Palliative steroid therapy and serum interleukin-6 levels in a patient with lung cancer

We report a patient with metastatic adenocarcinoma of the lung who had a detectable serum interleukin-6 (IL-6) level. Despite systemic chemotherapy, the tumor progressed, with elevation of serum IL-6 level. Palliative steroid therapy with 20 mg/day of prednisolone resulted in the decline of serum IL-6 level and, simultaneously, improved anorexia and oral intake. Although there was no weight gain or improvement in hypoalbuminemia, these results suggest that steroids may suppress the abnormal production of IL-6 in cancer patients and that this action affects symptoms. Further study is warranted to clarify the role of IL-6 in tumor-related symptoms and the effect of steroid therapy in relation to IL-6 production in cancer patients.

Detection of auto-antibodies against L-myc oncogene products in sera from lung cancer patients

Auto-antibodies against L-myc oncogene products (L-Myc) in sera from lung cancer patients were examined using bacterially synthesized glutathione S-transferase (GST) L-Myc fusion proteins and Western blot analysis. The detection rate of anti-L-Myc antibodies in sera from lung cancer patients was 10%, while that in sera obtained from normal volunteers was 0%. Five patients with non-small-cell lung cancers (2 adenocarcinomas, 2 squamous-cell carcinomas and I large-cell carcinoma) were included in the group with anti-L-Myc antibodies. These auto-antibodies belonged to the IgG class and recognized the carboxy terminus of L-Myc. Circulating L-Myc was not detected in sera from patients with anti-L-Myc antibodies. Differences in age, sex, performance status, histology, stage, smoking history and prior treatment were not significantly different between anti-L-Myc antibody-positive and antibody-negative patients. Anti-nuclear antibodies were detected in 40% of lung cancer patients and 57% of those with anti-L-Myc antibodies. Our data suggest that detection of anti-L-Myc antibodies may be helpful in the diagnosis and evaluation of the host-immune response to L-Myc in a subset of lung cancer patients.

Is postoperative radiotherapy for thymoma effective?

OBJECTIVE

The authors determined the effect of postoperative mediastinal irradiation in preventing local and pleural recurrence of thymoma.

SUMMARY BACKGROUND DATA

The role of mediastinal irradiation after incomplete resection or biopsy of an invasive thymoma is well established. However, routine use of adjuvant mediastinal irradiation for patients with thymoma after complete resection remains controversial.

METHODS

During the 19-year period from 1973 to 1992, operations were performed on 89 patients with thymoma. Of these 89 patients, 80 patients who underwent gross complete tumor resection including adjacent tissues that appeared to be invaded by tumor were selected for this study. The effects of postoperative mediastinal irradiation on the recurrence rate of thymoma were analyzed according to histologic type, clinical stage, and whether adhesions to or invasion of the pleura or pericardium were present.

RESULTS

Recurrence of thymoma was observed in 13 of 80 (16.3%) patients. No recurrence was observed in 23 patients with noninvasive thymoma. In patients with invasive thymoma whose tumor was macroscopically adherent to the pleura but not microscopically invasive (p1), recurrence was observed in 4 of 11 patients (36.4%) when mediastinal irradiation was not performed, but in none of 10 patients who received mediastinal irradiation. However, in patients with microscopic pleural invasion (p2), a high recurrence rate was observed with mediastinal irradiation (40%, 6/15 patients) or without mediastinal irradiation (30%, 3/10 patients). Postoperative mediastinal irradiation for patients with microscopical invasion to pericardium (c2) did not decrease the recurrence rate. Analysis of the mode of recurrence showed that mediastinal irradiation may have been effective in preventing local recurrence, but it did not control the pleural dissemination that was observed in 12 of 13 recurrent cases.

CONCLUSIONS

Mediastinal irradiation is not necessary for patients with noninvasive thymoma. In patients with invasive thymoma, postoperative mediastinal irradiation is effective in preventing recurrence in patients with p1 thymoma, but not in patients with p2 or c2 tumors. Further adjuvant therapy should be performed to supplement mediastinal irradiation in patients with p2 or c2 thymoma, even after complete resection.

