细胞免疫在幼年特发性关节炎发病机制中的作用

幼年特发性关节炎(JIA)是儿童时期常见的一种以慢性关节炎为主要特点的自身免疫性疾病,其发病机制尚不明确,而其免疫发病机制是目前研究的重点,以往研究多集中在体液免疫方面,目前的研究认为细胞免疫在JIA的发病过程中起重要作用.T淋巴细胞、巨噬细胞、树突状细胞(DC)、NK细胞、中性粒细胞、血小板及红细胞均是参与细胞免疫过程的细胞,在JIA慢性炎症的维持及关节损害中发挥着重要的作用.     

Modulation of venom-induced leukocyte histamjne release by mononuclear cells: effect of venom immunotherapy

Leukocyte histamine release and blood mononuclear cell proliferative responses to venoms were evaluated in nine patients with sting anaphylaxis. The effect of venom-activated mononuclear cells on the autologous mononuclear cell proliferative response and venom-induced leukocyte histamine release was also studied before and on maintenance immunotherapy. The mononuclear cell proliferative response was low (specific incorporations <2.0) and antigen nonspecific both before and during maintenance immunotherapy. Venom-induced in vitro leukocyte histamine release did not change significantly with immunotherapy. However, when patients were on maintenance immunotherapy, venom-activated mononuclear cells cocultured with autologous leukocytes significantly (p < 0.05) suppressed venom-induced histamine release. The suppressive effect of mononuclear cells was antigen specific and enhanced by in vitro mononuclear cell activation. Suppression of leukocyte histamine release by mononuclear cells extends the regulatory potential of these cells and may identify an additional mechanism by which immunotherapy protects Hymenoptera-sensitive individuals against systemic anaphylaxis     

少儿强直性脊柱炎与幼儿类风湿性关节炎HLA-B27亚型的鉴别诊断

目的：探讨HLA－B27等位基因亚型与少年强直性脊柱炎和幼年类风湿性关节炎的关联。方法：用PCR－SSP方法对74人HLA－B27等位基因亚型进行研究，其中少年强直性脊柱炎32例，幼年类风湿性关节炎28例，5个家系中患者的父亲或母亲5例，正常对照组9例，并进行关联分析。结果：本组人群的HLA－B27等位基因由HLA－B*2704、*2705、*2702、*2707 4种亚型组成，其中少年强直性脊柱炎患者HLA－B27等位基因亚型频率为B*2704 56.25%、B*2705 40.63%、B*2702 3.13%；幼年类风湿性关节炎HLA－B27等位基因亚型频率为B*2705 60．7％、B*2704 28．57％、B*2702 3．57％及B*2707为7．14％；少年强直性脊柱炎与幼年类风湿性关节炎结果比较，HLA－B*2704基因频率在少年强直性脊柱炎组高于幼年类风湿性关节炎组（RR＝3．21，P＜0．05）。结论：少年强直性脊柱炎与HLA－B*2704等位基因亚型关联。对HLA－B27等位基因亚型的检测可成为少年强直性脊柱炎和幼年类风湿性关节炎鉴别诊断中一个有价值的实验指标。     

IgE production in vitro by human blood mononuclear cells: a comparison between atopic and nonatopic subjects

In vitro IgE synthesis by blood mononuclear cells from atopic patients and nonatopic subjects was examined. A total of 1 X 10(6) mononuclear cells cultured in RPMI-1640 and 10% fetal calf serum with or without cycloheximide was found to be optimal to detect de novo synthesis. A modified Phadebas IgE paper radioimmunosorbent test was employed for the quantitation of supernatant IgE concentration. Kinetic studies indicated that about half the peak amount of IgE is secreted within the first 2 days and the maximum concentration is reached at day 7. Mononuclear cells obtained from six of six atopic patients with eczema and elevated serum IgE levels and 22/33 atopic patients without eczema spontaneously synthesized significant amounts of IgE in vitro. We failed to detect de novo IgE synthesis by the cells obtained from 40 nonatopic controls. Polyclonal activators such as pokeweed mitogen. Staphylococcus aureus Cowan I, concanavalin A, and phytohemagglutinin failed to induce or enhance in vitro IgE synthesis in normal and atopic subjects. These findings indicate that the study of immunoregulation of IgE synthesis in man will be difficult to accomplish until new methods are developed that allow induction of the IgE response in vitro in nonatopic subjects.     

