Postnatal expansion of the natural killer and keller cell population in humans identified by the monoclonal HNK-1 antibody

Human natural killer (NK) and killer (K) cells were directly enumerated using a monoclonal antibody (HNK-1) and an immunofluorescence assay. The frequency of cells bearing surface HNK-1 antigen was very low in the newborn (less than 1.0%) and increased progressively through childhood and into adult life. This was correlated with an age-related increase in functional NK and K cell activities. Males had a slightly higher proportion of HNK-1+ cells than females. In addition to HNK-1 expression on the surface membrane, a prominent cytoplasmic expression of HNK-1 antigen was found in some but not all surface HNK-1+ cells. The cytoplasmic accumulation of HNK-1 molecules appeared to occur in more mature cells of this lineage.

A differentiation antigen of human NK and K cells identified by a monoclonal antibody (HNK-1)

A monoclonal IgM antibody (HNK-1) was produced against a membrane antigen from the cultured T cell line, HSB-2. By indirect immunofluorescence, this antibody reacted with certain human cultured T cell lines (HSB-2 and MOLT-4 but not MOLT-3) but not with other lines of B cell or phagocytic cell origin. HNK-1 reacted with 15.1 +/- 7.1% of normal blood lymphocytes but was unreactive with monocytes, granulocytes, erythrocytes, and platelets. HNK-1+ cells separated by a fluorescence-activated cell sorter (FACS) were a homogeneous population of medium sized lymphocytes with abundant neutrophilic cytoplasm containing azurophilic granules. HNK-1+ cells were nonadherent, surface Ig-, mostly FcIgG receptor+ and both positive and negative for demonstrable sheep erythrocyte (E) rosetting capability. Cell suspensions enriched for E-rosetting T cells and depleted of FcIgG receptor+ cells contained few (6%) HNK-1+ cells. Depletion of HNK-1+ cells from blood mononuclear cell populations by complement (C) mediated lysis greatly reduced NK activity against K-562 target cells and K cell lytic activity against antibody-coated chicken red blood cells. Treatment with HNK-1 alone or C alone did not affect these activities. When the FACS was utilized to separate HNK-1+ and HNK-1- cells from 6 individuals, the HNK-1+ cell population contained almost all of the NK and K cell function. The monoclonal antibody HNK-1 thus defines the first differentiation antigen shown to be selectively expressed on human NK and K cells.

A differentiation antigen of human NK and K cells identified by a monoclonal antibody (HNK-1)

A monoclonal IgM antibody (HNK-1) was produced against a membrane antigen from the cultured T cell line, HSB-2. By indirect immunofluorescence, this antibody reacted with certain human cultured T cell lines (HSB-2 and MOLT-4 but not MOLT-3) but not with other lines of B cell or phagocytic cell origin. HNK-1 reacted with 15.1 +/- 7.1% of normal blood lymphocytes but was unreactive with monocytes, granulocytes, erythrocytes, and platelets. HNK-1+ cells separated by a fluorescence-activated cell sorter (FACS) were a homogeneous population of medium sized lymphocytes with abundant neutrophilic cytoplasm containing azurophilic granules. HNK-1+ cells were nonadherent, surface Ig-, mostly FcIgG receptor+ and both positive and negative for demonstrable sheep erythrocyte (E) rosetting capability. Cell suspensions enriched for E-rosetting T cells and depleted of FcIgG receptor+ cells contained few (6%) HNK-1+ cells. Depletion of HNK-1+ cells from blood mononuclear cell populations by complement (C) mediated lysis greatly reduced NK activity against K-562 target cells and K cell lytic activity against antibody-coated chicken red blood cells. Treatment with HNK-1 alone or C alone did not affect these activities. When the FACS was utilized to separate HNK-1+ and HNK-1- cells from 6 individuals, the HNK-1+ cell population contained almost all of the NK and K cell function. The monoclonal antibody HNK-1 thus defines the first differentiation antigen shown to be selectively expressed on human NK and K cells.

