Influence of non-specific immunologic factors on prognosis in advanced bronchogenic carcinoma

Summary Fifty-nine evaluable patients with stage III bronchogenic carcinoma, participating in a randomized clinical trial evaluating the effect of adjuvant immunotherapy with levamisole or BCG in the treatment of clinically advanced lung cancer, were studied for their immunocompetence by in vitro and in vivo assays. Immunological tests consisted of measurements of natural killer (NK) cell and killer (K) cell cytotoxicity, skin testing reactivity to recall antigens, absolute lymphocyte count, and serum immunoglobulin (Ig) levels. Pretherapy K cell cytotoxic levels, skin test reactivity to trichophyton antigen, and increased IgA levels were predictive of the overall clinical course. Despite non-specific immunotherapy, progressive decline of NK and K cell cytotoxicity occurred during the course of the disease. These findings, however, were of limited clinical value. Initial performance status and disease extent significantly influenced time to progression and survival. Little further prognostic information was obtained from the immunological tests over those provided by clinical performance status and disease extent. No statistically significant differences were found in either time to progression or survival between controls and patients receiving either levamisole or BCG.     

Partial suppression of cell mediated immunity in chromoblastomycosis

The cellular immune response of 8 patients from the Brazilian Amazon region with chromoblastomycosis was analyzed. Primary immunological responses of patients were tested by contact sensitization to 2,4-dinitro-chlorobenzene (DNCB), or rejection of first set skin allografts. 2 of 8 patients were reactive to DNCB after sensitization, and skin allograft rejection occured in an average of 14 days. Capacity of patients to mount recall immunological responses was measured by skin testing with two fungal antigens and three bacterial antigens. Delayed skin reaction to trichophytin and Candida antigens was negative in the majority of the patients. However, reactivity to mycobacterial (tuberculin), and bacterial (staphylococcal, streptococcal) antigen was high, or only slightly diminished respectively. The data suggest that patients with chromoblastomycosis have suppressed nonspecific, cell mediated immunity for some antigens (skin allografts, DNCB, fungal antigens), while reactivity to bacterial and mycobacterial antigens is not impaired.     

Immunologic function during adjuvant BCG immunotherapy for malignant melanoma: Induction of anergy

Summary Serial tests of immunological function were performed on 28 patients participating in a randomized controlled clinical trial of adjuvant Tice-stain BCG immunotherapy administered by tine technique for malignant melanoma. Cryopreserved lymphocyte samples obtained prior to study entry and at 3 and 6 months there-after were tested by mixed lymphocyte culture (MLC), cell-mediated lympholysis (CML), antibody-dependent cell-mediated cytotoxicity (K cell), and natural killing (NK cell) assays, the last two assays being performed with the Chang cell line. Delayed-type hypersensitivity (DTH) skin tests to recall antigens were performed at the same intervals.At entry to the study in vitro lymphocyte reactivity of patients was similar to that of normal controls, and most (75%) of the patients reacted to at least one recall antigen. Serial lymphocyte reactivity measured by the in vitro tests was not different in the BCG and control groups, but BCG treatment was associated with a marked, statistically significant (P<0.01) reduction in DTH skin test reactivity. BCG therapy was not shown to delay recurrence of the disease.     

Monoclonal antibodies to antigens abnormally expressed in breast cancer

We report the production, screening, and characterization of ten murine monoclonal antibodies directed at antigens that are expressed abnormally in human breast tumors. Immunoperoxidase staining of frozen and fixed tissues shows the antigens to be present at low levels on the luminal membrane of normal breast cells and at high levels in the cytoplasm and surface membrane of breast tumor cells. The ten antibodies appear to recognize six different epitopes on the basis of their quantitative differences in reactivity against four antigen preparations, as measured by ELISA. Immunoblots show that eight of the ten antibodies recognize a 300,000 MW molecule from breast tumor preparations; six of these antibodies also react with a second molecule from the same tumor preparations of 280,000 MW. Seven antibodies react with an antigen from milk fat globule membrane of 330,000 MW. It therefore appears that the two molecules from tumor tissue and the one molecule from normal tissue share common epitopes. Selected antibodies were tested for reactivity against 25 primary breast tumors and 14 pairs of primary and metastatic breast tumors. Three antibodies have broad reactivity and stain more than 80% of primary tumors; the three other antibodies identify subsets of those tumors. Results of staining pairs of primary and metastatic lesions show that metastases continue to express antigens of the primary lesion in a high percentage of cells.     

