Augmentation of insulin autoantibodies following interleukin-2 and lymphokine activated killer cell therapy

The sera of 33 patients who received interleukin-2 and lymphokine activated killer (IL-2/LAK) cells as therapy for advanced neoplasms were assayed for the presence of islet cell antibodies and insulin autoantibodies both prior to and following therapy. All sera were negative for islet cell antibody in all of these patients. However, 4 patients developed insulin autoantibody levels considered to be positive following IL-2/LAK cell therapy. In the entire group, the percent binding and counts displaced in the insulin autoantibody assay following therapy was significantly increased above the levels obtained prior to therapy. This is the first demonstration in non-diabetic humans that exogenous IL-2 in the absence of insulin treatment results in significant augmentation of insulin autoantibodies. These findings suggest that in non-diabetic individuals the B lymphocyte repertoire includes clones autoreactive to insulin.

Induction and clinical utilization of lymphokine-activated killer cells in patients with gastrointestinal tract cancers

In 18 patients with cancers of the gastrointestinal tract, lymphokine-activated killer (LAK) cell activity was studied and compared with that of healthy subjects. After cultivation with 10(3) iu/mL of recombinant interleukin-2, the cytotoxicity of patients' lymphoid cells was increased from 13.6 +/- 6.8% to 76.2 +/- 19.5% against Daudi cells and from 12.8 +/- 8.1% to 76.2 +/- 19.5% against K-562 cells. Based on these results, autologous LAK cells were given to patients. LAK cells injected into subdermal metastatic tumours demonstrated a significant inhibitory effect on tumour growth in comparison with that of control tumour nodules. Of four patients with metastatic tumours in the liver, to whom LAK cells were administered via the hepatic artery, tumour size was reduced by about 25% (minor response) in one patient, with a decrease of computerized tomography attenuation in the tumours occurring in the other three patients.

Nursing care of patients receiving activated lymphocytes

Activated lymphocytes are administered to patients as a component of many biological therapy clinical trials. Oncology nurses caring for these patients need to understand administration techniques, potential side effects, and management strategies. Activated lymphocytes may be administered intravenously or regionally; administration techniques and side effects differ depending on the route of administration. The major side effects with intravenous infusion are chills/rigors, fever, hypotension, tachycardia, respiratory compromise, headache, nausea, and vomiting. When activated lymphocytes are infused regionally, the most common side effects are immediate regional discomfort and delayed chills, fever, and hypotension. Management of these side effects involves intense nursing care including assessment, monitoring, and interventions to promote medical stability and symptom control. Astute assessment skills and sound nursing judgement are essential for the safe administration of activated lymphocytes.

Preliminary trial of specific targeting therapy against malignant glioma

The results of specific targeting therapy by use of lymphokine-activated killer (LAK) cells treated with bispecific antibody in 10 patients with malignant glioma were compared with the results of therapy with untreated LAK cells in 10 other patients. Both treated and untreated cells were given locally. The bispecific antibody was an anti-CD3 monoclonal antibody (mAb) chemically conjugated to anti-glioma mAb. Of the 10 patients given specific targeting therapy, 4 showed regression of tumour, and in another 4 patients computed tomography and histology suggested eradication of the glioma cells left behind after surgery. No recurrence was detected in the 10 to 18 months of follow-up. Patients receiving untreated LAK cells had recurrences within 1 year except in 1 case, and 8 patients died within 4 years. So far specific targeting therapy seems to be a new useful form of adoptive immunotherapy.

Anti-tumour efficacy of mouse spleen cells separated with Dolichos biflorus lectin (DBA) in experimental pulmonary metastasis of B16 melanoma cells

