Spectrum of in vivo and in vitro cell-mediated immune responses in coccidioidomycosis.

The cell-mediated immune responses of 12 healthy, coccidioidin skin-test positive subjects (Group I) were compared with those of 15 healthy, coccidioidin skin-test positive persons who had primary asymptomatic coccidiodomycosis, (Group II), 12 patients with active, pulmonary coccidioidomycosis (Group III), four patients with disseminated disease (Group IV), and five patients who had been in clinical remission for 1 year or longer (Group V). Lymphocytes from healthy subjects in Groups I and II responded in vitro to Coccidioides immitis antigen by undergoing an increased DNA synthesis (lymphocyte transformation) and/or by producing macrophage migration inhibitory factor (MIF). In contrast, patients in Groups III and IV failed to respond to Coccidioides antigens in vivo (skin tests) or in vitro (lymphocyte transformation and production of MIF). The responses of subjects in Group V with inactive disease fell in between those of healthy donors in Groups I and II and patients in Groups III and IV. The cellular immune defect, in terms of antigen recognition, appeared to be specific for C. immitis in all but one patient.     

Therapy of cytomegalovirus retinitis with transfer factor

A renal transplant recipient who was rapidly losing his vision due to cytomegalovirus (CMV) retinitis was treated with transfer factor (TF). TF was prepared from lymphocytes of a subject with CMV mononucleosis who had cell-mediated immunity to CMV as assayed by lymphocyte transformation ([³H] thymidine uptake) and migration inhibitory factor (MIF) production. Within 2 mo of initiation of TF therapy, all of the patient's foci of retinal inflammation became inactive. This was his second episode of acute retinitis within 4 yr. The first one required reduction in the dose of immunosuppressants to achieve remission, whereas during the present exacerbation, immunosuppressants were maintained at a pre-TF therapy dosage. It is of interest that immediately after initiation of TF, a previously quiescent area of retinitis became inflamed; however, after several additional doses of TF, this reactivation subsided. In addition, the patient developed (though transiently) a positive delayed skin test to one of the antigens (SK-SD) to which the donor of the TF was sensitive, and although lymphocyte transformation by CMV antigen remained negative, there was evidence of MIF production. Finally, the patient's urine CMV titer declined from persistently high titers of 10^3.5 to 10^4.5 TCID₅₀ to a titer of 10^0.5 TCID₅₀, which was the lowest observed during the 4 yr of study. We conclude that it is unlikely that these findings were due to chance. TF should receive wider clinical trials in certain viral infections, particularly in immunosuppressed hosts.     

Transfer of cell-mediated immunity with cell-free leukocyte extracts: II. Demonstration of antigen-specific and nonspecific components

Transfer of cell-mediated immunity was achieved with dialyzable cell-free extracts from lymphoid cells of mice primed to the contact sensitizing agent, 2,4-dinitrofluorobenzene (DNFB). The biological activity of the extract (Transfer Factor, TF) was analyzed in vivo by the ear thickness assay and in vitro by the macrophage migration inhibition (MMI) test and lymphocyte transformation using the soluble analog, sodium 2,4-dinitrobenzenesulfonate. Consistently positive responses occurred 20 hr following a single intravenous injection of 5 × 10⁷ lymphocyte equivalents per recipient. The most potent source of TF (memory TF) was lymph node cells obtained 30 days after primary exposure to DNFB. By contrast TF prepared at the peak of the response to DNFB was less potent which was shown to be due to the presence in it of a suppressor factor. Memory TF elicited macrophage inhibition factor production in naive lymph node cells whereas positive responses were only obtained in the ear thickness and lymphocyte transformation assays provided recipients had undergone prior subliminal sensitization. Specificity of TF was tested using picryl chloride and oxazolone as control antigens. Results from the MMI and ear thickness assays were consistent with the presence in Transfer Factor of an antigen-specific component. Its effects, however, on the proliferative response to antigen lacked specificity and depended on prior sensitization of recipients, rather than donors, to the inducing antigen. The target of the specific component was considered to be an Ly-1⁺, Ia^?, $\text{Ly}\text{2}\text{3}{}^{\mathrm{?}}$ T cell since MIF production and in vivo delayed hypersensitivity are known to be mediated by a T cell bearing this phenotype. Taken together these findings emphasize the value of using a battery of tests of cell-mediated immune function when studying soluble mediators such as Transfer Factor and suggest that the current system is a valid experimental model for analysis of the Transfer Factor phenomenon.     

