Inhibition of leucocyte migration by tumour-associated antigens of the colon and rectum

Production of Leukocyte Migration Inhibition Factor by Lymphocytes of Larynx Cancer Patients Stimulated by Laryngeal Carcinoma Solubilized Membrane Antigens

The production of leukocyte migration inhibition factor (LIF) from lymphocytes after stimulation with 3 M KCl soluble tumor and normal mucosa extracts was investigated in 30 patients with laryngeal carcinoma at different development stages and in 30 normal donors. The experiments were performed in heterologous and autologous systems. In heterologous systems 3 M KCl tumor extracts induced LIF production by heterologous lymphocytes from patients in 91 % of the cases, and normal mucosa extracts induced LIF production by heterologous lymphocytes from patients in 73 % of the cases and from normal donors in 90 % of the cases. In autologous systems 3 M KCl tumor extracts induced LIF production by autologous lymphocytes from the same patients in 65 % of the cases, whereas the normal laryngeal mucosa extracts induced LIF production by the same autologous lymphocytes in the 6 % of the cases. The high positivity percentage of the test in heterologous systems could be related to differences in the major histocompatibility complex. The 65 % test positivity in autologous systems using tumor extracts could be related to the presence of tumor associated antigens.

Lymphokine activated killer (LAK) cells in patients with gastrointestinal cancer

Lymphokine activated killer (LAK) cells are a recently described cellular immune phenomenon with exciting potential for the treatment of tumours arising from solid organs. A comparison of some aspects of LAK cell precursors and LAK cell function was undertaken in 44 control subjects and 44 preoperative patients suffering from gastrointestinal cancer (20 localised and 24 advanced). Lymphokine activated killer cell precursor (natural killer (NK) cell) activity was significantly diminished in patients with advanced tumours (p less than 0.02) as was fully mature LAK cell activity against an NK resistant target cell (p less than 0.012). T-lymphocyte responses were not significantly different between the three groups. The reduced LAK cell generation was associated with a significantly diminished proliferative response of LAK precursors to stimulation with high dose IL-2 in vitro (p less than 0.012). Impaired LAK cell generation may explain the failure of adoptive cellular immunotherapy with LAK cells in some patients with advanced gastrointestinal cancer and prompts the search for means of augmenting this activity in such patients.

Decreased interleukin-2 production in patients with gastrointestinal cancer

Mitogen-stimulated basal and maximal interleukin-2 production has been measured in 60 control subjects and 45 patients with gastrointestinal cancer (14 localized and 31 advanced). Peripheral blood T cell subsets in these subjects were also measured. In patients with advanced gastrointestinal cancer interleukin-2 production (mean +/- s.e.m. units/ml) is impaired when compared with that of control subjects (26.5 +/- 7 versus 61.1 +/- 9, P less than 0.0001) or patients with localized cancer (26.5 +/- 7 versus 59.4 +/- 13, P less than 0.02). This cannot be restored to normal by in vitro irradiation of the lymphocytes, suggesting that the impaired function is not due to IL-2 suppressor cells. Using monoclonal antibodies the percentages of T cell subsets were similar in all groups and we therefore conclude that the reduced production of IL-2 in these patients is due to deficient helper T cell function. These results provide a rational basis for the administration of exogenous IL-2 in the future management of patients with advanced gastrointestinal cancer.

Specific active immunotherapy in patients with adenocarcinoma of the colon utilizing tumor-associated antigens (TAA). A phase I clinical trial

