Follow-up investigations of bladder cancer patients by titration of natural and specific lymphocyte-mediated cytotoxicity

Summary A 44-hour incubation microcytotoxicity assay (MA) was used to titrate the lymphocyte-mediated cytotoxicity in 47 transitional cell carcinoma (TCC) bladder cancer patients and 65 clinical control patients. All titrations included three target cell lines: HU 456 (TCC), HU 609 (normal urothelium), and SAOS 2 (osteosarcoma). Tumor-specific cytotoxicity (TSC) was calculated as the difference between cytotoxicity to HU 456 and HU 609, and tumor type-specific cytotoxicity (TTSC) as the difference between cytotoxicity to HU 456 and SAOS 2. On the basis of TSC and TTSC values obtained before treatment TCC patients were divided into one group with high-grade specific cytotoxicity (HSC) and another with low-grade specific cytotoxicity (LSC). A prospective follow-up study of these patients revealed a significantly lower survival rate for patients with LSC compared with patients with HSC, even when the groups were corrected for differences in distributions according to clinical and histological tumor gradation. This indicates a growth-controlling function of the cellular immune reaction.Repeated cytotoxicity tests in a follow-up study of 26 TCC patients and one patient with a squamous cell carcinoma of the urinary bladder revealed a positive correlation between positive specific cytotoxicity and the presence of tumor tissue Gr 2–4. The reactivity vanished within 1 month after surgical removal of the tumor or at the end of radiotherapy. An increased cytotoxicity against HU 609, representing normal urothelium, was seen immediately following radiotherapy, and in a few cases after surgical treatment. Reapearance of elevated TSC and TTSC was noted during the months following radiotherapy. When the MA was considered as a diagnostic marker of tumor tissue during clinical control of patients with suspected TCC, 22% of positive reactions proved to be false-positive and 44% of negative reactions were false-negative. Thus, a negative result cannot be used to exclude recurrence, but a positive result may indicate the need for additional clinical examinations.Abbreviations NC natural cytotoxicity - TCC transitional cell carcinoma - TSC tumor-specific cytotoxicity - TTSC tumor type-specific cytotoxicity - MA microcytotoxicity assay - HSC high-grade specific cytotoxicity - LSC low-grade specific cytotoxicity - ICI integrated cytotoxicity index     

Suppression of human natural and antibody-dependent cytotoxicity by soluble factors from unstimulated normal lymphocytes

Serum-free culture supernatants of unstimulated normal human peripheral blood mononuclear cells contain soluble suppressor factor(s) (SSF) that significantly inhibit natural (NK) and antibody-dependent cellular cytotoxic (ADCC) activities of allogenic lymphocytes against a variety of target cells. Lymphocytes precultured with increasing concentrations of SSF showed a dose-dependent suppressive effect on these cytotoxic functions that was optimal at a concentration of 20% volume/volume. Adherent cells were not required for the production of SSF. Suppression was evident even at higher effector: target cell ratios and the inhibition was not reversed by washing lymphocytes. SSF was not itself cytotoxic, was stable at 56 degrees C, and its suppressive effect was maximal after 72 hr of incubation with effector lymphocytes. Initial estimate of the molecular weight of SSF by ultra-filtration was less than 20,000 daltons. Gel filtration of SSF on Sephacryl S-200 resulted in the elution of two peaks of activity; one in the region between markers of 13,700 and 25,000 daltons, and the other less than 13,700 daltons. Both fractions demonstrated significant suppressive activity on NK and ADCC functions of allogenic lymphocytes. SSF inhibition of NK activity could be partially reversed by incubating lymphocytes for 1 hr with human leukocyte interferon (IF) and almost completely reversed after 24 hr of IF treatment. A few selected monosaccharides (alpha-methyl-D-mannoside, L-fucose and L-rhamnose) showed a dose-dependent blocking effect on SSF activity, which suggests that SSF may act via receptor sites recognized by these sugars. As demonstrated for other lymphocyte functions, NK and ADCC activities may also be modulated by SSF elaborated by normal PBL.     

