A possible role of prostaglandins in the inhibition of natural and antibody-dependent cell-mediated cytotoxicity against tumor cells

We recently observed that certain tumor cell lines in tissue culture produced prostaglandins and that increased production occurred when the tumor cells were exposed to lymphocytes. The present experiments tested the effect of prostaglandins E₁ and E₂ on natural and antibody-dependent lymphocyte cytotoxicity against the same target cells in order to determine whether the production of prostaglandins by the tumor cells might influence the efficacy of the cellular immune response. Target cell lines T₂₄ and HCV₂₉ were labeled with ⁵¹Chromium and incubated at 37 °C for various times with lymphocytes prepared from venous blood of normal donors. Antiserum to T₂₄ and varying concentrations of prostaglandin E₁ or E₂ were added to the samples prior to incubation. In some experiments, lymphocytes or labeled target cells were preincubated with prostaglandins and then washed prior to their addition to the assay tubes. Cytotoxicity was determined by measuring the release of ⁵¹Chromium from the target cells after incubation. Both prostaglandins E₁ and E₂ inhibited natural and antibody-dependent lymphocyte cytotoxicity against the target cells. The effect appeared to represent a direct one on lymphocytes, and it was amplified by the presence of theophylline in the medium. Inhibition could be effected early on in lymphocyte/target cell interaction, and only a short exposure of lymphocytes to prostaglandins was required for the effect to be manifested. It thus appears that the production of prostaglandins by tumor cells may constitute a means by which the tumor cells subvert the effect of a cellular immune response that is directed against them.     

Production of prostaglandin E2 by bladder tumor cells in tissue culture and a possible mechanism of lymphocyte inhibition.

Human bladder tumor cell lines were found to produce and secrete prostaglandin E₂ (PGE₂) in tissue culture and to be inhibited in this activity by prostaglandin synthetase inhibitors. The addition of purified peripheral blood lymphocytes from normal human donors to the tumor cells in confluent monolayers enhanced the production of PGE₂ by the tumor cells. At concentrations similar to those produced by the tumor cells, PGE₂ induced the intracellular accumulation of cyclic adenosine 3′, 5′-monophosphate by the lymphocytes. Both natural and antibody-dependent lymphocyte cytotoxicities by purified peripheral human blood lymphocytes directed against the same tumor target cells were inhibited by prostaglandins E₁ and E₂ and enhanced by the presence of indomethacin during incubation. Taken together, these phenomena suggest the possible existence of a mechanism whereby tumor cells, by the production of prostaglandins, may subvert the cellular immune response mounted against them and defend themselves from lymphocyte attack.     

Augmentation of prostaglandin and thromboxane production in vitro by monocytes exposed to histamine-induced suppressor factor (HSF)

A possible mechanism to explain the suppression of mitogen-induced lymphocyte proliferation in vitro by histamine-stimulated mononuclear cells was investigated. In initial experiments, the inhibitory action of histamine-induced suppressor factor (HSF) on lymphocyte proliferation was documented to be reduced by the addition of indomethacin (1 μg/ml). Moreover, the addition of exogeneous PGE₂ (10^?7-10^?8 M) to mononuclear cell cultures reconstituted HSF activity in the presence of indomethacin. In order to ascertain the nature of the target cell responding to HSF, control and suppressor supernatants were incubated with human lymphocytes or monocytes (5 × 10⁶ cells/ml) for 24 hr. Following incubation, the supernatants were assayed for their content of prostaglandin E₂, F_2α, and thromboxane B₂. Monocytes (but not lymphocytes) incubated with supernatants containing HSF increased their production of prostaglandin E₂, F_2α, and thromboxane B₂ by 169, 53, and 49%, respectively. Suppressor supernatants were generated with histamine or an H-2 agonist (dimaprit) and chromatographed by gel filtration on Sephadex G-100. The elution profiles for the factor(s) inducing suppression of lymphocyte proliferation (25–40,000 daltons) and augmenting PGE₂ production (25,000 daltons) overlapped but were not identical. Collectively, these data suggest that HSF-mediated inhibition of lymphocyte proliferation may occur in part through the augmented production of prostaglandins and/or thromboxane B₂ by human monocytes.     

Regulation of the in vitro anamnestic antibody response by cyclic AMP. IV. Evidence for participation of prostaglandins of the E series in the early events.

