B-cells of the rheumatoid synovial tissue are a constant part of and, in some histopathological subtypes, the dominant population of the inflammatory infiltrate, located in the region of tissue destruction. The pattern of B-cell distribution and the relationship to the corresponding antigen-presenting cells (follicular dendritic reticulum cells: FDCs) show a great variety. B-cells may exhibit (i) a follicular organization forming secondary follicles; (ii) follicle-like patterns with irregularly formed FDC networks, and (iii) a diffuse pattern of isolated FDCs. Molecular analysis of immunoglobulin VH and VL genes from human synovial B-cell hybridomas and synovial tissue demonstrates somatic mutations due to antigen activation. The FDC formations in the synovial tissue may therefore serve as an environment for B-cell maturation, which is involved in the generation of autoantibodies. An autoantibody is defined as "pathogenic" if it fulfills the Witebsky-Rose-Koch criteria for classical autoimmune diseases: definition of the autoantibody; induction of the disease by transfer of the autoantibody; and isolation of the autoantibody from the disease-specific lesion. B-cells from rheumatoid synovial tissue show specificity for FcIgG, type II collagen, COMP, sDNA, tetanus toxoid, mitochondrial antigens (M2), filaggrin and bacterial HSPs. The contributions of these antigens to the pathogenesis of RA are still hypothetical. A possible contribution could derive from crossreactivity and epitope mimicry: due to crossreaction, an antibody directed originally against a foreign infectious agent could react with epitopes from articular tissues, perpetuating the local inflammatory process. The characteristic distribution pattern, the localisation within the area of tissue destruction, the hypermutated IgVH and IgVL genes, and their exclusive function to recognize conformation-dependent antigens suggest a central role for B-cells in the inflammatory process of rheumatoid arthritis. Therefore, the analysis of synovial B-cell hybridomas and experimental expression of synovial IgVH and IgVL genes will help to characterise the antigens responsible for the pathogenesis of rheumatoid arthritis. In the present study 55 IgVH genes amplified from 3 different anatomical regions of a RA patient were analysed adding further information on synovial B-cell maturation and recirculation in RA. This analysis demonstrated somatically mutated IgVh genes in all different regions with amino acid deletions and mixed IgVh molecules, suggesting the existence of a novel pathway to generate (auto)antibody specificities. The comparison of amino acid sequences of amplified genes belonging to the VH1 family (with predominantly the same germline counterpart) exhibited a strong homology, indicating an apparently conserved mutational pattern. This suggests that the number of antigens activating B-cells in the different locations is restricted. The most striking result was the finding of clonally related sequences in different anatomical regions indicating a recirculation of activated B-cells between the different affected joints. Also in the present study a synovial B-cell hybridoma was analyzed for its specific recognition of cartilage antigens. A heptameric peptide of cartilage oligomeric protein (COMP) could be defined as the target structure. The IgVH-gene (IgHV4-59*01) of the IgG2l hybridoma has somatically mutated genes with high R/S values