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Pathogenic mechanisms of P. aeruginosa keratitis: a review of the role of T cells, Langerhans cells, PMN, and cytokines.

The aim of this article is to review our current understanding of the role of cytokines, chemokines, T cells, Langerhans cells, and neutrophils (PMN) and their interactions in vivo in the host response to Pseudomonas aeruginosa ocular challenge. The cellular/cytokine network in vivo has begun to be unraveled, and the data discussed provide substantive evidence for a regulatory role of CD4(+) T cells (Th1 type) contributing directly to persistence of PMN in the cornea of susceptible C57BL/6 (cornea perforates) versus resistant BALB/c (cornea heals) mice. Additionally, in the susceptible mouse model, CD4(+) T cells interact with Langerhans cells and B7/CD28 ligation appears critical for antigen presentation and the susceptibility response. Various cytokines and chemokines (e.g., MIP-1alpha, IL-1beta, MIP-2, IL-12, and IFN-gamma) and their pattern of sustained upregulation after infection in susceptible versus resistant mice also will be discussed in light of an in vivo cytokine network. T-cell-mediated pathogenic mechanisms are of importance in development of the susceptible response to P. aeruginosa ocular infection. In the absence of T-cell infiltration into the cornea, PMN do not persist in the stroma, and cytokines and chemokines are better balanced, resulting in decreased stromal destruction and the resistance response.

Animals↗

Internalization by receptor-mediated endocytosis of T6 (CD1 "NA1/34") surface antigen in T6 positive human cord blood cells (Langerhans cell precursors?).

A subset of T6 positive cells was recently separated from normal human cord blood mononuclear cells. It was shown to coexpress HLA-DR and myeloid differentiation antigens (Mo1, MY4). The phenotype and ultrastructure of the cells suggested that these T6 positive cells might be the precursors of the Langerhans cells of the skin. We have previously demonstrated by immunogold labeling techniques that the T6 surface antigen of human Langerhans cells of the skin is internalized in unfixed Langerhans cells or indeterminate cells by a process of receptor-mediated endocytosis. This process involved the formation of coated pits, coated vesicles, endosomes and lysosomes. Following this process, in Langerhans cells, gold labeled Birbeck granules appeared in the cell center often in continuity with endosomes. In the present study, we used an indirect immunogold labeling technique to reveal the T6 antigen present on the surface of living T6 positive cord blood mononuclear cells. We observed the internalization of the T6 surface antigen by a process of receptor-mediated endocytosis similar to that described in Langerhans cells of the skin. This process, however, was not followed by the appearance of intracytoplasmic Birbeck granules.

Antigens, Differentiation, T-Lymphocyte↗

A novel cell-surface molecule expressed by human interdigitating reticulum cells, Langerhans cells, and activated lymphocytes is a new member of the Ig superfamily.

cDNA isolated from a human lymphocyte library were analyzed and shown to encode a novel cell-surface glycoprotein, termed HB15, expressed by dendritic cell subsets and activated lymphocytes. The predicted mature 186 amino acid protein was composed of a single extracellular V-type Ig-like domain, a transmembrane region, and a 39-amino acid cytoplasmic domain. In contrast to most Ig-like domains, analysis of a partial genomic DNA clone revealed that the extracellular Ig-like domain of HB15 was encoded by at least two exons. Northern blot analysis revealed that HB15 derived from three mRNA transcripts of approximately 1.7, 2.0, and 2.5 kb expressed by lymphoblastoid cell lines. Two mAb reactive with HB15 were produced and used to show that HB15 is expressed as a single chain cell-surface glycoprotein of M(r) 45,000. HB15 expression was specific for lymphoblastoid cell lines and mitogen-activated lymphocytes, and HB15 was not expressed at detectable levels by circulating leukocytes. Immunohistologic analysis revealed that HB15 had a unique pattern of expression, being found predominantly in hemopoietic tissues with strong expression by scattered interfollicular interdigitating reticulum cells and weak expression by germinal center cells. HB15 was also expressed by Langerhans cells within the skin. HB15 therefore serves as a unique marker for the subset of dendritic cells represented by Langerhans cells and interdigitating reticulum cells. Thus, the HB15 glycoprotein represents a newly identified member of the Ig superfamily that may play a significant role in Ag presentation or the cellular interactions that follow lymphocyte activation.