The addition of KLH to KLH-primed rabbit lymph node cell cultures induced an anamnestic antibody response. The further addition of prostaglandins of the E series, but not PGF1^α, enhanced this antibody response manifold. The addition to these cultures of prostaglandin synthetase inhibitors together with KLH inhibited antibody production. At the concentration (10^?4) required to inhibit antibody synthesis, by a variety of criteria one of these inhibitors, indomethacin, was shown not to exert its effects through cytotoxicity. By contrast, two other inhibitors of prostaglandin synthesis, Ro-20-5720 and Ro-3-1314, inhibited antibody synthesis because of their cytotoxicity. The inhibition of the antibody response by indomethacin did not occur when PGE1 or PGE2 was added concurrently to these cultures, clearly showing that inhibition was due to a deficiency of prostaglandins. These findings strongly suggest that induction and/or regulation of the in vitro anamnestic antibody response of KLH-primed lymph node cells to 1 and 100 μg KLH requires continued prostaglandin synthesis. Potential mechanisms for the regulation of the antibody response by prostaglandins are discussed.     

Human monocyte cytotoxicity to tumor cells. I. Antibody-dependent cytotoxicity.

Recent investigations examining mononuclear cell antibody-dependent cell-mediated cytotoxicity against tumor cell lines suggest that K lymphocytes and not monocytes are active in this cytotoxic reaction. We have found, however, that in an allogeneic assay system, human monocyte monolayers as well as lymphocytes mediate substantial lysis of 51Cr-labeled antibody-coated CEM lymphoblast tumor cells. This cytotoxicity is temperature-dependent and rapid, with most 51Cr release occurring in the first 4 hr of co-incubation. Interaction between target cell-bound antibody and the monocyte Fc receptor is necessary as demonstrated by the marked fall in antibody-dependent cell-mediated cytotoxicity (ADCC) produced by staphylococcal protein A, high concentrations of nonspecific immunoglobulin, and dilution of the target cell antiserum. Morphologic and functional characteristics of the monocyte-monolayer preparations establish their relative purity (greater than 95%) and indicate that monocytes and not contaminating lymphocytes are responsible for tumor cell lysis. Furthermore, preincubation of monocyte and lymphocyte preparations with latex particles or low concentrations of immunoglobulin distinguished monocyte from lymphocyte ADCC. Thus, normal human monocytes have the capacity to carry out antibody-dependent cytotoxicity against nucleated malignant target cells.     

In vitro enhancement of natural and antibody-dependent lymphocyte-mediated cytotoxicity against tumor target cells by interferon.

Interferon derived from virus-infected human leukocytes or fibroblasts was found to enhance spontaneous and antibody-dependent lymphocyte cytotoxicity against human target cell lines in vitro. The greater enhancement occurred with spontaneous lymphocyte cytotoxicity. Interferon exerted its effect directly on lymphocytes; no effect on target cells was seen. The mechanism of enhancement was unclear: It did not reflect antibody production or lymphocyte proliferation. Enhancement appeared to be immunologically nonspecific, but clarification of this effect awaits further study.     

Lymphocyte-induced production of prostaglandin E2 by tumor cells in vitro: Requirements for direct contact and lymphocyte viability

The production of prostaglandin E₂ by tumor cell lines in response to exposure to purified lymphocytes has prompted the suggestion that this phenomenon may represent a defense mechanism whereby tumors may subvert an immune response mounted against them. To further characterize this phenomenon, cell lines derived from carcinogen-induced bladder tumors and embryo fibroblasts in Fischer rats were incubated with purified lymphocytes from peripheral blood, spleen, thymus, and lymph nodes from Fischer rats under a variety of conditions, and the amount of prostaglandin E₂ (PGE₂) production was determined by radioimmunoassay. Increased numbers of blood or splenic lymphocytes were associated with the induction of increased levels of PGE₂ production by the tumor cells. However, no prostaglandin was produced by the tumor cells after exposure to thymus or lymph node lymphocytes. Irradiation of lymphocytes prior to exposure to the tumor cells led to lower levels of PGE₂ production by the tumors, as did sonication of the lymphocyte preparations prior to addition to the tumor monolayers. Separation of lymphocytes from direct contact with the tumor cells resulted in less PGE₂ production by the tumor cell lines; however, when these lymphocytes were later layered onto fresh tumor cell monolayers, PGE₂ production occurred. Results in the present study suggest that direct contact between intact, viable, functionally active lymphocytes and tumor cells is necessary for tumor cell prostaglandin production to occur. Moreover, PGE₂ production only appears to occur in response to exposure to particular populations of lymphocytes, and this may correlate with the number of specific effector or attacker lymphocytes that are present. This specificity of response to effector cell challenge may be important in probing the defense mechanisms tumor cells may have to lymphocyte challenge, as well as in gauging the efficacy of a particular cellular immune response as it may be regulated both by cells involved in effecting this response as well as by the targets in lymphocyte/tumor cell interactions.     

