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Biomedical subjects

R Hohlfeld

Publications and source records attributed to R Hohlfeld.

At least 163 records · Page 9Linked to original sources

Myasthenia gravis: stimulation of antireceptor autoantibodies by autoreactive T cell lines.

We studied autoreactive acetylcholine receptor (AChR)-specific T cell lines from two patients with myasthenia gravis. Anti-AChR autoantibody production by peripheral blood mononuclear cells (PBM) from the donors of the T cell lines was measured with an enzyme-linked immunoadsorbent assay, using purified human AChR as antigen. Freshly isolated PBM produced barely detectable amounts of anti-AChR autoantibodies. If, however, autologous AChR-specific T cells were added to the cultures, the production of anti-AChR autoantibodies, and of total IgM and IgG, was markedly stimulated, depending on the number of T line cells and on the amount of AChR present in the cultures. AChR-specific functional helper T-lymphocytes may have a role in the immunoregulation of myasthenia gravis.

Adult↗

Myasthenia gravis: reactivation of clinical disease and of autoimmune factors after discontinuation of long-term azathioprine.

In 15 patients with myasthenia gravis who were in stable clinical remission while receiving azathioprine, we monitored disease severity and serial autoantibody titers before and after discontinuation of azathioprine. Cellular immunoreactivity against tuberculin (PPD) and against Torpedo acetylcholine receptor (AChR) was measured serially in 11 patients. Eight of 15 patients (53%) had a clinical relapse after 3 to 11 months, necessitating the reinstitution of immunosuppressive treatment in 6 patients. Seven patients have remained clinically stable during an observation period of 20 to 40 months. Anti-AChR autoantibody titers correlated closely with the clinical course in the majority of patients, and rose markedly in 7 of the 8 patients who relapsed. Cellular stimulation indices correlated less closely with the clinical severity. Only in 3 patients did the clinical score, antibody titer, and cellular stimulation index rise concurrently. In 4 patients who had high cellular stimulation indices after the discontinuation of azathioprine, it was possible to isolate AChR-reactive inducer/helper T lymphocytes.

Adult↗

Strategies for the modulation of neuroimmunological disease at the level of autoreactive T-lymphocytes.

Cell lines of autoimmune T-lymphocytes have been established in several neuroimmunological model diseases and also in a human neurological autoimmune disease, myasthenia gravis. These cell lines generally have the T helper/inducer phenotype and recognize autoantigen in the context of class II histocompatibility antigens. Autoreactive helper T cell lines may become useful tools for the evaluation of new immunotherapeutic strategies. (1) Treatment with anti-Ia monoclonal antibodies presumably interferes with the interaction between Ia on the surface of antigen-presenting cells and the autoreactive T cell receptor; (2) Therapy with unmodified or modified autoantigen may be used to tolerize or delete the autoimmune T cells; (3) Monoclonal antibodies against the 'T cell domains' of autoantigen may prevent its recognition by the autoreactive T cells; (4) Treatment with monoclonal antibodies against T cell clonotypic or differentiation antigens may effectively delete or inactivate the autoreactive T cells. Furthermore, autoreactive helper T cells may be used to induce and establish anti-idiotypic suppressor T cell lines, or the autoimmune helper T cells may themselves display suppressive effects in an allogeneic system.

Animals↗

Genetic restriction of autoreactive acetylcholine receptor-specific T lymphocytes in myasthenia gravis.