Amino Acid Sequence↗

Quantitative studies on nonlymphoid mononuclear cell subpopulations in cutaneous infiltrates. I. Stage-related changes of dendritic nonlymphoid mononuclear cells, Langerhans' cells, and macrophages in lichen planus lesions.

In previous investigations on lichen planus, we suggested that in early lesions T4-positive cells might be antigen-specifically driven, whereas in late lesions T8-positive cells may be cytotoxic to keratinocytes. To verify this hypothesis, we investigated the following nonlymphoid mononuclear cell subpopulations in early versus late lichen planus lesions: interdigitating cells (phenotype: S100-positive, lysozyme-negative, T6-negative, M3-negative), Langerhans cells (phenotype: S100-positive, lysozyme-negative, T6-positive, M3-negative), macrophages (phenotype: S100-negative, lysozyme-positive, T6-negative, M3-positive). Interdigitating cells were moreover identified in semithin and ultrathin sections by distinctive morphological characteristics. The S100-positive/lysozyme-positive cell ratio was higher (p less than 0.01) in early lesions than late lesions. In dermis but not in epidermis (NS), of early lesions, T6-positive cells were less represented than S100 positive cells (p less than 0.025). Thus, Langerhans' cells largely predominated over interdigitating cells in epidermis, but the two populations were both represented in dermis. Lysozyme-positive and M3-positive cells, more abundant in late lesions than in early lesions (p less than 0.001), were often filled with pigment granules.

Antibodies, Monoclonal↗

Induction and regulation of contact hypersensitivity by resident, bone marrow-derived, dendritic epidermal cells: Langerhans cells and Thy-1+ epidermal cells.

Circumstantial evidence suggests strongly that epidermal Langerhans cells (LC) alone among epidermal cells (EC) are responsible for generating an immunogenic signal for contact hypersensitivity (CH) after epicutaneous application of hapten. However, data obtained from previous studies performed with intact skin or isolated EC do not address the immunogenic capacity of a second dendritic, bone marrow-derived population of cells that resides within the epidermis, Thy-1+ epidermal cells. To identify the cellular source(s) of the antigenic signals emerging from the epidermis, purified preparations of LC, Thy-1+ cells, and keratinocytes were prepared from CBA/J mouse skin. Each cell type was derivatized in vitro with TNBS and inoculated via various routes into syngeneic mice that were assayed for the induction of CH and specific unresponsiveness. IA+ LC, when derivatized with hapten and inoculated into mice, induced CH without evidence of down-regulation regardless of the route of immunization. Derivatized Thy-1+ EC did not deliver a positive signal for CH. Rather, Thy-1+ EC possessed the capacity to initiate down-regulation of the CH response when they were delivered i.v. We conclude that all cellular elements necessary for the induction and regulation of CH after epicutaneous application of hapten to skin reside within the epidermis. The resident, dendritic, bone marrow-derived populations within the epidermis have the capacity to determine the outcome of an epicutaneous antigenic encounter.

Animals↗

Differential distribution of ATPase- and T6-positive cells (Langerhans cells) in the limbus and cornea of Hereford and non-Hereford cattle.

Epithelial sheets from the limbus, cornea, and third eyelid of Hereford and non-Hereford cattle were examined for the presence of Langerhans cells (LC) using the membrane enzyme ATPase as a marker for LC. The aim of the study was to test the hypothesis that differences in LC density exist between the various ocular epithelia of these animals producing depressed immune surveillance in the case of Hereford cattle. The presence of LC in ocular tissues was confirmed by parallel studies which detected epithelial cells bearing T6, an antigen expressed by human LC. Studies using serial sections demonstrated that T6+ cells also reacted with an anti-human HLA-DR monoclonal antibody. The detection of T6+, DR+ and ATPase+ cells in ocular epithelium in the absence of infiltrating macrophages suggested that LC are present in these tissues. While there were no significant differences in the density of T6+ cells between non-Hereford and Hereford cattle, in the latter ATPase+ cells were significantly fewer in the lateral, medial, and upper limbus.