The influence upon mitogenic and cellular immunologic reactive systems in vitro by poly(I:C) and BCG murine interferons induced in vivo.

We have previously reported that lymphocytes from W/Fu rats immunized with syngeneic (C58NT)D tumor cells were cytotoxic against these cells in a 4-hr ⁵¹Cr release assay. We have investigated the feasibility of cryopreserving lymphocytes and target cells and have selected freezing conditions which provide good yields of viable cells and functional activity. Lymphocytes from different animals had a recovery of 60–80% viability which resulted in a corresponding 55–75% recovery of cytotoxic activity. Repeated testing of lymphocyte cytotoxicity from a pool of frozen spleen cells against either fresh or frozen (C58NT)D cells gave reproducible cytotoxicity. In addition, recovery of high levels of lymphocyte function was also demonstrated when cryopreserved cells were employed in long-term cytotoxic assays, i.e., ³H-proline and ¹²⁵IUdR release assays, in the lymphoproliferative response to mitogens (PHA and Con A)³ or tumor cells (MLTI) as measured by ³H-thymidine incorporation, and in the in vitro generation of secondary cytotoxicity.By employing these cryoprotective techniques it is possible to have: 1) a population of lymphoid cells with known functional activity and 2) a pool of target cells with known susceptibility to lysis and antigenic content. Furthermore, the use of frozen cells as internal standards in each test also permits the analysis of assay variation as well as the study of variation in various cell types.     

The effect of anti-inflammatory agents on human synovial fibroblast prostaglandin synthetase

Human synovial fibroblast prostaglandin synthetase activity is inhibited by many different non-steroidal anti-inflammatory agents. Aspirin, indomethacin and phenylbutazone significantly inhibit both PGE₁, PGE₂ and PGF_1α and PGF_2α synthesis; whereas penicillamine and aurothioglucose are more potent inhibitors of the F prostaglandins. Histidine and antimalarials do not inhibit, to a significant degree, human synovial prostaglandin synthetase activity. Hydrocortisone has no direct effect on prostaglandin synthetase activity. No changes in synthetase activity are observed when synovial cells are incubated with hydrocortisone, and the prostaglandin synthetase system subsequently isolated and assayed. The proposed inhibitory effects of hydrocortisone on prostaglandin production by synovium may be the result of an alteration of enzyme substrate or cofactor concentration rather than a direct effect on prostaglandin synthetase.     

Is prostaglandin a mediator for the inhibitory action of histamine,hydrocortisone, and isoproterenol?

We examined the inhibitory actions of prostaglandin E₂, histamine, isoproterenol, hydrocortisone, and interferon on lymphocyte mitogenesis. There was a high degree of intercorrelation between the amount of inhibition caused by prostaglandin E₂, histamine, isoproterenol, and hydrocortisone, but not interferon, in any given subject; that is if lymphocytes from a given subject were highly sensitive to inhibition by one of those agents, they were also sensitive to the other agents. The inhibitory actions of histamine, isoproterenol, or hydrocortisone could be partially blocked by adding prostaglandin synthetase inhibitors to the mitogen cultures. Preincubation of the lymphocytes for 18 hr prior to the addition of mitogens and inhibitors resulted in a loss in sensitivity to the inhibitors other than interferon. Removal of glass-adherent cells (the prostaglandin-producing cells) prior to culture lessened the inhibition caused by histamine and isoproterenol. The above data would suggest that these inhibitors may act via prostaglandin; however, all of these compounds actually decrease prostaglandin production in cultures of peripheral blood mononuclear cells. The implications of these findings are discussed.     