Twenty-two patients received specific active immunotherapy (TAA vaccine once per month for 3 months), with the duration of follow-up, as of July 1984, ranging from 3 months to 36 months (median, 21 months). Of these, seven had Dukes B2, seven had Dukes C, and eight had Dukes D lesions. All received surgical resection, and those with Dukes D disease underwent resection of all metastases where possible, with six clinically disease-free at the time of initiation of therapy. The age range of the 22 patients was 40 to 73 years (median, 60 years); sex distribution was 12 males and 10 females. All patients were monitored by physical examination and by laboratory parameters including complete blood count, liver and renal function tests, blood chemistries, urinalysis, chest x-ray, carcinoembryonic antigen levels, migration inhibition assays, complete immune complexes, serum chemistries, helper and suppressor and total T-cell and B-cell assays, and TAA antibody levels. As measured by delayed cutaneous hypersensitivity skin test and by migration inhibition assays (MIA), a strong postimmunization response is developed approximately 5 months after vaccination is completed. There were no clinical or biochemical manifestations of any type of systemic toxicity including hepatic, renal, gastrointestinal, respiratory, or neurologic during the period of follow-up. All patients developed skin ulcers at the vaccination and required 4 to 5 months to heal. With this small number of patients in a Phase I trial, survival is indicative of the safety of the vaccine only: 82% of the patients are alive (mean survival, 21 months) thus far, and 59% of the patients are without evidence of disease (NED) (mean NED, 22 months). These studies, therefore, justify a Phase II-III trial in a larger number of patients and have provided selection of appropriate monitoring tests for the larger trial.

Adjuvant treatment of colorectal cancer. Current status and concepts

Colorectal cancer is the second leading cause of cancer mortality in the United States, causing approximately 50,000 deaths per year. The overall prognosis and results of treatment have not changed impressively over the last three decades. Half of all the patients who undergo curative surgery finally succumb to locoregional or metastatic recurrence of their disease. Recent clinical research has been aimed at adjuvant therapeutic measures to improve survival after curative surgical resection. For rectal cancer, combined postoperative chemotherapy and radiation therapy have been shown to reduce the overall relapse rate and improve disease-free survival. Further studies of adjuvant treatment for rectal cancer are needed to evaluate the optimal radiation schedule and limit the side-effects of the treatment. Adjuvant treatment of colon cancer must still be regarded as unsettled. Since liver metastases are the most common unfavorable outcome of colon cancer, ongoing trials using liver-directed treatment (perfusion, irradiation) should be followed with interest. The lack of proven efficacy and the side-effects of these treatments strongly favor the inclusion of an observation-only control group in trials for adjuvant treatment of colon cancer. Unfortunately, there is as yet no proven significant benefit from immunotherapy as an adjuvant therapy for colorectal cancer, but further basic and clinical studies will be of great interest in this field.

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.

Human intracranial tumors: effect of autologous serum addition on leucocyte migration inhibition

42 human intracranial tumours were investigated by the leucocyte migration inhibition technique at various antigen concentration with and without autologous serum addition. A correlation was found between migration rate and antigen concentration. Autologous serum addition resulted in a non-specific stimulation of migration, however, stimulation by immune complexes was also present. Migration stimulation, as an in-vitro-equivalent of immunologic tumor enhancement, is discussed.

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.

Survival and the immune response in patients with carcinoma of the colorectum

One hundred and seven patients with colorectal carcinoma were examined for their immune response to autologous tumour. Patient leucocyte migration inhibition by tumour antigen, migration inhibition of normal subject's leucocytes by patient's serum, and the assessment of lymphocyte invasion of the tumour specimen were used to measure the immune response. Forty-one and 51% of patients were immune by leucocyte migration inhibition and tumour invasion by lymphocytes respectively. The immune patients had a survival advantage at three years on Chi-squared analysis. Patients whose serum contained a factor that inhibited the migration of leucocytes obtained from normal individuals had a diminished survival prognosis. The donors of these sera had a 50% chance of dying or of developing recurrent disease. These same individuals represented 30% of all those tested by this method. The immune patients included the sera donors as a subgroup 30% of all those tested by this method. The immune patients included the sera donors as a subgroup who, if excluded from the life table analysis, left a group of immune subjects who had very superior survival features.

The effect of levamisole on postoperative immunosuppression

Cell mediated immunity was studied before and after surgery in patients with colorectal cancer. Thymus-derived (T) lymphocytes were enumerated and their non-specific activity was measured by assessing phytohaemagglutinin (PHA)-induced blastogenesis. Specific T lymphocyte activity was measured by leucocyte migration inhibition in response to purified protein derivative of tuberculin (PPD) and autochthonous tumour extract. One group of patients received levamisole postoperatively and the other group consisted of controls. There was a more rapid return to preoperative levels of leucocyte migration inhibition to both antigens by the levamisole group. However, levamisole administration had only a marginal effect on the postoperative depression of cell counts and did not restore depressed lymphoblast transformation.