Adenosine Triphosphatases↗

Differentiation of Langerhans cells in Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) consists of lesions composed of cells with a dendritic Langerhans cell (LC) phenotype. The clinical course of LCH ranges from spontaneous resolution to a chronic and sometimes lethal disease. We studied 25 patients with various clinical forms of the disease. In bone and chronic lesions, LCH cells had immature phenotype and function. They coexpressed LC antigens CD1a and Langerin together with monocyte antigens CD68 and CD14. Class II antigens were intracellular and LCH cells almost never expressed CD83 or CD86 or dendritic cell (DC)-Lamp, despite their CD40 expression. Consistently, LCH cells sorted from bone lesions (eosinophilic granuloma) poorly stimulated allogeneic T-cell proliferation in vitro. Strikingly, however, in vitro treatment with CD40L induced the expression of membrane class II and CD86 and strongly increased LCH cell allostimulatory activity to a level similar to that of mature DCs. Numerous interleukin-10-positive (IL-10(+)), Langerin(-), and CD68(+) macrophages were found within bone and lymph node lesions. In patients with self-healing and/or isolated cutaneous disease, LCH cells had a more mature phenotype. LCH cells were frequently CD14(-) and CD86(+), and macrophages were rare or absent, as were IL-10-expressing cells. We conclude that LCH cells in the bone and/or chronic forms of the disease accumulate within the tissues in an immature state and that most probably result from extrinsic signals and may be induced to differentiate toward mature DCs after CD40 triggering. Drugs that enhance the in vivo maturation of these immature DCs, or that induce their death, may be of therapeutic benefit.

Antigens, CD↗

Langerhans cells in Langerhans cell granulomatosis are not actively proliferating cells.

Pulmonary Langerhans cell granulomatosis (LCG), also called histiocytosis X, is a disorder of unknown etiology characterized by the presence of destructive granulomas containing numerous Langerhans cells (LCs). The process may be localized or multifocal, and it remains unclear whether the same pathogenic mechanism is involved in all forms of the disease. It is often assumed that the massive accumulation of LCs at the sites of the lesions results from the abnormal proliferation of these cells, although it has been suggested that LCG in adults, at least in the lung, could be a reactive disorder initiated by activated LCs. Little is known, however, concerning the mechanisms responsible for the accumulation of large numbers of LCs in the course of the disease, and the relative contribution of recruitment and local proliferation of these cells remains to be established. To investigate this question, the proportion of replicating LCs was evaluated in biopsied granulomas from patients with localized or diffuse form of LCG by means of several histopathological techniques currently used in assessment of cell proliferation. The findings demonstrate that, except for proliferating cell nuclear antigen (PCNA), all parameters measured are low in all forms of the disease. They are similar to those of renewing epithelial cells and clearly less than those of neoplastic cells. These data strongly suggest that LCs in LCG granulomas are not a rapidly dividing cell population and that local LC replication makes only a minimal contribution to granuloma maintenance. Caution appears to be necessary in the use of PCNA as a marker of growth fraction.

Adenocarcinoma↗

Clonal proliferation of Langerhans cells in Langerhans cell histiocytosis.

X-chromosome-inactivation assays can be used to assess clonality. We used such an assay at the human androgen-receptor gene locus in three female patients with histologically proven Langerhans cell histiocytosis. All patients were heterozygous for this locus. Cells bearing the Langerhans cell phenotype were purified from involved tissue after fluorescence-activated cell sorting with monoclonal antibodies against the CD1a complex. After HhaI digestion of DNA, these CD1a positive cells demonstrated a non-random X-chromosome-inactivation pattern, whereas CD1a negative cells in the same tissue showed a random pattern. Our data suggest that Langerhans cell histiocytosis represents a clonal proliferation of cells bearing the Langerhans cell phenotype.

Antibodies, Monoclonal↗

Coincident expression of the chemokine receptors CCR6 and CCR7 by pathologic Langerhans cells in Langerhans cell histiocytosis.

It has been suggested that a switch in chemokine receptor expression underlies Langerhans cell migration from skin to lymphoid tissue. Activated cells are thought to down-regulate CCR6, whose ligand macrophage inflammatory protein-3 alpha (MIP-3 alpha)/CCL20 is expressed in skin, and up-regulate CCR7, whose ligands are in lymphoid tissues. In Langerhans cell histiocytosis (LCH), pathologic Langerhans cells (LCs) accumulate in several tissues, including skin, bone, and lymphoid organs. We have examined 24 LCH cases and find that pathologic LCs expressed CCR6 and CCR7 coincidentally in all cases. Furthermore, MIP-3 alpha/CCL20 is expressed by keratinocytes in involved skin and by macrophages and osteoblasts in involved bone. Expression of CCR6 by pathologic LCs may contribute to their accumulation in nonlymphoid organs such as skin and bone, whereas CCR7 expression may direct them to lymphoid tissue. Histiocytes in Rosai-Dorfman disease and hemophagocytic syndrome also coexpressed CCR6 and CCR7, suggesting that this may be a general attribute of abnormal histiocytes.