Human autoreactive helper T lymphocytes with specificity for acetylcholine receptor (AChR) were isolated from three HLA-DR3-positive patients who had myasthenia gravis (MG), an autoimmune disease known to be associated with HLA-DR3 in the North European population. The antigen-specific T cells were evaluated for genetic restriction. Antigen presentation studies were performed with mitomycin C-treated accessory cells from a panel of HLA-typed unrelated donors. AChR-induced proliferation of the autoreactive T cells was maximal in the presence of autologous or HLA-DR-compatible antigen-presenting cells. In two DR-heterozygous patients both parental DR specificities served as restriction elements of the polyclonal AChR-reactive T cell populations. Preferential restriction to HLA-DR3 was observed in one patient, but this was also seen with PPD-specific T cells from the same donor. A series of monoclonal antibodies against HLA class II molecules was used for inhibition experiments. The inhibitory effects of the antibodies were not due to unspecific toxicity and could be observed after separate treatment of the antigen-presenting cells but not of the responding T cells. Several monoclonal antibodies against monomorphic HLA-DR determinants (DA 231, MAS 53, MAS 54, L243, OKIa1) had pronounced inhibitory effects. Anti-HLA-DQ(DC) monoclonal antibodies (Leu-10; TU 22) had only mild or no inhibitory effects in two patients but significantly inhibited AChR-specific T cells in one patient. A monoclonal antibody against HLA-DR3 (antibody 16.23) was not or was only weakly inhibitory in the DR3-positive patients, although it bound to autologous T line cells and B cells by indirect immunofluorescence. In one patient it was possible to compare the inhibition patterns of AChR-specific and PPD-specific T cells. Most of the monoclonal antibodies affected AChR- and PPD-specific T cells to a similar extent, but three antibodies (TU 22, 36, 39) inhibited PPD-specific T cells more than AChR-specific T cells, indicating the possibility of differential restriction of antigen- and autoantigen-specific T cells. It is suggested that the in vitro system described here may be helpful for the evaluation of anti-HLA class II antibodies as potential immunotherapeutic reagents.

Animals↗

[Analysis of surface markers on cerebrospinal fluid-producing cells. Contribution to the differential diagnosis of intrathecal lymphomas].

For differentiating between inflammatory and neoplastic intrathecal lymphopleocytosis, analysis of CSF cell surface markers was employed in two patients. In one case, diagnosis of intrathecal spreading of a previously not diagnosed lymphoma was established by identifying a uniform population of CALLA-negative (CALLA = common acute lymphoblastic leukaemia antigen) lymphocytes carrying kappa light chains, which reacted with an anti-B monoclonal antibody. In the second case, cytological examination of CSF showed atypical lymphoid cells as well as lymphoblasts and numerous mitoses. On the other hand, analysis of the CSF cell surface markers revealed a typical inflammatory reaction pattern in which antibody-positive inducer (helper) T-lymphocytes predominated. This pointed to inflammatory lymphopleocytosis as likely diagnosis.

Adrenal Cortex Hormones↗

Physiochemical and immunological properties of acetylcholine receptors from human muscle.

The acetylcholine receptor protein from human muscle was extracted with the non-ionic detergent Triton X-100 and purified by affinity chromatography on alpha-Naja toxin sepharose 4B. Further purification on Dicap-MP sepharose 4B, a choline analog compound, led to ACHR preparations with specific activities of 2-7 nmol/mg protein. The isolated receptor, labeled with 125I-alpha-bungarotoxin was characterized by different methods and compared to ACHRs from Torpedo californica electroplax and rat-denervated skeletal muscle. Gel filtration on Ultrogel AcA 34 resulted in a stokes radius of 70 A for the receptor monomer and 99 A for the dimeric form. Sucrose density gradient centrifugation showed sedimentation coefficients of 9.1 S and 13.5 S. From these data the molecular weight of the ACHR monomer was estimated as 254 000 D and 540 000 D for the receptor dimer. The isoelectric point of the 125I-alpha-bgt-ACHR complex was determined by thin-layer isoelectric focussing to be pH 5. Purified ACHRs were used for immunization of rats and mice which developed an EAMG as verified by clinical observation and electrophysical measurements. Sera from the immunized animals as well as from myasthenia gravis patients were subsequently used to compare the cross-reactivity of ACHR preparations from different sources. While antibodies of rats immunized with Torpedo ACHRs cross-reacted with ACHR preparations from rat and human skeletal muscle, antibodies from mice immunized with rat ACHR only reacted with preparations from rats and mice. Antibodies from mice immunized with ACHR of human origin exhibited a broad cross-reactivity, as did antibodies from MG patients.

Animals↗

A practicable method for the analysis of T lymphocyte subsets in CSF lymphopleocytosis.