Transfer factor prevents relapses in herpes keratitis patients: A pilot study

Transfer Factor is a dialysable moiety obtained from immune lymphocytes. It has been successfully used for the treatment of several viral infections including labial and genital herpes. In the present study, thirty-three patients with low immune response to HSV antigens and suffering from herpes ocular infections were orally treated with HSV-specific transfer factor (TF). Their relapse index was reduced from 20.1 before treatment to 0.51 after TF administration, with only 6/33 patients relapsing. Although this is not a placebo-controlled-randomized study, the results suggest that TF specific for HSV antigens may be efficacious for preventing relapses of ocular herpes infections as has been the case with genital and labial localisations.Abbreviations CMI Cell-mediated immunity - CMV Cytomegalo-virus - EBV Epstein-Barr virus - HIV Human immunodeficiency virus - HK Herpes keratitis - HSV Herpes simplex virus - IRI Individual relapse index - KU Kerato-uveitis - LMT Leucocyte migration test - LST Lymphocyte stimulation test - MIF Migration inhibition factor - RHK Relapsing herpes keratitis - TF Transfer factor     

Human T lymphocytes become glucocorticoid-sensitive upon immune activation

A murine model for Transfer Factor (TF) was used in an attempt to identify the nature of its antigen-specific component. TF was prepared from lymph node cells of CBA/Ca/T6 mice sensitized 30 days previously with 2,4-dinitrofluorobenzene (DNFB). To assay for the specific component of TF, 2 × 10⁷ lymphocyte equivalents were injected intravenously into normal syngeneic recipients. Lymph node cells obtained 18–24 hr later gave a positive response in the macrophage migration inhibition (MMI) test in the presence of the soluble analog of DNFB (sodium 2,4-dinitrobenzenesulfonate). The activity of TF was abrogated by absorption with anti-Ia sera including both an Ia alloantiserum (A.TH anti-A.TL) and a xenogeneic rabbit anti-serum which exclusively recognizes carbohydrate-defined Ia antigens. Analysis by paper chromatography using the technique for purification of carbohydrate-defined Ia antigens revealed that MIF production was obtained exclusively with those fractions known to contain Ia antigenic activity. In addition, pretreatment of TF with insoluble conconavalin A (Con A) which has an affinity for carbohydrate-defined Ia antigens resulted in removal of its activity. Taken together these findings pointed to the presence in TF of I-region gene products. Absorption with antibody directed against the dinitrophenyl determinant abolished the capacity of TF to stimulate macrophage inhibition factor production suggesting that it might also contain antigen fragments possibly in association with Ia. No evidence was, however, obtained for H-2 restriction of the action of TF in vivo since it was found to exert an effect in a variety of strain combinations including A.TH and Balb/c which share no known common I-region specificities. Parallel experiments were carried out with the lymphocyte transformation assay since this is known to be a measure of the nonspecific components in TF. Pretreatment with mouse allo-anti-Ia^k serum directed against both protein-and carbohydrate-defined Ia antigens caused a partial reduction in the proliferative response. In contrast no change in response was observed when the TF was absorbed with insoluble Con A or anti-DNP serum. Furthermore, lymphocyte transformation was obtained with only one of the three paper chromatography fractions positive in the MMI assay as well as two other different fractions. Taken together, these findings permitted a distinction to be made between specific and nonspecific components of TF and indicated that the specificity of TF could be explained in terms of the presence of I-region gene coded products possibly in association with antigen fragments.     