Stem-cell factor regulates the expression of cyclin A and retinoblastoma gene product in the growth and differentiation pathway of human megakaryocytic cells

The biological effects of c-kit ligand (stem-cell factor: SCF) on an immortalized human megakaryocytic cell line (CMK) was evaluated using methods including the 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, surface marker analysis, DNA cell-cycle analysis and immunoblotting. SCF stimulated the growth of CMK cells. Incubation with SCF resulted in increased expression of IIb/IIIa platelet-related glycoprotein (gpIIb, IIIa), indicating enhanced differentiation of CMK cells. Treatment of CMK cells with SCF resulted in a decrease in the subpopulation in the G1 phase, with a reciprocal increase in those in the S phase and the G2 + M phase. Moreover, SCF significantly increased cellular expression of cyclin A, a regulatory subunit of cyclin-dependent protein kinase (CDK), and the ratio of phosphorylated/dephosphorylated retinoblastoma gene product (RB protein). These results suggest that SCF stimulates the growth and differentiation of megakaryocytic cells possibly through mechanisms related to the activation of cell-cycle-dependent serine/threonine kinase and inactivation of the nuclear tumor-suppressor gene product.

Novel metastasis model of human lung cancer in SCID mice depleted of NK cells

Metastasis is a critical problem in the treatment of human lung cancer. Thus, a suitable animal model of metastasis of human lung cancer is required for in vivo biological and preclinical studies. In this study, we tried to establish a suitable model for this, using SCID mice. Neither human SCLC H69/VP cells (5 x 10(6)) nor squamous-cell carcinoma RERF-LC-AI cells (1 x 10(6)), injected through a tail vein, formed metastases in untreated SCID mice. Pre-treatment of SCID mice with anti-asialo GM1 serum resulted in only a few metastases of H69/VP cells, but pre-treatment with anti-mouse IL-2 receptor beta chain Ab (TM-beta 1) resulted in numerous lymph-node metastases 56 days after tumor inoculation. H69/VP-M cells, an in vivo-selected variant line, formed significant numbers of lymph-node metastases even in SCID mice pre-treated with anti-asialo GM1 serum. SCID mice depleted of NK cells by treatment with TM-beta 1 showed different patterns of metastasis when inoculated intravenously with the 2 different human lung cancer cell lines (H69/VP and RERF-LC-AI cells): H69/VP cells formed metastases mainly in systemic lymph nodes and the liver, whereas RERF-LC-AI cells formed metastases mainly in the liver and kidneys, with only a few in lymph nodes. A histopathological study showed that the metastatic colonies consisted of cancer cells. The numbers of metastatic colonies formed by the 2 cell lines increased with the number of cells inoculated. TM-beta 1 treatment of SCID mice efficiently removed NK cells from peripheral blood for at least 6 weeks, whereas, after treatment of the mice with anti-asialo GM1 serum, NK cells were recovered within 9 days. These findings suggest that NK-cell-depleted SCID mice may be useful as a model in biological and pre-clinical studies on metastasis of human lung cancer.

Transduction of the macrophage colony-stimulating factor gene into human multidrug resistant cancer cells: enhanced therapeutic efficacy of monoclonal anti-P-glycoprotein antibody in nude mice

To develop a therapeutic modality for overcoming multidrug-resistant (MDR) cancer with anti-MDR1 antibody, we examined the effect of macrophage colony-stimulating factor (M-CSF) gene transfection into MDR AD10 cells on therapy of MDR cancer with anti-MDR1 antibody (MRK17) in nude mice. MDR human ovarian cancer (AD10) cells were transduced with the human M-CSF gene inserted into an expression vector to establish gene-modified cells capable of producing low (ML-AD10), intermediate (MM-AD10) nd high (MH-AD10) amounts of M-CSF. Systemic administration of MRK17 resulted in significant dose-dependent inhibition of subcutaneous growth of ML-AD10 tumors. In contrast, systemic administration of recombinant M-CSF in combination with MRK17 did not augment the therapeutic efficacy of MRK17 alone, but rather promoted the growth of the parent AD10 cells. To test the efficacy of in vivo M-CSF gene therapy combined with antibody, we mixed the parent AD10 cells with MH-AD10 cells producing a large amount of M-CSF, and inoculated the mixed cells subcutaneously. Treatment with MRK17 inhibited growth of the mixed cells more than that of the parent cells alone. Thus, combined therapy with anti-MDR1 mAb and M-CSF gene modification of MDR cancer cells may provide a new immunotherapeutic modality for overcoming MDR in humans.