Lack of T cell oligoclonality in enzyme-digested synovial tissue and in synovial fluid in most patients with rheumatoid arthritis.

The dominant presence of specific T-cell populations in the rheumatoid joint as detected by Southern blot analysis of T cell receptor (TCR) gene rearrangements would indicate local antigen recognition and T cell proliferation. We therefore studied TCR beta chain gene rearrangements using a C beta 2 probe in paired samples of T cell populations from synovial tissue and peripheral blood (n = 6) as well as synovial fluid (n = 16) and peripheral blood (n = 18) of patients with rheumatoid arthritis (RA). Peripheral blood mononuclear cells from healthy donors (n = 7) served as a control. T cells were studied directly after isolation or after non-specific expansion with OKT3 monoclonal antibody (MoAb) and T cell growth factor (TCGF). DNA samples were digested with EcoRI and HindIII to detect rearrangements to C beta 1 and C beta 2, respectively. Extra bands were detected in all EcoRI-digested DNA samples prepared from both freshly isolated and non-specifically expanded T cell populations of patients and healthy donors, possibly representing 'common' (V-) D-J rearrangements. Dominant rearrangements were found in only two out of 16 synovial fluid T cell populations (one freshly isolated and one expanded) and not in peripheral blood or synovial tissue derived T cell populations. No extra bands were detected in HindIII-digested DNA samples. To investigate the effect of in vitro culture techniques on rearrangement patterns we studied DNA samples prepared from synovial tissue T cells obtained both by outgrowth from tissue with TCGF or by enzyme digestion and subsequent expansion either with TCGF or with OKT3 MoAb and TCGF. Whereas the latter T cell population yielded 'common' rearrangements, the former T cell populations yielded different dominant rearrangements. These data indicate that oligoclonality of the T cell populations in synovial tissue and synovial fluid of patients with RA is a rare event. The data also show the influence of in vitro culture techniques on the result of TCR gene rearrangement analysis.     

CD4+CD25high调节性T细胞在类风湿性关节炎病程中的消长及其意义

目的研究类风湿性关节炎(RA)患者病情发展不同阶段外周血及滑液中CD4 CD25high调节性T细胞数量的差别,及其与类风湿性关节炎活动程度的相关性,探讨CD4 CD25highT细胞在RA发生发展中所发挥的免疫抑制和调节作用。方法分别选取未经过缓解病情抗风湿药(DMARDs)治疗的活动性RA患者11例,经DMARDs治疗病情缓解的RA患者12例,和DMARDs治疗后效果不佳的RA患者9例,以及正常对照8例,检测他们的外周血淋巴细胞,以流式细胞术检测CD4 CD25high调节性T细胞的百分率,并研究CD4 CD25highT细胞百分率与抗环瓜氨酸(CCP)抗体,C反应蛋白(CRP),血沉(ESR)及类风湿因子(RF)的相关性。对其中部分患者的血液和关节滑液同时进行分析。结果RA未经治疗组和治疗效果不佳组CD4 CD25highT细胞的百分率(分别是5.24%和6.43%)明显低于正常对照组和治疗后病情缓解组(分别是17.17%和11.79%,P<0.01)。RA患者CD4 CD25highT细胞的百分率与抗CCP抗体(58.0Ru/mL),ESR(38.8mm/h)及CRP(2.73μg/L)呈明显负相关(P<0.05),与类风湿因子(RF=14.4Iu/mL)无明显的相关性(P=0.054)。正常对照组的CD4 CD25highT细胞百分率与抗CCP抗体(均<5.0Ru/mL),ESR(4.67mm/h),CRP(0.15μg/L)及RF(1.37)无明显相关性(P>0.1)。RA患者关节滑液中CD4 CD25highT百分率明显低于强直性脊柱炎(ankilosing spondylitis,AS)关节积液患者(P<0.05)。结论试验结果表明未经缓解病情治疗和治疗后效果不佳者的外周血中,CD4 CD25high调节性T细胞相对减少,且与病情活动程度负相关,这可能是RA发生和发展的一个重要因素。     