Chemokine CCL20↗

Langerhans' cell histiocytosis cells are activated Langerhans' cells.

Langerhans' cell histiocytosis (LCH) is characterized by the presence of large mononucleated cells, associated with inflammatory cells. The Langerhans' cell (LC) lineage of the mononucleated cells is suggested by the presence of Birbeck granules and the expression of CD1a. We investigated the presence of 14 markers expressed by normal LCs in vitro. Nine skin and one lymph node frozen biopsies of LCH children were analysed by in situ immunohistochemistry. The data were compared with six skin and five lymph node frozen biopsies. LCH cells of the ten samples were positive for all 14 LC markers. We observed three different groups of markers, according to the respective staining of normal LCs and LCH cells. Group 1 included DR, DQ, CD1a, CD1c, and ICAM-3. Markers of group 1 were present on the majority of both normal LCs and LCH cells. Group 2 included CD1b, CD4, LFA-1, LFA-3, CD32, and CD68. Markers of group 2 were detected on the majority of LCH cells, but only on a fraction of normal LCs. Group 3 included CD11b, CD24, and B7/BB1. Markers of this group were detected on LCH cells, but not on normal LCs. This in situ immunohistochemical study confirms that LCH cells belong to the LC lineage. The different clinical LCH syndromes had the same immunohistochemical staining. The expression of some markers of groups 2 and 3 is known to be related to the activation of LCs in vitro. Our study suggests that LCH cells are activated LCs.

Antibodies, Monoclonal↗

Imiquimod, a topical immune response modifier, induces migration of Langerhans cells.

Langerhans cells are bone marrow derived dendritic cells that represent the major antigen-presenting cells in the skin. Langerhans cells take up and process antigen within the epidermis and present processed antigen to T lymphocyte in the regional lymph nodes and thus form an integral part of the cutaneous immune response. The cutaneous immune response can be modified by a number of pharmacologic agents, including corticosteroids, cyclosporine, and retinoids as well as physical agents, such as ultraviolet light. For the most part these agents act by suppressing immune function. A topical immune response modifier, imiquimod has been shown to enhance the cutaneous immune response. Imiquimod has anti-viral and anti-tumor effects in animal models and has been approved for the topical treatment of external genital and perianal warts in humans. The biologic activity of imiquimod in part is due to its effect as a cytokine inducer. Preliminary data suggested that imiquimod could have an effect on Langerhans cells. In order to clarify this effect on Langerhans cells, we examined Langerhans cell morphology and migration in imiquimod-treated skin. The density of Ia + cells decreased 2 d after treatment, falling to approximately 43% by day 10. The Ia positive in cells remaining in the skin appeared larger and more dendritic suggesting an activated state. ATPase staining of epidermal sheet confirmed the decreased number of Langerhans cells. To clarify status of Langerhans cells, the activation of B7 was examined. Activation of B7-1 or B7-2 was not detected. Imiquimod, however, did enhance Langerhans cell migration from skin to draining lymph nodes. This enhanced Langerhans cell migration was also associated with an enhanced allergic contact hypersensitivity. These results suggest that the mechanism of modulation of immune response by imiquimod is in part due to effects on Langerhans cells.

Adenosine Triphosphatases↗

Langerhans cells in Langerhans cell histiocytosis and peripheral adenocarcinomas of the lung.

The present paper deals with more precise characterization of Langerhans cells (LC) and accompanying lymphocytes in lung LC histiocytosis (LCH) and primary lung peripheral adenocarcinomas using immunohistochemical methods with various kinds of monoclonal antibodies against cell adhesion and activation markers and some cytokines. Tissue specimens were obtained from 4 patients with pulmonary LCH and from 29 patients with primary lung peripheral adenocarcinoma. In florid (exudative and granulomatous) nonfibrotic LCH lesions, LC, particularly those in contact with lymphocytes, were S100, CD1a, MHC Class II, CD11a and c, CD16, and CD54 positive. In this context, LC were CD4+ and CD25+. Lymphocytes around LC were CD3+ with a "memory" phenotype (CD45RO+) and, frequently, CD25+ and HLA-DR+. S100+ and CD1a+ LC were commonly observed in adenocarcinomas subclassified as papillary and as nonmucinous bronchioloalveolar, in both cases mainly where Clara cells and Type II pneumocytes were present. In carcinomas the vast majority of LC were HLA-DR+ and, rarely, weakly CD16+, CD25+, and CD54+. The infiltration of reactive cells in cancer tissue was mainly represented by T lymphocytes (CD3+CD45RO+). These T cells were HLA-DR- and CD25-. The presence of LC was associated with a strong reactivity of epithelial cells with antibodies PE-10 and 439-9B, both recognizing molecules mainly expressed by Type II alveolar cells. Several cells in LCH florid lesions showed immunoreactivity for both IL-1 alpha and beta. Immunostaining for IFN-gamma revealed the presence in the same areas of some positive cells showing lymphoid morphology. No IL-1 or IFN-gamma reactivity was found in adenocarcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

