The relative proliferation index as a more sensitive parameter for evaluating lymphoproliferative responses of cancer patients to mitogens and alloantigens

Adjuvant breast cancer vaccine improves disease specific survival of breast cancer patients with depressed lymphocyte immunity

PURPOSE

Beginning in 1995 breast cancer patients were vaccinated in the adjuvant setting with an autologous, allogeneic whole cell vaccine to evaluate the effect on host lymphocyte immunity and disease specific survival.

METHODS

The breast cancer patients had host lymphocyte immunity against tumor associated antigens evaluated by a Lymphocyte Blastogenesis Assay (LBA) before vaccination. Thirty-seven patients with depressed immunity were vaccinated in the adjuvant setting. Patients were given six intradermal injections (three weekly followed by three monthly). Ten weeks after the last injection the LBA was repeated.

RESULTS

Some patients experienced slight pain and swelling at the injection site with slight chills and fever, but there were no severe toxicities. The vaccinated patients had a mean follow-up of 12.7 years with mean follow-up of 8.9 and 9.2 years for the patients with normal and depressed immunity, respectively, in the historic control. The 10 year survival was 95% (20 of 21 patients) in the normal immunity historic control, 59% (33 of 56 patients) in the depressed immunity historic control and 89% (33 of 37 patients) in the patients with depressed immunity that were vaccinated in the present clinical trial. The disease specific survival of the vaccinated patients with depressed immunity in this trial is significantly greater than that of the historic controls of unvaccinated patients with depressed immunity to their tumor associated antigens.

CONCLUSION

This study confirms the importance of maintaining good host lymphocyte immunity after completion of standard therapy and validates the value of cancer immunotherapy in the adjuvant setting.

Phage as a modulator of immune responses: practical implications for phage therapy

Although the natural hosts for bacteriophages are bacteria, a growing body of data shows that phages can also interact with some populations of mammalian cells, especially with cells of the immune system. In general, these interactions include two main aspects. The first is the phage immunogenicity, that is, the capacity of phages to induce specific immune responses, in particular the generation of specific antibodies against phage antigens. The other aspect includes the immunomodulatory activity of phages, that is, the nonspecific effects of phages on different functions of major populations of immune cells involved in both innate and adaptive immune responses. These functions include, among others, phagocytosis and the respiratory burst of phagocytic cells, the production of cytokines, and the generation of antibodies against nonphage antigens. The aim of this chapter is to discuss the interactions between phages and cells of the immune system, along with their implications for phage therapy. These topics are presented based on the results of experimental studies and unique data on immunomodulatory effects found in patients with bacterial infections treated with phage preparations.

Detection of intracellular interleukin-2 production in peripheral T lymphocytes by flow cytometry in patients with pancreatobiliary malignancies

BACKGROUND AND AIMS

To date, it has been reported that cellular immunity is decreased in patients with cancer and investigations into cytokine production has been insufficient. Therefore, we examined intracellular cytokine production by using flow cytometry in patients with cancer and discussed the reasons for the impairment of their immune system.

METHODS

Eleven patients with hepatobiliary malignancies (68.5+/-11.8 years of age), eight age-matched controls (70.0+/-12.0 years of age) and 10 young volunteers (31.9+/-3.1 years of age) were used in the present study. Stimulated peripheral blood mononuclear cells from these patients were stained with fluorescence-labeled anticytokine monoclonal antibodies and analyzed with a Fluorescence activated cell sorter (FAC)Scan.

RESULTS

The percentage of positively stained T cells was calculated and compared with controls. Repeated measured ANOVA was used for statistical analysis. Interleukin (IL)-2 production was significantly decreased in patients with cancer compared to controls (P=0.0122), and it may suggest decreased cellular immune activity of the patients. Simultaneously, spontaneous intracellular IL-4 production was observed in patients and age-matched controls, but levels were significantly increased when compared with the young volunteers (P=0.0052, P=0.031, respectively).

CONCLUSIONS

It was of interest that spontaneous intracellular IL-4 production was detected in elderly subjects.

Impaired cytokine production in whole blood cell cultures of patients with gynaecological carcinomas in different clinical stages

The production of the cytokines IFN-gamma, IL-1-alpha, IL-2 and TNF-alpha was investigated in mitogen-stimulated, whole blood cell culture from 239 untreated patients with primary gynaecological carcinomas (breast, cervix, ovary, endometrium), and 191 healthy female controls. The cytokines were measured in the 4-day post-induction supernatants by a sensitive enzymoimmunological assay. In the blood cell cultures of all four groups of cancer patients, significantly lower values of IFN-gamma (P < or = 0.001), IL-2 (P < or = 0.01) and IL-1 alpha (P < or = 0.01) were found as compared to the controls, although lymphocyte and monocyte counts were almost identical. Grouping the tumour patients into different clinical stages we could show in the four groups of carcinomas a gradual depression of the cytokine production according to growing tumour burden.

