Sarcoidosis is a mukisystem disorder of ~ndetermined etiology and is characterized by ~:he presence of exuberant noncaseating epkhelioid ce!i granulomas in invalved organs (19). immunologic aberrations i:~ sarcoidosis have been recognized since the early part of ~:he twentieth century, w?~en Schaumann propo,Jnded the concept that sarcoidosis was a sys:emic disease rather than a cutaneous disorder, it has been recognized that sarcoidosis is associated with abnormalities of ao,n ceil-mediated and humoral immunity (5, i6, 17), and during the past decade new insights into the pathogenesis of this disease and i s imn~tmologic aberraiions have been ek:cldmea. CeH-Medimed ImaaunRy The presence of we11-developed granutomas in invoived organs of patients wkh sarcoidosis would suggest the presence of an ongoing heightened celluIar immune response. However, a plethora of studies, conducted since the early part of this century, have consistentiy demonstrated a variable degree of depression of cutaneous delayed hypersensitivity reaction to tuberculin in patients witk active sarcoidosis (5, 16, 17). This depression is noi iimited to tuberculin but is generalized and ex~ends to aiI recaii antigens, including potent natural sensitizers such as Californian keyhole limpet hemocyanin, as we11 as potent synthetic chemical sensit:lets such as 2,4-dinitrochlorobenzene. The depression of delayed cutaneous hypersensitivity is neither permanent nor absolute. This is suggested by the following observations: a) delayed cutaneous nypcrsensmv~ty ~s generally regained with resolution of sarcoidosis; b) the deve!opment of clinlcal!y manifest tuberculosis leads zo initial acquisition or reacquisition of previousiy suppressed reactivity of tuberculin; and c) ~ransient t~berculin responsiveness can be transferred passively by intravenous administration of transfer factor or by intracutaneous injection of peripherai white blood cells (probably iymphocytes) from tuberct~lin responsive individuals (25). These observations abc,~t cutaneous delayed hypersensitivity, which is an in viva method for evaluating cell-mediated immunity, led to the in vitro assessme:~t of ceilmediated immunity. Extensive quan~l~a~v~ and qualitative evaluation of lymphocytes and other effector cei!s froth peripheral blood and involved organs, particularly the lung, has demonstrated numerous abnormalities, listed in Table I (i i). These studies have provided some new insights into t]'~e pathogenesis of sarcoidosis as weil as an explanation, although incomplete, for the seemingly discordant observations of active granuloma formation in the tissues and the apparent depression of celluiar immunity. Current concepts of the pathogenesis of sarcoidosis suggest that rcdis t r ibut ion or compar tmentalization of immune effector cells, particularly the iymphocytes, occurs
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