Anti-tumour effector cells were generated through 4 days culture of normal C57BL/6 splenocytes in a medium containing concanavalin A supernatant and then fractionated with Dolichos biflorus lectin (DBA) into DBA+ (agglutinable with DBA) and DBA- (non-agglutinable with DBA) cells. The DBA- cells, infused intravenously into mice together with B16 melanoma cells, or adoptively transferred into mice 3 days after the injection of B16 cells, caused a marked decrease in the number of lung nodules, while the DBA+ cells exerted no effect. On the other hand, the DBA+ cells exhibited higher cytolytic activity in vitro than the DBA- cells in short-term 51Cr-release assays. Then, we analysed the mechanism of the strong anti-tumour activity of DBA- cells in vivo. We found that DBA- cells showed higher response to recombinant interleukin-2 (rIL-2) than DBA+ cells and proliferated very well with a small amount of IL-2. In addition, DBA- cells adhered more strongly to lung endothelial cells than DBA+ cells in response to rIL-1 or rTNF. Furthermore, DBA- cells produced larger amounts of macrophage activating factor (MAF) including IFN-gamma when cultured with B16 melanoma. Taken together, our results show that DBA- cells are effective in reducing experimental pulmonary metastases not only by the direct lytic activity but also by the indirect killing activity through the activated macrophage.

[Study on adoptive immunotherapy with tumor-infiltrating lymphocytes (TIL) for renal cell carcinoma--amplification of IL-2-elicited TIL proliferation by OKT3-monoclonal antibody]

Human autologous peripheral blood lymphocytes (PBL) and lymphocytes infiltrating renal cell carcinoma (TIL) were cultured with medium containing 1000 IU/ml of human interleukin 2 (IL-2). A high cytotoxic activity against fresh autologous as well as cultured allogenic tumor cells was developed. By culturing these lymphocytes with OKT3 monoclonal antibody during the initial 2 days of long-term culture, in terms of T cell activation signal, IL-2-driven lymphocyte proliferation was remarkably accelerated with maintenance of appreciable level of cytotoxic activity. The same culture method also induced an increase in OKT3 and IL-2 receptor positive lymphocyte population in LAK cells and TIL. This method may enable us to gain more autologous TIL in vitro for adoptive immunotherapy of renal cell carcinoma than the usual culture method with IL-2 alone. Five patients with metastatic renal cell carcinoma were treated with adoptive immunotherapy with TIL, LAK and IL-2. One patient with pulmonary metastasis has had a minor response which has lasted for 3 months so far. We have not experienced any serious side effects during the treatment.

Immune responses in humans while receiving adoptive immunotherapy with recombinant interleukin-2 and lymphokine-activated killer cells: acute anergy to mitogens and recall antigens

In this study we evaluated the in vitro immunologic responses of 11 patients receiving immunotherapy with either interleukin-2 (IL-2, 3 X 10(6) units/m2) or IL-2 plus lymphokine-activated killer cells (LAK) over a 30-day period. Blastogenic responses to mitogens or recall antigens were found to significantly decrease during therapy. Pokeweed mitogen immunoglobulin (Ig) production decreased significantly in 7 patients or showed no change. In vivo skin tests for cell-mediated immunity were also performed and the average number of positive responses before IL-2/LAK therapy decreased to no positive responses (day 29 of therapy). Experiments were performed to determine whether decreased responses were a result of active suppression or a dilution effect by immature/mature cells that cannot respond to mitogen or antigen. Pre-therapy cells were mixed with fresh autologous (anergic) cells from day 29 of therapy in varying ratios. Blastogenesis and Ig production was measured. Our findings demonstrate that the decreased immune response observed during and after therapy is a result not of active immunosuppression but rather of a dilution effect by cells with immune dysfunction. We conclude that: (1) in vitro blastogenesis or Ig production tests using mitogens or antigens for patients undergoing IL-2 immunotherapy have no predictive value, and (2) the immune cells that are present are refractory.

Anti-tumor effects of interleukin-2 and interleukin-1 in mice transplanted with different syngeneic tumors