in the CDR regions (9:2). Thus, indicating that this hybridoma originates from a synovial B-cell which has been antigen activated/selected for its affinity. To analyse the presence of the clonotypic IgHV4-59*01 sequences in other cases of RA and osteoarthritis (OA) synovitis, primers specific for the CDR3 rearrangement of this hybridoma were used. The clonotypic and clone related sequences (98 per cent ± 1 per cent homology) could only be detected in synovitis of RA cases but not in OA cases indicating that this B-cell is specific to RA synovitis. The identified heptameric peptide of COMP was used in a peptide ELISA to analyse whether there is a specific binding in RA serum samples. Serum samples (IgG) from RA patients (n=22) showed a significant higher efficiency to the COMP heptamer than the OA sera (n=24) and the age matched healthy controls (n=20) (for both p<1x10-4, Students t-test). The specificity of this B-cell hybridoma may therefore be defined as RA specific. Since COMP is restricted to cartilage and tendons which are organs specifically affected in RA this COMP specific autoantibody represents the first organ specific autoantibody in RA. The IgG2 COMP specific autoantibody with somatically mutated IgVH genes is different from germline encoded, antigen clearing IgM autoantibodies and may therefore be directly involved as an "arthritogenic autoantibody" in cartilage and tendons destruction by complement activation. / B-Zellen des rheumatoiden Synovialgewebes sind einerseits ein konstanter Bestandteil und andererseits in einigen histopathologischen Subtypen sogar die dominante Bevölkerung des entzündlichen Infiltrates, welches sich in direkter Nähe des zerstörten Gewebes befindet. Das Strickmuster der B-Zellen-Verbreitung und die Verbindung zu den korrespondierenden antigenerzeugenden Zellen (follikuläre dendritische Zellen, sprich: FDC) zeigen eine große Vielfalt. B-Zellen können a) in der Form eines follikulären Verbandes sich bildender Sekundärfollikel; b) als follikelähnliche Muster mit unregelmäßig geformten FDC-Netzwerken und c) als ein diffuses Muster isolierter FDCs auftreten. Molekularanalysen der immunglobulinen VH- und VL-Gene von menschlichen synovialen B-Zell-Hybridomen und Synovialgewebe zeigen somatische Mutationen aufgrund von Antigenaktivierung auf. Die FDC-Schichten im Synovialgewebe dürften daher als ein Nährboden für B-Zell-Reifung dienen, welche wiederum in den Prozeß der Autoantikörperbildung eingreift. Ein Autoantikörper wird als "pathogenisch" bezeichnet, wenn er das Witebsky-Rose-Koch-Kriterium für klassische Autoimmunkrankheiten erfüllt: Bildung des Autoantikörpers; Einleitung der Krankheit durch Übertragung des Autoantikörpers und Isolation des Autoantikörpers vom krankheitsspezifischen Entzündungskomplex. B-Zellen aus rheumatoidem Synovialgewebe zeigen Spezifität für die Fc-Region von lgG; Typ II Kollagen; COMP; sDNA; Tetanustoxin; mitochondrische Antigene (M2); Fillaggrin und bakterielle HSPs. Der Beitrag dieser Antigene zur Pathogenese in der RA ist weiterhin hypothetisch. Ein möglicher Beitrag könnte aus der Kreuzreaktion und Epitopähnlichkeit aufgrund dieser Kreuzreaktion herrühren. Ein Antikörper, der ursprünglich gegen einen fremden Infektionsherd gerichtet war, könnte mit Epitopen aus Gelenkgewebe reagieren und somit den lokalen Entzündungsprozeß aufrechterhalten. Das charakteristische Verteilungsmuster, die Lokalisierung inmitten des zerstörten Gewebes, die