[Effect of therapy on the lymphoid cell distribution in the venous blood of breast cancer patients]

Rosetting properties (E, EAh, EAox, EAC rosettes) and presence of surface immunoglobulins (SIg) were examined on peripheral blood lymphocytes from 30 breast cancer patients immediately prior to therapy and 4 weeks thereafter. Therapy consisted of limited radical surgery followed by combined X-ray and telecobalt radiotherapy. The results were compared to patients who had received the same treatment 1 year ago (n = 13), 2 years ago (n = 13) and 3 to 10 years ago (n = 20). All irradiated patients exhibited a considerable leuko- and lymphopenia with a particular decrease of E and EAh rosettes, and a concommittant relative increase of EAox and EAC rosettes. SIg positive cells showed no significantly different percentages before and after therapy although in absolute counts they were similarly reduced as the other subpopulations after radiotherapy. The possible prognostic influence of radiation induced lymphopenia is discussed without coming to clear conclusions.

Immunological characterization of mononuclear cells and morphological findings in patients with mammary carcinoma

Mononuclear cells from peripheral blood and draining lymph nodes of 40 patients with invasive mammary carcinoma were examined for various immunological cell surface markers including surface membrane immunoglobulins and rosetting properties (E, EA, EAC). No significant relationship could be established to anyone of the following criteria for which the literature reports varying prognostic values: Clinical staging of the disease , histological tumor type, grading, nuclear differentiation, round cell infiltration, perivenous infiltration, sinus histiocytosis, and lymph node reaction patterns (lymphocyte predominance, germinal center predominance, lymphocyte depletion, unstimulated nodes). From the reported results it is concluded that the analysis of lymphocyte cell surface markers in mammary carcinoma is not a suitable parameter for supporting the existence of specific or unspecific anti-tumor immune reactions which may be suspected from certain histological reaction patterns.

Studies of the producer cell of interferon in human lymphocyte cultures

The producer cells of interferon were studied in human leucocyte cultures stimulated by a variety of stimulants, including phytohemagglutinin (PHA), pokeweed mitogen (PWM), Corynebacterium parvum (CP) and Herpes Simplex Virus (HSV). When the cells were fractionated by the use of neuraminidase-treated sheep red blood cells (SRBC), the T cell population responded with interferon production to PHA and PWM but not to CP or HSV. However, the non-T population showed a vigorous response to the latter two stimuli. In contrast, nylon column eluate cells enriched for T cells responded well to CP and HSV with production of interferon. To resolve these contradictory data, we have used combinations of techniques. Nylon column eluate cells were further separated by SRBC and it was found that the nylon non-adherent rosetting cell did not produce interferon in response to HSV or CP whereas the nylon-nonadherent non-rosetting cell did. In additional experiments more elaborate techniques were used. Leucocytes were treated by plastic adherence and iron filings, passed over a nylon column and subsequently over an Ig-anti-Ig column, and then rosetted with SRBC. Again only the non-rosetting population produced interferon. In parallel experiments the capacity of the different cell populations to lyse three types of target cells in a chromium release assay as a test for "natural killer" (NK) cell activity was investigated. There was some correlation between interferon production and NK cell activity. Thus, our data indicate that interferon is produced by non-T, non-B cells, possibly by cells related to NK cells.

Immunological characterization of mononuclear cells in peripheral blood and regional lymph nodes of breast cancer patients

Mononuclear cells from peripheral blood and draining lymph nodes of 40 patients with invasive locoregional breast cancer were examined for immunological cell surface markers (E, EAhuman, EAox, EAC, SIg pos.). Concomitantly, blood lymphocytes from 36 healthy women and axillary and mesenteric lymph-nodes from patients without malignant diseases were tested as controls. In peripheral blood of tumor patients E rosette-forming cells were slightly diminished as compared to the control group, whereas EAox and EAC rosette-forming cells were increased. These differences may be age-dependent rather than tumor-related. In the draining lymph nodes of breast cancer patients as well as in the control lymph nodes, the percentages of EAC rosette-forming cells and SIg positive lymphocytes were significantly increased compared to peripheral blood, whereas E and EAhuman rosette values remained unchanged. Percentages of EAox rosettes on the other hand were strongly diminished in the draining lymph nodes, suggesting that the EAhuman and EAox rosetting techniques detect 2 types of Fc-receptor bearing cells. No significant differences were found between the cell surface marker analysis of tumor-free and metastatic lymph nodes of breast cancer patients and the control lymph nodes.

