Cellular reaction to complexes formed between rheumatoid factor and aggregated human gamma globulin.

During the course of experiments to investigate whether the addition of heat-denatured 7S y-globulin to rheumatoid leucocytes would produce transformation of the lymphocytes, an interesting phenomenon was observed. No specific stimulation of the lymphocytes was seen, but intracellular inclusions in neutrophils and macrophages, accompanied by extracellular bodies, were noted after culture of the cells for a few days. The extracellular bodies in stained smears were pale, eosinophilic, round structures, varying considerably in size and arranged either singly or in clusters. Frequently a surrounding ring of lymphocytes was seen. Because both intracellular and extracellular structures were almost invariably present when serum from rheumatoid patients was employed, but were absent when normal serum was used, they have been called "rheumatoid cells and bodies" (R.A. cells and R.A. bodies). Reports from a number of sources suggest that bodies similar to those we describe are particularly prone to appear in fluids from rheumatoid patients. Duthie (1964) reported the formation of structures of this type when rheumatoid blood was mixed with rheumatoid synovial fluid. Parker and Schmid (1962) and Astorga and Bollet (1964) have described inclusion bodies in normal leucocytes resulting from phagocytosis of precipitates produced by the interaction of rheumatoid factor and aggregated y-globulin. Since the present work was completed, Hollander and his colleagues (Hollander, McCarty, Astorga, and Castro-Murillo, 1965; Rawson, Abelson, and Hollander, 1965; Restifo, Lussier, Rawson, Rockey, and Hollander, 1965) have described inclusion bodies in leucocytes present in synovial fluids from rheumatoid patients and have discussed the possibility that such bodies may be formed from complexes of rheumatoid factor with autologous yglobulin. The present paper describes the "rheumatoid cell" and "rheumatoid body" and discusses their significance and possible diagnostic use. A brief account of the chief findings has already been presented (Williamson and Ling, 1964).