CA-50 as tumour marker in transitional bladder carcinoma

Monoclonal antibody CA-50 is a useful tumour marker in gastrointestinal carcinoma. We report an assessment of its value in bladder cancer patients. We found raised levels in 2 of 2 patients with infiltrating carcinoma and in 8 of 35 with superficial carcinoma. The recurrence rate was higher in patients with raised levels, since 6 of 8 with elevated levels and 15 of 27 with normal values had a recurrence within 6 months. T1 and T3 carcinoma had a mean CA-50 level higher than normal. G3 tumours had a mean level slightly above normal. A statistically significant difference emerged when comparing Ta with T1 + T3 carcinomas. A longer study, with serial determinations, could assess the role of CA-50 as a prognostic indicator in bladder cancer.

The study on cell surface antigens in epithelial tumor of the upper urinary tract: ABH-isoantigen and Thomsen-Friedenreich antigen

ABH-isoantigen (ABH-Ag) and Thomsen-Friedenreich antigen (T-Ag) were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method on 47 patients with epithelial tumor of the upper urinary tract (all patients underwent nephroureterectomy including the cuff of the bladder; 30 patients were diagnosed as transitional cell carcinoma of renal pelvis and 17 ureteral organs). The correlations between ABC expression for ABH-Ag and T-Ag with histological grade, stage and prognosis (5 year survival rate) were studied. A correlation was observed between grade (p less than 0.05) and deletion of the antigenicity of ABH-Ag, but no correlation was evident with stage and prognosis. A high correlation was evident, however, between grade (p less than 0.01), stage (p less than 0.01) and prognosis (p less than 0.01) and deletion of the antigenicity of T-Ag. The analysis of ABC expression for ABH-Ag and T-Ag may therefore be valuable for predicting the malignant potential in transitional cell carcinoma of the upper urinary tract. T-Ag determination in particular may provide a useful prognostic probe should it find clinical application.

Immunoresponse of tissue infiltrating lymphocytes in bladder tumors

Local immunocompetence was evaluated immunohistochemically in patients with bladder tumors before and after local injections of an immunomodulator. The subpopulations of tissue infiltrating lymphocytes (TIL) were examined by staining six serial sections with Leu4, Leu7, Leu10, LeuM3, OKT4, and OKT8 antibodies. T cells predominated over B cells in 19 of 25 bladder tumors. T cell infiltration was prominent around tumor cells, and it was marked in non-invasive tumors. B cells were rare in the stroma. In patients with low-stage tumors, OKT8 cells were more prominent than OKT4 cells. NK cells accumulated within cancer nests but their infiltration was scanty in invasive bladder tumors. Before surgery, immunomodulators (OK-432, IL-2) were injected intratumorally. Their administration resulted in marked increase of T and NK cells, irrespective of the stage of disease; there was a slight increase in B cells. These findings suggest that local immunosurveillance plays a role against bladder tumors. Further studies are required to elucidate host immune responses in the microenvironment of the cancer site, as well as the systemic immune reaction.

Blood group ABH-related antigens in normal and malignant bladder urothelium: possible structural basis for the deletion of type-2 chain ABH antigens in invasive carcinomas

A complete panel of mouse monoclonal antibodies (MAbs) against Type-2 chain (GaI beta I-4GlcNAc-R) blood-group antigens (N-acetyl-lactosamine, Lex, H, Ley, A monofucosylated, Aley, repetitive A) was used in a detailed immunohistological study of the modulation of these carbohydrate antigens in transitional-cell carcinomas. The histological and cellular locations of these antigens were studied in 19 normal bladder biopsies and 53 transitional-cell carcinomas with as well as without neuraminidase treatment of tissue sections in order to uncover potential sialylated antigens. The antigen expression was correlated to individual A1A2BO, Lewis, and secretor status. Several alterations of blood group expression were found: (1) loss of A and H antigens with accumulation of Ley antigens; (2) loss of correlation between antigen expression and secretor status; (3) disruption of the orderly stratification of blood-group antigen expression in relation to cell layers; and (4) changes in subcellular location of antigen expression. The present data indicate that deletion of Type-2 chain ABH antigens in transitional-cell carcinomas is associated with alpha 1-3 fucosylation of the H antigen leading to accumulation of Ley antigens.