Impaired cytokine production in whole blood cell cultures of patients with urological carcinomas

The production of the cytokines interferon gamma (IFN gamma), interleukin-1 alpha (IL-1 alpha) and tumor necrosis factor alpha (TNF alpha) was investigated in the mitogen-stimulated whole blood cell culture media from 51 patients with urinary bladder carcinomas, 52 patients with renal carcinomas, 31 patients with prostatic carcinomas and 360 healthy controls. The cytokines were measured 4 days after induction by a sensitive enzymo-immunological assay. In the blood cell culture supernatants of the patients with urinary bladder carcinomas significant lower levels of IFN gamma (P < or = 0.001), IL-2 (P < or = 0.01) and TNF alpha (P < or = 0.05) were found as compared to the controls. Blood cells of patients with renal carcinomas had lower production of IFN gamma (P < or = 0.01), IL-2 (P < or = 0.001) and IL-1 alpha (P < or = 0.01), whereas the values of the total group of patients with prostatic carcinomas were not significantly different from those of the controls. Lymphocyte and monocyte counts were almost identical in the control and all tumor patient groups. When the patients with renal carcinomas and prostatic carcinomas were analyzed according to their different clinical stages we could show a gradual depression of the IFN-gamma levels, which was related to tumor burden.

Evaluation of lymphocyte immunity in breast cancer patients

One hundred forty-two breast cancer patients were evaluated for three functional immunologic parameters: the ability of their lymphocytes to proliferate in response to general T-(phytohemagglutinin) and B-lymphocyte (pokeweed mitogen) stimulators and their ability to proliferate in response to specific autologous tumor antigens. Tests were performed on patient blood specimens collected approximately 2 hours prior to surgery or 2-4 weeks following chemotherapy. T-lymphocyte functional competence was impaired in 83/142 (58%) of the patients, while B-lymphocyte competence was impaired in 34/142 (24%) of these patients. A total of 21/52 (40%) of the patients had lymphocyte immunity against autologous tumor antigen. There were weak associations between the ability of patients' T- and B-lymphocytes to function normally, and their ability to respond to autologous tumor-antigen. There was no relationship of age, tumor burden (clinical or pathological tumor size), extension to skin and/or muscle, or metastasis to any of the three immunological parameters. A relationship (p = 0.0463) between T-lymphocyte competence and pathological nodal status was observed; individuals that were node positive for disease, tended to have impaired T-lymphocyte function. When evaluating T- and B-lymphocyte competence and lymphocytic immunity against tumor antigen in pre- and post-chemotherapy patients, an immunologic rebound (increase in immune parameters shortly after completion of chemotherapy) was observed in some patients. These results demonstrate the utility of measuring these immune parameters in breast cancer patients, their relevance to the natural biology of the disease, and the influence that chemotherapy may have on host immune function.

Superoxide anion-generating activity of polymorphonuclear leukocytes and monocytes in patients with lung cancer

Superoxide anion (O2-) production by polymorphonuclear leukocytes (PMN) and monocytes (MN) was measured in the peripheral blood of 70 patients with lung cancer. The O2- production by these cells was decreased in many, but not all, patients. The incidence of patients with lower O2- production increased as the stage advanced. The correlation between O2- production by these cells and peripheral blood smears was evaluated in patients with cancer. Patients with 80% granulocytes and 40% monocytes or more in their peripheral blood had a significantly lower O2- production by PMN and MN compared with those with less than 80% granulocytes and 40% monocytes, respectively. These results indicate that an abnormally increased number of granulocytes and monocytes in the peripheral blood of patients with cancer may depress immunoregulatory function. In addition, decreased O2- production by these cells should be considered when assessing the defense mechanisms and susceptibility to infection of these patients.

NK cell activity in treated prostate cancer patients as a probe for circulating tumor cells: hormone regulatory effects in vivo

Natural killer (NK) cell activity was studied together with tumor marker serotests (PSA, PAP) and blood testosterone, estradiol, cortisol, and prolactin concentrations in treated prostate cancer patients. NK cell activity data were correlated with tumor stage (stage D0 + D1 versus stage D2) and showed statistically insignificant differences. Both tumor progression and stabilization of metastatic disease, triggered by the application of more appropriate therapy in progressive subjects, yielded low NK activity data. By contrast, normal NK activity was found during both partial remission of stage D2 tumor and stabilization of the same disease, after an initial period of tumor remission. Differences between NK activity data from the aforementioned two groups are statistically significant (P less than 0.01). In subjects examined, the application of NK activity assay to those with advanced disease reflected changes in the outcome of the treatment more closely than it did routine tumor marker assessment. The activity of NK cells seems unaffected by changes in basal blood estradiol, cortisol, testosterone, and prolactin concentrations that occur during therapy with pharmacological agents (estradiol, cyproterone acetate, diethylstilbestrol, and flutamide) and during surgical castration. The reported NK activity recordings in treated prostate cancer patients might be indicative of the presence of tumor cells in the circulation. If this holds true, the measurement of NK activity would appear to furnish urological oncology with a new tool for early, rapid recognition of progressive metastatic tumors.

