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Plasma levels of the soluble fragments of Fc epsilon RII/CD23 (sCD23/IgE-binding factor) were measured to assess the level of activation of B lymphocytes associated with Epstein-Barr virus infection in 28 patients who received living-related liver transplantation and were treated with FK506 and steroids. In 6 patients with symptoms of EBV infection (EBV-related disorders), the plasma concentration of sCD23 increased to more than 9.8 ng/ml at the onset of symptoms. In a patient with B cell lymphoma, the plasma levels of sCD23 increased significantly when peripheral lymphadenopathy was noticed, and remained more than 10 ng/ml during the terminal period. In 4 of 6 patients, the increase of plasma levels of sCD23 preceded the increase of anti-EBV capsid antigen IgM. In the other 2 of 6 patients, there was no significant increase of the antibody, despite the integration of EBV DNA in the mononuclear cells in their ascites. The plasma levels of sCD23 of the patients without symptoms of EBV infection did not exceed 7.5 ng/ml. In contrast, the proportion of CD20+/CD23+ B lymphocytes in peripheral blood mononuclear cells was not significantly different in the patients with EBV-related disorders and those with latent asymptomatic EBV infection. Therefore, the plasma level of sCD23 is a sensitive and useful marker of EBV-related polyclonal and/or monoclonal B cell proliferation in transplanted patients with immunosuppression.

A high incidence of multiple primary neoplasms has been observed in our patients with ATL in comparison to persons with other forms of hematologic malignancy who we have observed during the past 23 years (1963-1985). Five of 15 patients with ATL (33.3 per cent) have had at least one other associated neoplasm in comparison to only 44 of 1156 patients with other forms of hematological malignancy (3.8 per cent). The incidence figures for secondary neoplasms associated with the other hematologic malignancies were 4.3 per cent (16/370) for acute non-lymphocytic leukemia (ANLL), 2.2 per cent (2/90) for acute lymphocytic leukemia (ALL), 4.8 per cent (1/21) for acute unclassifiable leukemia, 2.2 per cent (5/225) for chronic myelogenous leukemia, 4.7 per cent (2/43) for chronic lymphocytic leukemia, 5.9 per cent (8/136) for malignant monoclonal gammopathy and 3.7 per cent (10/271) for malignant lymphoma. The incidence of multiple neoplasms in patients with ATL in comparison to those with other hematological malignancies was statistically significant (p < 0.01 or p < 0.001). The neoplasms associated with ATL have been adenocarcinoma of the thyroid or stomach, and squamous cell carcinoma of the larynx, lip or lung. We identified ATL-derived factor (ADF) in the cytoplasm of the secondary neoplasms of the ATL patients by means of indirect immunofluoroscopy and immunohistochemical techniques utilizing anti-ADF antibody. We also identified ras p21 products in these neoplasms by means of p21 ras monoclonal antibody studies. The possibility that HTLV-I was the cause of the secondary neoplasms thus was investigated. HTLV-I provirus genome was not found in all the six cases of non-ATL leukemic cells of the patients with anti-HTLV-I antibodies as determined by means of Southern blot analysis utilizing pX DNA probe. These findings suggest that there is some association between ATL cells and pre-malignant cells through ADF or other unknown factors in the activation of ras oncogenes. Subsequent suppression of host immune defence mechanisms in ATL patients permits evolution of the secondary neoplasms.

Adult T-cell leukaemia (ATL)-derived factor (ADF), originally described as an inducer of interleukin-2 receptor-alpha (IL-2R alpha/Tac), has homology with the co-enzyme thioredoxin which is involved in many dithiol-dependent reducing processes. Using antibody against the C-terminal synthetic polypeptide of ADF and RNA probe of ADF, we examined the expression of ADF in various cell lines by immunofluorescence, immunohistochemical staining, Western blotting and in situ hybridization. ADF was intensely expressed on HTLV-I+ T-cell lines as compared with HTLV-I- T-cell lines. While the Epstein-Barr virus (EBV)+ B-lymphoblastoid cell lines were intensely positive for ADF, Burkitt-derived B cell line Jijoye with defective EBV was negative for ADF. Electron microscopic and photomicroscopic analysis of HTLV-I+ ATL-2 cells showed that ADF was localized on both the cell membrane and cytosol. In ATL-2 cells, a marked heterogeneity of ADF expression was observed. In in situ hybridization, heterogeneity of ADF messenger RNA (mRNA) expression was also demonstrated, indicating that ADF expression was regulated in the transcriptional level.

Using KOLT-2 monoclonal antibody (mAb) recognizing a 44,000 molecular weight (MW) T-cell activation antigen (CD28), we observed the co-expression of KOLT-2 (CD28) antigen and Tac (CD25) antigen, associated with a 55,000 MW chain of the interleukin-2 receptor (IL-2R) complex. IL-2R (p55), on several T-cell lines transformed by human T-lymphotropic virus-I (HTLV-I), as well as several subclones of the natural killer (NK)-like cell line YT. When YT cells (YTC3T, YT5.1) and IL-2-dependent HTLV-I+ T-cell line cells (ED, ATL35C) expressing both IL-2R (p55) and IL-2R (p70) chains were cultured with recombinant IL-2 (rIL-2), KOLT-2 antigen was down-regulated in 24 hr. However, KOLT-2 antigen on HPB-ALL (Kurume) cells expressing neither of the IL-2R chains was unaffected by IL-2. IL-2 also failed to down-regulate KOLT-2 antigen on MT-1 cells bearing IL-2R (p55)/Tac without IL-2R (p70). To clarify the role of IL-2R (p70) in the IL-2-induced down-regulation of KOLT-2 antigen, we analysed the effect of IL-2 on a Tac- subclone of YT (YT2C2) that expresses IL-2R (p70). As was the case with Tac+ YT cells, KOLT-2 antigen was down-regulated by IL-2, and this down-regulation was inhibited by anti-IL-2R (p70) mAb but not by anti-Tac mAb. These results show that the signalling through the IL-2/IL-2R system down-regulates KOLT-2 (CD28) antigen by way of the interaction between IL-2 and IL-2R (p70), irrespective of IL-2R (p55)/Tac. Possible involvement of the IL-2/IL-2R system in the CD28-mediated mitogenic mechanism is discussed.