Since Loewi’s death rheumatology research has developed enormously, partly because of advances in underlying basic science, especially genetics and immunology, and partly because of vastly improved clinical investigative techniques, notably imaging and biostatistics. However, it is interesting to reflect that many of the concepts which preoccupied Gerald Loewi and his colleagues are still central to present-day theorizing and speculation. The rationale for setting up the Juvenile Rheumatism Unit in the first place is now clinically irrelevant in most of the world, but the same scientific and clinical management questions continue to preoccupy rheumatologists despite the change in the spectrum of rheumatic diseases. Rheumatic fever has largely receded as an issue, but infection remains an important issue. While rheumatologists speculated on genetic and immunological factors which determine susceptibility to rheumatic fever after streptococcal infection, streptococci quietly left the rheumatology stage. But this was not wasted effort; our increasing realization of the importance and complexity of the microbiota and pandemics of novel infections have ensured the return of micro-organisms to rheumatology’s center stage.
Gerald Loewi and his colleagues were largely preoccupied with the broader issues of infection and the pathogenesis of rheumatic diseases in general and not just rheumatic fever. Indeed, when Leonard Glynn and John Holborow summarized the approach of the Taplow group to these issues, they were careful to name their seminal book Autoimmunity and Disease, not Autoimmune Diseases.1
Gerald Loewi’s personal contributions were largely centered on characterizing the cells participating in inflammatory synovitis. Hitherto these cells had been termed “mononuclear,” but the histological techniques of the day only permitted broad differentiation between “lymphocytes” and “macrophages”. In part he and his colleagues used experimental models of joint inflammation.2–4 But in addition and more importantly they analyzed cells in effusions and synovial membranes from patients with inflammatory arthritis using immunofluorescence techniques and electron microscopy.5–7 Their findings helped to identify the key role of T and B lymphocytes in the pathogenesis of synovitis in rheumatoid arthritis and other rheumatic diseases, thereby marking an innovative transition from descriptive to analytical immunopathology in rheumatology research. Gerald Loewi also explored the functions of the infiltrating cells. His collaborative studies with Ian MacLennan provided important insight on the cytotoxic effects on target cells of mononuclear cells isolated from synovial effusions either alone or in combination with specific antibodies.8,9 As a possible lead to the involvement of virus infection in the etiology of rheumatoid arthritis patients, Bracha Zisman (Rager) and Gerald Loewi analyzed the fate of vesicular stomatitis virus in white blood cells from such patients.10
The Taplow investigators were early to appreciate that what were traditionally termed “degenerative joint diseases” or “osteoarthritis” are in reality attributable to much more complex processes than “ageing” alone. Their biochemist colleague John Scott’s main field of interest concerned cartilage and collagen structure and function. His theoretical and technical expertise greatly helped his colleagues to explore the underlying causes of this group of disorders. It is now accepted that all structural joint components are involved in the degenerative process. Gerald Loewi and his collaborators made two fundamental observations supporting this transition in ideas. With Helen Muir, he showed that the major joint component, chondromucoprotein, is antigenic and thereby capable of inciting an auto-immune response.11 With Leonard Glynn and Jack Dorling, he made comparable observations relating to the potential auto-antigenicity of degenerating collagen fibers.12
There were limited means then available for exploring the genetic basis for the familial link with many rheumatic diseases suggested by contemporary population surveys in children and adults. This was a particular interest of Gerald Loewi’s colleagues, Eric Bywaters and Barbara Ansell. Blood group secretor status was one genetic marker which was available, and Gerald Loewi and John Holborow contributed to the unit’s exploration of this approach.