Spontaneous cell-mediated cytotoxicity (SCMC) associated with lymphocytes negative for acid alpha-naphthyl acetate esterase (ANAE) activity

A modified histochemical procedure for nonspecific acid alpha-naphthyl acetate esterase (ANAE) activity in human lymphocytes was used to identify a subpopulation of E-rosette forming cells. Performing a one hour reaction at pH 6.5 the distinct dot-like staining pattern was almost exclusively observed on high affinity E-rosettes which sedimented readily in a regular Ficoll-Metrizoate gradient. By combining latex phagocytosis with staining for ANAE activity, a clear-cut distinction between mononuclear phagocytes and lymphocytes could be made. An attempt was undertaken to relate the ANAE marker on human lymphocytes to their functional capacity in spontaneous cell-mediated cytotoxicity (SCMC) reactions. Using as targets two allogeneic (K562,IGR3) and a xenogeneic cell line (L1210) it could be clearly demonstrated that high SCMC activity is mediated by ANAE negative mononuclear cells, whereas enrichment for ANAE positive lymphocytes resulted in a loss of SCMC.

[Effector function of acute leukemias in "spontaneous" (SCMC) and antibody dependent cellular cytotoxicity-tests (ADCC) (author's transl)]

Blood lymphocytes from 13 untreated acute leukemia patients, 3 pre-leukemias 3 immunoblastic lymphadenopathias and one infectious mononucleosis showed significantly lower spontaneous (SCMC) and antibody-dependent cellular cytotoxicity (ADCC) against 51Cr-labeled allogeneic melanoma cells of the IGR3 cell line than effector lymphocytes from 20 age- and sex matched control persons. While control lymphocytes exhibited the highest cytotoxic activity after depletion of mononuclear phagocytes (Fraction FFF), followed by the "Ficoll" purified Fraction F and defibrinated whole blood, the reverse was true for acute leukemias: here, the highest cytotoxicity was found in whole blood followed by the lymphocyte fractions F and FFF. Comparatively high cytotoxicity was found with two leukemia patients who had received blood transfusions the day before testing. During the course of an acute erythroleukemia chemotherapy drastically reduced SCMC and ADCC activities. A therapeutical splenectomy, on the other hand, did not affect cellular cytotoxicity in the case of a hairy cell leukemia. The angioimmunoblastic lymphadenopathies showed strikingly high percentages of EA- and EAC-rosettes forming cells and showed a marked increase of SCMC and ADCC activities after elimination of mononuclear phagocytes from the effector cell population.

[Imprint cytology of axillary lymph nodes in breast neoplasms for intraoperative rapid diagnosis]

A total of 385 lymph nodes of patients suffering from breast cancer were examined intraoperatively for the presence of metastases. We applied imprint cytology and stained using the "Diff-Quick" set (3 times 30 seconds). The percentage of correct identifications following instant cytological examination amounted to 94.5 if compared with subsequent paraffin histology. The 21 diagnostic failures were composed of 3 false negative and 18 false positive results. These data make the advantages for routine clinical application quite obvious.

Human peripheral Nullymphocytes: ultrastructural aspects of the "K" cell effect against a melanoma target cell

A null cell fraction was isolated from human peripheral blood by Ficoll density gradient centrifugation followed by removal of mononuclear phagocytes, passage through Ig-antiIg columns and sedimentation of E-rosette forming T cells. In contrast to the T cell fraction in the Null cell population exhibited cytotoxic activity against antibody-sensitized human melanoma target cells (ADCC reaction). This activity could be attributed to a low affinity Fc-receptor bearing cells present in the Null cell preparation. At the ultrastructural level in 2 h ADCC reaction most tumor cells were surrounded by up to 10 lymphoid cells which showed narrow junctions with parallel plasma membranes and local evaginations of lymphoid cells into recessus of the target melanoma cells. The mononuclear cell type found in close contact with the antibody-sensitized target cells had the following morphological criteria: 8 to 10 mu diameter, irregular nucleus, discrete rough endoplasmic reticulum, isolated ribosomes, cytoplasmic organelles concentrated under a ruffling membrane in the contact area with the tumor cell.

Influence of continuous-flow blood separator leucophoresis on in vitro functions of human lymphocytes

The influence of continuous-flow blood separator leucophoresis on these in vitro functions of human lymphocytes was studied. In ten separation experiments, lymphocyte functions were examined in the presence and absence of mononuclear phagocytes before, during and at the end of continuous flow leucophoresis. Cell surface markers and effector functions in spontaneous cell-mediated cytotoxicity (SCMC) and antibody-dependent cellular cytotoxicity (ADCC) assays did not change significantly under the conditions of leucophoresis. By contrast, separator lymphocytes exhibited a significantly increased mitogenic response to pokeweed mitogen and PPD. Removal of mononuclear phagocytes corrected for this phenomenon. PHA and Con A responses were not affected by leucophoresis, nor was the number of circulating haemopoietic stem cells (CFU-C) significantly altered during a 4 hr continuous flow blood separator run.