Safety and immunogenicity of co‐administered MF59‐adjuvanted 2009 pandemic and plain 2009–10 seasonal influenza vaccines in rheumatoid arthritis patients on biologicals

Rheumatoid arthritis (RA) patients under immunosuppressive therapy are particularly susceptible to infections, mainly of the respiratory tract, thus vaccination may represent a strategy to reduce their incidence in this vulnerable population. In the 2009–10 influenza season, the safety and immunogenicity of co‐administered non‐adjuvanted seasonal and MF59‐adjuvanted pandemic influenza vaccines were evaluated in this study in 30 RA patients under therapy with anti‐tumour necrosis factor (TNF)‐α agents or Abatacept and in 13 healthy controls (HC). Patients and HC underwent clinical and laboratory evaluation before (T0), 1 (T1) and 6 months (T2) after vaccinations. No severe adverse reactions, but a significant increase in total mild side effects in patients versus HC were observed. Both influenza vaccines fulfilled the three criteria of the Committee for Proprietary Medicinal Products (CPMP). Seroconversion rate for any viral strain in patients and HC was, respectively, 68 versus 45 for H1‐A/Brisbane/59/07, 72 versus 81 for H3‐A/Brisbane/10/07, 68 versus 54 for B/Brisbane/60/08 and 81 versus 54 for A/California/7/2009. A slight increase in activated interferon (IFN)‐γ‐, TNF‐α‐ or interleukin (IL)‐17A‐secreting T cells at T1 compared to T0, followed by a reduction at T2 in both patients and HC, was registered. In conclusion, simultaneous administration of adjuvanted pandemic and non‐adjuvanted seasonal influenza vaccines is safe and highly immunogenic. The largely overlapping results between patients and HC, in terms of antibody response and cytokine‐producing T cells, may represent further evidence for vaccine safety and immunogenicity in RA patients on biologicals.     

Changes of lymphoproliferative responses of T cell subsets to allergen and mitogen after hyposensitization in asthmatic children

The cellular basis for the mechanism of hyposensitization was studied by examining the changes in the numbers and proliferative responses to house dust and phytohemagglutinin (PHA) of T cell subsets of 25 house dust-sensitive asthmatic children before and 1 yr after hyposensitization. The results demonstrated (1) No difference was observed in the mean percentages of OKT3+ cells and OKT8+ cells between normal subjects and patients both before and after hyposensitization, but the absolute numbers of both types of cells in untreated patients were much higher than in the normal subjects or treated patients because of relative lymphocytosis in the untreated patients, (2) While the mean percentage of OKT4+ cells of the untreated patients was lower than that of the normal subjects (40.8 +/- 4.7% vs 44.8 +/- 4.5%, p less than 0.007), the absolute number was higher in the former than that in the latter because of the same reason. After hyposensitization, the mean percentage of the OKT4+ cells was slightly increased, and (3) Hyposensitization was able to restore the proliferative capability to PHA and depress the sensitivity to specific allergen of OKT4+ cells on the one hand and augment the proliferative responses to both PHA and allergen of OKT8+ cells on the other. Taken together, these immunologic changes may explain partly the suppressed IgE-antibody production and decreased lymphoproliferative response to specific allergen after hyposensitization.     

类风湿关节炎患者外周血CD4+T细胞亚群的分析

目的 研究类风湿性关节炎(RA)患者不同时期外周血Treg和Th1、Th2、Th17细胞以及中性粒细胞上CD64的表达水平,及它们与RA的活动性指标和自身抗体的相关性.方法 采集78例RA患者和21例健康人外周静脉血,采用流式细胞术检测淋巴细胞亚群(Treg,Th1、Th2、Th17细胞)的变化.结果 RA的CD3+ CD4+T细胞和CD4+ CD25+T细胞增多,活动期RA组Treg比率高于缓解期RA组和健康对照组,缓解期RA组Th2细胞减少,RA中Th1,TH17细胞与健康对照组相比无统计学意义,Treg和Th1、Th2、Th17细胞与RA的活动性指标(ESR,CRP和PLT)均无关联.结论 CD4+T细胞亚群数量异常可能与RA疾病发展有关.     