Propagation of mouse cytotoxic clones with characteristics of natural killer (NK) cells

Splenocytes obtained from normal mice (BALB/c nude, BALB/c, C₃H, C57Bl/6) and from mice bearing lung or pulmonary carcinomas were propagated for 1–12 months in the presence of crude or mitogen-depleted T-cell growth factor (TCGF). Clones from several TCGF-propagated lymphoid cell lines were established by limiting dilution or the soft agar techniques. All the cultured lines and the majority of the clonal populations derived from them exhibited strong cytotoxic activity in vitro (⁵¹Cr release assay) toward a variety of syngeneic and allogeneic tumor target cells, both freshly obtained and passaged in culture, and both lymphoid and solid in origin, and including targets usually resistant to fresh NK cells. Considerable cytotoxic activity was also observed with several rat and human cultured tumor lines. Only low cytotoxic activity was detected against normal lymphoid mouse cells. Cloned populations generally exhibited more restricted target cytotoxicity than the parental cultured lines, and the pattern of reactivity varied among the clones. Of the clones tested for surface markers, all were positive for Thy 1.2, T200, and asialo GM1 and had strong binding to peanut agglutinin (PNA), all had undetectable receptors for IgG or IgM, and some were positive for Lyt 2. The cytotoxic activity was augmented by pretreatment of the effector cells with interferon and inhibited by the presence of mannose or galactose during the assay. Several clones were capable of mediating antibody-dependent cellular cytotoxicity and lectin-induced cellular cytotoxicity (LICC), and produced relatively large quantities of interferon and lymphotoxinlike material. The findings indicated continuous culturing in TCGF of previously antigen-nonstimulated mouse lymphocytes selects for the growth of at least two distinct populations with activated NK activity, one reacting preferentially with lymphoid tumor target cells (designated CNK-L), and the second reacting effectively with both lymphoid and solid tumor targets (designated CNK-SL). Both populations have several features of both T lymphocytes and NK cells.     

Nonspecific cytotoxic effects of antigen-transformed lymphocytes. Kinetics, cell-requirements and the role of recruitment

PPD-stimulated human peripheral blood lymphocytes have been shown to exert a nonspecific cytotoxic effect on allogeneic and xenogeneic target cells labeled with ⁵¹Cr. Chromium release induced by washed transformed lymphocytes was linear with time. At lymphocyte to target cell ratios of 120:1, significant killing could be demonstrated as early as $\text{1}\text{2}$ hr. At 8 hr, killing occurred with ratios as low as 3:1. The cytotoxic effect was related to the ability of the lymphocytes to transform to PPD, but reached an earlier peak than either DNA or RNA synthesis. Supernatants from lymphocyte cultures were not cytotoxic: instead, viable transformed cells were required. Partial removal of macrophages from the original cultures increased the cytotoxic effect.Lymphocytes could also be nonspecifically recruited to exert a cytotoxic effect by a mitogenic-like factor produced in transforming cultures. Preliminary evidence suggested that this factor acted independently of PPD and of histocompatibility antigens. These results are discussed with reference to possible amplification mechanisms for late cytotoxic effects, and to delayed hypersensitivity reactions in vivo.     

Prostaglandin-mediated regulation of the mixed lymphocyte culture and generation of cytotoxic cells

We examined the role of prostaglandins or prostaglandin-producing cells in the regulation of proliferation and generation of specific cytotoxicity in one-way mixed lymphocyte cultures of mouse spleen cells. Cultures treated with indomethacin or other prostaglandin synthesis inhibitors resulted in enhanced proliferation and cytotoxicity. The level of prostaglandins produced in vitro, as measured by RIA, was 10^?8M and was found to be completely blocked by indomethacin. Adding back 10^?8M PG restored baseline (control) proliferative responses. Kinetics of the enhanced MLC response were unchanged from controls as were the specificities of the cytotoxic cells. Cells from indomethacin-treated cultures were more efficient at killing targets than those from control cultures. Prostaglandins appear to have a preferential effect on the induction of cytotoxic cells.     