Peyer's patch lymphocytes express natural cytotoxicity but not natural killer activity

The distribution of natural cytotoxic (NC) cells in the gut-associated lymphoid tissues (GALT) and in peripheric lymphoid organs was analyzed in comparison to that of natural killer (NK) cells. It was found that cells from the intestinal epithelium, mesenteric lymph nodes and spleen possess significant levels of NC and NK activity, whereas in thymus and popliteal lymph nodes both the natural activities are negligible. As previously shown for splenocytes, the NC activity of GALT cells is detectable in the 16-hour assays and not in the 4-hour assays. Interestingly, Peyer patches lymphocytes (PPL) possess extremely high NC activity but no NK activity. The NC activity of PPL is still high in NK-deficient mouse strains such as A/J and SJL/J. To further support the observation that the effector PPL are truly NC cells, it was shown that, as previously reported for spleen NC activity, overnight incubation at 37 degrees C of the lymphocytes only marginally affected the cytotoxicity of PPL, which could in turn be augmented by interleukin-3 (IL-3) containing supernatants. On the contrary, IL-2 could not increase NC or NK activity by PPL whilst augmenting NK activity of splenocytes. Thus, for the first time a cell population is identified which expresses only NC activity and not NK and which can be positively regulated only by IL-3.     

Analysis of natural killer activity and natural killer cell subsets in patients with bladder cancer

Summary In order to analyze the state of the natural resistance system of bladder cancer patients in vivo, we measured natural killer (NK) activity and NK cell subsets of peripheral blood lymphocytes (PBL) from 46 patients with bladder cancer and 25 age- and sex-matched healthy volunteers. The mean NK activity in patients with lowstage bladder cancer was similar to that in the controls, while NK activity in patients with high-stage bladder cancer was significantly depressed. The mean proportions of Leu7⁺ cells in patients with both low-stage and highstage bladder cancer were significantly higher than that in the controls. The mean proportion of Leu11a⁺ cells in patients with low-stage bladder cancer was similar to that in the controls, while in patients with high-stage bladder cancer it was significantly higher. This study demonstrates the abnormal immunological state of bladder cancer patients; namely, abnormalities exist not only in NK activity but also in the proportions of circulating NK cell subsets.     

Effects of atrial natriuretic factor on proliferative response and natural cytotoxicity of human lymphocytes]

Effect of synthetic analogues of atrial natriuretic factor (ANF) on proliferative response and natural cytotoxic lymphocytes of human subjects was investigated in vitro. ANF-III and ANF-IV increased blast transformation lymphocytes induced by a Con-A suboptimal dose. The increase of cells activity was comparable with the effect of interleukin-2, added at a dose of 50-100 unit/ml.     

Mechanism and regulation of natural cytotoxicity. Minireview on cancer research

Natural killer (NK) cells comprise a heterogeneous population of effector cells functionally and phenotypically distinct from B cells and mature antigen-sensitive T cells, with the capacity to spontaneously lyse target cells of widely different tissue provenance in a genetically unrestricted fashion. As such they have been widely implicated in immunosurveillance against neoplastic and virus-infected cells, as well as in the homeostasis of haematopoietic differentiation and regulation of immune function. In common with cytotoxic T cells, the lytic mechanism may be resolved into several discrete stages. Target cell recognition appears to involve several chemical entities, while susceptibility is also influenced by a multiplicity of factors operative at post-recognition stages of the lytic process. NK activity is subject to both positive and negative regulation. The potentiating effects of interferons and interleukin-2, products of activated T cells, indicate a possible pathway by which adaptive immune responses may augment natural cytotoxicity under local physiological conditions. Negative regulation is mediated by certain prostaglandins and a variety of cell types including macrophages, granulocytes and thymocytes as well as subsets of peripheral blood lymphocytes.     

Neuroimmunomodulation with enkephalins: in vitro enhancement of natural killer cell activity in peripheral blood lymphocytes from cancer patients

To initiate investigations into the effects of enkephalins on immune function in cancer patients, the effect of methionine-enkephalin and leucine-enkephalin on natural killer (NK) cell activity in isolated peripheral blood lymphocytes from cancer patients was investigated. Incubation of lymphocytes with either enkephalin resulted in significant increases in NK cell activity. At effector:target cell ratios of 100:1, 33:1 and 11:1 leucine-enkephalin significantly (p less than 0.05) enhanced NK activity at dilutions of 10(-6), 10(-8), 10(-10), and 10(-14) mg/ml. Similar results were obtained with methionine-enkephalin with the exception that the 10(-6) dilution gave insignificant changes at both the 33:1 and 11:1 cell ratios. The results indicate a difference in dose response to both enkephalins between lymphocytes from cancer patients and normal volunteers.     