The levels of soluble granzyme A and B are elevated in plasma and synovial fluid of patients with rheumatoid arthritis (RA).

Cytotoxic cells possess specialized granules which contain perforin and a group of serine proteinases termed granzymes. Granzyme-positive cells have been identified in synovial fluid and tissue of patients with RA, where they may play an important role as mediators of granule-mediated apoptosis, extracellular proteolysis, and cytokine induction. The aim here was to define further the involvement of cytotoxic cells in RA. Plasma and synovial fluid samples from the knee joint were obtained from 31 RA patients. The disease controls included 20 osteoarthritis (OA) patients and 10 reactive arthritis (ReA) patients. A recently developed capture ELISA was used to detect soluble granzymes A and B in all patients. Compared with OA and ReA disease controls, markedly increased levels of soluble granzymes A and B were detected in both plasma and synovial fluid of RA patients (P < 0.00001). When values for soluble granzymes A and B in plasma and synovial fluid were used simultaneously as independent variables, logistic regression analysis indicated that a diagnosis of RA could be predicted correctly in 84% of the RA patients and a diagnosis of non-RA in 90% of the controls. The markedly elevated levels of soluble granzymes A and B in plasma and synovial fluid of RA patients strongly suggest that cytotoxic cells are active participants in the pathogenesis of RA. Moreover, the results suggest that measurement of granzymes may assist the laboratory evaluation of patients with arthritis. Larger studies in patients with early disease may clarify the role of this test system in differential diagnosis.     

Immune induction of human monocyte plasminogen activator. Characteristics of an assay for cell-mediated immunity

We characterized immunologic induction of monocyte plasminogen activator (PA) to determine whether assay for PA induction reliably detected cell-mediated immunity (CMI). Mononuclear leukocytes (MNL) were incubated in teflon-lined culture tubes for 1-4 days in the presence or absence of phytohemagglutinin-P (PHA), concanavalin A (Con A) or Candida antigen. PA activity of the monocytes in those suspensions was then measured using a micro fibrin plate assay. Monocytes in stimulated MNL had more PA activity than monocytes in unstimulated MNL. Maximal differences between stimulated and unstimulated cells were seen after 2 days of culture. Dose-response studies demonstrated that PA induction occurred at submitogenic concentrations of stimuli. Peak induction was seen using suboptimally mitogenic concentrations of PHA, Con A and Candida antigen. PA induction in response to Candida stimulation corresponded with skin test results. More than 90% of healthy adults tested had positive assays to all stimuli. LPS, in picogram concentrations, induced PA activity in the absence of lymphocytes, but such induction was prevented by polymyxin B. Supernates from activated MNL also induced PA in purified monocytes. This indirect assay of PA induction was less sensitive than direct assay of the MNL. A standard indirect assay for leukocyte inhibitory factor (LIF) was also less sensitive than the direct PA induction assay. The direct PA induction assay is sensitive and convenient and requires small volumes of blood. It may prove valuable in in vitro analysis of cell-mediated immunity in health and disease.     

Persistent lymphadenopathy associated with hypertransfusion in sickle-cell disease

We report the results of an immunologic evaluation of two hypertransfused (HT) patients with sickle-cell disease (SCD) who have developed persistent generalized lymphadenopathy. In order to interpret the results of this evaluation, we studied seven other HT patients with SCD and seven nonhypertransfused patients with SCD. Patients with SCD had decreased percentages of T-lymphocytes to include both helper and suppressor subsets in their peripheral blood. These decreases resulted in T helper/suppressor ratios not different from those of healthy normal control subjects. Lymphocyte proliferative responses to mitogen were decreased in the nonhypertransfused group, whereas mononuclear cell populations from both patient groups had higher levels of spontaneous suppressor cell activity than did control subjects. The patients with lymphadenopathy were distinguished from other HT sickle-cell anemia patients by immunologic abnormalities that included decreased percentages of T4+ lymphocytes, decreased T helper/suppressor ratios, and decreased lymphocyte responses to mitogen. Furthermore, the serum of these patients contained antibody specific for human T cell lymphotropic virus type III (HTLV-III). We believe that these two patients have developed acquired immunodeficiency syndrome-related lymphadenopathy as the result of transfusion-acquired HTLV-III. We propose that hypertransfusion treatment in SCD, possibly in association with phenytoin administration, places individuals at risk for HTLV-III-associated syndromes.     