Immunological and functional characteristics of peripheral blood and synovial fluid lymphocytes from patients with rheumatoid arthritis

Spontaneous (SCMC) and antibody dependent cellular cytotoxicity (ADCC); mitogenic responsiveness (PHA, Con A, PPD, dextran and pokeweed) as well as lymphocyte subpopulations (E-, EA-, EAC-rosettes, S-Ig) were studied simultaneously in peripheral blood (PBL) and synovial fluid lymphocytes (SFL) of fifteen patients with rheumatoid arthritis. Marked differences were observed in the cytotoxic activity of SFL and PBL. Whereas SCMC activity of SFL was always significantly elevated above the cytotoxic levels of PBL, the reverse was true for the ADCC reaction; here, 50% of the patients showed a decreased cytotoxicity of SFL compared to PBL. Synovial fluid neutrophils (SFN) were found to be inactive in both cytotoxic assays. No differences were found in ADCC activity of PBL between normal controls and RA patients. In SCMC assays a significantly increased activity of control PBL was only observed at L/T ratios of 100:1. Overnight incubation of PBL from RA patients and normal controls resulted in a marked decrease in SCMC and, to a smaller extent, in ADCC activity. SFL from three out of four patients lost less SCMC activity after overnight incubation than the corresponding PBL. In one patient even an increased activity in both cytotoxic systems was obtained. Regarding lymphocyte populations, T-cells were significantly decreased in PBL of RA patients. With the exception of a significantly lowered percentage of C3 receptor positive cells in SFL, no significant differences were recorded in the lymphocyte distribution between the patients' PBL and SFL. In the RA patients, the response to T-cell mitogens was significantly depressed in SFL while PPD and pokeweed reactivity was equal to that of PBL.

[IgG levels in the sera of melanoma patients (author's transl)]

397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG4 subclass was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.

[IgG levels in the sera of melanoma patients (author's transl)]

397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG 4 sub-class was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.

Experience with BCG adjuvant immunotherapy in stage II malignant melanoma

23 "high risk" melanoma patients treated with BCG-AIT are compared with a non-randomized control group of 35 Stage II melanoma patients receiving other treatment. The results are discussed. It has been noted that patients with weak initial BCG reactions survived longer than patients with strongly positive first BCG reactions. This observation could be interesting for the choice of immunotherapy.

Inhibition of spontaneous and antibody-dependent cellular cytotoxicity by sera and isolated antiglobulin preparations from rheumatoid arthritis patients

Using sera from patients with rheumatoid arthritis and antiglobulin preparations obtained from such sera, inhibition of human lymphocyte cytotoxicity in antibody-dependent (ADCC) and spontaneous cell-mediated cytotoxicity (SCMC) reactions against an allogeneic melanoma cell line (IGR3) has been demonstrated. Fractionation of effector cell preparations indicated that Fc-receptor-bearing lymphocytes were operative in both reactions. Removal of phagocytic and adherent cells from the effector cell population resulted in more pronounced inhibition of SCMC and ADCC reactions by rheumatoid sera. The results indicate that antiglobulin preparations from human sera containing rheumatoid factor activity can effectively block the cytotoxic activity of Fc-receptor-bearing effector lymphocytes (K cells) in vitro. On analogy with the inhibition of ADCC and SCMC reactions by immune complexes and aggregated IgG, antiglobulin complexes present in the antiglobulin preparations are responsible for this effect.

IgG4 subclass in malignant melanoma

Three hundred and ninety-seven sera from 185 melanoma patients were studied. These sera were classified into three groups according to stage of disease. An alteration in the level of the IgG4 subclass was found. It was related to the dissemination of disease. The percentage of abnormalities (either increased or decreased levels of IgG4) was more frequent in patients with stage II and III diseases (55 and 53%, respectively) than in patients with stage I(19%). The higher frequencies of high titers of IgG4 were essentially detected in advanced disease. The biologic significance of the increase of IgG4 in melanoma remains obscure. The increase may be related to the development of facilitating antibodies of the IgG4 subclass.

Human peripheral blood "null-lymphocytes", a highly enriched pool for granulocytic stem cells (CFU-C)

A "Null"-lymphocyte preparation containing a high concentration of granulocytic stem cells (CFU-C) was isolated from human peripheral blood. 3 lymphocyte purification procedures were shown to produce an enrichment of CFU-C: 1. Removal of mononuclear phagocytes by iron phagocytosis and plastic adherence procedures. 2. Passage through Ig anti-Ig columns. 3. Removal of E-rosette-forming T cells. A combination of all 3 purification steps resulted in a 30- to 40-fold enrichment of CFU-C in the final "Null"-lymphocyte population as compared to the initial lymphocyte fraction isolated by Ficoll-Urografin density gradient centrifugation.

