Infiltration of polymorphonuclear neutrophils (PMN) as well as lymphocytes is commonly observed at the sites of inflammation. However, it is still unclear whether PMN influence the function of lymphocytes. The current studies examined the effects of PMN upon immunoglobulin production. PMN did not significantly influence the IgM production by B cells stimulated with Staphylococcus aureus (SA)+IL-2 in the absence of T cells. By contrast, PMN significantly enhanced the IgM production induced by immobilized anti-CD 3 stimulated T cells. PMN also enhanced the interferon-γ (IFN-γ) production by immobilized anti-CD 3 stimulated T cells. PMN fixed by paraformaldehyde enhanced the IgM production and the IFN-γ production induced by immobilized anti-CD 3 as effectively as fresh PMN. These results indicate that PMN enhance the Ig production by upregulating the functions of immobilized anti-CD 3-activated T cells through direct cellular interaction with T cells.

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Rheumatoid factor (RF), an autoantibody against the Fc portion of denatured IgG, has long been recognized as an important biologic marker not only for rheumatoid arthritis but also for other auto-immune diseases.
In this study, we measured the level of serum RF in four patients with RF positive systemic vasculitis using laser nephelometry. Three patients were diagnosed as polyarteritis nodosa and the other patient was diagnosed as systemic vasculitis without the finding of typical necrotizing vasculitis from biopsies. In the result, we found that the level of RF paralleled the disease activity in these cases. When active phase of the disease, the level of RF showed very high, and after the treatment combined with plasmapheresis, corticosteroid and immunosuppressive agent, the level of RF decreased in acorrdance with CRP, ESR and clinical features. These suggested that RF was the disease specific marker for RF positive vasculitis and benefical informations for proper diagnosis and better treatment could be provided by measurement of the level of RF in patients with RF positive systemic vasculitis.

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Kawasaki disease (KD) is characterized by marked activation of immune system and generalized vasculitis including coronary arteritis, and the intravenous gammaglobulin therapy is recomended as the first line of the choices. However, in some fulminant cases the coronary arteritis progresses rapidly and extensively in the early phase of the disease despite of the aggressive high-dose gammaglobulin administration. Recent observations indicated that the vasculitis begins at the endotherial cells which are activated by several inflammatory cytokines and are adhered to by cytokine-activated cytotoxic immune cells. Thus, it is important for the prevention of coronary arteritis and the resultant coronary aneurysm to reduce the inflammatory cytokines in the plasma.
We reported here a 4-year-old girl with coronary arteritis which began on the 3 rd day of the disease. The patient was fulfilled the revised criteria of KD at the hospital admission. As the initial intravenous gammaglobulins (400mg/kg/day for 3 consecutive days and the subsequent 1g/kg single intravenous infusion) revealed ineffective, which was judged by echocardiograpy in the persistence of brightness of the slightly widened coronary artery, and by laboratory data, we conducted therapeutic approach of plasmapheresis (replacement of plasma with 5% albumin in saline) on 8-10th days of KD. Fever was down to normal range soon after the first plasmapheresis, and after the second pheresis CRP was reduced, and finally on the 10th day echocardiography demonstrated marked improvement of inflamed coronary artery.
The precise mechanism of the effective plasmapheresis is to be investigated, but it is possible that the removal of inflammatory cytokines from the plasma ceased the subsequent endotherial cell damage and coronary arteritis. Thus, the KD children unresponsive to intravenous gammaglobulins should receive plasmapheresis when coronary artery is involved on echocardiography and the laboratory markers of inflammation are persistently increased.

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Recently, genotyping of HLA class II alleles by digestion of polymerase chain reaction (PCR) amplified polymorphic DNA region with restriction endonucleases (PCR-RFLP) has been reported and claimed to be a simple and reliable technique. We tested the use of PCR -RFLP for genotyping of DQA 1, DQB 1, DPB 1 and DRB 1 alleles of 40 normal individuals and 19 patients with systemic lupus erythematosus (SLE). In agreement with previous reports, we observed an association of SLE with the DRB 1*1501-DQA 1*0102-DQB 1*0602 haplotype and noted an unreported association with DPB 1*0501. Although these observations must be confirmed with larger sample sizes, we believe that the PCR-RFLP is simpler and more practical than the sequence-specific oligonucleotides (PCR-SSO) for genotyping and can be invaluable to the more widespread molecular determination of HLA-class II specificities, including in non-specialized laboratories.

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This paper reports a rare case of the limited form of Wegener's granulomatosis (WG) with pulmonary giant bulla, which was pathologically identified only in the lung and showed a high level of soluble intercellular adhesion molecule-1 (ICAM-1) but not anti-neutrophil cytoplasmic antibody (ANCA).
A 46 year-old male was admitted for the further examination of right anterior chest pain and dyspnea. Chest X-ray and CT examination showed giant bulla accompanied with the invasive lesions in upper lobe of right lung. Partial lobectomy was done. Granulomatous and necrotizing vasculitis characteristics of WG were confirmed by the histopathology of resected tissues.
Immunological analysis on admission showed a high level of soluble ICAM-1 and ANCA negative, but that of soluble ICAM-1 was reduced after surgical operation and remained within normal range during an administration of prednisolone and cyclophosphamide.
These results suggest that soluble ICAM-1 may be one of the useful parameters for a diagnosis of WG and for an estimation of its treatments, especially in the cases of ANCA negative WG.

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A 43-years-old woman was admitted to the Hokkaido University Hospital because of high fever, muscle weakness and dyspnea in May 1993. She had had muscle weakness of upper extremities since December 1992. She had developed swollen hand, polyarthralgia and Raynaud's phenomenon. High fever and severe dyspnea developed in May 1993. Chest roentogenogram was normal in April 1993. Physical examination showed Velcro rales in both lower lung fields. Her laboratory data showed incrased muscle enzymes, high titers of anti-nuclear-antibody (1:1280) and anti-RNP-antibody (index 199.4 (normal<7)). Anti-DNA, anti-Sm and anti-Jo-l-antibodies were all negative. Blood gas analysis showed severe hypoxemia. Chest roentogenogram revealed diffuse bilateral interstitial infiltrates prominent in the bases. Diagnosis of mixed connective tissue disease with acute interstitial pneumonitis was made. She was treated with steroid pulse therapy (methylprednisolone 1g×3 days) followed by high dose oral prednisolone (60mg/day), and diffuse interstitial infiltrates disappeared within one week. Prednisolone could be tapered to 17.5mg/day without relapse.
Acute interstitial pneumonitis is a rare complication of mixed connective tissue disease, but may be life threatning. In such cases, high dose steroid therapy should be started without delay.

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