained the ANAE activity, and more than 90% of the blast-derived secondary T lymphocytes were ANAE-positive. Only 2%-8% of blast cells activated by Staphylococcus aureus strain Cowan 1 were ANAE-positive. We therefore conclude that ANAE is not a reliable marker for T cells when activated cells (blasts) are considered.     

Identification of Resting Human T and B Lymphocytes by Acid α-Naphthyl Acetate Esterase Staining Combined with Rosette Formation with Staphylococcus aureus Strain Cowan 1

We describe a method enabling the identification of both lymphocyte class and morphology from a single microscopic slide. As a marker for B cells we used surface immunoglobulin. The surface-Ig-carrying cells were rosetted after poly-valent anti-Ig treatment with Staphylococcus aureus strain Cowan 1 (StaCw) and the cells were cytocentrifuged onto a microscope slide. The lymphocytes forming rosettes with StaCw were identical with cells expressing surface Ig studied by fluorescein-isothiocyanate-conjugated anti-Ig. As a marker for T cells we used the acid alpha-naphthyl acetate esterase (ANAE) histochemical marker. The cell smears were first stained for ANAE and subsequently counterstained to distinguish also cell morphology. The ANAE-marker-carrying cells were all included in the population of lymphocytes forming rosettes with sheep erythrocytes. Thus both T and B lymphocytes could be simultaneously identified from a single microscopic slide, and we therefore recommend the method for routine clinical work.     

Inflammatory cells in skin lesions of scabies

Cell infiltrates of biopsy specimens from nodular or papulovesicular skin lesions of seven patients with scabies were characterized by α-naphthyl acetate esterase (ANAE) staining and immunoperoxidase labelling. T lymphocytes were the dominant cells in the dermal inflammatory infiltrates of both nodular and papulovesicular lesions. Their mean proportion in the deeper dermal infiltrates was 64% and in the papillary infiltrates 42%. However, they were few in number around the burrows in the epidermis. In contrast, macrophages were frequent in the epidermis and papillary dermis, where they accounted for 47% and 25% respectively of all mononuclear cells. Immunoperoxidase staining revealed immunoglobulin-positivc plasma cells (from 1% to 10%, of all mononuclear cells) only in the dermal infiltrates of nodular lesions. IgE-positive plasma cells were encountered in all four specimens. These results emphasize the importance of macrophages in scabies infestation and suggest that a local IgE-mediated antibody response may occur in nodular lesions of scabies.     

Polyclhonal B-cell activation and increased lymphocyte helper-suppressor ratios in discoid lupus erythematosus

We studied polyclonal B-cell activation in twenty-six patients with discoid lupus erythematosus (DLE). Spontaneous plaque-forming cells of the IgA class (IgA-SPFC) as determined by a reverse haemolytic plaque assay were significantly more common in patients with DLE than in fifty control subjects. The patients showed a positive correlation between IgA-SPFC and OKT4/8 ratios and also had a significantly higher mean OKT4/8 ratio. The two groups did not differ with regard to cells producing IgG or IgM or cells with OKT3, OKT4, OKT8 or OKMI markers. None of the three patients with DLE who had IgA-SPFC values which were above the mean (+2 s.d.) for the control subjects had positive tests for ANA or low serum C3 or C4, but two of the three also had increased IgG-SPFC values. The results indicate that polyclonal B-cell activation occurs in a small proportion of patients with DLE.