[IgG subclasses in malignant melanoma]

The 397 sera from 185 melanoma patients have been studied and classified in three groups according to the stage of disease. Our findings revealed an alteration of the level of IgG4 subclass which is related to the dissemination of disease. The percentage of abnormalities (either increased or decreased levels of IgG4) was more frequent in stage II and III (55% and 53% respectively) than in stage I (19%), The higher frequencies of high titers of IgG4 were essentially detected in advanced disease. The biological significance of the increase of IgG4 in melanoma remains obscure. It may be related to the development of facilitating antibodies of IgG4 subclass.

Estimation of T- and K-cell activity in the peripheral blood of sarcoidosis patients

Depressed ADCC activity was found in sarcoidosis patients in clinical Stage II when whole blood was used as the effector cell pool. Whole blood in Stage I patients as well as purified peripheral lymphocytes of sarcoidosis patients did not reveal a diminished cytotoxic activity. Stimulation experiments with PHA, Con A, and PPD in two different concentrations resulted in a normal PHA response, a significantly decreased Con A response (regardless of the clinical stage of the patients), and a significantly decreased PPD responsiveness of peripheral lymphocytes in Stage II patients, respectively. Regarding the distribution of peripheral B and T lymphocytes, only a significantly depressed T-cell number in Stage I sarcoidosis patients was observed. Peripheral cells forming EA and EAC rosettes and staining for membrane-bound immunoglobulins were within normal ranges. Serum antibody titers to different herpes viruses, including Epstein-Barr virus, were found not to be elevated. Twenty percent of sarcoidosis patients showed anti-immunoglobulins in their sera specific for the Fc and Fab fragment.

Antibody-dependent cellular cytotoxicity and B-and T-cell activity in the peripheral blood of myasthenia gravis patients

Antibody-dependent cellular cytotoxicity (ADCC) was found to be significantly decreased in whole blood as well as in purified lymphocyte preparations from myasthenia gravis patients. Decreased ADCC was found not to correlate with the clinical classification nor with the therapy regimen, including immunosuppressive agents. PHA, Con A, and PPD responsiveness of peripheral blood lymphocytes was normal. Likewise no significant decrease was observed in the T-and B-cell distribution in the peripheral blood.

Spontaneous and antibody-dependent cellular cytotoxicity in melanoma patients and healthy control presons

Spontaneous cell-mediated cytotoxicity (SCMC) and antibody-dependent cellular cytotoxicity (ADCC) against 51Cr labeled allogeneic target cells of a human melanoma cell line (IGR3) were determined with purified effector lymphocytes and defibrinated whole blood from 14 melanoma patients and 13 healthy control persons. Peripheral blood lymphocytes were isolated by Ficoll gradient centrifugation (fraction F); subsequently the phagocytic and adherent cells were removed and the supernating cell population (fraction fff) was passaged through IgG anti-IgG columns to obtain a B cell free lymphocyte suspension (fraction fff-c). cells from the 3 lymphocyte fractions and from defibrinated whole blood were simultaneously tested for cytotoxic activity against unsensitized IGR3 target cells (SCMC assay) and IGR3 cells perviously sensitized with a rabbit anti-melanoma IgG (ADCC assay). Dose-response curves were established with all lymphocyte fractions and with whole blood. The following results were obtained. 1. With all lymphocyte fractions tested, ADCC was approximately 15 time higher than SCMC, whereas with whole blood, the difference tended to be less pronounced. 2. Elimination of phagoctic and adherent cells had no significant effect on SCMC and ADCC. 3. Passage over IgG anti-IgG columns drastically reduced cytotoxicity in both assays without, however, completely abolishing it. 4. The only difference seen between lymphocyte cytotoxicity of melanoma patients and control persons was a slight, but non-significant depression of SCMC and ADCC in melanoma patients. The results confirm and extend our previous report that SCMC against an allogeneic tumor cell-line is due to not-specific "Null" or "K" cell-activity rather than to specific T cell cytotoxicity. In one experiment freshly explanted melanoma cells were labeled with 51Cr and reacted wiht autologous blood and purified lymphocyte fractions. It was found that cellular cytotoxicity depending on serum factors (ADCC) was an effective lytic mechanism, whereas T cell-mediated cytotoxicity could not be demonstrated.