[Methodological study of hemodynamic analysis of lung mass by contrast enhanced dynamic CT]

We investigated a method of analyzing the hemodynamics of the lung mass by contrast enhanced dynamic computed tomography (dynamic CT) to determine the difference in vascular supply between the pulmonary artery and bronchial artery using an experimental model. Our experimental model consisted of two injectors connected to two tubes, representing the pulmonary artery and bronchial artery, which were further connected to a chamber representing the lung mass. Following infusion of contrast medium into each tube with some delay time, dynamic CT scans were performed to obtain time density curves of the two tubes and the chamber. Using the time-density curve of contrast passage, flow rates from the two tubes into the chamber were calculated by the curve fitting method. Calculated values correlated well with the adopted flow rates of fluid from the injectors (r = 0.893) in the experiment. The results indicate our method of individually measuring flow rates of dual-input blood flow, i.e., from the pulmonary artery and bronchial artery, into the lung mass is applicable clinically to determine blood flow by the two arteries supplying the lung mass.

Interleukin-1 receptor antagonist in pleural effusion due to inflammatory and malignant lung disease

Interleukin (IL)-1 is a key cytokine in inflammatory reactions. To clarify the mechanism of inflammation in the pleural cavity, we investigated the contribution of IL-1 and its antagonism to inflammatory processes in the pleural cavity. Interleukin-1 receptor antagonist (IL-1Ra) levels as well as IL-1 beta and interferon-gamma (IFN-gamma) levels were measured by enzyme immunoassay in pleural effusions from 70 patients. Pleural macrophages were also examined as possible sources of these cytokines in 10 patients. IL-1Ra was detectable in 28 patients (40%) out of 70 patients with pleural effusions. Patients with tuberculosis had significantly higher IL-1Ra as well as IFN-gamma levels in pleural effusion than patients with lung cancer. Transudative pleural effusions had low or undetectable IL-IRa levels. On the other hand, IL-1 beta levels were low, except in cases of parapneumonic pleural effusion. Spontaneous production of IL-1Ra pleural macrophages was observed in six patients, and IL-4 significantly augmented its production. Although spontaneous production of IL-1 beta was observed in only two patients, pleural macrophages produced significant amounts of IL-1 beta in response to lipopolysaccharide in all 10 patients examined. These results suggest that interleukin-1 receptor antagonist regulates various reactions by interleukin-1 in pleural effusion, and that pleural macrophages may act in situ as a source of interleukin-1 receptor antagonist.

[Evaluation of image quality of medical facsimile as a radiological image recording system]

We examined the usefulness of a new medical facsimile (MFAX) system in recording and transmitting various kinds of medical images, including X-ray images and colored histopathologic images. The system consists of an image scanner, a magnetic disk for image storage, a transmission circuit and a thermal image printer. Transmission time for a FCR (Fuji computed radiography) image by super-fine mode was 6 minutes. We used ROC (receiver operating characteristics) curves to evaluate the ability of eight radiologists to detect the small simulated nodules placed on an anthropomorphic chest phantom and shown on MFAX images. The radiologists observed both the FCR films and MFAX copies and determined the presence or absence of simulated nodules using five confidence levels. The results obtained for FCR films and MFAX images showed no statistically significant difference.

Anti-ganglioside GM2 monoclonal antibody-dependent killing of human lung cancer cells by lymphocytes and monocytes

Ganglioside GM2 (GM2) frequently appears on the cell surface of human cancers of neuroendocrine origin. A mouse-human chimeric monoclonal antibody (mAb), KM966, against GM2 was previously found to promote the lysis of various cancer cells by human blood mononuclear cells (MNC). In this study, we analyzed the effector cells responsible for the chimeric mAb-dependent cell-mediated cytotoxicity (ADCC) against small cell lung cancer (SCLC) cells and examined the enhancing effect of various cytokines on the ADCC activity. The ADCC activity was assessed by 4-h 51Cr release assay. Highly purified lymphocytes (> 99%) and monocytes (> 90%) were separated by centrifugal elutriation from peripheral blood MNC of the same healthy donor. KM966 induced lysis of SCLC cells mediated by both lymphocytes and monocytes to similar extents, in a dose-dependent manner. Pretreatment of lymphocytes with various cytokines [interleukin (IL)-2, IL-12 and interferon-gamma] and that of monocytes with macrophage-colony-stimulating factor significantly augmented the killer activity against SCLC cells in the presence of KM966 mAb. KM966 was also effective for the lysis of non-small cell lung cancer cells in direct proportion to the GM2 expression levels. These findings suggest that combined treatment of KM966 mAb with cytokines may be therapeutically useful for in vivo killing of lung cancer cells expressing GM2 through the ADCC reaction.