hypermutierten IgVH- und IgVL-Gene und ihre ausschließliche Funktion, strukturabhängige Antigene zu erkennen, läßt auf eine zentrale Bedeutung der B-Zellen im Bezug auf den Entzündungsverlauf in der rheumatoiden Arthritis schließen. Deswegen wird die Analyse synovialer B-Zellen-Hybridome und die experimentelle Erkundung synovialer IgVH- und IgVL-Gene eine große Hilfe zur Charakterisierung der Antigene sein, welche verantwortlich für die Pathogenese in der RA sind. In dieser Studie wurden 55 IgVH-Gene analysiert, die von 3 verschiedenen anatomischen Regionen eines RA-Patienten amplifiziert wurden, wodurch man zusätzliche Informationen über synoviale B-Zellen-Reifung und -Rezirkulation in der RA erhielt. Diese Analyse zeigte somatisch mutierte IgVH-Gene in allen verschiedenen Regionen auf, mit Aminosäuredeletionen und gemischten IgVH-Molekülen, die Grund zur Annahme geben, daß eine neue Möglichkeit existiert, (Auto-) Antikörperspezifizierungen zu generieren. Der Vergleich von Aminosäuresequenzen amplifizierter Gene, die zur VH1-Familie gehören (mit überwiegend denselben Keimbahngenen) zeigten eine starke Homologie auf und wiesen auf ein scheinbar erhaltenes Mutationsmuster hin. Dieses läßt annehmen, daß die Anzahl der Antigene begrenzt ist, die B-Zellen in den verschiedenen Regionen aktivieren. Das markanteste Ergebnis war das Auffinden klonal verwandter Sequenzen in verschiedenen anatomischen Regionen, die darauf hinweisen, daß aktivierte B-Zellen zwischen den verschiedenen befallenen Gelenken rezirkulieren. Desweiteren wurde in dieser Studie ein synoviales B-Zellen-Hybridom analysiert bezüglich seiner spezifischen Erkennung von Knorpelantigenen. Ein heptameres Peptid des COMP könnte als eine mögliche Zielstruktur definiert werden. Die IgVH-Gene (IgHV4-59*01) des IgG2?-Hybridomes besitzt somatisch mutierte Gene mit hohen R/S-Werten in den CDR-Regionen (9.2). Somit weist dies darauf hin, daß dieses Hybridom aus einer synovialen B-Zelle stammt, welche aufgrund ihrer Affinität antigen-aktiviert wurde. Um das Vorkommen der klonotypischen IgHV4-59*01-Sequenzen in anderen Fällen der RA und Osteoarthritis (OA)-Synovitis zu analysieren, wurden Primer benutzt, die spezifisch für die CDR3 dieses Hybridomes sind. Die klonotypischen und klonal verwandten Sequenzen (98 Prozent ± 1 Prozent Homologie) konnte nur in Fällen der RA-Synovitis erkannt werden, jedoch nicht bei OA-Fällen, was darauf hinweist, daß diese B-Zelle spezifisch für die RA-Synovitis ist. Das identifizierte heptamere COMP-Peptid wurde in einer Peptid-ELISA verwendet, um festzustellen, ob es eine spezifische Bindung in RA-Seren gibt. Seren (IgG) von RA-Patienten (n=22) zeigten eine bedeutend höhere Wirksamkeit des COMP-Heptamers an als in OA-Seren (n=24) und den altersabhängigen gesunden Kontrollen (n=20); (für beide p<1x10-4; Students t-Test). Die Spezifizierung dieses B-Zellen-Hybridomes könnte daher als RA-spezifisch angesehen werden. Da COMP sich auf Knorpel und Sehnen beschränkt - welches hauptsächlich in der RA betroffene Organe sind - repräsentiert dieser COMP-spezifische Autoantikörper den ersten organspezifischen Autoantikörper in der RA. Der IgG2-COMP-spezifische Autoantikörper mit somatisch mutierten IgVH-Genen unterscheidet sich von dem der antigenvernichtenden IgM Autoantikörper und könnte daher direkt in die Knorpel- und Sehnenzerstörung durch Komplementaktivierung miteinbezogen sein, als ein "arthritogener Autoantikörper".