A practicable indirect immunofluorescence technique for the analysis of surface markers of cerebrospinal fluid (CSF) cells is described. Preliminary results in 10 patients with acute or chronic CSF lymphopleocytosis of different etiology showed an almost uniform pattern of cell subsets. The majority of CSF cells represented OKT3-positive T lymphocytes with a mean helper (OKT4-positive) to suppressor (OKT8-positive) ratio of 3,4 to 1.

Antibodies, Monoclonal↗

[Immunogenetics of myasthenia gravis. Significance of HLA-, complement and Cm gene systems for clinical and immunologic parameters].

In 82 non-related patients with myasthenia gravis the following immunogenetic marker systems were investigated: HLA-A, -B, -C, -DR antigens, complement polymorphisms for Bf, C3 and C4 as well as immunoglobulin allotypes G1m, G3m and Km. In 78 patients the level of circulating acetylcholin receptor autoantibody was measured. The HLA antigens showed no significant differences in frequency when compared with healthy controls. This was also true for the HLA-bound Bf and C4 polymorphism, the non-HLA-bound C3 polymorphism and the immunoglobulin allotypes. A significant (P less than 0.005) increase in heterozygote frequency of 39.7% in the Gm allotype combination G1m (1), (17); (3) when compared with an expected frequency as calculated from the gene frequency of 19.8% was found. HLA-B8 and/or HLA-DR3 positive myasthenia gravis patients showed a significantly (P less than 0.025 and less than 0.005) earlier average onset of the disease whereas in HLA-DR2 positive patients the average onset was later (P less than 0.05). The same HLA antigens correlated with quantitative differences in the acetylcholine receptor autoantibodies: HLA-B8 and/or -DR3 positive patients had on average higher antibody levels than HLA-B8 or -DR3-negative patients. The difference for HLA-DR3 was statistically significant (P less than 0.05). On the other hand patients with HLA-DR2 antigens had significantly lower antibody levels (P less than 0.025). Increased mean antibody levels were also seen in G1m(1), (17) allotype (P less than 0.005) and G3m(21) (P less than 0.05). As the HLA antigens and Gm allotype genes are situated on different chromosomes (C6 and C14) two distinct gene regions are identified in myasthenia gravis. These are associated with quantitative differences in acetylcholine receptor antibody titres.

Autoantibodies↗

Myasthenia gravis: long-term correlation of binding and bungarotoxin blocking antibodies against acetylcholine receptors with changes in disease severity.

Sixty patients with myasthenia gravis were examined prospectively by measuring serial titers of antibodies against human acetylcholine receptor, and these were correlated with a quantitative clinical score. Serial titers of antibodies detected by the standard immunoprecipitation assay (binding antibodies) correlated with the clinical score in most patients. Antibodies blocking the binding of alpha-bungarotoxin to receptors (blocking antibodies) were detected in 29 patients. Serial blocking antibody titers correlated with changes in muscle weakness less often than binding antibody titers. Titers of both classes of antibodies often followed a divergent course, suggesting that the autoimmune B-cell clones that formed these classes of antibodies may have been activated asynchronously.

Acetylcholine↗

T-lymphocytes in experimental autoimmune myasthenia gravis. Isolation of T-helper cell lines.

The role of T-lymphocytes in Experimental Autoimmune Myasthenia Gravis (EAMG) was investigated. We generated highly purified, acetylcholine receptor (AChR)-specific T-cell populations and subsequently characterized these cell lines with respect to their membrane phenotype and their function. Using a series of mouse monoclonal antibodies directed against rat lymphocyte surface differentiation antigens, the vast majority of line cells was shown to express a leucocyte common antigen, a T-common antigen and a T-helper antigen. Small subpopulations were Ia or T suppressor antigen-positive. Adaptive transfer to sublethally irradiated, thymectomized recipients revealed that 1 X 10(6) AChR-specific line cells could cooperate effectively with 10 X 10(6) AChR-primed, complement (C3) receptor-bearing (B-cell enriched) spleen cells in the production of anti-AChR autoantibodies. Recipients of B-cells along with relevant line cells developed an acute myasthenic syndrome 6-7 days after cell transfer. Electron-microscopical examination revealed the typical features of "acute phase" EAMG with heavy mononuclear infiltration. There was, however, no evidence antibody-independent cytotoxic activity exerted by AChR-specific line cells.

