Pépin, Bose, and Thoen reply.
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Biomedical subjects
Publications and source records attributed to J Thoen.
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Using the anti-TcR gamma/delta-1 monoclonal antibody and flow cytometry, we examined the number of T gamma delta cells in paired samples of peripheral blood and synovial fluid or tissue from 24 children with juvenile rheumatoid arthritis (JRA), five adult patients with JRA, and 14 patients with rheumatoid arthritis (RA). No significant difference was found in the synovial compartment T gamma delta values compared with the blood in JRA, adult JRA, or RA patients. Nor was any significant difference found in the peripheral blood or synovial compartment T gamma delta values in any of the three patient groups compared with the peripheral blood of normal controls. However, seven of the children with JRA had very high T gamma delta values in the synovial compartment while none of the normal children had high T gamma delta values in the blood (P = 0.02, Fisher's exact test). This may indicate a possible separate JRA patient group with high T gamma delta levels in the synovial compartment. In six JRA patients further analysed for T gamma delta subpopulations, a significant predominance of V delta 1+ cells was found in the synovial compartment compared with the corresponding peripheral blood samples (P less than 0.05, Wilcoxon's signed test) and with peripheral blood of child controls (P less than 0.05, Mann-Whitney U test). In these six patients, the T gamma delta-cell expression of the very early activation antigen CD69 were significantly higher (P less than 0.05, Wilcoxon's signed test) in the synovial compartment compared with the peripheral blood. Synovial T gamma delta cells expressing HLA-DR and interleukin 2 receptors could also be detected, in contrast to the peripheral blood in which no T gamma delta cells expressing these antigens could be found. These data suggest that the synovial T gamma delta cells had been activated in vivo.
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Mononuclear cells were eluted from synovial membranes of 39 patients with rheumatoid arthritis and 12 patients with juvenile rheumatoid arthritis. A considerable cell loss, about 50% or more, was seen during the various isolation steps. The CD4/CD8 ratio just after enzyme treatment (stage I) was significantly higher than at later stages, i.e. after removal of adherent cells (stage II, p less than 0.05) and after Isopaque Ficoll gradient centrifugation (stage III, p less than 0.01). This indicates a selective loss of CD4+ cells during isolation. In addition, stages I and II had higher CD4/CD8 ratios than peripheral blood of normal controls (p less than 0.01 and p less than 0.03), but not significantly higher than in peripheral blood of patients (p greater than 0.05). The CD4/CD8 ratio in eluted synovial membrane cells did not differ between patients with high and patients with low disease activity (p greater than 0.05). No correlation was found between any of the CD4/CD8 ratios and individual disease activity variables. Furthermore, a laboratory activity index and a disease outcome index were determined for each patient and no correlation was found between these indices and the CD4/CD8 ratios.
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The percentage of T4 and T8 positive cells in peripheral blood of 78 patients with rheumatoid arthritis (RA) and 26 patients with juvenile rheumatoid arthritis (JRA) was determined using a rosette technique. The T4/T8 ratio +/- SEM (standard error of the mean) in the RA patients was increased, 2.02 +/- 0.09, as compared with normal blood donors, 1.71 +/- 0.06 (p less than 0.02). The subgroups of RA patients who had a significantly increased T4/T8 ratio were ANA positive patients (p less than 0.02) and patients on no medication (p less than 0.05). In the total group of JRA patients the T4/T8 ratio was 2.01 +/- 0.12 versus 1.75 +/- 0.08 in controls (p = 0.061). Polyarticular JRA patients had an increased T4/T8 ratio as compared with controls (p less than 0.05) while patients with the pauciarticular form had a normal ratio (p greater than 0.10). No correlation between the T4/T8 ratio and a disease outcome index, a laboratory activity index, ESR, WBC, platelet count, hemoglobin, serum albumin, age and disease duration was found (K less than +/- 0.20, p greater than 0.10).