TFX immunotherapy in children with ALL during remission

The in vivo effect of thymus factor X (TFX) on the E-rosetting capacity, the absolute peripheral blood lymphocytes and T-cell number per microliter, the skin test reactivity to recall antigens, and the immunoglobulin production was evaluated in 20 children with acute lymphoblastic leukaemia. The in vitro effect of TFX was also tested. The mean percentage of E-rosettes in these patients increased from 50 to 64%. Although absolute peripheral blood lymphocyte and T-cell number per microliter rose significantly, the mean values did not reach those in healthy children. The tests with recall antigens were positive in 13% of patients prior to immunotherapy and 32% following the therapy. The influence of immunotherapy on infectious episodes and on the stabilisation of remission was also evaluated. TFX in vivo appears to restore immunocompetence, decrease infections, and prolong remissions in children with ALL in remission.     

Application of the Macrophage Migration Inhibition Test to Screen Patients with Early Cancer and Obtain Prognostic Determinations of Cancer Treatment

A modified direct method of the macrophage migration inhibition test (MMIT) was attempted on a large number of patients with malignant or benign tumors. Results of the MMIT in almost all patients with benign tumors were negative except for those with hydatidiform moles, dermoid cysts and viral benign tumors such as verruca plana which were positive. The number of cases determined as false positives were exceptionally few. Conversely, about the half of the patients with malignant tumors were positive. The majority of negative cancer patients were confirmed pathologically to be advanced cases and, therefore, were postulated to have been immunologically unresponsive. The remaining false negative patients were diagnosed to be very early cases with their malignant foci too small to be effective antigenic stimuli. The MMIT was also performed postoperatively on some of the patients using autologous antigens, which had been preserved by freezing, for examination of changes in the per cent migration index. The results led the authors to conclude that postoperative repetitions of the test permitted them to tell that cancer cells had been completely eradicated or that a relapse might occur in the near future. Examinations of cross reactivity between tumor antigens revealed that such reactivity exists between cancer antigens and antigens originating in hydatidiform moles and that there is also a very strong cross reactivity between allogeneic cancer antigens regardless of differences in the organs of origin. This fact suggests that the present test is effective for the screening of preoperative patients with early cancer.     

Preparation of Staphylococcus aureus antigens for evaluation of their immunological reactivity with the human sera by the western blot method]

Extracellular antigens as well as cell wall extracts of 4 S. aureus strains isolated from different kinds of infection were analysed by Western-Blott technique. Materials obtained in two systems of bacteria cultivation (with and without aeration) were compared. Four systems of PAGE (native conditions, with 8.0 M urea, with SDS and SDS after previous reduction of the material with 2-mercaptoethanol) were compared in order to get the best differentiation of proteins and antigens. Immunological reactivity of the antigens mixture with two human sera: highly positive (with three S. aureus antigens in ELISA) from patient with staphylococcal sepsis and negative (from blood donor) were analysed. The best results were obtained after reduction of the cell wall extracted material in SDS-PAGE. The different protein patterns depending on the strain and the method of bacteria cultivation were observed. The standardisation of Western-Blott technique was performed, including titration of the sera to get the best differentiation of the antigens. The difference in immunological reactivity of the positive and negative sera with staphylococcal antigens mixture showed rather quantitative than qualitative character.     

Correlation between lymphocyte-mediated auto-tumor reactivities and the clinical course

Summary T-cell-enriched lymphocyte populations of 69 lung carcinoma (44 squamous cell, 23 adeno-, and two large cell carcinoma) patients were investigated at the time of surgery for proliferative response to, and/or cytotoxic potential against, freshly separated autologous tumor cells. Tumor-free period and survival time of the patients were correlated with the reactivity obtained in the in vitro tests. The observation time varied between 20 and 78 months (mean 52). Tumor-free period and survival time were longer and survival rate higher in the group with lymphocyte reactivity toward their tumors. In the non-reactive group, all patients but one died within 3 years. Almost all patients had cytotoxic lymphocytes against K562, the three who did not belonging to the category with short survival time.     

Using virally expressed melanoma cDNA libraries to identify tumor-associated antigens that cure melanoma

Multiple intravenous injections of a cDNA library, derived from human melanoma cell lines and expressed using the highly immunogenic vector vesicular stomatitis virus (VSV), cured mice with established melanoma tumors. Successful tumor eradication was associated with the ability of mouse lymphoid cells to mount a tumor-specific CD4(+) interleukin (IL)-17 recall response in vitro. We used this characteristic IL-17 response to screen the VSV-cDNA library and identified three different VSV-cDNA virus clones that, when used in combination but not alone, achieved the same efficacy against tumors as the complete parental virus library. VSV-expressed cDNA libraries can therefore be used to identify tumor rejection antigens that can cooperate to induce anti-tumor responses. This technology should be applicable to antigen discovery for other cancers, as well as for other diseases in which immune reactivity against more than one target antigen contributes to disease pathology.     