[Biologic significance and clinical value of carcinoembryonic antigen in tissues in transitional cell carcinoma of the urinary tract]

Avidin-biotin complex immuno-histochemical technique with monoclonal antibody to CEA was used to study comparatively relationship of expression of carcinoembryonic antigen in tumor tissue of 82 patients with transitional cell carcinoma (TCC) of upper tract and bladder with prognosis of the patients with TCC and its biologic significance. Our study showed that the detection of CEA in patients with transitional cell carcinoma of upper tract could reflect subsequent recurrence and survival of the patients and related with histologic grade (P less than 0.01). But the expression of CEA in patients with bladder tumor was not related with the clinical course of the patients and the histologic grade (P greater than 0.05).

Immunohistochemical evaluation of nonspecific cross reactive antigen and carcinoembryonic antigen (CEA) in urinary bladder carcinoma

The immunohistochemical expression of CEA in formalin-fixed paraffin sections in urinary bladder carcinomas was compared to the use of polyclonal anti-CEA antiserum (P-CEA), NCA-absorbed anti-CEA (NCA-aCEA) and monoclonal antibody to CEA (M-CEA). The urinary bladder carcinomas examined consisted of 19 cases of transitional cell carcinoma (TCC) and 7 cases of squamous cell carcinoma (SCC). Both TCC and SCC were positive for CEA with the use of P-CEA and NCA-aCEA, and the degree of staining was markedly dependent on the grade of malignancy in TCC. However, the reaction to M-CEA was generally very weak or negative in TCC and SCC. In SCC, the staining reaction was confined to keratinized foci and not found in all malignant tumour cells when polyclonal CEA antiserum was used. These findings indicate that positive reactions seen with conventional CEA antibodies (P-CEA and NCA-aCEA) are possibly related to NCA and that urinary bladder carcinoma may contain relatively more NCA than true CEA.

A monoclonal antibody (BL2-10D1) reacting with a bladder-cancer-associated antigen

A hybridoma cell line secreting an IgM monoclonal antibody (MAb) was produced after immunizing a mouse with RT4 cells and a crude suspension of human bladder carcinoma cells (WHO grades II and III TCC). This MAb reacted with RT4 target cells derived from a human transitional bladder cancer but failed to react with a majority of non-bladder cancer cell lines. Immunohistological studies indicate that this MAb reacts inconstantly with normal bladder: in positive cases only a few superficial cells (5% to 10% umbrella cells) are stained but not intermediate or basal cells of the urothelium. This MAb was evaluated on 118 tumors: it reacted with tumor tissue in a majority of grade I (79.5%) and grade II papillary TCC (77.3%), less with grade III papillary TCC (45%) and very rarely with invasive non-papillary TCC (14%). In cases of flat lesions a strong reactivity of superficial, intermediate and/or basal layer cells was observed in 50% of moderate and severe dysplasia and in all cell layers of carcinomas in situ (CIS)(9/9).

Blood group antigen expression in frozen sections of presenting bladder cancer: 3-year prospective follow-up of prognostic value