Transfer factor and cellular reactivity to varicella-zoster antigen in childhood leukemia

The present studies were designed to evaluate possible efficacy of specific human transfer factor (TF) in preventing or attenuating varicella-zoster (VZ) infection in children with acute lymphocytic leukemia (ALL). TF was prepared following leukapheresis of adult donors who were convalescing from chicken pox. Recipients were VZ seronegative children with ALL, 12 in remission and 3 in relapse; a single injection of TF was given equivalent to 10⁸ lymphocytes per 7 kg body wt. The following VZ-specific parameters were measured: lymphocyte blastogenesis, cytotoxicity and leukocyte inhibitory factor (LIF) production, and indirect fluorescent and CF antibody titers. No patients in relapse converted immune response while $\text{10}\text{12}$ in remission developed positive reactivity in at least one assay of cell-mediated immunity (CMI); $\text{3}\text{12}$ were positive in all three parameters of CMI and $\text{8}\text{12}$ in two assays. Cytotoxicity was the most consistently positive test following TF administration. No patients developed VZ antibody. Seventeen months follow-up has demonstrated persistent cellular immunity.     

Production of macrophage migration inhibitory factor and lymphotoxin by leukocytes from normal and Wiskott-Aldrich syndrome patients

The production of macrophage migration inhibitory factor (MIF) and lymphotoxin (LT) by cultured leukocytes from patients with Wiskott-Aldrich syndrome (WAS) and normal controls was studied. The presence of these lymphokines in leukocyte culture supernatants usually correlated directly with the dose of stimulant used. Doses of nonspecific mitogens and specific antigens, which produced maximal in vitro lymphocyte transformation, stimulated maximal production of these mediators. When the incorporation of tritiated thymidine by stimulated leukocyte cultures from patients with Wiskott-Aldrich syndrome (WAS) was deficient, they usually produced less MIF and lymphotoxin than normal. However, when their in vitro lymphoproliferative responses were normal, the lymphotoxin activity in supernatants of WAS leukocyte cultures was normal.     

In vitro studies during long term oral administration of specific transfer factor

153 patients suffering from recurrent pathologies, i.e. viral infections (keratitis, keratouveitis, genital and labial herpes) uveitis, cystitis, and candidiasis were treated with in vitro produced transfer factor (TF) specific for HSV-1/2, CMV and Candida albicans. The cell-mediated immunity of seropositive patients to HSV-1/2 and/or CMV viruses was assessed using the leucocyte migration inhibition test (LMT) and lymphocyte stimulation test (LST) in presence of the corresponding antigens, and the frequency of positive tests before, during and after TF administration was studied. The data were stratified per type of test, antigen and the recipients’ pathology, and statistically evaluated. For the LMT, a total of 960 tests were carried out for each antigen dilution, 3 different antigen dilutions were used per test. 240/960 tests (25.4%) were found positive during non-treatment or treatment with unspecific TF, whereas 147/346 tests (42.5%) were found positive when the antigen corresponding to the specificity of the TF administered to the patient was used (P<0.001). When the data were stratified following pathology, a significant increased incidence of positive tests during specific treatment was also observed (0.0001<P<0.05). In the LST (1174 tests), a significant increase of thymidine uptake was observed in the absence of antigen (control cultures), during treatment with both specific and unspecific TF, but also in the presence of antigen and/or autologous serum during specific TF administration (P<0.0001). TF administration also significantly increased the soluble HLA class I antigens level in 40 patients studied to this effect.     

Suppression of cellular immune responses following transfer factor: Report of a case

A girl with chronic mucocutaneous candidiasis and recurrent staphylococcal infections had abnormal cellular immunity and defective granulocyte chemotaxis. Administration of dialyzable transfer factor caused conversion of the candida skin test and MIF production by candida-stimulated lymphocytes but had no effect on granulocyte chemotaxis and produced no clinical benefit.Nine months later, while her cellular immunity was still intact, she received four additional doses of dialyzable transfer factor. Following these injections, the delayed skin tests and antigen-induced lymphocyte transformation and lymphokine production temporarily became negative. There were no effects on granulocyte chemotaxis.These observations suggest that transfer factor may have both suppressive and activating immunologic activities.     

Human transfer factor: fractionation and biologic activity.