Relation between immunity and survival in carcinoma of the colon and rectum

Twenty-two patients with cancer of the colon and rectum were evaluated before and after surgical treatment by leukocyte migration inhibition assays using autologous and allogeneic tumor extracts. All patients were resected for cure. Patients with cancer of the colon demonstrated significant migration inhibition against autologous extracts before surgery and in the immediate postoperative period. Patients with rectal cancer did not demonstrate significant migration inhibition at any time. The possibility that immunity plays a role in the poorer prognosis of patients with rectal cancer is discussed.

Randomized trial with Poly A-Poly U as adjuvant therapy complementing surgery in patients with breast cancer: in vitro study of cellular immunity

The immunologic reactivity of patients with initially operable breast cancer was measured by the leukocyte migration inhibition test using autologous tumor extract (T), autologous serum (S), and a combination of both (T + S). These patients formed part of a randomized clinical trial comparing, on the one hand, conventional treatment and, on the other, conventional treatment complemented by injections of poly A-poly U. A sequential study was carried out on 159 patients, testing them 7 days, 2 months, 4 months, and 1 year after the operation. Statistical comparisons revealed no significant difference in the reaction of the two groups. In addition, no significant differences were found between those with lymph node involvement and those without. Radiotherapy given to those with lymph node involvement did not significantly change their reactions. We were able to show that the percentage of patients with a positive leukocyte migration inhibition test (LMIT) increases regularly and significantly with time. This study confirmed the presence in some autologous serum of a synergistic factor (SS factor) which increased the inhibition of migration of leukocytes by autologous tumor extract. This factor was found in 18 patients, equally divided between both therapeutic groups. In the group with SS factor, the percentage with lymph node involvement appeared greater (83% compared with 68% among those patients who had no SS factor), and the incidence of metastases was also increased (44% compared with 21%). This factor seemed to indicate a bad prognosis. However, there was a difference in the results between the two therapeutic groups in patients with the synergistic factor. Of nine patients undergoing conventional treatment, six had devleoped metastases, whereas only two out of the nine patients who also poly A-poly U developed metastases. The same trend was observed in the whole trial population.

Leucocyte-migration-inhibition test in patients with colorectal cancer: clinicopathological correlations

Leucocyte-migration-inhibition test was used to study the immune reactions of leucocytes from 136 colorectal cancer patients, 43 patients with non-cancerous chronic colorectal diseases and 82 controls, with saline extracts of HT29 line. A positive inhibition was found in only 43% of colorectal cancer patients. It was higher in carcinomas of limited extension than in invasive ones (64% against 39%). Furthermore, operation by itself had a depressive effect on the reaction, as the positivity in 25 patients tested twice was 64% before operation and 32% after. Leucocytes from patients with non-cancerous chronic colorectal diseases gave many positive reactions (65%). The percentage of positivity was about the same for diseases with high, low or no risk of cancerization. Hence the antigen(s) of tumour extracts that react with patient's leucocytes are, at least partially, unrelated to cancer.

Cell-mediated immunity in patients with renal cell carcinoma as measured by leukocyte migration inhibition test

The cell-mediated immune (CMI) response to tumor-associated antigens present in 3 M KCL extracts of renal cell carcinoma tissue was measured in patients with renal cell carcinoma (RCC) by the leukocyte migration inhibition (LMI) test. Of 30 patients with histologically proved RCC, 19 (63%) gave a positive LMI test; whereas, 2 of 28 (7%) of the normal donors, 13 of 43 (30%) patients with other cancers, and 5 of 14 (36%) benign kidney disease patients gave positive tests. Thirteen per cent of RCC patients reacted to a normal kidney extract. Although 33% gave a positive response to a lung carcinoma extract, the incidence of reactivity was less than that observed with the lung cancer patients. These results suggest that a CMI response to a renal carcinoma-associated antigen was measured by the LMI test. Correlation of the LMI data with the stage of disease and clinical status indicated that 71% of patients that had a localized tumor and were clinically free of disease one year postnephrectomy lost their tumor-directed CMI response. Patients with distant metastasis (Stage D) were LMI positive provided they had not received radiation or hormone therapy at the time of testing. These results suggest that the demonstration of CMI, as measured by the leukocyte migration inhibition test, correlates with the presence of active disease.