Blood group antigen (BGA) expression was studied on frozen sections from the initial, presenting, transitional cell bladder cancers of 73 patients. Clinical follow-up was prospective and, after 3 years, 59 patients were available for assessment. Of 32 tumours that retained substantial BGA (BGA+ and BGA +/- ), 11 progressed. Of 27 tumours with less than 5% or undetectable BGA expression (BGA-), 14 did not progress. Of 24 pTa tumours, 17 had substantial BGA expression and 7 were BGA-; 5 patients progressed, 4 substantially BGA positive and 1 BGA-, all to category pT1; 15 tumours were category pT1, 7 substantially BGA positive and 8 BGA-; 7 patients progressed, 1 substantially BGA positive and 6 BGA-, all of whom died from bladder cancer; 20 were pT2 or deeper, 8 substantially BGA positive and 12 BGA-; 12 patients progressed, 6 substantially BGA positive and 6 BGA-, all of whom died from bladder cancer. Despite improved understanding of the biochemistry and techniques of detection of BGA, these results preclude the use of BGA determination as a guide to prognosis in individual transitional cell carcinoma, whether used alone or in combination with pT category.

[The efficacy of recombinant interleukin 2 in local treatment of superficial bladder tumors]

The present study was undertaken to assess the efficacy of recombinant Interleukin 2 (rIL-2: S-6820) in treatment of superficial bladder tumors. Three intratumor injections at a dose of 5 x 10(5) units/day via urethra, were performed every other day under endoscopic control in 12 patients with superficial bladder cancer. On the 15th day after completion of the series of injections, the tumor had disappeared in one patient and 50% regression over was observed in two other patients. Therefore, the response rate to the rIL-2 treatment in our study was 25.0%. Each tumor which responded to the therapy, was single, small and low grade. In the peripheral blood of the 12 patients, an increase in IL-2 receptor-positive lymphocytes and augmentation of natural killer activity were detected after the rIL-2 intratumor injection. There were no serious side effects except for moderate fever in our study.

[Clinical studies on the measurement of urinary tissue polypeptide antigen (TPA) levels using Prolifigen TPA kit "Daiichi"-II in urothelial cancers]

We have investigated the clinical significance of urinary tissue polypeptide antigen (TPA) as a tumor marker for urothelial cancers. Urinary TPA levels were determined by the immunoradiometric assay of Prolifigen TPA Kit "Daiichi"-II in 486 healthy controls and 1835 patients with various diseases including 526 with urothelial cancers and 140 with prostatic cancer. The mean value of urinary TPA was 199 +/- 213 (1SD)U/1 in 486 healthy controls. 95% of them having a level below 600 U/l. Therefore, 600 U/l was applied as a cut-off level. Positive rates of urothelial cancers and reactivated prostatic cancer were 57.6% (148 of 248 cases) and 45.5% (5 of 11 cases) respectively. On the other hand, the false positive rate of most urological benign diseases was only about 20% except for the acute stage of urinary tract infections and upper urinary tract stones with hydronephrosis. There was no significant difference in the positive rate between urinary TPA level and urinary cytology in urothelial cancers. The combination of both tests raised the positive rate to 73.1%. Therefore, urinary TPA may be useful in the monitoring of urothelial cancers, and the combination of urinary TPA and urinary cytology may increase the diagnostic accuracy.

Influence of interferon alfa-2c on the kinetics of spontaneous cell-mediated cytotoxicity in urothelial carcinoma in vivo and in vitro

It was demonstrated that patients with superficial bladder cancer displayed a raised spontaneous cell-mediated cytotoxicity (SCMC) compared to patients with advanced bladder cancer and healthy control subjects. By use of recombinant interferon alfa-2c, the activity of the spontaneous cell-mediated cytotoxicity at the level of the individual cell could be increased both in vitro and in vivo. In vitro, this was the case in patients with superficial bladder cancer as well as in patients with advanced bladder carcinoma, and in healthy control subjects. The kinetics of cytolysis were not affected by recombinant human interferon (rHu IFN) alfa-2c. After in-vivo application of rHu IFN, there was an elevation of the target binding cells (TBC) and the number of active natural killer (NK) cells within 24 h, but this was only detected for a brief period of time.