Human transfer factor (TF) was fractionated by exclusion chromatography and the fractions were tested for biologic activity in vivo and in vitro. Specific TF activity in vivo was found to reside in the major UV-absorbing peak (Fraction III). Fraction III eluted at 2.7 X V(O) and transferred tuberculin, candida, or KLH-reactivity to previously negative recipients. Fraction III from nonreactive donors was ineffective. When the fractions were tested in vitro, we found that both the mitogenic activity of whole TF and the suppressive activity to mitogen activation when present in TF was found in Fraction I. Fraction III contained components responsible for augmentation of PHA and PWM responses. In addition, Fraction III contained the component responsible for antigen-dependent augmentation of lymphocyte transformation. Fraction IV was suppressive to antigen-induced lymphocyte transformation. These data suggest that TF preparations contain components which can affect immune reactions in both specific and nonspecific ways.     

Immune abnormalities associated with chronic mucocutaneous candidiasis

Twenty six patients with chronic mucocutaneous candidiasis (CMCC) have been studied. Four immunological patterns emerged.Five patients failed to produce migration inhibitory factor (MIF) in vitro although their lymphocytes were normally activated to DNA synthesis after challenge with candida antigen. Four of these patients were unable to mount delayed hypersensitivity (DH) reactions to candida antigen (CAg), purified protein derivative (PPD), or dinitrochlorobenzene (DNCB). The lack of DH in these patients is thought to reflect their inability to produce MIF.Another group of nine patients with absent DH to candida also failed to produce MIF after challenge with candida antigen. Their lymphocytes were, however, not activated in vitro by this antigen probably due to a factor present in their serum, which specifically inhibited candida induced transformation of lymphocytes from healthy individuals.Two patients were able to produce MIF in vitro but they were unable, nevertheless, to mount DH reactions. Furthermore, they did not show delayed inflammatory response to intradermal injections of a MIF preparation. It is postulated that these patients have defective macrophage function.In 10 patients no significant abnormalities in cellular or humoral immunity were revealed.It is concluded that chronic mucocutaneous candidiasis is a syndrome associated with several distinct immunological abnormalities. The pathogenesis of the syndrome is discussed and it is emphasized that chronic mucocutaneous candidiasis is a model which can be used for advancing our knowledge of the immune system.     

Macrophage migration inhibitory factor (MIF) is necessary for progression of autoimmune diabetes mellitus

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine of the innate immune system that plays a major role in the induction of immunoinflammatory responses. To examine the role of endogenous MIF in the pathogenesis of type 1 diabetes (TID) we evaluated the effects of administration of neutralizing anti-MIF antibodies to NOD mice with accelerated forms of diabetes induced by injection of cyclophosphamide or by transfer of diabetogenic spleen cells. Both accelerated forms of diabetes were markedly reduced by anti-MIF antibody. Furthermore, MIF-deficient (MIF(-/-)) mice were less susceptible to the induction of immunoinflammatory diabetes, insulitis and apoptosis within the endocrine pancreas by multiple low doses of streptozotocin (MLD-STZ) than genetically matched wild type (WT) mice. MIF deficiency resulted in lower proliferation and lymphocyte adhesion, as well as reduced production from the spleens and peritoneal cells of a variety of inflammatory mediators typically associated with development of the disease including IL-12, IL-23, TNF-alpha, and IL-1beta. Furthermore, MIF deletion affected the production of IL-18, TNF-alpha, IL-1beta, and iNOS in the islets of Langerhans. These data, along with the higher expression of IL-4 and TGF-beta observed in the periphery and in the pancreas of MLD-STZ-challenged MIF(-/-) mice as compared to WT controls suggest that MIF deficiency has induced an immune deviation towards protective type 2/3 response. These results suggest that MIF participates in T1D by controlling the functional activity of monocytes/macrophages and T cells and modulating their secretory capacity of pro- and anti-inflammatory molecules.     

