Abnormalities of B cell, helper T and suppressor T cell functions in a patient with common variable hypogammaglobulinemia

Common variable hypogammaglobulinemia (CVH) probably includes a variety of disorders, in that, B cell or helper T cell deficiency and suppressor T cell hyperfunction. A 24-year-old male had had recurrent eczema since his tender age. He had suffered from idiopathic thrombocytopenic purpura(ITP)at 11-year-old, peptic ulcer and colitis at 17-year-old, pyelonephritis at 18-year-old. He suffered from liver damage and ITP at 21-year-old and was given glucocorticoid and thrombocyte infusion. Since Dec’ 1980, he was taken pneumonia and low immunoglobulin level was found. The quantitative immunoglobulin levels were IgG 126, IgA, 3, IgM 29, IgD 1 (mg/dO, IgE 14 IU/m1. Peripheral lymphocyte counts were normal and T: B ratio was 72: 26 (control 68: 32). The patient had delayed hypersensitivity skin reactions for PHA and SK-SD. His lymphocytes responded to in vitro stimulation by PHA or Con A. Ig production in vitro by PWM-stimulated lymphocytes from the patient was examined. Coculture of B cells from the patient and T cells from normal resulted in reduced synthesis of all classes of Ig. Combination of the patient T cells and normal B cells also gave low Ig synthesis and X-ray treatment of the patient T cells did not enhance Ig synthesis. Moreover, coculture of normal lymphocytes and patient T cells resulted in reduced synthesis of Ig. Thus it was demonstrated that poor immunoglobulin synthesis was due to B cell insufficiency, and hypofunction of helper T cells, as well as hyperfunction of suppressor T cells.