Immunological studies in acquired immunodeficiency syndrome. Functional studies of lymphocyte subpopulations.

The lymphocyte transformation response in vitro to mitogens (phytohaemagglutinin, concanavalin A, and pokeweed mitogen) and antigens (purified protein derivative and tetanus) was studied in three patients with acquired immunodeficiency syndrome (AIDS), three patients with pre-AIDS, and six healthy controls before and after depletion of T4- or T8-positive cells. In controls, T8-depleted lymphocytes responded as well as peripheral blood mononuclear cells (PBMC) when monocytes were added, whereas T4-depleted cells gave about 50% of this response to mitogens and no response at all to antigens. No evidence of suppression was seen when various mixtures of T4- and T8-depleted cells were made. In particular, there was a virtually linear relationship between the percentage of T8-depleted cells and the response to antigens. The PBMC of all AIDS and pre-AIDS patients had very low or absent responses to mitogens and antigens, and except in one case, this response did not increase after depletion of T8-positive cells (and addition of monocytes), indicating that these patient cells also lack suppressor activity in this assay. However, a significantly increased response to mitogens was seen when the T8-depleted suspensions were adjusted to contain 20,000 T4-positive cells per well, but the response was still significantly lower than that of similar suspensions from controls. Thus, not only are the poor responses of PBMC from AIDS and pre-AIDS patients due to a low concentration of T4-positive cells, but the responsiveness of these cells also seems deficient. Furthermore, T8-positive patient cells also have an impaired responsiveness. Our experiments do not exclude the possibility that the low response is due to a T8-negative suppressor cell, but it seems more likely that both the T4- and the T8-positive cells are deficient and/or that there is a deficiency in accessory cells. These possibilities are currently under study.