We have studied the anti-tumor effects of human recombinant IL-2, alone or in association with LAK cells, in mice transplanted subcutaneously (s.c.) with the following syngeneic tumors: highly metastatic Friend leukemia cells (FLC), nonmetastatic FLC, lymphoma RBL-5 cells and HeJ16 fibrosarcoma cells. In these tumor models, peri-tumoral injections of IL-2 were more effective in inhibiting tumor growth than a systemic treatment. Although s.c. IL-2 treatment resulted in marked inhibition of tumor growth in mice injected s.c. with highly metastatic FLC, it was not effective in inhibiting growth of FLC in the liver and spleen. IL-2 therapy was more effective at increasing survival time in mice transplanted with non-metastatic FLC or with RBL-5 cells. In mice transplanted with HeJ16 fibrosarcomas, s.c. IL-2 treatment resulted in highly significant anti-tumor effect and survival of 70% of tumor-injected mice. No general correlation was found between in vitro sensitivity or resistance to the cytolytic activity of LAK cells and the anti-tumor effects observed in vivo. Subcutaneous injection of IL-1 beta in mice transplanted with highly metastatic FLC resulted in a marked increase in survival time and inhibition of metastatic tumor growth in liver and spleen. Combined treatment of IL-1 beta and IL-2 produced a synergistic anti-tumor effect: 60% of mice injected with highly metastatic FLC survived. Combined IL-1/IL-2 treatments exerted no anti-tumor activity either in DBA/2 mice injected with antibody to Thy 1.2 antigen or in nude mice, indicating that T cells play important roles during IL-1/IL-2 therapy. In vitro treatment of FLC with IL-1 beta resulted in a slight inhibition of cell multiplication, whereas even high doses of IL-2 did not affect FLC multiplication. Our results indicate that local combined treatments with IL-1 and IL-2 can induce potent, host-dependent (T cell-mediated) anti-tumor effects against highly malignant tumors.

[Effects of lymphokine-activated killer cells and interleukin-2 on the ascites formation and the survival time of nude mice bearing human ovarian cancer cells]

Effect of intraperitoneal instillations of interleukin-2 (IL-2) and/or lymphokine-activated killer (LAK) cells on the ascites formation and the survival time was examined by using a nude mice model with malignant ascites by intraperitoneal inoculation of human ovarian cancer cells (HRA) derived from ascites of a patient with serous cystadenocarcinoma of the ovary. On 28 days after tumor inoculation, all nude mice in both untreated and spleen cells only treated groups formed ascites. Two of 10 nude mice treated with IL-2 only after tumor inoculation survived without forming ascites during the experimental period. On the other hand, all nude mice treated with LAK cells only formed ascites by 14 days after tumor inoculation. When LAK cells and IL-2 were combined 5 of 10 mice survived without forming ascites during the experimental period. The survival time of the IL-2 only treated group was significantly prolonged, compared to that of medium only, spleen cells only and LAK cells only treated groups. When administration of LAK cells was followed by IL-2, the survival time was further prolonged.

Potent graft antitumor effect in natural killer-resistant disseminated tumors by transplantation of interleukin 2-activated syngeneic bone marrow in mice

The current study is a continuation of our previous work showing that bone marrow activated in interleukin 2 has antitumor and antiviral activity in vitro. The antitumor efficacy of IL-2-activated bone marrow cells in vivo was assessed here. Our results indicated that bone marrow cells activated in IL-2 for 3 days (ABM) have antitumor activity in vivo and cause significant tumor regression in mice being treated with ABM and concurrent i.p. administration of IL-2. In mice also bearing larger tumor burdens, those receiving ABM and i.p. IL-2 showed the most significant tumor regression. The ABM seem to be more potent than conventional IL-2-activated spleen lymphokine-activated killer cells. In studies done using lower dosages of IL-2 or log lower number of cells, the ABM caused more significant tumor regression than lymphokine-activated killer cells. We also assessed the antitumor efficacy of short term (1 day) IL-2-activated bone marrow, the short term-activated bone marrow being preferred in bone marrow, transplantation because of the minimum amount of cells lost due to its shorter incubation period. We also showed that short term-activated bone marrow caused tumor regression similar to ABM and could reconstitute lethally irradiated mice similar to fresh bone marrow. Therefore, the biomodulation of bone marrow cells could be used as an active therapeutic tool in autologous bone marrow transplantation, producing graft versus tumor effects without any graft versus host effect.