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This thesis investigates the epidemiology of hepatitis B virus infection (HBV) and estimates HBV-related liver disease burden in Vietnam and Australia using a cross-sectional study design and mathematical modelling. A population-based seroprevalence survey was undertaken in rural Northern Vietnam. In a sample of 870 study participants, prevalence of anti-HBV core antibody (anti-HBc) and hepatitis B virus surface antigen (HBsAg) was 68.2% and 19.0%, respectively, and hepatitis B e antigen (HBeAg) was detected in 16.4% of the HBsAg-positive group. Factors associated with HBV infection (anti-HBc and/or HBsAg-positive) were age 60 years or older (adjusted odds ratio (AOR), 3.82; 95% CI, 1.35??10.80; P = 0.01), residence in Vu Thu district (AOR, 3.00; 95% CI, 2.16??4.17; P <0.001), hospital admission (AOR, 2.34; 95% CI, 1.33??4.13; P = 0.003) and history of acupuncture (AOR, 2.01; 95% CI, 1.29??3.13; P = 0.002). Household contact with a person with liver disease (AOR, 2.13; 95% CI, 1.29??3.52; P = 0.003), reuse of syringes (AOR, 1.81; 95% CI, 1.25??2.62; P = 0.002) and sharing of razors (AOR, 1.69; 95% CI, 1.03??2.79; P = 0.04) were independent predictors of HBsAg positivity. Alanine aminotransferase (ALT) level was elevated (>40 IU/L) in 43% of the HBsAg-positive group; the proportion of elevated ALT was higher in HBeAg-positive (65%) compared with HBeAg-negative (39%) (P = 0.02). Based on data from the seroprevalence study, other prevalence estimates and HBV natural history parameters, a mathematical model was used to estimate HBV-related liver disease burden in Vietnam. Estimated chronic HBV prevalence increased from 6.4 million cases in 1990 to around 8.4 million cases in 2005 and was projected to decrease to 8.0 million by 2025. Estimated HBV-related liver cirrhosis and hepatocellular carcinoma (HCC) incidence increased linearly from 21 900 and 9400 in 1990 to 58 650 and 25 000 in 2025. Estimated HBV-related mortality increased from 12 600 in 1990 to 40 000 in 2025. To estimate HBV-related HCC incidence among Australians born in the Asia-Pacific region (APR), a mathematical modelling was developed utilising HBV natural history parameters, HBV prevalence estimates in APR countries and immigration data. Chronic HBV cases among the APR-born population increased rapidly from the late 1970s, reaching a peak of 4182 in 1990. Chronic HBV prevalence increased to more than 53 000 in 2005. Estimates of HBV-related HCC increased linearly from one in 1960 to 140 in 2005, with a projected increase to 250 in 2025. Universal HBV vaccination programs in countries of origin had limited impact on projected HBV-related HCC to 2025. HBV-related HCC survival was analysed in a population-based linkage study in New South Wales (NSW), Australia. Between 1994 and 2002, 278 HCC cases notified to the NSW Cancer Registry were linked to chronic HBV infection notifications to the NSW Health Department. The majority of cases were male (83.5%) and overseas born (93.6%); Asian-born cases accounted for 72.1%. Median survival following HCC diagnosis was 15 months. HCC survival was poorer among older age groups (P <0.001), and among cases with regional spread (HR 3.23; 95% CI, 1.83??5.69; P <0.001) and distant metastases (HR 3.85; 95% CI, 2.44??6.08; P <0.001). Sex, region of birth, and study period (1994??1997 versus 1998??2002) were not associated with HCC survival. The results of these studies show that HBV infection remains a major public health challenge in highly endemic countries such as Vietnam. HBV-related liver disease burden in Vietnam was estimated to increase for at least two decades despite the introduction of a universal infant HBV-vaccination program. Similarly, HBV-related HCC among Australians born in the APR was estimated to continue to increase over the next two decades. Survival for HBV-related HCC even in settings such as Australia continues to be extremely poor. Strategies are required to expand HBV treatment to individuals with chronic HBV infection who are at greatest risk of progression to advanced liver disease.