Animals↗

[Myasthenia gravis. Prototype of an anti-receptor autoaggression disease (author's transl)].

Myasthenia gravis is a classic autoaggression disease in which autoantibodies against the acetylcholine receptors (AChR) of the neuromuscular end-plate have a decisive patho-genetic significance. With sensitive radioimmunoassays anti-AChR antibodies are demonstrable in over 90% of myasthenics and consequently are of great diagnostic significance. The treatment possibilities to date have distinctly improved the prognosis but are either symptomatic or unspecific. More recent knowledge on pathophysiology and pathogenesis and the strategies for development of a specific immunotherapy deducible from this are discussed. X

Adult↗

Neuromuscular Transmission in experimental autoimmune myasthenia gravis (EAMG). Quantitative ionophoresis and current fluctuation analysis at normal and myasthenic rat end-plates.

Chronic experimental autoimmune myasthenia gravis (EAMG) was induced in rats by immunization with acetylcholine receptor (AChR) purified from the electroplax of Torpedo californica. 35--40 days after immunization, serum anti-AChR antibody titers were about 40 nM. At this stage, electrophysiology was performed on isolated M. omohyoideus muscle-preparations from myasthenic and from normal (control) rats. For the study of the equilibrium interaction between acetylcholine (ACh) and AChR, dose-response curves were obtained by quantitative ionophoretic application of ACh to voltage-clamped end-plates. Analysis of dose-response curves yielded the following parameters: maximum end-plate conductance per unit surface gmax (EAMG) = 10.3 +/- 1.1 nS/micrometer 2, gmax (normal) = 20.2 +/- 1.8 nS/micrometer 2; apparent dissociation constant K (EAMG) = 96 +/- 5 microM, K (normal) = 58 +/- 6 microM; Hill-coefficient nH (EAMG) = 2.3 +/- 0.1, nH (normal) = 2.3 +/- 0.1. Single channel properties were derived from an analysis of ACh-induced end-plate current noise: the mean single channel conductance was gamma (EAMG) = 20.1 +/- 2.2 pS, gamma (normal) = 27.6 +/- 1.8 pS and the mean channel life-time tau (EAMG) = 1.39 +/- 0.09 ms, tau (normal) = 1.32 +/- 0.08 ms (T = 22 degrees C). The electrophysiological data are interpreted as follows: (1) At myasthenic end-plates there is a 50--60% reduction of functioning AChR (decrease of gmax). A total number of about 2 x 10(6) (1 x 10(6)) channels per end-plate was calculated for control (myasthenic) rats. (2) The affinity of AChR for ACh is reduced and/or there is an impediment of the conformational change from the closed- to the open-channel configuration (increase of K). (3) Single channel properties are essentially unaffected.

Acetylcholine↗

Autoimmune rat T lymphocytes monospecific for acetylcholine receptors: purification and fine specificity.

We prepared highly purified acetylcholine receptor (AChR)-specific T lymphocytes from rats with experimental autoimmune myasthenia gravis (EAMG). Inbred rats were primed with AChR frm 3 different sources: from the electric organs of Electrophorus electricus and Torpedo californica and from denervated rat muscle. After 20 to 30 days, lymphocytes from regional lymph nodes (primary cells) were challenged with soluble AChR in vitro. The activated blast cells were isolated by density gradient centrifugation and allowed to revert back to small secondary lymphocytes in the absence of antigen. These secondary anti-AChR cells were highly responsive to the type of AChR with which they had been primed. Their reactivity critically depended on help by syngeneic accessory cells. Anti-Electrophorus AChR primary and secondary cells cross-reacted detectably with rat AChR and vice versa, whereas anti-Torpedo AChR primary and secondary cells did not significantly cross-react with Electrophorus or rat AChR. Secondary T cells strongly reactive against rat AChR could be selected in vitro from Electrophorus AChR-primed populations by using rat AChR as selecting stimulant. These cells responded equally well against Electrophorus and rat AChR and thus include autoreactive T cell clones.

Animals↗