[Adoptive immunotherapy in patients with medulloblastoma by LAK cells]

Medulloblastoma is one of the most popular malignant brain tumors in children. It accounts for about 15% of all pediatric brain tumors. Radiochemotherapy has prolonged the 5-year survival rate up to 60-85% for patients with medulloblastoma. But the conventional therapy is not so effective to recurrent cases, especially with meningeal dissemination, and generally fatal. There remains a big problem of the neurotoxicity to infants in a growth process under the whole-neuraxis irradiation and chemotherapy. Aiming to relieve the radiation and antitumor drugs, adoptive immunotherapy is greatly expectant. We have had clinical trials of adoptive immunotherapy for 8 patients with medulloblastoma by lymphokine-activated killer (LAK) cells. They were from 2-9 years in age and had cerebrospinal fluid (CSF) dissemination of the tumors. All patients underwent the whole-neuraxis irradiation and chemotherapy. After they had CSF dissemination, they were submitted to an adoptive transfer of allogeneic LAK cells. LAK cells were induced from peripheral blood lymphocytes (PBL) of their relatives with human recombinant interleukin-2. 3-15 x 10(9) LAK cells were transferred intrathecally in 2-3 months. In 3 of 8 patients, neurological signs were improved and malignant cells had never been detected on CSF cytology after the adoptive immunotherapy. One among these 3 patients showed complete response in 20 months. Thus, this is an attractive treatment for patients with medulloblastoma, especially with CSF dissemination, which cannot be cured by current therapeutic intervention.

Therapeutic efficacy of sequential therapy with OK-432, cyclophosphamide, IL2-cultured lymphocytes and in vivo IL2 against advanced murine plasmacytoma

BALB/c mice inoculated IP with a syngeneic plasmacytoma MOPC104E were treated with a combination of a streptococcal preparation, OK-432 (1 KE, 0.1 mg/mouse), low-dose of cyclophosphamide (CPA, 1 mg/kg) and adoptive transfer of tumor-bearer-spleen cells (2 x 10(7) cells) cultured with IL2 and sonicated tumor extract (adoptive immunotherapy; AIT). The consecutive protocol of OK-432 (day 8, 9 post inoculation) - CPA (day 10) - AIT (day 11) was the most effective. Rate of complete remission was highest when recombinant (r-) IL2 was injected to the mice after AIT. Moreover, another bacterial preparation, Nocardia rubra cell wall skeleton and another low-dose chemotherapy, Mitomycin C could be used successfully instead of OK-432 or CPA. Transfer test of intraperitoneal cells (tumor cells plus host cells) of mice on day 11 post inoculation (on the day of AIT) revealed that OK-432 augmented the susceptibility of peritoneal cells to cultured lymphocytes in inhibition of transplantability, and that CPA after OK-432 augmented the anti-tumor effect of tumor-bearer-spleen cells which act synergistically with cultured lymphocytes. This therapy schedule seems to be the best model to augment the effect of AIT with minimal side effect.

[Initial results of immunotherapy approaches to tumor treatment in the animal model]

The possibilities of using immunocytes in cancer therapy have been increasing during the last few years. Contrary to the promising results gained by in vitro experiments, several clinical trials have shown that, on the one hand, it is difficult to preserve a quantity of cells big enough to inhibit tumours, and they have also shown that, on the other hand, antitumour lymphocytes do not get into the tumour. That is why we concentrated on improving the tumour selectivity of the antitumour lymphocytes. We carried this out practising two sets of experiments. First we incubated patient lymphocytes with tumour extract and vaccinated them in this manner. Secondly, by binding antitumour antibodies to lymphocytes, we could improve the ability of lymphocytes to bind with tumour cells. We tested these therapy models on human tumours and on tumour cell lines. Both were implanted in the renal capsule space of nude mice.

[Therapy by biological response modifiers]

Recent progress in biotechnology has uncovered the presence of trace substances which participate in the immunological response between cancer and host, they are cytokines, monoclonal antibodies, and immunomodulating agent which are called as biological response modifiers (BRM). The genetic engineering enables mass production of these substances, and their clinical application in treating hematological malignancies is expected. The role of biologically active substances as important pharmacological reagents was initially explored in human with purified interferon. The most recent example of such rapid progress has been with IL-2 and TNF. Clinical trials with recombinant IL-2 and TNF have begun in 1984. Although IL-2 is effective for the activation of T lymphocyte, intravenous injection of IL-2 was not so effective for treatment of hematological malignancies. On the other hand, IL-2 activated Killer cells were potent effectors of adoptive immunotherapy. Tumor necrosis factor, a cytotoxin derived from macrophages showed marked decreases in percentage of leukemic cells of peripheral blood in treating leukemic patients.