LPS-dependent cyclooxygenase-2 induction in human monocytes is down-regulated by IL-13, but not by IFN-gamma

We investigated the effects of Th2 cell-associated cytokines, IL-4, IL-10, and IL-13, on prostaglandin (PG) production by human peripheral blood monocytes (HPBM) in terms of four parameters: PGE2 synthesis; cyclooxygenase activity; protein; and mRNA of two cyclooxygenase isozymes (cyclooxygenase-1 and cyclooxygenase-2). LPS-stimulated PGE2 synthesis and cyclooxygenase activity were suppressed by IL-4, IL-10, or IL-13. Furthermore, the LPS-dependent increase of cyclooxygenase activity in HPBM was attributable to cyclooxygenase-2 because it was inhibited by NS-398 (a cyclooxygenase-2-specific inhibitor). Western and Northern blot analyses revealed that the LPS-induced increases in cyclooxygenase-2 protein and mRNA were attenuated by the addition of IL-4, IL-10, or IL-13. In contrast, cyclooxygenase-1 protein and mRNA were hardly detected in monocytes that were incubated with or without LPS in the presence or absence of IL-4, IL-10, and IL-13. These results suggest that the reduction of LPS-induced PGE2 synthesis and cyclooxygenase activity by IL-4, IL-10, and IL-13 in HPBM are mainly due to the down-regulation of cyclooxygenase-2 selectively induced by LPS. Conversely, IFN-gamma, a Th1 cell-associated cytokine, did not affect PGE2 production and cyclooxygenase activity. These data suggest a mechanism for modulation of inflammation by the anti-inflammatory Th2 cell-associated cytokines but not a Th1 cell-associated cytokine.

LPS-dependent cyclooxygenase-2 induction in human monocytes is down-regulated by IL-13, but not by IFN-gamma

We investigated the effects of Th2 cell-associated cytokines, IL-4, IL-10, and IL-13, on prostaglandin (PG) production by human peripheral blood monocytes (HPBM) in terms of four parameters: PGE2 synthesis; cyclooxygenase activity; protein; and mRNA of two cyclooxygenase isozymes (cyclooxygenase-1 and cyclooxygenase-2). LPS-stimulated PGE2 synthesis and cyclooxygenase activity were suppressed by IL-4, IL-10, or IL-13. Furthermore, the LPS-dependent increase of cyclooxygenase activity in HPBM was attributable to cyclooxygenase-2 because it was inhibited by NS-398 (a cyclooxygenase-2-specific inhibitor). Western and Northern blot analyses revealed that the LPS-induced increases in cyclooxygenase-2 protein and mRNA were attenuated by the addition of IL-4, IL-10, or IL-13. In contrast, cyclooxygenase-1 protein and mRNA were hardly detected in monocytes that were incubated with or without LPS in the presence or absence of IL-4, IL-10, and IL-13. These results suggest that the reduction of LPS-induced PGE2 synthesis and cyclooxygenase activity by IL-4, IL-10, and IL-13 in HPBM are mainly due to the down-regulation of cyclooxygenase-2 selectively induced by LPS. Conversely, IFN-gamma, a Th1 cell-associated cytokine, did not affect PGE2 production and cyclooxygenase activity. These data suggest a mechanism for modulation of inflammation by the anti-inflammatory Th2 cell-associated cytokines but not a Th1 cell-associated cytokine.