Murine T-cell hybridomas that produce lymphokine with macrophage-activating factor activity as a constitutive product

Responder spleen cells primed to alloantigens in vivo could generate high degree of cytotoxicity against low- or nonimmunogenic stimulators such as thymocytes or uv light-treated spleen cells in vitro. However, a removal of adherent cells from primed responder cells remarkably reduced the cytotoxicity after stimulation with such low-immunogenic stimulators. Adding a small number of peritoneal adherent cells (PACs) also suppressed the cytotoxic activity of unseparated responders against low-immunogenic stimulators. These suppressive effects by PACs were blocked by indomethacin. By adding prostaglandin E₂, cytotoxic T lymphocyte (CTL) generation of primed unseparated responders against low-immunogenic stimulators was suppressed; however, cytotoxic activity against mitomycin C-treated stimulators was not suppressed. These results suggested that prostaglandins released from PACs selectively inhibited the function of splenic adherent cells that were required for CTL generation of primed responder spleen cells against low-immunogenic stimulators in vitro.     

Differences in antibody-dependent cellular cytotoxicity against tumor cells in in vitro differentiating mononuclear phagocytes from bone marrows of normal and inflamed mice

Mononuclear phagocytes, differentiated in vitro from bone marrow cells of mice inflamed in vivo with either Corynebacterium parvum or thioglycollate, expressed a higher activity in antibody-dependent cellular cytotoxicity (ADCC) against tumor cells, than those of normal mice. A good correlation between the cytolytic activity and chemiluminescence activity of the different mononuclear phagocyte populations was observed. The ADCC activity of BMDMP from normal mice was inhibited by exogenous prostaglandin E₂ (PGE₂) to a higher extent than that of BMDMP of inflamed mice. When the three BMDMP populations were cultured in the presence of aspirin (without exogenously added PGE₂), the ADCC was significantly increased. The three populations gave identical high values. This suggests that the differential ADCC activity of BMDMP from normal and inflamed mice is due to their differential response to endogenous prostaglandins. PGE₂ showed also a differential effect on the mononuclear phagocyte-forming capacity of bone marrow macrophage precursor cells from normal and inflamed mice. Bone marrow precursor cells from inflamed mice showed a higher resistance to the suppressive effect of PGE₂ (10^?5M) on mononuclear phagocyte-forming capacity than those of normal mice which were totally suppressed. It is concluded that the observed differential properties of the three bone marrow-derived mononuclear phagocyte populations originate at the level of bone marrow precursor cells and that, therefore, the similar functional differences observed in inflammation-induced peritoneal macrophage populations, observed by our and other groups, stem at least partly from differences at the level of bone marrow precursor cells.     

Regulatory mechanism of delayed-type hypersensitivity in mice. II. Effect of suppressor cells on the development of memory cells for delayed-type hypersensitivity

Murine lymph node cells (LNC), which we showed previously to noncompetitively inhibit antibody-dependent cellular cytotoxicity (ADCC) to an erythrocyte target, were tested for their ability to inhibit ADCC to a tumor target, EL-4. Both a 4-hr ⁵¹Cr-release cytotoxicity assay and an overnight ¹²⁵IUdR (iododeoxyuridine) postlabeling cytostasis assay were used. Normal autologous lymph node cells inhibited spleen cell-mediated ADCC in both assays. Inhibition by LNC was dose dependent, but comparable numbers of sheep erythrocytes did not inhibit, indicating that LNC-mediated inhibition was not simply a matter of crowding. Inhibitory activity was enriched in LNC after removal of Fc receptor-bearing cells on EA monolayers.     

Properties of histamine-induced suppressor factor in the regulation of lymphocyte response to PHA in mice

Splenic T lymphocytes release a suppressor factor into the culture supernatant when incubated for 24 hr with histamine (10^?4M). Histamine-induced suppressor factor (HISF) inhibits lymphocyte response to PHA; it is released by T lymphocytes (either nylon-nonadherent or nylon-adherent lymphocytes) and not by B-cells or macrophages; its production is not observed after depletion of histamine receptor-bearing lymphocytes and is blocked by the H2 receptor antagonist (cimetidine) but not by the H1 receptor antagonist (diphenhydramine). Gel filtration by Sephadex G100 chromatography indicates that HISF had an approximate MW of 45,000 to 68,000. Its inhibitory activity was removed by passage over a histamine RSA-Sepharose column, but not by passage over rabbit anti-mouse Ig-Sepharose column; it was blocked by prostaglandin synthetase inhibitor (PGS) (Ro 205720) indicating that this activity is mediated by a prostaglandin (PG) synthesis.     

Enhancement by interferon of natural killer cell activity in mice.