T-cell subpopulations and natural killer (NK) cells from peripheral blood, synovial fluid and synovial membranes from patients with seronegative spondyloarthropathies were investigated. Thirty-four patients with ankylosing spondylitis, sixteen patients with psoriatic arthropathy and six patients with pauciarticular juvenile chronic arthritis were studied. All the patient groups had normal proportions of T4+ and T8+ cells as well as normal T4/T8 ratios in peripheral blood. In the synovial fluids the T4/T8 ratios were reduced in ankylosing spondylitis and psoriatic arthropathy (p less than 0.05). Although both the T4 and T8 subpopulations were reduced, the T4/T8 ratios in the synovial membranes of patients with these two disorders tended to be within the normal range of that of peripheral blood. Increased numbers of T-cells in the synovial fluid from patients with ankylosing spondylitis expressed class II MHC antigens. The natural killer cell activity was normal in peripheral blood and synovial fluids of patients with ankylosing spondylitis and psoriatic arthropathy while it tended to be reduced, although not significantly, in pauciarticular juvenile chronic arthritis. Synovial membranes were almost devoid of NK cell activity. The number of Leu 7+ cells were reduced in synovial fluid of patients with psoriatic arthropathy (p less than 0.04), but not as significantly as in the two other patient groups.
The effects of piroxicam and D-penicillamine on T lymphocytes, NK cell activity and rheumatoid factor production as well as clinical parameters were studied in patients with rheumatoid arthritis. The level of total rheumatoid factor fell during treatment with D-penicillamine (p less than 0.02) and there was a positive correlation (K greater than 0.50, p less than 0.05) between this fall in rheumatoid factor and the improvement of several clinical activity parameters. No significant change was observed in the level of rheumatoid factor during treatment with piroxicam. Natural killer cell activity decreased from 21.1 +/- 2.5 to 15.8 +/- 1.9 after treatment with piroxicam for 3 weeks (p less than 0.05) as compared with changes in the controls. No change in natural killer cell activity was seen after treatment with D-penicillamine. Moreover, no significant changes in the numbers of T4+ and T8+ lymphocytes nor in the numbers of HLA-DR positive T cells were seen in the two treatment groups. Both laboratory and clinical activity parameters improved during the treatment with D-penicillamine, while only subjective parameters improved during treatment with piroxicam.
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NK cell activity and Leu 7+ cells were determined in mononuclear cells (MNC) from patients with rheumatoid arthritis (RA) and IgM rheumatoid factor positive polyarticular juvenile rheumatoid arthritis (JRA). NK cell activity was measured in a 51Cr release assay and the Leu 7 positive cells were enumerated in indirect immunofluorescence. The mean NK cell activity +/- SEM was reduced in MNC from peripheral blood (PB), synovial fluid (SF) and synovial membranes (SM's) of patients with RA, with the values of 19.5 +/- 1.4 (p less than 0.00003), 18.3 +/- 3.1 (p less than 0.009) and 2.9 +/- 0.5 (p less than 0.0003) respectively, compared with 26.1 +/- 1.4 in MNC from the PB of healthy controls. The mean percentages of Leu 7 positive cells in MNC from PB and SF on patients with RA were normal while the mean percentage of Leu 7+ cells in MNC eluted from SM's was significantly reduced as compared to that of MNC from PB of healthy controls (p less than 0.0006). In JRA similar results concerning NK activity and Leu 7 positive cells were found but the number of experiments was too low for statistical analysis. MNC from the SF, in contrast to that of BP and SM, had a significant cytotoxicity against the Raji cell line which is a non-NK cell target.
The stage of activation of synovial inflammatory T cells was studied in rheumatoid arthritis and compared with that of normal T cells stimulated in vitro by dendritic cells. Increased numbers of rheumatoid inflammatory T cells expressed activation antigens such as HLA-DR, interleukin 2 receptors (Tac), and transferrin receptors. These T cells also had high spontaneous proliferation. Peripheral blood T cells stimulated by autologous dendritic cells showed a similar expression of activation antigens and had high proliferation. Resting T cells and T cells cocultured with monocytes expressed much less activation markers. Exogenous interleukin 2 significantly increased the proliferation of the various T cells. All responses were inhibited by an antibody which blocks the interleukin 2 receptor. Supernatants from mitogen-stimulated rheumatoid inflammatory mononuclear cells and mitogen-stimulated T cells preactivated by dendritic cells usually contained less interleukin 2 than supernatants from mitogen-stimulated normal T cells. Furthermore, the various in vivo and in vitro-activated Tac-positive T cells, in contrast to nonactivated Tac-negative T cells from peripheral blood of patients and controls, significantly absorbed interleukin 2. The results indicate a turnover of interleukin 2 in rheumatoid inflammatory T cells comparable to that of T cells activated by dendritic cells.
