Rene J. Duquesnoy

Immunologically mediated disease of the airways after pulmonary transplantation

Obliterative bronchiolitis has occurred in eleven of 30 recipients of cardiopulmonary allografts who survived at least 4 months after transplantation, has caused significant morbidity, and has been associated with four of eleven late deaths in this series. Although some improvement, or at least stability, of pulmonary function has followed augmented immune suppression, it appears that once the process is recognized clinically, much of the damage to the airways is irreversible. The histopathology, response to therapy, and, most important, the response of donor specific alloreactivity in the lymphocytes from the lung (bronchoalveolar lavage and peripheral blood) suggest immune- mediated basis for bronchiolitis obliterans. The presence of donor specific alloreactivity detected by primed lymphocyte testing predicted obliterative bronchiolitis in five of six recipients (83% sensitivity, 91% specificity) was absent in ten of eleven recipients who have not as yet developed the process (negative predicted value of 91%). Currently, the presence of a positive primed lymphocyte test in the bronchoalveolar lavage of the cardiopulmonary recipient is an indication for early treatment by augmented immune suppression.

Population studies of the HLA-linked SB antigens

Using allogeneic T-cell recognition we have previously defined five new histocompatibility antigens designated “SB” antigens. To standardize typing for these antigens, cryopreserved, primed lymphocytes are now used as standard reagents and a technique of cluster analysis has been modified to score typing results objectively. Two primed lymphocyte reagents are used to define each SB antigen; although derived from independent responder-stimulator combinations, the concordance between the reagents is good (r is greater than 0.86). The SB-antigen distribution in a population of 215 normal donors is consistent with Hardy-Weinberg equilibrium of alleles of a single locus. Estimated gene frequencies ranged between 3 percent (SB5) and 36 percent (SB4) with 31 percent blanks. Analysis of association between the SB antigens and A, B, DR antigens in 200 normal donors revealed that associations were generally weak with a few exceptions, in particular, the A1, B8, DR3, SB1 “haplotype” and also the B7, DR2, SB5 “haplotype”.

Serological and cellular definition of a new HLA-DR associated determinant, MC1, and its association with rheumatoid arthritis

A new serological HLA-DR associated determinant was defined by a cluster of six B cell alloantisera. This determinant, designated as MC1, was strongly associated with DR1 and DR4 and appeared unrelated to MB, MT, and SB. The antigen frequency of MC1 was 47% in Caucasoids and 43% in Blacks. Mixed leukocyte culture cloning yielded an alloreactive T cell clone with PLT specificity associated with MC1. We have also observed that certain alloreactive clones may also acquire expression of MC1 but not DR4 during long-term culture maintenance in the presence of DR4, MC1-positive feeder cells. Disease association studies showed a significantly increased frequency of MC1 in adult rheumatoid arthritis patients (93.5% vs 47.4% in normals; relative risk 16.1). These findings suggest that MC1 represents a novel HLA-D encoded determinant.

Association of PLT specificity of alloreactive lymphocyte clones with HLA-DR, MB and MT determinants

The HLA-D region encodes for several serologically defined systems, including DR, MB, and MT. The antigens of MB and MT are strongly associated with two or more DR specificities. The purpose of this study was to determine the role of MB and MT antigens in lymphocyte alloactivation. A soft agar colony assay was used to generate alloreactive lymphocyte clones primed in mixed leukocyte culture against a stimulator who typed as HLA-DR4,-;MB3,-; MT3,-. In secondary primed lymphocyte typing (PLT) assays, several clones were identified with PLT specificities strongly associated with DR4, MB3, or MT3. The data suggest that HLA-D controls different lymphocyte-activating determinants associated with the serologically defined DR, MB, or MT antigens.

Linkage disequilibrium of HLA-SB1 with the HLA-A1, B8, DR3, SCO1 and of HLA-SB4 with the HLA-A26, Bw38, Dw10, DR4, SC21 extended haplotypes

Homozygous typing cells from 13 normal HLA-A1, B8, Dw3, DR3 and five normal HLA-A26, Bw38, Dw10, DR4 individuals were typed for the following markers: HLA-SB, MB, MT; complement proteins BF, C2, C4A, C4B; and GLO. Ninety-one percent of A1, B8, Dw3, DR3 homozygous individuals (HI) tested were homozygous for BF*S, C2*C, C4A*QO, and C4B*1 (SCO1 complotype), which indicates that the SCO1 complotype is in linkage disequilibrium with the A1, B8, DR3 haplotype in randomly selected normal populations. Sixty-seven percent of HLA-A1, B8, Dw3, DR3, SCO1 positive HI also expressed SB1; since the frequency of SB 1 in random Caucasian populations is 11.2%, this finding indicates that SB1 is in linkage disequilibrium with the A1, B8, DR3, SCO1 extended haplotype. All HI with the A26, Bw38, Dw10, DR4 haplotype were homozygous for both SC21 and SB4, suggesting that SC21 and SB4 should be included in the A26, Bw38, Dw10, DR4 extended haplotype. On the other hand, neither of the GLO markers were found in association with either haplotype. The results of this study indicate that HLA-SB is included in some extended haplotypes and may be important in these markers for diseases such as insulin-dependent diabetes mellitus. This study also demonstrated an apparent influence of HLA-SB on primary mixed lymphocyte culture (MLC) responses. The mean relative response of primary MLCs between individuals matched for HLA-A, B, D, DR, MB and MT but not SB was 40% of that for the MLCs with mismatched HLA-D, significantly higher than the MLCs matched for all HLA and complotypes.