Treatment- and disease-related complications of prostate cancer

One of the highlights of the 16th International Prostate Cancer Update was a session on treatment- and disease-related complications of prostate disease. It began with presentation of a challenging case of rising prostate-specific antigen levels after radical prostatectomy, followed by an overview of the use of zoledronic acid in prostate cancer, a review of side effects of complementary medicines, an overview of complications of cryotherapy, an assessment of complications of brachytherapy and external beam radiation therapy, and a comparison of laparoscopy versus open prostatectomy.     

Recombinant interleukin-2 treatment in patients with metastatic colorectal cancer: Effect on natural cytotoxicity

Summary Natural cytotoxicity (natural killer, NK, and lymphokine-activated killer, LAK, activity) was documented in 12 patients with metastatic colorectal cancer, both before and after a 5-day course of continuous therapy with intravenous recombinant interleukin-2 (rIL-2). Treatment induced a substantial increase in circulating CD56⁺ lymphocytes (pretreatment: 12.1±6.9%, mean ± SD; posttreatment: 39.2±6.9%. Maximal NK cell activity was induced by treatment with rIL-2 but only suboptimal augmentation of LAK cell cytotoxicity was obtained. This study indicates that although continuous infusion of rIL-2 does have a significant effect on natural cytotoxicity, this is suboptimal and further studies are necessary to define the most efficacious immunity-enhancing regimens of therapy, thereby hopefully improving clinical outcome of rIL-2 treatment.     

Lymphocytes from children and infants mediate natural cell mediated cytotoxicity, (cytotoxicity)

Summary Lymphocytes from infants and young children were tested for natural cell mediated cytotoxicity (NCMC) against K562 and CCRF-CEM. NCMC by lymphocytes from pediatric donors of all ages was equivalent to that mediated by lymphocytes from adults. Since it has been suggested that the biological function of NCMC is to effect immunological surveillance against cancer, the appearance of NCMC effector cells early in development is consistent with early mobilization of the policing mechanism.This work was supported by Grant CA 25765 from the National Cancer InstitutePartially supported by a Grant from the Concern Foundation.     

Effect of histamine and histamine antagonists on natural and antibody-dependent cellular cytotoxicity of human lymphocytes in vitro

The in vitro effect of histamine and its antagonists, cimetidine and clemastine fumarate, on natural killer (NK) and antibody-dependent cellular Cytotoxicity (ADCC) activities of human lymphocytes was investigated. The histamine 1 (H1) antagonist, clemastine fumarate, and the histamine 2 (H2) antagonist, cimetidine, but not histamine alone, inhibited the NK and ADCC activities of lymphocytes when added directly to the mixture of effector and target cells in a ⁵¹Cr-release assay. This inhibition was proportional to the concentration of drugs added and was observed at various effector to target ratios against several targets. H1 and H2 antagonists also inhibited NK activities of T cells as well as Percoll-separated, NK-enriched effector cells. The inhibition was significantly reversed by histamine. In target binding assays, clemastine fumarate and cimetidine also decreased the target binding capacity of effector lymphocytes. Further, PBL precultured with histamine (10^?3–10^?4M) for 24 hr showed a significant decrease in their NK and ADCC activities. In coculture experiments, PBL precultured with histamine suppressed the NK activity of normal autologous effector lymphocytes. PBL precultured with histamine showed an increased number of OKT8⁺ cells, as estimated using monoclonal antibodies. The suppression of Cytotoxicity was not due to either direct toxicity, steric hindrance, crowding, or cell death, but by functionally viable suppressor cells. An immunoregulatory role for histamine in NK and ADCC reactions is proposed.     