Spatial relationship between Merkel cells and Langerhans cells in human hair follicles.

The distributions of Merkel cells and Langerhans cells within human hair follicles have been reported. However, there has been no description of the relationship between Merkel cells and Langerhans cells, which were discovered by 19th century German pathologists. Merkel cells and Langerhans cells share some similar characteristics such as the localization of human hair follicles, a close association with peripheral nerves and the expression of several neuropeptides. Merkel cells were stained with CK20 or CAM5.2, while Langerhans cells were stained with CD1a or S-100 protein. We thus immunohistochemically confirmed the preferential localization of Merkel cells and Langerhans cells in normal human hair follicles. Using a double staining technique, two- and three-dimensional observations demonstrated that a small proportion of Merkel cells were closely contacted with Langerhans cells below the sebaceous gland level, presumably indicating the bulge area. Merkel cells and Langerhans cells connected directly or approached each dendrite within the basal layer of the outer root sheath. For the first time, we demonstrated a close anatomical relationship between Merkel cells and Langerhans cells within the bulge area of human hair follicles where follicular stem cells may be present. These morphological observations suggest a functional interaction between follicular Merkel cells and Langerhans cells. We herein hypothesize that Merkel cells communicate with Langerhans cells by characteristic dendrites in which some neuropeptides or cytokines may be stored.

Hair Follicle↗

Biochemistry and biology of the Langerhans cell.

Langerhans cells mainly present in the normal epidermis and are thought to be identical to the proliferating cells in the lesions of histiocytosis-X. The Langerhans cell is positive not only for ATPase, esterase, and acid phosphatase, but also for S-100 protein. Since these findings are similar but distinct from those of monocytes and macrophages, the Langerhans cell may be a cell line independent of the monocyte-macrophage system, designated as T-zone histiocytes. Immunologically, the Langerhans cell has Fc and C3 receptors and Ia-like antigen. Thus, the Langerhans cell may be a member of the immune network, as antigen-presenting cells, in the epidermis. One hypothesis is that Langerhans cells activated by external stimuli induce a local immune reaction by activation and proliferation of T-cells, with the interaction of keratinocytes and macrophages. Because of cytochemical and immunologic similarities between Langerhans cells and histiocytosis-X cells, histiocytosis-X may be a proliferative disorder of immature or neoplastic Langerhans cells.

Histiocytosis, Langerhans-Cell↗

Epidermal Langerhans cells efficiently mediate CD1a-dependent presentation of microbial lipid antigens to T cells.

Langerhans cells are a critical component of skin immunity, capable of capturing protein antigens in the epidermis and presenting them to specific T cells in the context of major histocompatibility complex class II molecules. Recently, a major histocompatibility complex independent pathway of lipid antigen presentation has been identified and is mediated by molecules of the CD1 family (CD1a, CD1b, CD1c, and CD1d). Because Langerhans cells are professional antigen-presenting cells and express CD1a molecules prominently, we hypothesized that Langerhans cells might play a role in T cell responses directed against not only peptide antigens but also lipid antigens. Here, we show that freshly isolated immature Langerhans cells as well as mature Langerhans cells that have migrated from the epidermis are efficient in presenting foreign microbial lipid antigens to specific T cells whereas dermal dendritic cells express much less CD1a molecules and function inefficiently. Further, we found that Langerhans cells migrating from epidermal sheets that were exposed to microbial lipid antigens expressed lipid-antigen-loaded CD1a molecules on the cell surface, resulting in activation of specific T cells. These results underscore an outstanding ability of Langerhans cells to mediate CD1a-dependent lipid antigen presentation. Thus, Langerhans-cell-mediated skin immunity may involve T cell recognition of both peptide and lipid antigens.

Antigen Presentation↗