Immunologic monitoring and immunotherapy in Ewing's sarcoma

Summary Serial immunological monitoring was performed on 31 patients with Ewing's sarcoma who were on a randomized immunotherapy trial with BCG administered by dermal scarification with a Heaf gun. Patients were skin-tested for delayed hypersensitivity reactions (DCHR) to recall antigens and extracts of tumor cells, and with keyhole limpet hemocyanin (KLH). In vitro testing consisted of lymphocyte counts, percentages of cells forming rosettes with sheep erythrocytes at 29° C and at 4° C, and leukocyte migration inhibition to tuberculin (PPD) and to 3 M KCl extracts of tumor cells. At the time of diagnosis, nearly all patients had positive DCHR to mumps and streptococcal antigens and were negative to PPD. Neither the skin tests nor the lymphocyte counts at this time gave useful prognostic information. In tests during and after therapy, the patients who responded and remained free of detectable disease had a higher incidence of DCHR to KLH and of rosette values in the normal range than did the patients who developed recurrent disease. The BCG immunotherapy had no apparent effect on immunologic parameters except for conversion of reactions to PPD.     

Immunological Studies in Ugandan Patients with Hepatocellular Carcinoma

Immunological studies were performed on Ugandan patients with hepatocellular carcinoma to test the hypothesis that the high rate of persistence of hepatitis-associated antigen in these patients is the result of defects in host immune response. The responses to 1-chloro-2,4-dinitrobenzene sensitization and to a battery of recall skin test antigens were normal, as was the humoral antibody response to tularaemia antigen. Neither hypogammaglobulinaemia nor specific immunoglobulin deficiencies were found. Thus it appears unlikely that generalized defects in host immune responses can account for the high incidence of persistent hepatitis B virus infection found in Ugandan patients with hepatocellular carcinoma.     

DR antigens expressed on tumor cells do not contribute to the blastogenetic response of autologous T cells

Summary Tumor cell suspensions prepared from surgical specimens were characterized for cellular composition and reactivity with monoclonal antibodies detecting T lymphocytes, monocytes, and the monomorphic determinants of DR molecules (antigens encoded by the D region of the major histocompatibility complex in man). About half the adenocarcinoma preparations contained tumor cells which expressed DR antigens. Lymphocytes of certain patients were stimulated in vitro by the autologous tumor cells, and this was independent of the expression of DR antigens on the tumor cells. In addition, pretreatment of the stimulator tumor cells with anti-DR Mab (monoclonal antibody) had only marginal effect on their stimulatory potentialIn contrast, when the same tumor cells were used as stimulators of allogeneic lymphocytes, proliferation was more often seen with DR-positive tumors and the reaction was often inhibited by the anti-DR Mab treatment. There were exceptions, however, which suggest that other DR antigens not detected by the reagents used may have been expressed on these cells. The allostimulatory capacity of the tumor cells was usually weak and did not occur with all responder lymphocytes. It is important to note that stimulation of autologous lymphocytes could occur with tumor preparations that did not elicit allogeneic response.Thus, the in vitro stimulation of autologous blood-derived T cells by suspensions of unpropagated cells separated from solid tumors reflects the sensitization state of the patients against their tumor cells.     

Cell-mediated immunity in Cryptococcosis

Cell-mediated immune responses in patients who had recovered from cryptococcosis were compared to those of healthy subjects. Cryptococcal patients were mildly lymphopenic but showed no defect in percentage of thymus-derived lymphocytes. One-third had positive delayed skin test reactions to cryptococcal antigen. Their skin test reactivity to two commonly used noncryptococcal antigens was less intense than healthy control subjects. Strongly positive and specific lymphocyte transformation occurred in the presence of an extract of Cryptococcus neoformans (cryptococcin) in half of the patients. In contrast, few healthy subjects had positive transformation responses to cryptococcin. One patient who was followed sequentially through treatment of cryptococcal meningitis acquired strong cryptococcin reactivity during the course of treatment. Cellular immunologic response to cryptococcin identifies many subjects who have had C. neoformans exposure, and may be of value for assessing immunologic status of patients undergoing therapy. These studies also indicate that most patients with cryptococcosis have a degree of deficiency in cell-mediated response to fungal antigens even when a specific underlying disease process cannot be identified.     