In vivo and in vitro evaluation of cell-mediated immunity in patients with paracoccidioidomycosis

The cellular immune response to specific and nonspecific agents was investigated. both in vivo and in vitro, in 19 patients with paracoceidioidomycosis. In addition, the immunologic study of an investigator aceidentally inoculated with P. brasiliensis was included in this study. Nearly half of the patients showed depressed cell-mediated immune responses, as evaluated by intradermal tests with an antigenic preparation from P. brasiliensis (P.b.Ag.), ubiquitous antigens, and by the ability to develop sensitization to 2,4-dinitrochlorobenzene. A similar proportion of impaired responses was observed when the patients' lymphocytes were cultured with phytohemagglutinin (PHA). C'. albicans antigen and P.h.Ag. A factor was detected in the plasma of some patients which reduced the ability of patients' and normal lymphocytes to undergo blastic transformation. A positive correlation was found between the ability to develop delayed cutaneous hypersensitivity reactions to P.b.Ag. and other ubiquitous antigens, normal in vitro responsiveness to PHA and the absence of humoral blastogenic inhibitory factor. The inhibition of leukocyte migration, but not lymphocyte transformation, correlated positively with delayed hypersensitivity. The percentage of T lymphocytes was significantly reduced in the group of patients, being the absolute number and percentage of B cells bearing receptors tor complement normal. Two polar immunological patterns emerged. One characterized by positiveness in the skin test to P.b.Ag. and lack of significant abnormalities in cellular immunity, and another anergic to P.b.Ag., with cell mediated immunity severely depressed. Between the two polar groups, there were patients with intermediary patterns of immune response. This paper also includes the results obtained with the administration of transfer factor and levamisole to some of the patients.     

Leukocyte procoagulant activity in man: an in vitro correlate of delayed-type hypersensitivity

Human mononuclear leukocytes generate cell-bound procoagulant activity (LPCA) after incubation with an antigen (mumps or tuberculin) to which the donor was previously sensitized. An inhibitor of coagulation appears to be liberated into the extracellular culture fluid during incubation of leukocytes with the sensitizing antigen. Removal of this activity before measuring LPCA resulted in a reliable test that correlated directly with delayed skin reactivity. The assay was particularly sensitive in that cells from weakly sensitized donors who reacted only to high doses of tuberculin (100 TU) in the delayed skin tests produced detectable LPCA in vitro. By contrast cells from weakly sensitized donors did not react to PPD in the lymphocyte blast transformation test or the direct macrophage migration inhibition factor test. The LPCA assay correlated closely with the blast transformation and MIF tests in which cells were used from more strongly sensitized donors who reacted in skin tests with lower doses of tuberculin (1 or 10 TU). The assays were antigen-specific in that cells from donors sensitive to mumps antigen but not to tuberculin reacted only to mumps antigen in vitro. The assay was extremely reproducible; cells from individual donors reacted to the same extent over a period of 8 mo). We propose that the assay system reported here represents an improved method for the measurement of cell-mediated immunity in vitro because it requires fewer donor cells, is technically simpler, and is more sensitive than previously described methods.     

Lymphokines in sensitized rats. III. Influence of prednisolone treatment of lymph node and spleen architecture in sensitized rats and upon MIF release in vitro.

The influence of prednisolone (corticosteroid, C.S.) treatment upon established cell-mediated immunity (CMI) induced by complete Freund's adjuvant (CFA) has been studied in rats by using in vitro migration inhibitory factor (MIF) assays, type IV skin reactions, and regional lymph node and spleen histology. Additionally, changes in the mononuclear-polymorphonuclear ratio of peripheral blood and T-cell accumulation in bone marrow in response to C.S. treatment have been determined. These results have been evaluated by comparison with equivalent experiments upon animals treated with anti-rat lymphocyte serum (ALS), oxisuran, or 2-[(methylsulfinyl)-acetyl]pyridine, which selectively suppresses CMI. The results suggest the existence of a population of “educated” T-cells in the thymic cortex of sensitized rats, and they suggest that prolonged C.S. administration does not suppress T-effector cells involved in established CMI but, rather, affects lymphocyte and monocyte migration patterns, including the migration of educated T-cells from the thymic cortex into other tissue compartments.     