Immunocompetence of tissue infiltrating lymphocytes in bladder tumors

Tissue infiltrating lymphocytes (TIL) in bladder tumors have been assumed to be an expression of local host resistance against the tumor. We investigated the functional activity of TIL compared to peripheral blood lymphocytes (PBL). Isolation of TIL was performed using the enzyme cocktail treatment with Ficoll-Hypaque discontinuous gradient centrifugation. Analysis of lymphocyte subsets by flow cytometry demonstrated Leu 4, 43.6% (T cells); Leu 10, 10.5% (B cells) and Leu 7, 13.1% (natural killer (NK) cells) in TIL. The cytotoxic activity of TIL and PBL was tested in a four hour 51Cr-release assay. Myeloid K562 cells (NK sensitive), HT 1197 (bladder tumor) and fresh bladder tumors were used as target cells. The spontaneous NK cell activity of PBL was 23.7%, whereas that of TIL was only 3.5%. However, in vitro culture with IL2 induced a significant augmentation of NK activity in TIL as well as in PBL. On the other hand, the spontaneous lymphokine activated killer cell (LAK) activity of PBL and TIL was very low. IL2-cultured PBL and TIL exhibited the highest levels of lysis against fresh bladder tumors. Unlike PBL, IL2-induced cytotoxicity of TIL against autologous bladder tumors was higher than that against allogenic bladder tumors. Immunomodulators OK432 and Il2 were injected intratumorally during endoscopy. Analysis of the lymphocyte subsets in TIL showed an increase of T and NK cells following immunomodulator injection. Endoscopic injection of immunomodulators into bladder tumors augmented NK cell functional activity in TIL as well as PBL. These findings suggest that local immunosurveillance is directed against bladder tumors. Further studies are required to understand more fully the local and systemic host immune responses in cancer.

Interleukin 2 suppression of a murine bladder cancer implanted into kidney, bladder and skin; its organ specificity

Little is known about organ associated tumor response to systemic interleukin 2 (IL2) therapy. The effect of IL2 on bladder cancer growth in the skin and in the genitourinary tract was investigated. C3H mice were implanted with the syngeneic transitional cell carcinoma, MBT-2, intradermally (i.d.), beneath the left renal subcapsular area, and in one experiment, simultaneously in the bladder. IL2 (human recombinant form; Biogen Research Co) was given i.p. at 5000 U thrice daily for 5 consecutive days commencing on Day 3, or for 10 to 11 days commencing on Day 10 with some doses omitted at signs of toxicity. For comparison, mice bearing 3-d and 10-d tumors in the skin and subcapsular kidney were treated with chemotherapy (cisplatin, 6 mg./kg. X 3; mitomycin C, 3 mg./kg. X 3; cyclophosphamide, 75 mg./kg. X 1). IL2 therapy mediated growth suppression of 10-d tumors in the genitourinary organs and skin at a similar rate. In contrast to IL2, systemic chemotherapy mediated tumor suppression in an organ specific manner; renal subcapsular tumors responded to the chemotherapy, whereas i.d. tumors were insensitive. Three-day tumors (both i.d. and renal subcapsular tumor) responded relatively well to each treatment compared to 10-d tumors. These data suggest that in systemic immunotherapy with IL2, anatomic location of the tumor is less important for inducing an antitumor response than in chemotherapy.

Phagocytic and natural killer cytotoxic responses of murine transitional cell carcinoma to postsurgical immunochemotherapy