A comparative study of natural killer cell activity, lymphoproliferation, and cell phenotypes in nonhuman primates

Three different species of nonhuman primates (baboons [Papio hamadryas], rhesus monkeys [Macaca mulatta], and African green monkeys [Cercopithecus aethiops]) were evaluated for their natural killer cell activity, and for the ability of their peripheral blood mononuclear cells to proliferate in response to known mitogens (concanavalin A, phytohemagglutinin, and pokeweed mitogen) and to react with a panel of mouse monoclonal antibodies directed against human leukocyte surface antigens. Rhesus monkeys displayed the highest natural killer cell cytotoxic activity (185.7 +/- 33 lytic units) compared with those of baboons (83.8 +/- 19 lytic units) and of African green monkeys from West Africa (39.08 +/- 8 lytic units) and from the Caribbean basin (37.9 +/- 9 lytic units). No correlation was observed between the natural killer cell cytotoxic activity and the percentage of CD16+ natural killer cells among the three species studied. High spontaneous proliferative capacity was observed in African green monkeys obtained from West Africa compared with those of the other species studied. Although no significant differences were noted in T and B cell mitogen-induced in vitro proliferation, baboon mononuclear cells were less responsive to concanavalin A (stimulation index of 16 +/- 3 [mean +/- standard error of mean]) than to phytohemagglutinin (stimulation index of 47 +/- 12). However, rhesus and African green monkey cells proliferated more efficiently in response to concanavalin A. Unlike in human beings where the ratio between helper-inducer (CD4+) and cytotoxic-suppressor (CD8+) T-lymphocytes is generally greater than 1, the CD4+/CD8+ ratios in baboons and rhesus and African green monkeys were 0.58, 0.69, and 0.35, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell-mediated immune responses--prognostic indicators of survival from breast cancer

The prognostic significance of cell-mediated immunity measured by a single post-operative in vitro lympho-proliferation assay with an autologous tumor hypotonic membrane preparation (HMP) and in the mixed leukocyte culture (MLC) is shown in white and black breast cancer patients followed for as long as 14 years. Nine of 16 white patients and 6 of 11 black patients who did not respond to their tumor but who had a normal MLC died of systemic breast cancer as compared to 1 of 20 white and 2 of 5 black patients who responded to the HMP and/or had a depressed MLC. When high-risk clinical variables (nodal status, tumor size and cell differentiation) were combined with high-risk immunological risk factors in white patients, the prognostic values of both the immunological and clinical categories were enhanced. Seven of 9 concordant high-risk white patients died from systemic breast cancer. These results point to the necessity of immunological testing as an aid in clinical staging of breast cancer patients.

The basics of immunological tests

This review article describes the cells and the humoral factors of the immune system. It also explains what tests are available to assess the immune functions of patients. Each test listed states the amount of blood needed and the time required to perform the assays.

Transmission of simian acquired immunodeficiency syndrome with a type D retrovirus: immunological aspects

Simian acquired immunodeficiency syndrome (SAIDS) was transmitted to four of four rhesus macaques with blood from rhesus macaques naturally infected with a type D retrovirus, simian retrovirus-2 (SRV-2). Three of the four blood recipients died with SAIDS at 13, 15, and 26 weeks postinoculation. The fourth animal is alive with SAIDS. All four test monkeys became viremic and produced antiviral antibody. None of the inoculated monkeys produced measureable neutralizing antibody to SRV-2. The survivor produced higher levels of antiviral antibody than the monkeys that died. Phytohemagglutinin and concanavalin A reactivity of peripheral blood lymphocytes was depressed from weeks 6 to 12 after inoculation. Clinical findings included development of splenomegaly in all four monkeys, and diarrhea in two monkeys. Blood counts remained within the normal range except for a depression in the number of polymorphonuclear lymphocytes in two monkeys. Hematocrits were decreased in two monkeys just prior to their death. All four test monkeys developed lymph node atrophy and bone marrow hypoplasia. Total proteins and immunoglobulin production were normal. This report provides evidence that SRV-2, as well as other type D retroviruses, causes SAIDS in macaque species.