A modified leukocyte adherence inhibition test in the laboratory investigation of gastrointestinal cancer

A modification of the leukocyte adherence inhibition (LAI) technique has been used to test 60 hospital patients with gastrointestinal symptoms, for specific immunoreactivity against extracts of tumours of colon, pancreas and stomach. The modified technique employed mononuclear cells and soluble tumour extracts in glass test tubes, the non-adherent cells being enumerated in an electronic counter. Laboratory tests were completed before the eventual diagnosis was known. Groups of patients with adenocarcinoma of colon or rectum (11), carcinoma of pancreas (3) and adenocarcinoma of stomach (6) were clearly distinguished from each other and from patients with non-malignant diseases or with neoplasms of different histological type.

Leukocyte migration inhibition by cancer patients' sera

Sera from 38 of 89 melanoma patients, 4 of 15 patients with other cancers and 3 of 43 control donors inhibited the migration of autologous leukocytes. Sera from patients with clinically detectable metastatic disease and from the recipients of BCG were most frequently inhibitory. Autologous sera from 31 of 71 melanoma patients and 3 of 31 control donors increased the leukocyte migration inhibition induced by formalinized melanoma cells. This activity occurred in sera from patients at all stages of malignancy, whether bearing detectable tumour or not and whether receiving BCG or not. Abrogation of tumour-cell-induced leukocyte migration inhibition by serum was less frequent, occurring with 8 of 71 melanoma patients (6 Stage III, 1 Stage I and 1 Stage II) and no control sera. Preincubation of formalinized tumour cells had no effect on their activity in the leukocyte migration assay but the preincubation of melanoma leukocytes with either autologous serum or foetal calf serum inhibited leukocyte reactivity in around 50% of tests. However, this was also seen with control leukocytes and the effect appears to be immunologically non-specific.

Cellular immunity in mammary cancer patients as measured by the leukocyte migration test (LMT). A follow-up study

In 58 cases of mammary cancer treated by surgery the leukocyte migration test (LMT) has been applied to the study of cellular immunity using homogenate from autochthonous and homologous tumors as antigens. A positive test, i.e. inhibition of migration by antigen, was observed in 52 patients from 1 day up to 40 days after surgery. Six patients were negative. There was extensive immunological cross-reactivity among mammary cancer in that a positive test was also obtained with homogenate from homologous mammary tumors. Generally, antigens from other tumors did not react. The test was also negative when the leukocytes were derived from healthy persons. Sera from mammary cancer patients abrogated the inhibitory effect of tumor antigen. The disappearance of positivity about 40 days after surgery and its reappearance during the metastatic process indicates that the positive LMT is associated with progressive disease.

Migration inhibition with various cell fractions in human colorectal cancer

The unseparated leucocytes, separated mononuclear cells and granulocytes of six control subjects and nine patients with colorectal cancer have been studied by a direct cell migration inhibition technique. A migratory index was calculated from the migration in the presence and absence of a perchloric acid extract of large bowel tumours. In 10% homologous AB serum, no significant migration inhibition occurred with any of the cells from control subjects. Five of the nine cancer patients showed significant inhibition with their unseparated leucocytes, seven of seven with their mononuclear cells, and none of nine with their granulocytes. In 10% autologous serum, some controls exhibited migration inhibition with their unseparated leucocytes and their granulocyte fraction, but not with the mononuclear cell fraction. Migration inhibition was also now apparent in the granulocyte fraction of the cancer patients. It is concluded that, with a soluble tumour antigen preparation, a mononuclear cell population increases the sensitivity of the direct migration inhibition test and that autologous serum may interfere directly with the migration of granulocytes, by an action not dependent upon the release of inhibitory factors from sensitized lymphocytes. This could explain some of the inconsistencies of the assay when using an unseparated leucocyte population.

The leucocyte adherence inhibtion test in cancer of the large bowel

A recently introduced assay of cell mediated immunity and humoral inhibitory factors has been evaluated in colorectal cancer patients. Using a perchloric acid extract of adenocarcinoma of the large bowel as antigen, 16/27 patients with colorectal cancer had significant cellular reactivity when their separated peripheral leucocytes were tested in homologous AB serum. In autologous serum only 7/27 had significant reactivity; 6/20 patients with a variety of other malignancies showed sensitization to the colorectal antigen preparation. It is concluded that the leucocyte adherence inhibiton test may offer a simple method of assaying for serum blocking factors in sequential studies but will be of little value in the diagnosis of large bowel cancer.