Postsurgical immunochemotherapy with Corynebacterium parvum (CP) and cis-diamminedichloroplatinum (II) (CDDP) was evaluated in mice with transitional cell carcinoma (MBT-2). C3H/He mice were transplanted subcutaneously in the hind limb with 5 x 10(5) tumor cells. Ten to 14 days later when the tumor reached a diameter of five to seven mm., it was surgically removed. Mice were then randomized into four groups to receive a total of three treatments on days 1, 3 and 5 after surgery: 1) saline (control group); 2) CP, 250 micrograms. into the surgical site; 3) CDDP, 5 micrograms./gm. body weight intraperitoneally; and 4) combined CP and CDDP. Recurrence of tumor occurred in 70%, 52%, 55% and 28% of mice receiving surgery only, CP, CDDP, and combined CP and CDDP respectively. In the second part of the experiment, phagocytic activity using chemiluminescence assay and natural killer (NK) activity using chromium-51 release assay were determined with cells from the peritoneum, spleen and inguinal lymph nodes. CP or CDDP alone enhanced the phagocytic and NK activity. The most significant enhancement was obtained with cells from the inguinal lymph nodes of mice receiving combined CP and CDDP, the group with the lowest tumor recurrence. These results suggest that combination of CP and CDDP may be useful in control of postsurgical recurrence of bladder cancer.

Tumor-specific immunotherapy of murine bladder cancer with butanol-extracted antigens and ethylchlorformate polymerized tumor protein

Successful treatment of superficial bladder cancer using nonspecific immunotherapy with Bacillus Calmette-Guerin (BCG) has been well documented. Investigation of two potential tumor-specific immunotherapeutic agents using a murine transitional-cell carcinoma model (MBT-2) is reported. The survival of mice immunized with tumor proteins obtained by treating tumor cells with either 1-butanol or ethylchlorformate was compared to the survival of animals immunized with BCG. Long-term immunity conferred by each of these agents was also assessed. Significant protection by both agents was noted in all treatment groups compared to controls. Long-term immunity was also found to result from treatment with both investigational agents as well as with BCG. Butanol-extracted antigens and ethylchlorformate polymerized tumor protein may be useful as immunotherapeutic alternatives to BCG.

Defect in lectin-induced interleukin 2 production by peripheral blood lymphocytes of patients with invasive urinary bladder carcinoma

The production of interleukin 2 (IL-2) by phytohaemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC) from 21 patients with transitional cell carcinoma of the urinary bladder (BTCC) and 16 control blood donors was measured with a solid phase enzyme immunoassay based on the dual antibody immunometric sandwich principle. PBMC from patients with invasive BTCC (grade III-IV) showed a defect in the production of IL-2. The concentration of IL-2 in the supernatants of PBMC cultures from these patients was substantially lower (0.4 +/- 0.1 U/ml) than that observed in the supernatants of PBMC cultures from patients with non-invasive BTCC, grade II (1.5 +/- 0.7 U/ml), and from tumour-free controls (1.4 +/- 0.8 U/ml). These results suggest an immune dysfunction based on quantitatively impaired IL-2 production in patients with invasive BTCC and indicate that exogenous IL-2 could be used as an immunological response modifier for the treatment of these patients.

Correlation of urine cytology with ABO(H) antigenicity in transitional cell carcinoma of the bladder

Cell surface ABO(H) antigenicity of superficial bladder tumours was assessed by the indirect immunoperoxidase test in 49 patients. Good correlation was obtained between surface antigenicity of tumours and the results of urine cytology. Malignant cells were detected cytologically in 22(56%) of cases with ABO(H) antigen negative tumours which are known to behave more aggressively than ABO(H) antigen positive ones. In contrast, malignant cells were found in the urine cytology of only one (10%) of patients with ABO(H) antigen positive tumours.

Human bladder cancer associated antigens: evaluation of antigenicity in TCC tissues of different grades and in normal urothelium