Indomethacin enhancement of immunocompetence in melanoma patients

Lymphocyte responses to the mitogens concanavalin A (Con A) and phytohemagglutinin (PHA) are important in vitro parameters of immunocompetence in cancer patients. The tempo and intensity of this response is regulated by monocytes. We found that the blood lymphocyte response to one or both of these mitogens was significantly depressed in 32 of 33 melanoma patients compared to 29 normal control subjects. However, these responses were significantly enhanced when the drug indomethacin, a prostaglandin synthetase inhibitor, was added to cultures of peripheral blood mononuclear cells (PBMCs) from the melanoma patients, but not from the normal control subjects. For example, at a 1 microgram/ml dose of Con A, the mean response of melanoma patients increased from 56% to 81% of the normal mean response, whereas at 20 micrograms/ml PHA the mitogen response increased from 57% to 77% of normal when PMBC were incubated with indomethacin (P less than 0.001). Overall, indomethacin enhanced the mitogen responses of melanoma patients by 35% to 85%, whereas indomethacin increased the response in normal subjects by only 5% to 15%. The mitogen response of monocyte-depleted ER+ lymphocytes for melanoma patients was equivalent to that of normal control subjects, and there was no enhancement of this response in the presence of indomethacin. This suggests that the abnormality was due to an altered function of immunoregulatory monocytes. The enhancement by indomethacin in melanoma patients was not significantly influenced by their stage of disease, age, or the proportion of blood monocytes. The decreased levels of cellular immunocompetence in these melanoma patients, as measured by their lymphocyte proliferative responses to mitogens, therefore appears to be associated with an abnormality in monocyte function that is partially corrected by indomethacin.

Polypoid melanoma, a virulent variant of the nodular growth pattern

Thirty-two patients who had polypoid melanoma were identified in a registry of 552 melanoma patients. The tumor is regarded as a variant of nodular melanoma and is associated with an increased thickness, more frequent ulceration than the nodular variant of melanoma, younger patient age, and higher probability of occult metastasis. Polypoid melanomas were most frequently present on the trunk, and were also encountered in unusual sites, such as the mucosa of the nose, hard palate, and anorectal junction. In terms of survival, the patients with the polypoid nodular variant fared significantly worse than those with nonpolypoid nodular (P = 0.05) and those with superficial spreading (P = 0.003) melanomas. The five-year survival rate for polypoid variant was 42%, in contrast to 57% for the nonpolypoid nodular and 77% for the superficial spreading melanomas. The poor prognosis of patients who have polypoid melanoma is most likely due to its being the type of melanoma with the deepest penetration at the time of surgical excision.

A multifactorial analysis of melanoma: III. Prognostic factors in melanoma patients with lymph node metastases (stage II)

Twelve prognostic features of melanoma were examined in a series of 185 patients with nodal metastases (Stage II), who underwent surgical treatment at our institution during the past 20 years. Forty-four per cent of the patients presented with synchronous nodal metastases (substage IIA), 44% of the patients had delayed nodal metastases (substage IIB), and 12% of the patients had nodal metastases from an unknown primary site (substage IIC). The patients with IIB (delayed) metastases had a better overall survival rate than patients with IIA (synchronous) metastases, when calculated from the time of diagnosis. These differences could be explained on the basis of tumor burden at the time of initial diagnosis (microscopic for IIB patients versus macroscopic for IIA patients). Once nodal metastases became evident in IIB patients, their survival rates were the same as for substage IIA patients, when calculated from the onset of nodal metastases. The survival rates for both subgroups was 28% at five years and 15% for ten years. Substage IIC patients (unknown 1 degrees site) had better five-year survival rates (39%), but the sample size was small and the differences were not statistically significant. A multifactorial analysis was used to identify the dominant prognostic variables from among 12 clinical and pathologic parameters. Only two factors were found to independently influence survival rates: 1) the number of metastatic nodes (p = 0.005), and the presence or absence of ulceration (p = 0.0019). Additional factors considered that had either indirect or no influence on survival rates (p > 0.10) were: anatomic location, age, sex, remission duration, substage of disease, tumor thickness, level of invasion, pigmentation, and lymphocyte infiltration. All combinations of nodal metastases were analyzed from survival differences. The combination that showed the greatest differences was one versus two to four versus more than four nodes. Their five-year survival rates were 58%, 27% and 10%, respectively (p < 0.001). Ulceration of the primary cutaneous melanoma was associated with a <15% five-year survival rate, while nonulcerative melanomas had a 30% five-year survival rate (p < 0.001). The combination of ulceration and multiple metastatic nodes had a profound adverse effect on survival rates. While tumor thickness was the most important factor in predicting the risk of nodal metastases in Stage I patients (p < 10(-8)), it had no predictive value on the patient's clinical course once nodal metastases had occurred (p = 0.507). The number of metastatic nodes and the presence of ulceration are important factors to account for when comparing surgical results, and when analyzing the efficacy of adjunctive systemic treatments.