The concurrence of Saethre-Chotzen syndrome and malignancy in a family with in vitro immune dysfunction

The occurrence among 13 siblings of a malformation-mental retardation syndrome and diverse malignancies was investigated for etiologic relationship by clinical, genetic, immunologic, and virologic techniques. Three sisters and their father had Saethre-Chotzen syndrome, an autosomal dominant trait with craniosynostosis and asymmetric facies. One affected sister also had nasopharyngeal carcinoma; tow nondysmorphic brothers had Hodgkin's disease, and another had seminoma with teratocarcinoma of the testis. Decreased in vitro lymphocytic proliferation to various mitogens was observed in both available siblings with tumor, one sibling with Saethre-Chotzen syndrome, and two clinically normal siblings and their father. Both parents and all siblings had normal karyotypes and no increase of antibodies to Epstein-Barr virus. The malformation syndrome and the various neoplasias segregated independently of each other and of 47 genetic markers, including histocompatibility antigens (HLA). This study illustrates an approach to defining etiology when rare disorders cluster in a family and suggests that the occurrence of malignancies in this family may be related to subclinical immune dysfunction. Whether the Saethre-Chotzen syndrome predisposed to malignancy, perhaps through impaired immunity, awaits additional observations.

Characterization of cell-mediated immunity in long-term survivors of gastric or colorectal cancer

Cell-mediated immunity was assessed in 12 patients who were long-term survivors of gastric and colorectal adenocarcinomas. A slight decrease in the T-lymphocyte count was accompanied by preserved proliferative reactivity to mitogens (phytohemagglutinin) or alloantigens in 75 percent of the patients. The influence of autologous patient serum on in vitro lymphoproliferative test results was not significant. Selected sera from both study groups showed values of immune complexes that were within the normal range. The colorectal cancer group had antibody-dependent cellular cytotoxicity within the ranges already established for the normal control subjects. Cellular immune mechanisms seem to have been well preserved in long-term survivors of gastric or colorectal carcinoma.

The effect of experimental conditions on the assessment of T cell immunomodulation by biological response modifiers (thymosin fraction five)

The coculture of spleen cells with specific antigens in the presence of thymosin fraction five (F5) results in the stimulation of the lymphocyte response. To observe the stimulation, a suboptimal responder-to-stimulator ratio must be utilized. Suboptimal assay conditions also are needed in immunization challenge studies in which thymosin F5 acts as an effective immunoadjuvant. The data reported here suggest that to study the efficiency of a biological response modifier, suboptimal assay conditions are best for observation of immunomodulation. We also report that thymosin F5, in addition to exhibiting adjuvantlike activity for T cells, is stimulatory in assays of mixed lymphocyte response and in the in vitro stimulation of cytotoxic T effector cells, following a mixed lymphocyte-tumor culture.

Immunomodulation and therapeutic characterization of thymosin fraction five

In this report we describe the characterization of the immunomodulatory efficiency and therapeutic properties of thymosin fraction five (F5). We consistently observed the immunostimulation of T-cell activity in assays of allogeneic mixed lymphocyte response (MLR) and the development of cytotoxic effector cells in an allogeneic mixed lymphocyte tumor response-cell-mediated cytotoxicity assay (MLTR-CMC). No induction of suppressor cell activity was observed. Thymosin F5 also acted successfully as an adjuvant when admixed with irradiated tumor cells. We were unable to demonstrate either NK cell or macrophage activation by thymosin F5. Therapeutic protocols using thymosin F5 and directed against pre-existing experimental and spontaneous metastases, had a significant immunotherapeutic potential.

Effect of 2-mercaptoethanol and mycostatin on guinea pig lymphocyte transformation: interpretation of results depends on the method of calculation

The stimulating effects of 2-mercaptoethanol (2-ME) reported in murine cell cultures were confirmed for guinea pig lymphocyte transformation (LT). 2-ME was mitogenic for peripheral blood lymphocytes (PBL) and lymph node lymphocytes (LNL) and enhanced PPD-induced LT. The effect on LNL was dependent on the magnitude of the response of non-2-ME treated cultures. The 2-ME effect on PPD-stimulated LNL was reversed when stimulation index (SI) replaced the delta cpm estimate. Mycostatin (MYC) inhibited the blastogenic response of PBL control cultures, whereas its effect on LNL control cultures varied. The interpretation of the effect of MYC on PPD-stimulated cultures was dependent on the use of the delta cpm or SI estimates. The interpretation of LT experiments is therefore highly dependent on whether delta cpm or SI is used for expression of results. Analysis of effects on control and stimulated cultures should precede the addition of 2-ME or MYC to cultures for LT.