This thesis examines the results of a hepatitis B vaccination questionnaire study that was completed by medical officers, nurses, carers of the developmentally disabled, and correctional officers in the Greater Western Sydney area of New South Wales, Australia. The main aim of the study was to contrast these four high risk occupational groups for their acceptance of hepatitis B vaccination, seroconversion status, and behavioural, attitudinal, motivational and institutional determinants of their vaccination status. The results of the thesis revealed that medical officers and nurses were the most likely to be tested and vaccinated for seroconversion, while DD carers and correctional officers had the largest number of Not Vaccinated respondents. The findings of the questionnaire are discussed in some detail. It is also suggested that groups differ in the degree of hepatitis risk anxiety they experience as well as the degree of control felt over their health status. A number of indications for personal, institutional and governmental interventions to increase vaccination levels are discussed. / Doctor of Philosophy (PhD)

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In Type 1 diabetes, beta-cells is subjected to an autoimmune-mediated apoptotic and inflammatory attack. Whilst lymphocytes are the primary contributor of beta-cell death, exposure of beta-cells to stress signals such as cytokines, transform these cells into an inflammatory state activating transcripts for toxic agents. Demonstrating a significant role for beta-cells in participating in their own destruction through the elaboration of toxins and chemotactic molecules that could contribute to increased cellular infiltration. The Nuclear Factor-kappa B (NF-kB) is a transcription factor that provides for early immediate stress responses governing inflammation and cell survival. In islets, NF-kB is thought to have an important role in beta-cell inflammation and apoptosis. Few studies however, have explored the role of NF-kB in beta-cell protection. Indeed, we found that the expression NF-kB is responsible for the islet-intrinsic immediate-early pro-inflammatory gene expression. Importantly however, we also found that in islets, NF-kB is responsible for the expression and regulation of anti-apoptotic genes. We demonstrated for the first time that similar to other cells, the expression and regulation of the anti-inflammatory/ anti-apoptotic gene A20, in islets, is regulated by NF-kB. Consequently, we found a somewhat paradoxical role for NF-kB, where on the one hand it is responsible for beta-cell death, whilst on the other hand it is also responsible for beta-cell survival. In vivo however, we found that islet survival and function was severely impaired in the absence of NF-kB activity. We observed that blockade of NF-kB abrogate cytokine-induced A20 expression, and inhibited the activation of glucose-stimulated insulin secretion in vitro. In contrast, blockade of NF-kB by over-expression of A20 resulted in an improved islet allograft survival with good metabolic control. Thus demonstrating the importance of NF-kB-dependent anti-apoptotic genes for islet survival and function. The findings presented in this thesis demonstrate a fundamental bimodal role for NF-kB in maintaining the balance of survival of beta-cells in the context of T1D. These data, uncovers a sophisticated molecular mechanism in the regulation of beta-cell death, survival, and metabolic function. Thus providing a better understanding of the role of NF-kB in beta-cells in the context of T1D.

Doctor of Philosophy / First part of the thesis is focused on experimental preparation of new hard quaternary amorphous materials Si-B-C-N with high thermal stability. Materials were prepared in the form of thin films using reactive magnetron sputtering. The technique used proved to be suitable for reproducible synthesis of these materials. The Si-B-C-N films were generally found to be amorphous with low compressive stress and good adhesion to silicon or glass substrates. The process and film characteristics were controlled by varying the sputter target composition, the Ar fraction in the N2–Ar gas mixture, the negative rf-induced substrate bias, and the substrate temperature. Main conclusions describe the relationships between process parameters, discharge and deposition characteristics and film properties (elemental composition, chemical bonding structure, material hardness, compressive stress or electrical conductivity of materials prepared). Second part of the thesis is focused on ab-initio simulations of structures of experimentally prepared Si-B-C-N materials. In the performed liquid-quench simulations, the Kohn-Sham equations for the valence electrons are expanded in a basis of plane wave functions, while core electrons were represented using Goedecker-type pseudopotentials. We simplified the ion bombardment process by assuming that the primary impact creates a localized molten region of high temperature and sufficiently short cooling time, commonly referred to as a thermal spike. Main conclusions deal with N2 formation in studied materials, effect of implanted Ar on structure and properties of prepared materials, ability of Si to relieve that part of compressive stress which is caused by implanted Ar, and ability of B to improve thermal stability of Si-B-C-N materials. The calculated results are compared with experiment.