The immunopathogenesis of fibrosis in systemic sclerosis

Systemic sclerosis (SSc) is an idiopathic systemic autoimmune disease. It is characterized by a triad of hallmarks: immune dysfunction, fibrosis and vasculopathy. Immune dysfunction in SSc is characterized by the activation and recruitment of immune cells and the production of autoantibodies and cytokines. How immune abnormalities link the fibrosis and vasculopathy in SSc is poorly understood. A plethora of immune cell types are implicated in the immunopathogenesis of SSc, including T cells, B cells, dendritic cells, mast cells and macrophages. How these different cell types interact to contribute to SSc is complicated, and can involve cell-to-cell interactions and communication via cytokines, including transforming growth factor (TGF)-β, interleukin (IL)-6 and IL-4. We will attempt to review significant and recent research demonstrating the importance of immune cell regulation in the immunopathogenesis of SSc with a particular focus on fibrosis.     

Successful induction of severe destructive arthritis by the transfer of in vitro-activated synovial fluid T cells from patients with rheumatoid arthritis (RA) in severe combined immunodeficient (SCID) mice

In order to investigate the role of pathogenic T cells in RA, the establishment of an RA model using patients’ T cells is thought to be essential. In this study, multiple and severe destructive arthritis was established by transferring in vitro-stimulated synovial fluid T (SFT) cells from patients with RA through simultaneous injection into knee joint and peritoneal cavity of SCID mice without causing xenogeneic graft-versus--host disease (GVHD). Neither the transfer of unstimulated SFT cells nor sole i.p. injection was sufficient to induce severe arthritis. Interestingly, in contrast with SFT cells, in vitro-activated peripheral blood lymphocytes from RA patients failed to trigger such arthritis, suggesting that pathogenic T cells might be concentrated in synovial fluid of RA patients. This, the first severe arthritis model mimicking RA induced by RA patients’ T cells, is expected to provide important information about RA pathogenesis and a possible therapeutic approach.     

High levels of the soluble form of CD30 molecule in rheumatoid arthritis (RA) are expression of CD30+ T cell involvement in the inflamed joints.

The CD30 is a surface molecule expressed by Th2-type lymphokine-producing T cells upon activation. CD30-expressing activated T cells release a soluble form of the molecule, which can be detectable both in vitro and in vivo. In the present study, high levels of soluble CD30 were found in peripheral blood and synovial fluid from patients with RA. However, CD30+ CD3+ cells, either CD4+ or CD8+, were significantly present in synovial fluid, but not in peripheral blood, of RA patients. Serum values of soluble CD30 were higher in active than inactive RA patients and directly correlated with rheumatoid factor serum titres. These data strongly support an involvement of CD30+ T cells in the immune processes of rheumatoid synovitis, and may suggest a relationship between Th2-type cytokine-secreting T cells and the pathological response in RA.     

Induction of Fas-dependent apoptosis in synovial infiltrating cells in rheumatoid arthritis

Apoptosis is a feature of the synovium of rheumatoid arthritis(RA). We have recently shown that RA synoviocytes were susceptibleto anti-Fas mAb and undergo apoptosis in vitro. To investigatewhether infiltrating mononuclear cells also undergo Fas-dependentapoptosis, double-labeling techniques combined with immunohistochemicalexamination with anti-CD3 mAb and the TdT-mediated dUTP-biotinnick end labeling (TUNEL) method to detect apoptotic cells,or in situ RT assay to detect Fas mRNA, were performed usingfrozen tissue sections. We also examined the in vitro inductionof Fas-dependent apoptosis in freshly isolated synovium infiltratingmononuclear cells (SIM), synovial stromal cells (SSC) and peripheralblood lymphocytes (PBL) using tissues from nine patients withRA and three with osteoarthritis (OA). The results showed expressionof Fas antigen and apoptotic cells in a number of CD3-bearingcells in RA synovial tissues. In vitro treatment with anti-FasmAb produced a significant apoptosis of RA SIM and SSC, whilenone of PBL, and neither SIM nor SSC from OA exhibited apoptosis.Moreover, 50% of CD4⁺, CD3⁺ and CD45RO⁺ cells, and >90% ofFas-expressing cells of RA SIM underwent apoptosis in responseto anti-Fas mAb, as detected by flow cytometry. Our resultssuggest that RA synovial infiltrating lymphocytes acquire highsusceptibility to anti-Fas mAb and undergo apoptosis. Such aphenomenon of infiltrating T cells in RA synovium may play animportant pathophysiological role and suggest a possible therapeuticeffect for anti-Fas mAb in RA.     