Antitumor reactivity in vitro and in vivo of lymphocytes from normal donors and cancer patients propagated in culture with T cell growth factor (TCGF)

Peripheral blood lymphocytes (PBL) from 38 normal donors and from 27 cancer patients were propagated in bulk cultures for 3-6 weeks using T cell growth factor (TCGF). In addition, cultures derived from lymphocyte preparations enriched for or depleted of natural killer (NK) cells and several clones of cultured cells were studied. The following main observations were made: (a) PBL of both patients and healthy donors could be expanded to large numbers (up to 2500-fold); (b) CLC derived from unfractionated PBL exhibited intermediate levels of cytotoxic activity against autologous and allogeneic fresh lung tumor cells and strong cytotoxicity toward several cultured adherent tumor cells; (c) whereas cultures originated from populations enriched for NK cells were highly cytotoxic against both adherent tumor target cells and against an NK-sensitive leukemic cell line (K562), cultures derived from populations depleted of NK cells were preferentially cytotoxic to adherent target cells; (d) clones of CLC were also strongly cytotoxic, but 2 out of 3 clones tested showed a narrower spectrum of target cytotoxicity than that of uncloned CLC; (e) CLC, when mixed with two carcinoma cell lines, were able to inhibit tumor growth in nude mice.

Characterization of the cellular immune response in American cutaneous leishmaniasis

The in vitro and in vivo cellular immune reactivity of 49 patients with American cutaneous leishmaniasis (ACL) was evaluated using mitogens and parasite antigens. Patients were examined before treatment and were classified on the basis of clinical and histopathological criteria as suffering localized cutaneous leishmaniasis (LCL, 32 patients) or mucocutaneous leishmaniasis (MCL, 11 patients). A small group (6 patients) of treated diffuse cutaneous leishmaniasis (DCL) patients was also examined. The lymphocyte proliferative responses to PHA were significantly lower than those of controls (87 individuals, from either endemic or nonendemic zones) in LCL, and particularly MCL. Con A responses were, however, effectively normal in these patients. Both in vivo and in vitro cellular immune responses to leishmanial antigens were significantly greater in MCL and LCL patients than in the controls, the intensity of the reactions being by far the greatest in MCL. DCL patients demonstrated a complete absence of specific immune responsiveness both in vivo and in vitro. The significance of these results in the mechanisms leading to the resolution of the infection or production of pathologic lesions is discussed.

Effect of infections with swine fever virus on immune functions. II. Lymphocyte response to mitogens and enumeration of lymphocyte subpopulations

Peripheral blood and spleen lymphocytes from pigs infected with a low-virulent strain of swine fever virus (SFV) were transiently hyporesponsive to the mitogenic action of PHA, PWM and Con A. The mitogenic reactivity of lymphocytes from lymph nodes from such pigs appeared to be enhanced rather than depressed at that time. In addition, hyper-responsiveness of peripheral blood lymphocytes (PBL) to these mitogens occurred in some pigs. PBL from pigs lethally infected with virulent SFV showed a persistent depression of the response to these mitogens, whereas lymphocytes from lymph nodes had a high responding capacity. A lymphocyte response to SFV antigens could not be demonstrated in infected pigs. These SFV infections did not markedly affect the percentage of lymphocytes in the blood and most lymphoid organs rosetting with sheep red blood cells. On the other hand, surface immunoglobulin-bearing lymphocytes were markedly increased in lymph nodes from pigs exposed to virulent SFV. The sum of both lymphocyte subpopulations in the lymph nodes from these pigs often considerably exceeded the 100% value, which strongly suggests the presence of cells bearing both surface immunoglobulin and receptors for dextran-treated sheep red blood cells. Possible correlations between these findings are discussed. The results suggest that infections with SFV induce systemic alterations in the process of lymphocyte recirculation in the pig.

Association of depressed mixed lymphocyte reactivity with the development of bladder carcinoma in patients with papillomas

Patients with bladder papillomas have an excellent overall prognosis, although approximately 10% of such patients develop frank bladder cancer. It is therefore important to devise methods for subclassifying bladder papillomas in an attempt to identify those patients at high risk for progression to carcinoma. The lymphoproliferative responses in 27 patients with bladder papillomas were tested in the mixed lymphocyte reaction (MLR). Patient responses were compared to those of normal individuals tested simultaneously. A relative proliferation index (RPI) was defined as a percent response relative to the mean normal response. A RPI less than 0.5 was defined as a depressed MLR and greater than 0.5 as a normal MLR. All patients were followed at three-month intervals for at least five years for the development of superficial or invasive bladder carcinoma. Of the 27 patients, 12 had a depressed MLR and 10/12 (83%) developed cancer within five years. Of the 15 patients with a normal MLR, only three developed bladder carcinoma. The number of papilloma patients surviving free of bladder carcinoma at five years was 12/15 (80%) with a normal MLR and 2/12 (17%) with a depressed MLR (P less than 0.01). Measurement of the MLR appeared to offer a useful adjunct in the evaluation of staging and biologic potential of bladder papilloma.