[Detectability of simulated nodules on chest phantom by Fuji computed radiography: comparison of different nodule sizes, configurations and tube voltages]

The detectability of simulated nodules placed on a chest phantom and shown on FCR images has been studied. Different tube voltages (130 kVp, 100 kVp), presence or absence of compensation filter, various sites and different sizes (5 mm/10 mm) and configurations (spherical or broad based) of the nodule were examined. 112 FCR chest phantom images were evaluated by ten radiology specialists utilizing ROC analysis. The detection rate for nodules was influenced in general by the site. The detection rate was as follows in decreasing order: intercostal, overlaid with one rib, two ribs, diaphragm and heart. Detection of nodules of 10 mm in height was mainly influenced by the density of the lung where the nodule was located, whereas that of nodules of 5 mm in height was more dependent on the site of the nodule, probably greatly influenced by the amount of structure mottle. Spherical nodules of 5 mm in height were more frequently recognized than the broad-based ones. High kVp (130 kVp) resulted in a higher detection rate for both sizes of nodules than low kVp (100 kVp). Detection of spherical nodules overlying the heart or diaphragm was improved with the use of a compensation filter.

Digital tomosynthesis imaging of the lung

We report our preliminary results of pulmonary imaging by digital tomosynthesis, and describe some advantages of these digitally processed longitudinal tomographic images. Digital tomosynthesis of the lung was performed in 60 subjects, including 56 patients with a localized lesion or diffuse disseminated lesions, with a fluororadiographic TV unit with linear tomographic capability, in conjunction with an image processing unit. Dual energy subtraction digital tomosynthesis was also available in our system. Multiple longitudinal tomographs of the lung, which were reconstructed from a single set of tomographic image data, facilitated easy evaluation of the morphology of pulmonary abnormalities together with related broncho-vascular structures located in the same longitudinal plane as the lesion, and were immune from any problem caused by inconsistent depth of respiration. The image quality of the reconstructed tomographs was greatly improved by digital image processing to reduce tomographic blur and enhance image clarity. Dual energy subtraction digital tomosynthesis was effective in clearly showing the size, configuration, and distribution of calcification in the lesion. Digital tomosynthesis provided useful information in making the roentgenologic diagnosis of pulmonary lesions.

Characteristics of IL-6 and TNF-alpha production by respiratory syncytial virus-infected macrophages in the neonate

The production of IL-6 and TNF-alpha and the expression of their mRNA were studied with neonatal (cord blood) and adult blood monocyte-derived macrophages (MDM) after in vitro infection with respiratory syncytial virus (RSV). Cord blood MDM exhibited production of high levels of IL-6 within 24 hr after infection. Little or no IL-6 production was detected after 24-48 hr and after in vitro stimulation with inactivated (nonreplicating) virus. Adult blood MDM also produced high levels of IL-6 within 24 hr of RSV infection. Unlike cord blood MDM, adult MDM demonstrated significant activity of IL-6 after 24 hr of infection with live RSV and after exposure to the inactivated virus. The pattern of TNF-alpha production by cord and adult blood MDM after live RSV infection resembled closely the pattern of IL-6 production. Both cell types produced TNF-alpha in the first 24 hr after infection. However, little or no production was observed after 24 hr of infection and after exposure to the inactivated virus. The profile of mRNA expression was similar to the production of IL-6 or TNF-alpha. mRNA expression occurred over a shorter period in cord blood MDM. These observations suggest that inflammatory and immunoregulatory cytokines, such as IL-6 and TNF-alpha, are produced by neonatal as well as previously primed adult macrophages. However, neonatal cells may be less efficient in inducing IL-6 production.

MR findings indicative of hemosiderin in giant-cell tumor of bone: frequency, cause, and diagnostic significance

OBJECTIVE

We studied the frequency, cause, and diagnostic significance of MR findings indicative of large amounts of hemosiderin in giant-cell tumor of bone.

MATERIALS AND METHODS

The clinical, MR, and histologic findings in 16 patients with giant-cell tumors of bone were reviewed. Eight tumors occurred in uncommon locations or in patients who were not in the usual age range; the other eight were more typical. Areas of decreased MR signal intensity considered to be caused by hemosiderin were identified. The number and distribution of RBCs within the tumor were studied histologically, and the presence of hemosiderin was determined on histologic sections made with iron stains.

RESULTS

In 10 cases in which MR images showed areas of low signal intensity, large amounts of hemosiderin were noted histologically. The low-signal-intensity areas were nodular, zonal, whorled, or diffuse and occupied at least one fifth of the tumor volume. On histologic examination, many erythrocytes were in direct contact with the tumor cells, and the hemosiderin was seen in both mononuclear and multinuclear tumor cells.