Analysis of the cellular infiltrates and expression of cytokines in synovial tissue from patients with rheumatoid arthritis and reactive arthritis

The cellular infiltrates and cytokine patterns in synovial tissue (ST) from patients with rheumatoid arthritis (RA) and reactive arthritis (ReA) were compared in order to determine the mechanisms responsible for the chronic and destructive course of RA. Since the results could be influenced by differences in disease duration, ST was studied from patients in both early and late stages of the disease. Ten patients had early RA (<1 year), ten long-standing RA (>1 year), six early ReA (<1 year), and five long-standing ReA (>1 year). Histological analysis demonstrated that the scores for infiltration by lymphocytes and plasma cells, and the scores for inflammation, were significantly higher in RA than in ReA. Immunolabelling studies showed that in particular, the scores for infiltration by CD38+ plasma cells, granzyme B+ cells, and interferon-gamma (IFNγ)+ cells were significantly higher in RA than in ReA. The results were independent of the disease duration. The increased number of lymphocytes, plasma cells, and granzyme B+ cells in rheumatoid synovial tissue supports the paradigm that RA is the result of specific immune recognition in the joint and that granzyme B+ cells play an important role in joint destruction. © 1998 John Wiley & Sons, Ltd.     

Th细胞在类风湿关节炎发病作用的研究进展

T细胞功能紊乱,尤其是辅助性CD4+T细胞异常活化,在类风湿关节炎(rheumatoid ar thritis,RA)的发生发展中处于中心环节,CD4+T细胞亚群Th1/Th2细胞及Th17/Treg细胞之间的失衡可能是RA发病的最直接和最重要的因素。Th细胞相关细胞因子通过作用于多种细胞并相互调节形成一个复杂的网络,Th1和Th17细胞通过产生炎性细胞因子IFN、TNF-α、IL-2、IL-1、IL-17等造成了滑膜炎的发生,Th2和Treg细胞通过直接接触或分泌细胞因子IL-4、IL-10等参与抗炎效应。本文旨在阐述Th细胞及相关细胞因子的促炎和抗炎平衡在RA发生发展中所起的关键作用。     

Analysis of Vκ genes in rheumatoid arthritis (RA) synovial B lymphocytes provides evidence for both polyclonal activation and antigen-driven selection

To define mechanisms of sustained activation of synovial B lymphocytes in RA, we studied hybridomas established from the local synovial B cell repertoire of two RA patients for V_κ gene expression and for antigen-binding specificity. The analyses revealed that members of the main V_κ families (I, II and III) were utilized at frequencies consistent with random V_κ gene family use. Furthermore, although the hybridomas expressed genes frequently seen in response to other self- and exogenous antigens, only one V_κI- and two of three V_κIII-expressing hybridomas exhibited reactivity with self-antigens. Nucleotide sequence analysis revealed that all hybridomas, with the exception of rheumatoid factor (RF)-producing hybridomas, expressed V_κ genes highly related to known germ-line genes (99.3–100% homology) and that diversity was generated by deletions and random nucleotide insertions at the V_κ–J_κ junction. Examination of the few nucleotide changes seen within the V_κ genes revealed a predominance of silent to replacement changes. Moreover, most of these changes can be attributable either to allotypic variations or to limited random nucleotide replacements independent of antigen selection. In contrast, one IgG-RF (B4D8) exhibited predominantly replacement nucleotide changes in the complementarity-determining regions, suggestive of antigen-driven selection. The random expression of immunoglobulin variable region genes with no, or little, evidence of mutation in the synovial B lymphocyte repertoire, including natural polyreactive antibodies, alongside mutated IgG-RF, suggest that both polyclonal activation and antigen-driven responses occur in RA synovia.