Effect of extracorporeal photopheresis on selected immunologic parameters in psoriasis vulgaris

Extracorporeal photopheresis (ExP) was administered every other week in an outpatient setting to four patients with chronic refractory psoriasis vulgaris without arthropathy. The duration of treatment ranged from six to 13 months. Two patients received methotrexate concomitantly during the initial phase of the study. All patients demonstrated a decrease in erythema, induration, and scaling of lesional skin, accompanied by incomplete clearing of lesions such that the percentage of involvement (SI) ranged between 40 to 80 percent of baseline scores. Exacerbations of psoriasis occurred with minor provocations, and two patients who were predisposed to developing epithelial skin neoplasms as a consequence of prior treatments continued to develop tumors during the study interval. Prolonged ExP treatment was otherwise well tolerated, without evidence of toxicity on routine laboratory safety tests or changes in lymphocyte counts. All patients, however, exhibited decreased intradermal skin responses to recall antigens and a decreased capacity of peripheral lymphocytes to produce interleukin 2 (IL-2) in response to polyclonal stimuli in vitro. These observations suggest that the observed anti-inflammatory effect of alternate-week ExP on psoriasis is mediated in part to a direct inhibition of lymphokine production or release by psoralen-ultraviolet-exposed lymphocytes.     

Specific Immunodiagnosis of Hepatocellular Carcinoma by Leucocyte Adherence Inhibition

The leucocyte adherence inhibition test provides a rapid, reliable, and specific technique for the immunodiagnosis of primary hepatocellular carcinoma (malignant hepatoma). The patient''s blood leucocytes are tested in vitro for cell-mediated immunity against tumour-associated antigens and the serum is tested for blocking factor which interferes with the immunological reaction. Specific reactivity of both leucocytes and serum was consistently detected in patients with malignant hepatoma, and negative reactions were obtained in other liver diseases including secondary tumours of the liver. The test has provided positive evidence for the presence of hepatoma when more conventional methods gave doubtful or negative results. A positive result preceded the clinical appearance of tumour by up to three years in two patients.     

Cell mediated immunity after measles in Guinea-Bissau: historical cohort study.

OBJECTIVE: To investigate whether children who have had measles have reduced general cell mediated immunity three years later compared with vaccinated children who have not had measles. DESIGN: Historical cohort study. SETTING: Bissau, Guinea-Bissau. SUBJECTS: 391 children aged 3-13 years who were living in Bissau during a measles epidemic in 1991 and still lived there. These included 131 primary cases and 139 secondary cases from the epidemic and 121 vaccinated controls with no history of measles. MAIN OUTCOME MEASURES: General cell mediated immunity assessed by measurement of delayed type hypersensitivity skin responses to seven recall antigens. Anergy was defined as a lack of response to all antigens. RESULTS: 82 out of 268 cases of measles (31%) were anergic compared with 20 of the 121 vaccinated controls (17%) (odds ratio adjusted for potential confounding variables 2.2 (95% confidence interval 1.2 to 4.0); P 0.009). The prevalence of anergy was higher in secondary cases (33% (46/138)) than in primary cases (28% (36/130)), although this difference was not significant. Anergy was more common in the rainy season (unadjusted prevalence 31% (91/291) than in the dry season (11% (11/98)) (adjusted odds ratio 4.8 (2.2 to 10.3)). This seasonal increase occurred predominantly in the case of measles. CONCLUSION: Reduced general cell mediated immunity may contribute to the higher long term mortality in children who have had measles compared with recipients of standard measles vaccine and to the higher child mortality in the rainy season in west Africa.     

Immunogenicity of inactivated seasonal influenza vaccine in adult and pediatric liver transplant recipients over two seasons

Immunological responses to influenza vaccination administered to liver transplantation recipients are not fully elucidated. To compare inactivated influenza vaccine's immunogenicity between adult and pediatric recipients, 16 adult and 15 pediatric living donor liver transplantation recipients in the 2010–11 influenza season, and 53 adult and 21 pediatric recipients in the 2011–12 season, were investigated. Seroprotection rates (hemagglutinin‐inhibition [HI] antibody titer 1:40) were 50–94% to all three antigens among adults and 27–80% among children in both seasons. Seroconversion rates (fourfold or more HI antibody rise) were 32–56% among adults and 13–67% among children in both seasons. No significant differences were observed between the two groups. In addition, 20/53 adult and 13/21 pediatric recipients received a vaccine containing identical antigens in both of these seasons. Geometric mean titer fold increases of all three antigens in adult recipients were significantly lower than those in recipients who had not received a preceding vaccination. In contrast, in pediatric recipients, there were no significant differences between the groups who had and had not received preceding vaccinations. The number of patients with rejection did not differ significantly between the two groups (0/53 vs. 1/21) in the 2011–12 season. The incidence of influenza after vaccination was significantly different between adult and pediatric recipients (0/16 vs. 5/15 in 2010–11 and 0/53 vs. 3/21 in 2011–12, respectively). Overall, there were no significant differences in antibody responses between adult and pediatric groups. Influenza infection was more frequent in pediatric recipients. Long‐term response to preceding vaccinations appeared to be insufficient in both groups.     