Lymphocytes from peripheral blood (PB) and synovial fluid (SF) from 21 patients with rheumatoid arthritis (RA) and 18 patients with juvenile rheumatoid arthritis (JRA) were studied with respect to T cell phenotypes using monoclonal antibodies in a rosette assay. The percentage of HLA-DR positive T cells was counted in PB and SF using indirect immunofluorescence. Suppressor cell activity of T cells from PB and SF was investigated by measuring the immunoglobulin production by pokeweed mitogen (PWM) stimulated B cells mixed with T cells at various ratios. The mean T4/T8 ratio was significantly lower in SF than in PB of both RA and JRA patients (p = 0.0062 and p less than 0.0001 respectively). The mean percentages of HLA-DR positive T cells were elevated in SF compared with PB in both patients groups (p less than 0.03 and p less than 0.04 in RA and JRA patients respectively). Mean suppressor cell activity and helper cell activity of T cells from SF and PB of JRA patients was normal. Thus there seems to be a dichotomy between the number of T8+ cells and suppressor cell function in mononuclear cells from SF of patients with JRA. This indicates that a considerable proportion of the T8+ cells in the SF do not have suppressor functions.
Hand radiography of 200 patients with rheumatoid arthritis RA was repeated after an interval of 12 months. Twenty joints including ten metacarpophalangeal joints, eight proximal interphalangeal joints and two interphalangeal joints of the thumbs were assessed. The number of joints with erosion was recorded, being referred to as Erosion Score. Additionally, each joint was graded on a zero to five point scale and the gradings of the individual joints were summed to form a score referred to as Damage Score. The progression in these scores during 12 months was recorded. The radiological joint damage was found to develop rapidly during the first years after disease onset and to assume a slow rate of increase after 9 years of the disease. The results imply that the disease duration is a critical feature for therapeutic studies. We suggest that patients with disease duration of less than 36 months only are suitable for therapeutic trials of RA and that the follow-up time should be at least 18 months if radiological assessment is used.
Dendritic cells were isolated from peripheral blood, synovial fluid, and synovial tissue of patients with rheumatoid arthritis and from peripheral blood of healthy blood donors on the basis of semiadherence to plastic surfaces. The cells were compared with autologous peripheral blood monocytes with respect to their stimulating capacities in allogeneic and autologous mixed leukocyte reactions (MLR). Dendritic cells from the various compartments stimulated allogeneic T cells 6-14 times more than monocytes did. Dendritic cells also stimulated autologous T cells 10-24 times more than monocytes did. Evidence in favour of the dendritic cell as the major stimulating cell type in MLR was also found in mixed experiments in which various ratios of dendritic cells and monocytes were used as stimulator cells. Furthermore, the activating structures on the dendritic cells seem to be major histocompatibility complex class II antigens, since anti-HLA-DR antibodies inhibited the responses. The results, especially from the autologous MLR, indicate that dendritic cells are important accessory cells for the various immune responses in rheumatoid inflammation.
Fourteen patients with classical or definite rheumatoid arthritis were studied for the effect of piroxicam treatment on clinical parameters and cellular immunity. The treatment caused reduced disease activity as assayed by an augmented grip strength, reduced total stiffness, reduced duration of morning stiffness and reduced Ritchies articular index. No effect of the treatment was observed on the percentages of T8 and T4 positive cells nor on the natural killer (NK) cell activity in the peripheral blood mononuclear cells. In contrast, the treatment led to a reduction in the total amount of rheumatoid factor. Since rheumatoid factor is mainly produced locally in the inflamed synovial membranes, our results suggest an effect of piroxicam on the immune system locally but not in the peripheral blood.
The immune system is extremely complex. It comprises many different types of cells and their products. In patients with rheumatic diseases the immune system is activated and has disturbed regulation. It is also believed that immune reactions are involved in the pathogenesis of these disorders. Nonsteroidal antiinflammatory drugs (NSAID) have therapeutic effects on rheumatic diseases. These effects can all be explained by inhibition of prostaglandin production locally in the diseased joints, leading to reduced inflammation. Little or no effects on the number of circulating lymphocyte subpopulations or on peripheral blood mononuclear cell immune reactions can be seen after treatment of patients with rheumatoid arthritis (RA) with NSAID. The possibility, however, exists that immune reactions locally in the diseased joints are modulated by NSAID secondary to reduced prostaglandin production.