Prognostic significance of lymphocyte proliferative responses to mitogens in gastric cancer patients

In 501 Japanese patients with gastric cancer, the relationships between preoperative lymphocyte proliferative (LP) responses to mitogens and prognosis of patients were evaluated. Peripheral blood lymphocytes were cultured in the presence of either autologous or allogeneic serum and their LP responses to phytohemagglutinin (PHA) and pokeweed mitogen were investigated. An apparent inverse relationship between LP responses and stage of the disease was found in LP responses to PHA in the presence of autologous serum. The survival rate of patients with higher responses was significantly greater than those with lower responses, when LP responses to PHA in the presence of autologous serum served as the criterion. Probabilities of staging which were computed on the basis of LP response to PHA affirmed the reciprocal relationship between LP responses and stage of the disease. From these results, it is concluded that evaluation of LP responses may be a valuable tool in the assessment of the clinical stage and in the prediction of prognosis.

Autologous mixed lymphocyte reaction in the peripheral blood and pleural effusions of cancer patients

T cells proliferate in response to autologous non-T cells in the autologous mixed lymphocyte reaction (AMLR). AMLR was impaired in the peripheral blood of patients with advanced lung cancer (4,159 +/- 3,878 delta cpm vs. 11,221 +/- 4,156 delta cpm for normal donors) but normal or even higher in their malignant pleural effusions (13,257 +/- 7,075 delta cpm vs. 10, 870 +/- 5,013 delta cpm for nonmalignant control effusions). Blood T cells also failed to respond to autologous effusion non-T cells, while effusion T cells strongly responded to autologous erythrocytes blood non-T cells. The presence of blood T cells did not inhibit effusion AMLR of the same patients. A subset of T cells that form rosettes with autologous erythrocytes if found to proliferate in AMLR. The number of autorosette-forming cells was lower in blood T cells of cancer patients than in blood T cells of normal donors and in effusion T cells of the patients. After enrichment of autorosette-forming cells, there was no difference in AMLR of normal blood and cancer blood and effusions. These results indicate that the loss of AMLR in the blood of cancer patients is due to a reduction of number of autoreactive T cells and not to a defect of autologous stimulator non-T cells.

Immunology of human gastric cancer: a preliminary report

The immunological spectrum in fifteen patients with gastric cancer is presented. Patients were divided in three groups. Those with nonadvanced cancer, those with advanced but resectable lesions and those with advanced but nonresectable tumors. Preoperatively, elevated levels of circulating immune complexes (CIC) associated with hyporesponsiveness to phytohemagglutinin (PHA) and in mixed lymphocyte culture (MLC) as well as a positive leukocyte inhibitory serum factor (LIF-S) were found in nearly half of the patients. Inhibitory or enhancing autologous serum factors were detected. Postoperatively, immunologic parameters return to normal in patients with nonadvanced cancer, while in advanced cancer, antibody and cell-mediated immune response remained altered, with some changes associated with chemotherapy. These findings are probably related with the presence or absence of tumor and offer a distinct approach in evaluating the immunologic response of a tumor-bearing patient.

Further aspects of T cell function in systemic lupus erythematosus

Generation of effector cells, the expression of cell mediated lympholysis (CML) and the reactivity of mononuclear cells in solid cultures, were explored in patients with Systemic Lupus Erythematosus (SLE). While proliferative responses to alloantigens were comparable to the controls, a significant decrease in CML capacity was found in SLE T lymphocytes; further, T cells stimulated with a T cell mitogen in solid cultures showed a diminished proliferative response to soluble factors. Functional cell interaction defects rather than intrinsic T cell abnormalities may be operating in SLE.

Immunologically defined prognostic subgroups as predictors of response to BCG immunotherapy

Fifty-two stage I and II patients with nonsmall cell lung cancer were randomized after resection to no further therapy, BCG, or BCG plus allogeneic tumor cells. Patients have been observed for 16-65 months (mean 39.5). When the two immunotherapy arms were combined and plotted against controls, trend analysis suggested (P = 0.088) an increase in disease-free interval (DFI) only for stage I patients. The one-way mixed lymphocyte culture (MLC) values were depressed in some patients prior to any immune stimulation. Immunotherapy significantly benefited DFI among patients with a depressed MLC.