Injection of mice with several interferon inducers, Newcastle Disease virus, polyinosinic-polycytidylic acid and tilorone resulted in an increase in spleen cell cytotoxicity for ⁵¹chromium-labeled mouse YAC tumor target cells in 4-hr in vitro assays. This increase in spleen cell cytotoxicity was abrogated by injection of mice with potent anti-mouse interferon globulin. Inoculation of mice with mouse interferon (but not human leucocyte or mock interferon preparations) also resulted in a marked enhancement of spleen cell cytotoxicity. The extent of enhancement of spleen cell cytotoxicity was directly proportional to the amount of interferon injected and a significant increase was observed after inoculation of as little as 10³ to 10⁴ units of interferon. An effect could be detected as soon as 1 hr after injection of interferon. The increase of spleen cell cytotoxicity after inoculation of an interferon inducer was not due to a localization and accumulation of cytotoxic cells in the spleen but reflected a general increase in cytotoxic cell activity in various lymphoid tissues (except the thymus). The splenic cytotoxic cells from interferon or interferon-inducer-injected mice had the characteristics of natural killer (NK) cells since (i) interferon enhanced spleen cell cytotoxicity in athymic (nu/nu) nude mice, (ii) classical spleen cell fractionation procedures by nylon wool columns, anti-Thy 1.2 serum plus complement, anti-Ig columns, and depletion of FcR+ rosette-forming cells, failed to remove the effector cells generated in vivo or in vitro. Therefore like NK cells, interferon-induced cytotoxic cells lack the surface markers of mature T and B lymphocytes, are not adherent, and are devoid of avid Fc receptors. Furthermore like NK cells, the spleen cells from interferon-treated mice lysed various target cells (known for their sensitivity to NK cells) without H-2 or species restriction. Incubation in vitro of normal spleen cells with interferon also resulted in an increase in cytotoxicity for YAC tumor cells. We conclude that interferon acts directly on NK cells and enhances the inherent cytotoxic activity of these cells.     

Lymphocyte and macrophage adenyl cyclase activity in animals with enhanced cell-mediated resistance to infection and tumors.

As cyclic AMP has been associated with the inhibition of lymphocyte cytotoxicity, studies were performed to investigate adenyl cyclase activity in lymphocytes and macrophages of Toxoplasma-infected mice in which the efferent limb of the cell-mediated immune response had previously been found to be activated. In peritoneal or splenic lymphocytes from $\text{Balb}\text{c}$ mice chronically infected with Toxoplasma in which growth of an isogeneic bladder tumor was found to be inhibited, adenyl cyclase activity was significantly less than in lymphocytes from uninfected control mice. Stimulation by prostaglandin E₁ or NaF in vitro led to higher levels of adenyl cyclase activity in lymphocytes from unifected animals than in cells from Toxoplasma-infected animals. Similar observations were made with peritoneal macrophages from Toxoplasma-infected and uninfected mice. Lower levels of adenyl cyclase activity were also found in lymphocytes from tumor-bearing mice than in lymphocytes from nontumor-bearing controls. These data suggest that production of cyclic AMP by lymphocytes is inhibited with activation of certain cell-mediated immune functions.     

The role of apoptosis in antibody-dependent cellular cytotoxicity

Apoptosis in three lymphoma cell lines has been studied following cytotoxicity induced in vitro by normal human blood lymphocytes utilizing either natural killer (NK) or antibody-dependent cellular cytotoxic (ADCC) mechanisms. Guinea-pig L₂C leukaemic lymphocytes, but not the human cell lines Daudi and Jurkat, revealed a degree of time- and temperature-dependent apoptotic death upon simple culture in vitro. NK cytotoxicity at low effector: target ratios (E: T) induced both release of⁵¹Cr and apoptosis. However NK cytotoxicity at higher E : T, and ADCC at all E : T, increased the level of⁵¹Cr release while reducing the level of apoptosis. The findings were consistent with the apoptotic process being cut short by intervention of necrotic death. The same characteristics accompanied ADCC whether the effectors were recruited by Fc regions of antibody coating the targets, or by bispecific antibodies attaching one arm to the targets and the other to Fc receptors type III on effectors. This finding, and the high level of cytotoxicity elicited by the bispecific method, confirm the belief that NK cells, in addition to exerting NK cytotoxicity, represent the principal effectors for ADCC among blood mononuclear cells. Our results suggest that NK cells have both apoptotic and necrotic mechanisms available for killing their targets, but use only the latter for ADCC.