Includes 25 papers previously published in Journals / 114, 16 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Sc.)--University of Adelaide, Dept. of Biochemistry, 1975

Classical immunoglobulin transgenic (Ig-Tg) mouse models such as the MD4 anti-hen egg lysozyme (-HEL) Ig-Tg line have been used extensively to study B cell responses in tolerance and immunity. This thesis describes a new generation of gene-targeted mice (designated SWHEL mice) whereby the VH10 Ig variable gene encoding the HyHEL-10 specificity of the original anti-HEL Ig-Tg mouse was targeted to the Ig heavy chain locus. B cells in the SWHEL mouse are therefore capable of undergoing class switch recombination (CSR) and somatic hypermutation (SHM), representing a major advance on the original MD4 mouse model. SWHEL mice were found to not only contain a large population of HEL-specific (HEL+) B cells but also a significant population of non-HEL-binding (HEL-) B cells generated by VH gene replacement. HEL+ SWHEL B cells were found to belong to the B2 lineage and displayed high levels of surface IgM. Nevertheless, they matured normally and colonised the primary B cell follicle and marginal zone (MZ) of the spleen. The SWHEL model thus provided an opportunity to re-examine some of the original observations made in the MD4 system and also to extend these observations, particularly with regard to the regulation of CSR by self-reactive B cells. As expected, analysis of SWHEL B cells exposed to high avidity membrane-bound HEL revealed that they underwent clonal deletion in the bone marrow (BM). More interestingly, analysis of HEL+ B cells exposed to low avidity soluble HEL revealed that they were able to emigrate from the BM to the spleen as anergic B cells. However, unlike anergic MD4 B cells, anergic SWHEL B cells were reduced in frequency, displayed an immature B cell phenotype, were excluded from the follicle and had a reduced lifespan. Direct measurement of B cell antigen receptor (BCR) occupancy by HEL and the frequency of HEL- competitor B cells was combined with mixed BM irradiation chimeras to demonstrate unequivocally that the difference in phenotype and fate of HEL+ B cells in the two systems was due solely to competition from HEL- B cells. In addition, the SWHEL model of B cell self-tolerance was used to show that while self-reactive B cells were hypo-responsive to BCR stimulation, BCR-independent signals delivered via anti-CD40 plus IL-4 or lipopolysaccharide could trigger them to undergo CSR and secretion of potentially pathogenic isotype-switched autoantibodies. Finally, the SWHEL model was used to study the responses of adoptively transferred follicular (Fo) and MZ B cells to in vivo activation with HEL conjugated to sheep red blood cells (HEL-SRBC). These studies revealed that both HEL+ MZ and Fo B cells were capable of mounting a robust T cell-dependent IgG1 antibody response to HEL-SRBC. However, HEL+ MZ B cells did not efficiently localise to the T cell-B cell border following antigen engagement and preferentially migrated to the bridging channels and red pulp. In contrast, HEL+ Fo B cells rapidly localised to the T cell-B cell border and subsequently colonised numerous germinal centres. As a result, the rate and pattern of SHM by HEL+ Fo and MZ B cells was shown to be distinct, with preferential targeting of mutations to the second complementarity-determining region in the former and to the second framework region in the latter. Together these data indicate illustrate the value of the SWHEL model and its potential to greatly advance the current understanding of B cell responses in tolerance and immunity.