Tumour immunology and the gut

This review set out to answer several questions related to tumour immunology and the gut. It is evident that in patients with gastrointestinal cancer there is a general depression of the immune response and this seems to be correlated with the stage of the disease. Paradoxically a specific immune response against definable tumour antigens can be demonstrated, both cellular and humoral mechanisms being involved although the complexities of this paradox require further analysis. Immunotherapy has been employed in gastrointestinal tumours in a sporadic way. The results suggest that gastrointestinal neoplasms may respond at least as well as other tumours. A firm conclusion awaits the results of controlled trials in which the bulk of the tumour has been effectively dealt with by other means or where combined immunochemotherapy is being used.

[Carcinofetal antigens. III. Further carcinofetal antigens (author's transl)]

The occurrance and significance of important carcinofetal antigens other than AFP and CEA are reported. These included the alpha 2 H-protein which is produced in the liver and increases in serum of patients with various tumors, the fetal sulphoglycoprotein antigen FSA from the gastric juice of patients with gastric cancer, the carcinoplacental alkaline phosphatase (REGAN-isoenzyme)which is found in the serum of patients suffering from e.g. bronchogenic, mammary, urogenital and gastrointestinal carcinomas, the beta-S-fetoprotein which is most likely to be identical with C-reactive protein, gamma-fetoprotein, the carcinofetal antigen in glial tumors (CFGA); ectopic production of placental hormones like human gonadotropin, placental lactogen, plasminogen-activators; leukemia-associated antigens. Furthermore, some other less known carcinofetal antigens are mentioned.

A study of lymph nodes draining colorectal cancer using a two-stage inhibition of leucocyte migration technique

A two-stage technique for leucocyte migration inhibition has been developed which demonstrates the sensitization of lymph node lymphocytes to colorectal tumour extract. The studies have confirmed that some lymph nodes draining colorectal carcinomata contain sensitized lymphocytes. However, the degree of lymphocyte sensitization to tumour extract does not seem greater than that seen in lymph nodes of the small bowel mesentery or of the peripheral blood.

Immunity in colonic tumor patients after operation: determination by leukocyte-migration inhibition

Tumor immunity in 31 colonic tumor patients was studied by determining in vitro leukocyte-migration inhibition. In tissue culture 30 per cent inhibition of patient leukocyte migration by tumor antigen could be demonstrated in half of the patients, suggesting that they were immune. This immunity was not related to the clinical or pathologic stage of the disease and varied in different patients. It was transient in some and persistent in others. In addition, a positive response at a fixed time after operation was not found.

Prognostic evaluation of regional lymph node morphology colorectal cancer

Histologic sections from 143 patients treated with surgery for infiltrating adenocarcinoma of the distal large bowel were studied with emphasis on the morphologic characteristics of the regional lymph nodes. Lymph nodes were classified into four groups designated lymphocyte predominance, germinal center predominance, lymphocyte depletion, and unstimulated. Results were correlated with the extent of disease and five year survival data. There was no significant association between the histologic pattern of the lymph nodes and the extent of the primary lesion. There was a higher survival rate in patients whose nodes showed germinal center predominance (71 per cent) compared with those whose nodes showed lymphocyte predominance or the unstimulated pattern (both 54 per cent), but these results were not statistically significant.

Inhibition of leucocyte migration in patients with large intestinal cancer by extracts prepared from large intestinal tumours and from normal colonic mucosa

The degree of migration inhibition in response to tissue extracts has been examined in leucocyte preparations obtained from patients with large intestinal cancer and from age and sex matched control individuals. A greater degree of migration inhibition was observed in response to a colorectal tumour extract in cells obtained from the cancer patients. Inhibition also tended to be more marked in response to the tumour extract than in response to a normal colonic mucosal extract in these patients. These results suggest that altered cellular immune reactivity is demonstrable by this simple in vitro technique in patients with large intestinal cancer.