[Intrapleural transfer of LAK cells combined with rIL-2 in the treatment of advanced lung cancer with malignant pleural effusion]

Ten patients with advanced lung cancer complicated by malignant pleural effusion were treated by intrapleural transfer of autologous LAK cells induced from lymphocytes of malignant effusions in the presence of rIL-2 and by administration of rIL-2 10 days before and after the transfer of LAK cells. The pleural effusions disappeared in 8 patients and significantly reduced in the other two. The number of tumor cells in the pleural effusion was obviously decreased while the number of lymphocytes was significantly increased. No changes were found in 4 responders during 4 months follow-up after treatment. No serious side effects were observed in all these 10 patients. The results indicated that transfer of LAK cells combined with rIL-2 in the treatment of patients with malignant pleural effusion due to advanced lung cancer is effective, safe and feasible.

[An immunological and clinical evaluation of combined TAE-LAK adoptive immunotherapy]

To clarify the immunological effects of transcatheter arterial embolization (TAE) therapy for hepatocellular carcinoma (HCC), various immunological parameters were measured before and after TAE respectively. In most effective group of which AFP levels at first week after TAE therapy had decreased more than 50% compared with those before TAE, the percentage of OKT-4 and IL-2R positive cells in the peripheral blood lymphocytes (PBL) had significantly increased in number. In addition, IL-1, TNF, IL-2 and LAK activity were also enhanced by it. These immunological enhancement after TAE therapy was suggested to be a favourite condition for transferring LAK cells to the patients with HCC. Therefore the combination therapy with TAE and LAK-adoptive immunotherapy was conducted in 12 patients with HCC. Partial response to it was obtained in one case and minor response in three. However, no effectiveness was also found in eight (Progressive Disease: 1 case, No Change: 7 cases). Immunological response after combined TAE-LAK adoptive immunotherapy revealed that NK activity and LAK activity were markedly enhanced. Furthermore, the percentage of OKT-11+, IL-2R+ and Leu-7- 11c+ cells in the PBL had increased in number with statistically significant differences and OKT-8+ cells had increased in relative number. In conclusion, this study suggested that this combination therapy might be a well designed immunological and clinical therapy for HCC because it was done under the condition of well enhanced immunological parameters against tumors.

[The rationale and practice of CTL therapy against cancer in the mouse and human]

It is essential to investigate and elucidate the immune response especially T cell response to either syngeneic or autologous tumor for establishing a rational immunotherapy of cancer. We reported that major immune effector cells capable of inducing tumor regression are cytotoxic T lymphocytes (CTL). We found that there are at least two distinct CTL subsets directed to syngeneic tumor. One CTL subset which is selectively induced by syngeneic solid tumor is independent from CD4 positive helper T cells but requires a soluble factor (s) released from macrophage-like accessory cells designated killer T cell activating factor (KAF) in its induction and generation directed to the homologous tumor. The other CTL subset which is usually induced by syngeneic tumor of hematocytic origin is dependent on CD4 positive helper T cells in its induction. On the basis of our findings regarding the induction and activation mechanism of CTL to syngeneic tumors in the mouse, we have investigated the mechanisms of human CTL generation to autochthonous tumor in peripheral blood mononuclear cells of cancer patients. It was found that the nature of human CTL and its generation to autochthonous tumor are similar to those of murine CTL to syngeneic solid tumor. We are now establishing a rational cancer specific immunotherapy utilizing intravenous passive cell transfer of in vitro activated CTL to autochthonous tumor into an original cancer patient.

[Treatment of multiple myeloma with LAK cells plus interleukin 2 or interleukin 2 alone]

Three patients with multiple myeloma were treated with 3.3-10 x 10(5) u/day intravenous or subcutaneous IL 2 alone. Both their Leu7 and CD16 positive cells in the peripheral blood and NK and LAK cell activity elevated but no M protein decreased. LAK cells and IL-2 administered to three patients intravenously. Lymphocyte counts in the peripheral blood elevated remarkably in one patient and CD3, 8, 16, 2, 38, Leu7 positive cells and NK cell activity increased in three patients. Though the reduction of M proteins were observed in three patients (17%, 75.8% and 40%, respectively), they returned to pretreatment level in 35 days, 55 days and 200 days after the therapy. Significance of the therapy against multiple myeloma was discussed.