Phenotypic,functional and molecular analysis of lymphocytes associated with bladder cancer

 Bladder-washing-derived lymphocytes (BWDL) from 67 patients with bladder cancer were studied. The large majority of samples contained a pure population of T lymphocytes, whereas B and NK cells were absent. A comparative analysis of bladder lymphocytes and peripheral blood lymphocytes (PBL), collected in parallel, showed that BWDL significantly differed from PBL. In vitro cultures of bladder lymphocytes were attempted on 21 samples but in vitro expansion was only possible on six patients treated with bacillus Calmette-Guérin (BCG). This finding indicates that BWDL are characterized by a severe proliferative defect. Nevertheless, the addition of BCG on bladder lymphocytes expanded in vitro enhanced their proliferation, suggesting that this population is sensitized against BCG antigen(s). The analysis of T cell receptor restriction patterns showed that bladder lymphocytes from patients under BCG treatment were oligoclonal. A possible explanation for the efficiency of the immune response and good clinical outcome in patients treated with BCG could be found in the high homology between some BCG antigens and human heat-shock proteins, which are overexpressed in transformed cells. Received: 8 June 1995 / Accepted: 22 November 1995     

Alpha-glycosylceramides enhance the antitumor cytotoxicity of hepatic lymphocytes obtained from cancer patients by activating CD3-CD56+ NK cells in vitro

Alpha-glycosylceramides, such as alpha-galactosylceramide and alpha-glucosylceramide, induce antitumor immunity in various murine cancer models. In the murine hepatic metastasis model, V alpha 14 TCR+NK1.1+ T cells, which accumulate preferentially in the liver, are considered to play a key role in the induction of antitumor immunity by alpha-glycosylceramides. We recently reported that V alpha 24 TCR+ NKT cells, the human homologues of murine V alpha 14 TCR+NK1.1+ cells, are rarely seen among freshly isolated human hepatic lymphocytes. Therefore, it is important to examine whether alpha-glycosylceramides also enhance the antitumor cytotoxicity of human hepatic lymphocytes, as they have been shown to do in murine systems, to determine the usefulness of alpha-glycosylceramides in cancer immunotherapy in humans. Here, we show that alpha-glycosylceramides greatly enhance the cytotoxicity of human hepatic lymphocytes obtained from cancer patients against the tumor cell lines, K562 and Colo201, in vitro. The direct effector cells of the elicited cytotoxicity were CD3-CD56+ NK cells. Even though V alpha 24 TCR+NKT cells proliferated remarkably in response to alpha-glycosylceramides, they did not contribute directly to the cytotoxicity. Our observations strongly suggest the potential usefulness of alpha-glycosylceramides for immunotherapy of liver cancer in humans based on their ability to activate CD3-CD56+ NK cells in the liver.     

Monocyte antibody-dependent cellular cytotoxicity in cancer patients

Summary Antibody-dependent cellular cytotoxicity (ADCC) mediated by peripheral blood monocytes was determined in 120 patients who had gastrointestinal tract (GIT), lung and breast cancer, melanoma, or Hodgkin's and non-Hodgkin's lymphoma. Results were expressed in terms of maximum cytotoxicity and cytotoxicity at E : T=1 : 10 and were compared with the results obtained in 63 normal subjects. There was a significant decrease in maximal cytotoxicity for both the GIT cancer and the melanoma patient groups, but not for any of the other groups. These differences were not confirmed when results were expressed at low effector: target cell ratios, e.g., cytotoxicity at E : T=1 : 10. The relationship between monocyte ADCC and disease extent was examined in those groups with sufficient numbers. Monocyte ADCC was higher in patients with GIT cancer of limited extent than in patients with extensive GIT cancer and in the control group.     

Behaviour of lymphocytes from cancer patients and normal individuals cultured with phytohaemagglutinin.

Blood lymphocytes from cancer patients with solid tumours without any previous immunosuppressive treatment and from normal individuals, were cultured in vitro with a wide range of phytohaemagglutinin (PHA). Sixty two per cent of all the cancer patients studied show a minimal of no response to PHA in comparison with the normal population. The rest (38%), show a quantitative identical response than normals. However, the maximal response in these patients occur in the high PHA doses, while the normal individuals show their maximal activity with low PHA doses. The low or no PHA response showed by the 62% of patients, may indicate they have impaired cellular immunity. The high response showed by the other 38%, may indicate that the patients of this group have high cellular immunity capacity. This immunity, however, higher PHA doses are required to reach the maximal response compared with the seems to be different from that of normal individuals, since higher PHA doses are required in cancer patients to reach maximal response. These results also suggest that a large range of PHA doses may be important to detect the degree of cellular immunity in cancer patients compared with the normal population. One or two random PHA doses, may not show a distinction.