CONCLUSION

Hemosiderin is commonly seen on MR images of giant-cell tumors of bone (63%) and is probably related to the extravasated erythrocytes in the tumor and the phagocytic function of the tumor cells. This MR finding supports the diagnosis, even in giant-cell tumors in uncommon locations or in patients who are not in the typical age range.

Magnetic resonance imaging of neurogenic tumors of the thoracic inlet: determination of the parent nerve

To investigate the value of magnetic resonance imaging (MRI) in determining the parent nerves of neurogenic tumors in the thoracic inlet, analysis of MR images was performed in nine patients with surgically resected neurogenic tumors in the thoracic inlet (two neurofibromas and one schwannoma of the vagus nerve, three schwannomas of the brachial plexus, and two schwannomas and one ganglioneuroma of the sympathetic nerves). These MR images were compared with surgical and pathologic findings. The multidirectional capability and excellent tissue contrast of MRI facilitated recognition of the location, shape, and extent of the tumors. MRI, which permitted an easy understanding of the spatial relation between the tumors and the subclavian vessels, scalenus muscles, and brachial plexus, was useful in determining the nerves of origin. Two neurofibromas, four of six schwannomas, and one ganglioneuroma were recognized to extend along the axes of the parent nerves on MR images. MRI is useful in determining the parent nerve of neurogenic tumors in the thoracic inlet and is helpful in planning surgical treatment of these tumors.

Systemic chemotherapy alters interleukin-1 beta and its receptor antagonist production by human alveolar macrophages in lung cancer patients

The purpose of this study was to determine whether cytotoxic chemotherapy influences the number and function of alveolar macrophages (AM) in patients with lung cancer. AM were obtained by bronchoalveolar lavage from 24 patients with lung cancer and 17 control patients. The functional integrity of AM was determined by their ability to produce interleukin-1 beta (IL-1 beta) and interleukin-1 receptor antagonist (IL-1ra) before and after platinum-containing systemic chemotherapy. The productions of IL-1 beta and IL-1ra were quantitated by enzyme immunoassays. The proportions of multinucleated cells among AM were significantly decreased after systemic chemotherapy in lung cancer patients. No significant difference in spontaneous and lipopolysaccharide (LPS)-stimulated IL-1 beta or IL-1ra production by AM was observed between lung cancer patients and control patients. Significant increase of IL-1 beta and significant decrease of IL-1ra production by AM were demonstrated in patients with small cell lung cancer who experienced response to systemic chemotherapy. These results suggest that systemic chemotherapy may influence functional roles of AM in the lung, and consideration of influence of systemic chemotherapy on host functions is important in cancer treatment.

Epidural dumbbell-shaped chordoma mimicking a neurinoma

The authors present a case of cervical chordoma which manifested in a 5-year-old boy as a dumbbell-shaped epidural tumor without bone destruction. Both CT and MRI demonstrated tumor features suggesting this diagnosis, which was confirmed by histology.

Identification and localization of immunoglobulin binding factor in bronchoalveolar lavage fluid from healthy smokers

Immunoglobulin binding factor (IgBF), which is abundant in human seminal plasma, is known to bind immunoglobulin, interact with anti-Fc gamma RIII antibodies, and block pokeweed mitogen (PWM)-stimulated lymphocyte blastogenesis. In this study, we investigated whether IgBF is present in the lower respiratory tract, whose secretions come into contact with the external environment. For this, IgBF was measured in brochoalveolar lavage fluid (BALF) from 42 healthy normal subjects (23 nonsmokers and 19 smokers) by enzyme-linked immunosorbent assay (ELISA). IgBF was detected in BALF from these normal subjects, and its level was significantly higher in BALF from smokers (127.2 +/- 98.7 ng/ml versus 23.3 +/- 20.7 ng/ml). On gel filtration chromatography of BALF, IgBF was eluted in a region corresponding to a molecular weight of 27 kD. Western blot testing with a monoclonal antibody to IgBF indicated that IgBF in BALF had a molecular weight of 27 kD under nonreducing conditions and of 16 kD under reducing conditions. Thus, the migration pattern of IgBF in BALF corresponded to that of IgBF in seminal plasma. IgBF immunoreactivity was detected histochemically in mucus glands and goblet cells in the lower respiratory tract. These results demonstrate that IgBF is present in the lower respiratory tract, and that smoking may cause its increased production in this region.