Immune investigations and therapy in patients with advanced lung cancer

Summary Fifty-one patients with advanced lung cancer were divided at random into two groups before conventional therapy was started. One group of 29 patients was treated with a Methanol Extraction Residue of Bacillus Calmette-Guérin (MER) administered intradermally in addition to the conventional radiotherapy and/or chemotherapy treatment. These patients will be referred to as the group. The other group of 22 patients was treated by the conventional method only and is designated the RC group.The general immunological status of these two groups of patients was evaluated once a month by the following in vivo and in vitro tests: Skin tests to five memory antigens: PPD, SK/SD, Candidin, Trichophytin, and mixed bacteria; lymphocyte stimulation in response to the mitogen PHA and to PPD and Candidin. In addition, E- and EAC-rosettes were determined in peripheral blood.The results show that after some of the treatments increased formation of E rosettes, improved in skin reactivity, and higher stimulation indices of cultured lymphocytes were found in the RCM group than in the RC group.Professor and Established Investigator of the Chief Scientist's Bureau, Israel Ministry of Health     

Acquired B antigen]

Many cases of acquired B antigens, always observed in group A subjects have been so far reported. Most of them were found in patients with digestive tract disease, essentially colonic cancer. An investigation on 200 patients in a gastroenterology department showed that this B-like antigen was quite frequent (10,6%); it occurred only in A1 individuals and was related to infectious syndrome. Immunological and serological studies of many cases had shown that this B-like antigen differs from that of normal B cells. Groupe A1 cells transfused to patients acquired B activity; on the contrary group A2 and O cells remained unchanged. Likewise, only A1 cell became active when incubated in vitro with C. Tertium A., known to contain a deacetylase. In 1970, we postulated that a deacetylase enzyme could be responsible for this B-like antigen: this enzyme could transform the N-acetylgalactosamine (A specific sugar) into galactosamine, which could cross react with anti-B sera. The relationship between the acquired B antigen and a deacetylase was recently confirmed: A1 acquired B cells, chemically acetylated lost their B reactivity and enhanced their A1 activity. A polyagglutinability, different from that associated with T, Tn, Cad, Hempas has been always found in acquired B cells; nervertheless, because of its weakness, it could sometimes be unnoticed. Besides, it disappeared prior to B reactivity in case of recovery. Like acquired B activity, it decreased in low pH medium of after acetylation of the cells. Nevertheless, this polyagglutinability appears, contrarly to acquired B antigen, in vitro, on all the cells, irrespective of their ABO phenotypes. A deacetylation of N-acetyl-neruaminic acid could explain such a phenomenon.     

Transfer factor in chronic mucocutaneous candidiasis

Fifteen patients suffering from chronic mucocutaneous candidiasis were treated with an in vitro produced TF specific for Candida albicans antigens and/or with TF extracted from pooled buffy coats of blood donors. CMI of the patients was assessed using the LMT and the LST in presence of candidine. The aim of the study was the clinical evaluation of TF treatment and the incidence of positive tests before, during, and after therapy. Immunological data were matched using the Chi square test. 87 LMT were performed for each antigen dose and at the dilution of 1/50, 58.9% (33/56) tests were positive during non-treatment or non-specific TF treatment. On the contrary 83.9% (26/31) were positive during specific TF treatment (P<0.05). In the LST, a significant decrease of thymidine uptake in the control cultures in presence of autologous or AB serum was observed when patients were matched according to non-treatment, and both non specific (P<0.05) and specific TF treatment (P<0.01). Only during specific TF treatment was a significant increase of reactivity against the Candida antigen at the highest concentration noticed, when compared with the period of non specific treatment (P<0.01). Clinical observations were encouraging: all but one patient experienced significant improvement during treatment with specific TF. These data confirm that orally administered specific TF, extracted from induced lymphoblastoid cell-lines, increases the incidence of reactivity against Candida antigens in the LMT. LST reactivity appeared not significantly increased with respect to the periods of non treatment, but was significantly increased when it was compared to the non-specific TF treatment periods. At the same time, a clinical improvement was noticed.