Lymphocytes from patients with B-chronic lymphocytic leukemia (B-CLL) express large numbers of P2X7 receptors for extracellular adenosine triphosphate (ATP). Activation of P2X7 receptors induces multiple downstream effects, of which the best documented is the opening of an ionic channel that is selective for divalent cations. Another effect of ATP is to induce the shedding of L-selectin (CD62L), a molecule which is involved in the adhesive interactions of lymphocytes on endothelial cells. High levels of soluble L-selectin and CD23 are found in the serum of patients with B-CLL, although the mechanisms involved in their production are poorly characterized. Because extracellular ATP causes shedding of L-selectin, we studied the effect of ATP on shedding of CD23, an adhesion molecule expressed on the surface of B-CLL lymphocytes. ATP induced the shedding of CD23 at an initial rate of 12% of that for L-selectin, while the EC50 of ATP (35 uM) and BzATP (10 uM) was identical for shedding of both molecules. Inactivation of the P2X7 receptor by pre-incubation with OxATP, an irreversible inhibitor of P2X7 purinoceptor, abolished ATP-induced shedding of both molecules. Moreover, KN-62, the most potent inhibitor for the P2X7 receptor inhibited ATP-induced shedding of both CD23 and L-selectin with the same IC50 (12 nM). Ro 31-9790, a membrane permeant zinc chelator which inhibits the phorbol-ester stimulated shedding of L-selectin also inhibited shedding of CD23 from B-CLL lymphocytes, but the IC50 was different for the two shed molecules (25 versus 1 ug/ml respectively). Although L-selectin was completely shed by incubation of cells with phorbol-ester no CD23 was lost under these conditions. Also, Ca2+ inhibits ATP-induced CD23 shedding but not L-selectin shedding. Since soluble CD23 and L-selectin are found in the serum of normal subjects and B-CLL patients, the expression of these two adhesion molecules on lymphocytes before and after transendothelial migration was studied in an in vitro model of this process. In normal and B-CLL subjects, 71�b5% of L-selectin from both T and B cells and 90% of CD23 from B cells was lost following transmigration, while the expression of a range of other adhesion molecules such as VLA-4, ICAM-1, LFA-1 and CD44 was unchanged. Lymphocytes incubated with OxATP retained their capacity for transendothelial migration and showed the same loss of L-selectin as control leukaemic lymphocytes. Ro 31-9790, which can protect ATP-induced both L-selectin and CD23 shedding, had no effect on inhibiting L-selectin and CD23 lost during transmigration. These data show the presence of a second pathway for the downregulation of L-selectin and CD23 from the lymphocyte surface. Data in vivo from 'knock-out' mice show that L-selectin is essential for the emigration of lymphocytes through high endothelial venules into lymph nodes. The migration of normal and B-CLL lymphocytes across confluent human umbilical vein endothelial monolayers was studied in an in vitro model of this process. Lymphocytes treated with ATP or BzATP showed 56�b25% or 67�b16% loss of L-selectin on the surface and 36�b24% or 64�b19% decrease of transmigration, respectively, while OxATP, which does not alter the L-selectin level, had no effect on lymphocyte transmigration. Further experiments examined this correlation between L-selectin expression and lymphocyte transendothelial migration in this model system. A quantitative assay for cell surface L-selectin showed that expression of L-selectin was lower on B-CLL lymphocytes (8,880�b5,700 molecules/cell) than on normal lymphocytes (29,500�b7,500 molecules/cell, p less than 0.001). Also the rate of transmigration of B-CLL lymphocytes (1.5�b0.9 migrated cells/HUVEC) was lower than normal peripheral lymphocytes (2.4�b0.9 migrated cells/HUVEC, p=0.04). Incubation of lymphocytes in complete medium for 24 hrs increased the expression of L-selectin on B-CLL lymphocytes by 1.5 to 2 fold while the normal lymphocyte L-selectin remained at the initial level. This upregulation of B-CLL L-selectin correlated with a 2 fold increased rate of transendothelial migration. A correlation was found between L-selectin expression on lymphocytes and their ability for transendothelial migration (r^2=0.6). This study shows that the adhesion molecules L-selectin and CD23 can be lost from lymphocytes by two different physiological pathways. One is by P2X7 receptor activation by extracellular ATP while the second is activated by transendothelial migration of these cells. A second finding is that B-CLL lymphocytes have lower level of L-selectin expression and an impaired ability for transendothelial migration compared with normal peripheral blood lymphocytes. Do these results explain the high serum levels of soluble L-selectin and CD23 observed in B-CLL? Although B-CLL lymphocytes do not recirculate as rapidly as normal peripheral blood lymphocytes, the greatly increased number of leukaemic cells in B-CLL ensures that much more soluble L-selectin and CD23 is generated during the recirculation of these cells through the body.