Cytostasis of tumor cell lines by granulocytes from cancer patients and normal human donors

Granulocytes of normal human donors were previously shown to have cytostatic activity in vitro against a variety of tumor cell lines. In the present study, we have compared the levels of granulocyte-mediated cytostatic activity in cancer patients and normal donors. In an initial study of 25 tumor-bearing patients and 21 individuals with benign or no disease, decreased cytostatic activity was observed in 84% of the cancer patients. Nine cancer patients with no evidence of disease had reactivity in the normal range. Granulocytes separated by a one-step method on a double Ficoll-Percoll gradient showed decreased reactivity. This procedure eliminated the differences previously detected between tumor-bearing patients and controls. Addition of either pooled normal AB human serum or autologous serum to the assay restored the reactivity. Only with autologous serum and not with allogeneic serum, were the differences between tumor-bearing patients and controls again seen. Therefore, in a subsequent study, we examined the effect of serum on cytostasis by normal granulocytes that were isolated on double gradients. We observed lowered serum restorative activity (SRA) in 41 of the 46 (89%) tumor-bearing patients tested. Fractionation of sera by Sephadex G-200 chromatography indicated that SRA of both cancer patients and normal donors was in the 100,000 molecular weight region.

Lymphoproliferative responses to autologous tumor extracts as prognostic indicators in patients with resected breast cancer

Patients with operable breast cancer were tested postoperatively to assess lymphoproliferative responses. Patients with lymphocytes capable of recognizing and proliferating in response to autologous tumor extracts had a significantly longer disease-free interval than those with a low response to their autologous extract. In this group of patients, immunological responses to autologous tumors predicted subsequent clinical course better than pathological evaluation based on tumor presence in axillary lymph nodes. Low or negative reactivity to autologous tumor often was not accompanied by a general, impaired ability to respond in LP assays. In fact, patients with low autologous tumor response and normal MLC were at particularly high risk for recurrence.

Effects of vanadium on immunologic functions

Exposure of mice to vanadium caused a dose-related but nonsignificant decrease in the antibody-forming cells in the spleen of animals challenged with sheep erythrocytes. Delayed hypersensitivity reaction was not affected in similarly sensitized animals. Serum immunoglobulins were also not altered by the vanadium treatment. Splenic lymphocytes obtained at 1, 4, 8 and 13 wk of exposure to 0, 1, 10, and 50 mg of vanadium per liter of drinking water showed an increased DNA synthesis related to vanadium treatment when cultured in the presence of phytohemagglutinin and pokeweed mitogen but not with bacterial lipopolysaccharide. Addition of vanadium to splenic cultures in vitro caused a marked enhancement of lymphocyte transformation at low concentrations, whereas a decreased cellular proliferation was observed at high concentrations of vanadium.

Clinical manifestations of familial 13;18 translocation

Female first cousins, aged 21 and 2 1/2 years, with many of the characteristic features of trisomy 18, were found to have identical unbalanced translocations, 46,XX,--13, + der(13)t(13;18) (p13;q12)mat. Clinical features of another cousin, two uncles, and an aunt suggested that they, too, had a partial trisomy 18 phenotype. The long survival and normal menstrual and secondary sexual development in one case are remarkable. A heritable balanced translocation, 46,XX or XY, t(13;18) (p13;q12), was detected in the mothers of the cases, a sib, an aunt, and two uncles. Translocation carriers had abnormalities in gonadal structure or function, with aspermia in males and polycystic ovaries with infertility in several females, suggesting that some gene controlling reproductive development occurs on the long arm of chromosome 18, with normal function interrupted at the breakpoint. Balanced translocation carriers may also be at greater risk for both benign and malignant neoplasms, which included acute leukaemia in an uncle and adenocarcinoma of the stomach at an early age in the grandmother. Although aetiological laboratory studies identified no premalignant state, the clinical findings suggest a defect that may predispose to cytogenetic abnormalities and malignancy.

Impaired cell-mediated immunity function in thyroid cancer

Immunological parameters were studied in 31 patients with thyroid cancer. Serum immunoglobulin levels, T and B cell percentages in peripheral blood, showed no significant difference as compared with those of control group. The blastogenesis with phytohemagglutinin P (PHA) was significantly reduced, especially, in those having larger tumor size or metastasis or in those over age 60. The positive rate of skin test with purified-protein-derivative (PPD) and Streptokinase-Streptodornase (SK-SD) was also markedly reduced. The impaired blastogenesis of lymphocyte and reduced positive rate of skin test in those cancer patients suggested that the cell-mediated immunity function, in spite of adequate count of T-cells, was impaired.