Detection of non-HLA-DR determinants by alloreactive lymphocyte clones☆

Using the soft-agar colony assay, we have generated three MT3-associated clones: HJ1, HJ13, and HJ39, from an MLR combination of two unrelated individuals. Another clone, HJ37, appeared to recognize a novel HLA-D determinant. PLT inhibition studies with monoclonal anti-Ia-like antibodies (Mab) were conducted on clones HJ1, HJ39, and HJ37. Five different anti-DR Mab had no significant inhibitory effect on these clones. On the other hand, two Mab SG171 and Q5/13 which appear to react with DR and MT3 (I-A like) molecules strongly inhibited the two MT3-specific PLT clones. While SG171 and Q5/13 had little effect on HJ37, it was observed that a polymorphic Mab 17.15 had a strong inhibitory effect. These results, in concordance with biochemical data on Ia molecules precipitated by these Mab, suggest that these alloreactive clones may recognize non-DR PLT determinants. They also provide further indirect support that MT3 molecules represent the human homologue of murine I-A molecules.

Immunogenetic analysis of the HLA complex with alloreactive T cell clones

Recently developed technologies to clone alloreactive human lymphocytes have provided a powerful tool for the immunogenetic analysis of the HLA region. Alloreactive T cell clones can be used as specific reagents for HLA encoded cellular determinants detected in secondary proliferation assays such as the primed lymphocyte test (PLT) and, in cell-mediated lympholysis (CML). Lymphocyte clones can also be used for functional assays (e.g., for suppressor or helper activity) to determine the influence of HLA specific restriction.

Immunogenetic analysis of the HLA-D region: Serological and cellular detection of the MB system

Abstract The HLA-D region contains three serologically defined systems: DR, MB, and MT. The antigens of MB and MT are strongly associated with groups of DR antigens. This study dealt with the detection of MB by lymphocytotoxicity testing using B cell alloantisera obtained from multiparous women. Selective absorptions of anti-MB and anti-DR sera have demonstrated that MB antigens are distinct and that DR antigens show no crossreactivity. Primed lymphocytes (PLT cells) were generated from mixed leukocyte cultures whereby the stimulator had one incompatible DR-MB combination. Frequently such PLT cells showed specificity not only for DR but also for MB antigens. The latter could be blocked by preincubation of the secondary stimulator with anti-MB serum. Also, it was possible to generate alloreactive lymphocyte clones with specificity for MB. These data suggest that MB antigens may function as lymphocyte-activating determinants. The immunogenetic relationship between DR, MB, and MT suggests a multilocus control of HLA-D region products involved with lymphocyte activation.

Detection of HLA-DR associated PLT determinants by alloreactive lymphocyte clones

This study deals with alloreactive T-cell clones which recognize cellular determinants associated with HLA-DR antigens. Two clones, CB55 and DS56, exhibited a PLT specificity that was perfectly associated with DR5. On the other hand, clones CB7, DS 1 and HS 1 showed PLT reactivity with approximately one-half of the DR5 positive cells and none of the DR5 negative cells, whereas clone MD4 largely reacted with the other half of DR5 positive cells. Another MLR culture generated two alloreactive clones DS6 and DS9 with PLT specificity for DR2. However, these clones did not respond to DR2 cells, which were also positive for the DR2-associated HLA-B7 and B18 antigens. Monoclonal antibody (mAb) inhibition studies showed heterogenous patterns, whereby monomorphic non-DR mAbs inhibited the DR2-associated PLT clones while the DR5-associated PLT clones were inhibited by different groups of anti-DR and non-DR mAbs. These observations suggest the existence of several lymphocyte-activating determinants associated with HLA-DR antigens. This diversity may be an important consideration in studies of the role of HLA-DR in immune mechanisms and transplant compatibility.

Heterogeneity of cytolytic and suppressor clones of alloactivated cells generated from soft agar colonies.

Long-term cell cultures (or clones) were developed from soft agar colonies of lymphocytes alloactivated in mixed leukocyte culture reaction (MLR). Two types of colonies were identified: upper colonies that grew on the agar surface, and lower colonies found within the agar layer. Virtually all cytolytic clones originated exclusively from the upper colonies. Two groups of cytolytic clones could be distinguished, one with strong and the other with weak proliferation upon restimulation. Upper clones were capable of inhibiting primary MLR proliferation and this appeared to be related to their cytolytic effect on the stimulator. Many noncytolytic lower clones were found to suppress primary MLR cultures. Considerable heterogeneity was apparent from differences in the magnitude of suppression and the ability of the clones themselves to undergo stimulator-induced proliferation. Kinetic studies of MLR suppression were conducted to further analyze this heterogeneity. Two major kinetic patterns were observed. One showed a biphasic proliferation pattern of the MLR + clone culture. The first peak appeared to reflect an enhanced proliferation of the clone. The second phase seemed to represent diminished proliferation of the MLR responder. This type of suppression may be related to T cell growth factor depletion from MLR by the proliferating clone. The other kinetic pattern showed a consistently low proliferation of the MLR + clone culture throughout the 8-day assay period. Subsequent testing of these suppressor clones in third-party MLR cultures suggested that the specificity of suppression was unrelated to HLA-DR, MB, MT, and SB.