The expression of five antigens, associated with transitional cell carcinoma (TCC) of the urinary bladder on biopsies of tumors or normal urothelium, was studied by immunostaining with the corresponding monoclonal antibodies. Both tissue sections and single cell preparations were investigated with either indirect immunoperoxidase staining or immunofluorescence. All 5 antigens were expressed on the majority (70-90%) of sectioned tumor specimens from 44 TCC patients, and 4 of them were similarly expressed on single cell tumor preparations from 26 additional patients. However, in both types of preparation, the degree of expression of these antigens varied from scattered staining of less than 25% of the tumor cells to homogenous staining of all or almost all cells. This degree of expression varied individually for each of the antigens and was not related to the malignancy grade of the tumors. However, as most of the tumors were of grades II or III, no conclusions regarding the relationship of antigen expression to the aggressiveness of the tumors can be drawn. In any event, all tumors expressed at least one and mostly several of these antigens. Antigen expression on biopsies of normal bladder mucosa from TCC patients or on urothelial biopsies from patients with prostate hyperplasia was also observed on single cell specimens (34 patients) but not on sectioned material (9 patients). However, the frequency of positive specimens was much lower (4-20%). Moreover, the number of cells expressing one or, occasionally, several of the antigens in normal urothelium was small (usually less than 5%). Because of these marked differences in antigen expression between tumors and normal tissue, the results indicate that a combination of 3-5 of the antibodies used in this study may be suitable for diagnostic purposes.

Radioimmunolocalisation of bladder tumors xenotransplanted in nude mice

We have previously reported on the derivation of mouse monoclonal antibodies (Mabs), identifying several cell surface antigens selectively associated with cancer of the urinary bladder (TCC) (1-4). Three of these Mabs (4E8, SK4H and 8F4) have now been assessed for their ability to localise TCC-tumor xenografts in nude mice. The biodistribution of 125I-labeled intact Mabs as well as the corresponding Fab and F(ab')2 fragments from two of them were investigated in animals carrying TCC tumors or antigen negative control tumors. Using direct measurements of excised tissues, all three antibodies were seen to accumulate specifically in the TCC tumors, giving tumor to normal tissue ratios of between 3 and 20 depending on the Mab used and the time after injection. Antibody fragments were generally more efficient in their localisation, mainly due to a dramatic reduction in the blood background as compared to intact Ig. One of the antibodies, 4E8, was also employed for external imaging with gamma camera scintigraphy using 111In or 131I as tracers. Excellent visualisation of the tumor sites could be obtained both with Fab fragments and intact antibody within 12-24 hours after injection. As expected, background radioactivity was significantly lower with fragments than with whole molecules. 111In labeled antibodies appeared in all instances to be superior to the corresponding 131I conjugates. In conclusion, the present study indicates that the three anti TCC antibodies may become useful for the in vivo diagnosis of bladder cancer in man.

[Contribution of monoclonal antibodies within the framework of urothelial tumors of the bladder]

The advent of hybridoma technology has proved a major breakthrough in the field of tumor immunology and enables analysis at the molecular level of tumor heterogeneity. This approach seems particularly promising in urothelial tumors of the bladder and carries implications for diagnosis, prognosis and therapy of this disease. Two murine monoclonal antibodies (G4 and E7), obtained by xenogenic immunization of Balb/c mice with a human transitional carcinoma cell line (TCC) (647V) have proved especially useful. Use of a panel of monoclonal antibodies covering the entire spectrum of TCCs, most of which are already available, can be expected to result in significant modifications in the management of urothelial tumors. Advances in the field of monoclonal antibody technology may provide specific tools applicable to humans in vivo.

T-antigen. A prognostic indicator of high recurrence index in transitional carcinoma of the bladder

Forty biopsies from 36 patients with bladder tumors were tested for T-antigen (TAg) expression on tumor cells on sections untreated or treated with neuraminidase; a 37.5% of tumors showed abnormal expression of TAg either as an aberrant expression, or absence of this antigen after removing sialic acid. These changes were not well correlated with histologic signs of anaplasia or infiltration, nor with other biologic properties of tumor cells such as the expression of blood group antigens (ABH). However, a practical utility of TAg in the study of bladder tumors, is suggested by the analysis of those biopsies with low-grade low-stage tumors, on which the abnormal expression of TAg was more discriminatory than the ABH changes in defining those patients suffering tumors with a particular aggressiveness. Circulating antibody titer was also investigated in 20 patients but all of them displayed titers in the normal range, with independence of the results observed in their corresponding bladder biopsies.