Immunology of histoplasmosis: Humoral and cellular activity from a polysacchari-de-protein complex and its deproteinized fraction in experimentally immunized mice

In a previous publication it was reported that a polysaccharide-protein complex (PPC), sensitive to -glucosidase, was isolated from Histoplasma capsulatum. This complex was strongly reactive in an agar gel diffusion assay with sera from patients with histoplasmosis, but was unreactive with sera from patients with coccidioidomycosis. Here, the studies with human sera have been expanded and attempts were made to determine the response of mice immunized with nonviable H. capsulatum or Cocccidioides immitis to PPC or its deproteinized fraction (D-PPC) using more sensitive tests for antibody and including also test for cell-mediated immunity. Histoplasmin and coccidioidin were compared with PPC or its deproteinized fraction (D-PPC) in all assays. In a counterimmunoelectrophoresis (CIE) assay, PPC and D-PPC reacted only with sera from patients with histoplasmosis, whereas cross reactions were noted with histoplasmin and coccidioidin using heterologous sera. Cross-reaction were observed with all four antigen preparations and both types of antisera using a micro complement fixation assay. The assay for macrophage migration inhibitory factor (MIF) was also relatively nonspecific, in that inhibition occurred with cells from animals sensitized with Histoplasma or Coccidioides using both homologous and heterologous antigens. In the footpad assay, histoplasmin and coccidioidin were highly cross-reactive in animals sensitized with the heterologous fungus, but the PPC and D-PPC from H. capsulatum elicited significant reactions only in animals sensitized with Histoplasma.     

Efficacy of transfer factor in treating patients with recurrent ocular herpes infections

Recurrent ocular herpes is an insoluble problem for the clinician. As cellular immunity plays an important role in controlling herpes relapses, and other studies have shown the efficacy of HSV-specific transfer factor (TF) for the treatment of herpes patients, an open clinical trial was undertaken in 134 patients (71 keratitis, 29 kerato-uveitis, 34 uveitis) suffering from recurrent ocular herpetic infections. The mean duration of the treatment was 358 days, and the entire follow-up period 189121 before, and 64062 days after TF treatment. The cell-mediated immune response to the viral antigens, evaluated by the lymphocyte stimulation test (LST) and the leucocyte migration test (LMT) (P<0.001), was significantly increased by the TF treatment. The total number of relapses was decreased significantly during/after TF treatment, dropping from 832 before, to 89 after treatment, whereas the cumulative relapse index (RI) dropped, during the same period, from 13.2 to 4.17 (P<0.0001). No side effects were observed. It is concluded that patients with relapsing ocular herpes can benefit from treatment with HSV-specific TF.     

Macrophage migration inhibitory factor (MIF): a key player in protozoan infections

Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine produced by the pituitary gland and multiple cell types, including macrophages (Mø), dendritic cells (DC) and T-cells. Upon releases MIF modulates the expression of several inflammatory molecules, such as TNF-α, nitric oxide and cyclooxygenase 2 (COX-2). These important MIF characteristics have prompted investigators to study its role in parasite infections. Several reports have demonstrated that MIF plays either a protective or deleterious role in the immune response to different pathogens. Here, we review the role of MIF in the host defense response to some important protozoan infections.     

Macrophage migration inhibitory factor in zinc-allergic systemic contact dermatitis

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine whose expression has been found to be critical to the generation of the antigen-specific immune response. Recent studies suggested that MIF plays a role in the initiation and maintenance of allergic disease. The aim of this study was to investigate whether MIF is involved in the pathogenesis of zinc-allergic systemic contact dermatitis. A 49-year-old Japanese woman developed facial edema, blepharedema and pruritic edematous erythema with papules over the entire body. Based of the results of a metal patch test, drug lymphocyte stimulating test and drug challenge test, diagnosis of zinc-allergic systemic contact dermatitis was made. Serum MIF and TNF-alpha levels of the patient, 20 healthy controls and other 6 patients who showed positive reaction to metal patch test were measured by an ELISA. Moreover we examined MIF production of peripheral blood mononuclear cells (PBMCs) from our patient, 3 healthy controls and other 2 patients who showed positive reaction to metal patch test at various metal concentrations. The patient's serum showed high MIF and TNF-alpha levels compared to healthy controls and other metal allergy patients. Furthermore, zinc stimulation of patient's PBMC showed higher MIF and TNF-alpha secretion compared with healthy subjects. The MIF content of 2 patients with other metal allergy was not significantly increased after metal stimulation. Our data suggest that zinc in the peripheral blood of zinc-allergic patients induce PBMCs to produce increased MIF levels, which could lead to systemic contact dermatitis.