Patient with extensive small cell lung cancer given moderately dose-intensified chemotherapy and peripheral blood stem cell support

Although recent progress in multi-drug chemotherapy has increased the median survival of patients with extensive Small cell lung cancer (SCLC) to 7 months, 2-year survivors are still exceptional. We describe a 40-year-old man with extensive SCLC involving the lungs and systemic nodes who was initially treated with 6 cycles of an alternating combination regimen consisting of cyclophosphamide, doxorubicin, vincristine, cisplatin and etoposide. After the second cycle of the regimen, Peripheral blood stem cells (PBSC) were harvested and frozen. The patient then received a moderately dose-intensified regimen consisting of cisplatin (80 mg/m2) and etoposide (500 mg/m2 X 3), followed by infusion of the thawed PBSC. Hematopoietic recovery was rapid, and the patient remained tumor free for 12 months until multiple tumor recurrence.

[123I-MIBG myocardial SPECT in two patients with familial amyloid polyneuropathy]

201T1C1 SPECT and 123I-MIBG SPECT were performed in two patients with familial amyloid polyneuropathy (FAP). Both patients showed normal accumulation of 201T1C1 and no accumulation of 123I-MIBG in the myocardium at the early and delayed images. These results indicate that the patient with FAP-related myocardial change accompanies sympathetic nerve dysfunction. The dysfunction is supposed to be caused by disturbance of re-uptake of MIBG by the terminal ending of the sympathetic nerve (uptake-1) through the amyloid-deposited connective tissue.

FK506 and cyclosporin A inhibit granulocyte/macrophage colony-stimulating factor production by mononuclear cells in asthma

Bronchial asthma is associated with eosinophilic inflammation and expression of T-cell-derived cytokines, which influence eosinophilic function. FK506, a newly established immunosuppressive agent, may have potential as a therapeutic instrument for asthma because of its suppressive effect on T-cell activation. To assess this, we compared the inhibitory effects of FK506 and cyclosporin A on production of granulocyte/macrophage colony-stimulating factor and interleukin-5 by interleukin-2- or Dermatophagoides farinae-stimulated mononuclear cells from patients with asthma, and their contribution to proliferation and survival of eosinophils in vitro. FK506 inhibited granulocyte/macrophage colony-stimulating factor production by stimulated mononuclear cells from asthma patients at lower concentrations than cyclosporin A. Both drugs inhibited eosinophil proliferation and survival activity from mononuclear cells at comparable concentrations. Interleukin-5 production by stimulated mononuclear cells was also inhibited both by FK506 and cyclosporin A. We conclude that both FK506 and cyclosporin A have potential for therapy of bronchial asthma.

Granulocyte-macrophage colony-stimulating factor augments lymphokine-activated killer activity from pleural cavity mononuclear cells of lung cancer patients without malignant effusion

The role of recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) in augmentation of lymphokine-activated killer (LAK) cell induction by interleukin-2 (IL-2) from pleural cavity mononuclear cells (PCMNCs) was examined in sixteen patients with resectable primary lung cancer not associated with malignant effusion. None of the patients had received any anticancer therapy prior to this study. Incubation of PCMNCs of patients without malignant effusion with GM-CSF for 4 days in the presence of IL-2 resulted in a significant increase in LAK activity against natural killer-resistant Daudi cells. This result was obtained by using the 4 h 51Cr-release assay. PCMNCs and blood mononuclear cells (BMNCs) were harvested simultaneously from pleural cavity lavage fluid and peripheral blood in lung cancer patients. The LAK activity developed from PCMNCs and BMNCs following incubation with IL-2 for 4 days, but the LAK activity from PCMNCs was significantly lower than that from BMNCs (P < 0.05). Incubation of PCMNCs with GM-CSF augmented the LAK activity from PCMNCs to a level as high as that from BMNCs. These results suggest that the combined use of GM-CSF with IL-2 may result in augmentation of LAK activity developed from PCMNCs of lung cancer patients without malignant effusion.