Natural killer activity of lymphoid cells isolated from human ascitic ovarian tumors

Lymphocytes and tumor cells were isolated from the carcinomatous ascites of 24 patients with epithelial ovarian tumors by stepwise application of density and velocity sedimentation on discontinuous Ficoll-Isopaque gradients and fetal bovine serum. Tumor-associated lymphocytes showed a lower percentage of cells with receptors for sheep erythrocytes (E) or for complement than did peripheral blood lymphocytes from the same patients. NK activity was measured, 51Cr-labelled K562 cells being used as targets in a 20-h assay. Tumor-associated lymphocytes showed significant NK activity. Cytotoxicity levels were lower than for peripheral blood effector cells from the same patients, and these in turn showed significantly lower cytotoxic capacity than peripheral blood lymphocytes from 64 control subjects. Similar results were obtained when lysis was measured after 4 h of incubation. Tumor-associated lymphocytes forming E rosettes were at least as effective as the unseparated population. When tumor-associated lymphocytes were mixed with normal effector cells, in three of six preparations with low NK activity tested, significant inhibition of normal lymphocyte NK activity was observed. Adherent macrophages from carcinomatous ascites, which contained lymphocytes that had suppressive activity, showed no inhibitory activity. Interferon (IF) boosted the NK activity against K562 of tumor-associated lymphocytes. Purified ovarian carcinoma cells were relatively resistant to lysis by normal lymphocytes. However, they inhibited lysis of K562 cells in cold target competition assays, though less efficiently than K 562 itself, and were consistently lysed when effector cells were stimulated with IF. It is therefore suggested that ovarian carcinoma cells express NK-relevant recognition structures, but are relatively resistant to cytolysis by unstimulated effector cells.

Comparison of immune derangements in patients with different malignancies

Immune function was evaluated in 109 patients with carcinoma of the breast, bladder, head and neck, and lung. Patients with head and neck cancer showed the most profound derangements of immune function; patients with lung cancer showed no detectable abnormalities. Non-irradiated patients with disseminated head and neck cancer had significantly depressed lymphocyte counts (mean 1357/mm3, P less than .05), E-rosette forming cells (mean 770/mm3, P less than .05), and response to phytohemagglutinin (P less than .05) as compared to controls. This immunodeficiency was detected in patients with localized as well as advanced disease. Although significant differences were noted between patients with head and neck cancer and the other tumors, these differences were minimized by radiation therapy. All irradiated patients showed comparable degrees of immune dysfunction. Absolute Fc-receptor cells were depressed in all irradiated patients and in non-irradiated patients with disseminated breast cancer.

Association of depressed postoperative lymphoproliferative responses to alloantigens with poor prognosis in patients with stage I lung cancer

Thirty-five patients with Stage I carcinoma of the lung were tested postoperatively to assess lymphoproliferative responses. Depressed lymphocyte proliferation (LP) responses to alloantaigen in the mixed leukocyte culture (MLC) as measured by thee relative proliferation index (RPI) were associated with a significantly shorter disease-free interval. In this group of patients, the immunologic responses predicted subsequent clinical course better than the TNM classification or the histological type of the tumor, and therefore this procedure appears promising for improved staging of patients with early stages of lung cancer (stage I lung cancer and T1N0M0). The depressed response to alloantaigen was a more sensitive discriminator of disease recurrence than PHA alone or even conbined with PHA.

Circulating breast tumour antigen-sensitive T lymphocytes in early breast cancer and high risk benign breast disease

Levels of circulating T lymphocytes sensitized to breast tumour associated antigens (BTA) were correlated with pathological tumour stage or benign histopathology in preoperative studies of 180 patients by the antigen-stimulated active rosette-forming T cell (AgARFC) assay. Incubation of lymphocytes with allogeneic BTA extracts produced increased AgARFC compared with incubation without BTA. Significant levels of BTA-sensitive T cells were found in 78 per cent of breast cancer patients compared with 23 per cent of patients with benign disease (P less than 0.0005, by X2). Over 93 per cent of stage I cancer patients responded to BTA, compared with 69 per cent of stage II patients (P less than 0.025) and 59 per cent of stages III-IV patients (P less than 0.005). Twenty-nine per cent of 42 patients with fibrocystic disease were positive to BTA in contrast to 8 per cent of 25 patients with fibroadenomas. This was a 3.6-fold higher incidence of BTA-sensitive T cells associated with fibrocystic disease than with fibroadenomas, which was in agreement with the increased breast cancer risk rate associated with fibrocystic disease. These findings suggest that the AgARFC assay may detect early malignant change in fibrocystic disease. The AgARFC assay was found to reliably detect early invasive carcinoma.

Overview on new immunologic markers for diagnosis of cancer

There is a large and increasing number of tumor-associated markers which can be detected immunologically and which may be useful for detection, diagnosis and monitoring of cancer. These include cell surface antigens and other components specifically associated with tumor cells, ectopic hormones, and normal materials which are produced in increased amounts by or in response to the tumors. Some of these markers are only antigenic in heterologous species, whereas others are reacted to by the tumor-bearing host. The major current problem is to determine which of these markers may be applied to practical problems of immunodiagnosis.