Immunochemical characterization of a human B lymphocyte differentiation antigen (p65)

A human B-cell differentiation antigen (BDA-1) with a molecular weight of 65,000 was identified by use of an anti-B-cell xenoantiserum. BDA-1 was isolated by immunoprecipitation of cell lysates from a B-lymphoblastoid cell line (SB) and from blood B lymphocytes (sIg+ER-) of four normal individuals. It was not detectable in cell membrane lysates from two T-lymphoblastoid cell lines (HSB-2 and MOLT-3) or from enriched normal T cells (sIg-ER+). BDA is single-chain molecule since its migration in SDS-PAGE gels was not altered by heating the protein to 100 degree C or by treatment with 2-mercaptoethanol. Immunodepletion experiments demonstrated that the antigen recognized by anti-BDA xenoantiserum has neither structural nor antigenic relationships with Ia-like antigen or beta 2-microglobulin.

Surgical management of regional lymph nodes in cutaneous melanoma

The initial evaluation of melanoma patients should include an assessment of the regional lymph nodes for metastatic disease. Clinical palpation of the nodes is an important but relatively crude index of metastatic melanoma. In clinically normal nodes, the risk of microscopic metastatic melanoma can be predicted by such prognostic factors as thickness, ulceration, and anatomic location of the melanoma. Other prognostic factors, including the level of invasion and growth pattern (nodular and superficial spreading) provided no additional predictive information after these dominant factors were accounted for. Stage I patients with intermediate thickness melanoma (0.76-4.00 mm) have an improved survival rate with elective lymphadenectomy, while those with thin (less than 0.76 mm) and thick (greater than or equal to 4.00 mm) melanomas do not benefit from elective node dissection. Stage II melanoma patients with documented nodal metastases have relatively poor survival rates because of a high risk for distant microscopic metastases. A surgical strategy for deciding about the timing, the extent, and the treatment goals of regional node dissection in melanoma patients is reviewed.

The prognostic significance of ulceration of cutaneous melanoma

Ulceration of a cutaneous melanoma on microscopic sections is an adverse prognostic finding. The five-year survival rate is reduced from 80% for non-ulcerated melanomas to 55% in the presence of ulceration for Stage I melanoma patients and from 53 to 12% for Stage II melanoma patients (P less than 0.001). As a group, ulcerated lesions are thicker and more likely to have a nodular growth pattern. However, survival rates were still worse for ulcerated melanomas when matched with nonulcerated lesions for thickness and stage of disease. The width but not the depth of surface ulceration significantly correlated with survival. The median ulcer depth was 0.08 mm (range 0.01-1.2 mm). In those few lesions with ulcer craters more than 0.2 mm in depth, the melanomas were so thick they had the same poor prognosis regardless of whether thickness was measured to the base of the ulcer or to the top of the lesion. The Breslow microstaging method of measuring thickness is therefore a valid prognostic indicator, even for ulcerated lesions. The incidence of ulceration for the entire patient group ranged from 12.5% for melanomas less than 0.76 mm thickness to 72.5% for melanomas greater than 4.0 mm thick (P of correlation = 0.0001); from 12% for Level II invasion to 63% for Level V lesions (P = 0.005); from 23% for superficial spreading growth patterns to 49% for nodular and 74% for polypoid lesions (P = 0.0001); and from 27% for lesions with a heavy lymphocyte infiltration to 60% for minimal or absent host response (P = 0.005). There was no significant correlation with anatomic location, pigmentation of the melanomas, or with the patient's age and sex. Since ulceration appears to have such an important influence on survival rates, this parameter should be considered as a stratification criterion in clinical trials and accounted for when analyzing results of melanoma treatment.

Isolation and partial characterization of the human homologue of Thy-1

A glycoprotein of 25,000 daltons was isolated from a human T lymphoblastoid cell line (MOLT-3). A monovalent antiserum raised against this antigen precipitated mouse Thy-1.1 antigen as well as a 25,000-dalton antigen from human blood T cells. The unabsorbed serum was also cytotoxic for both mouse and human T cells. By multiple criteria, this human T antigen appears to be homologous with mouse Thy-1.

A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma

Stage I melanoma encompasses an extraordinary diversity of biologic behavior. In such a setting where numerous parameters appear to influence survival, a multifactorial analysis using Cox's regression model is a valuable statistical model. Using a computerized data base of 394 clinical stage I melanoma patients treated at this institution during the past 20 years, a multifactorial analysis was used to compare the relative prognostic strength of 11 parameters. Two pathological factors (tumor thickness and ulceration) and two clinial factors (initial surgical treatment and anatomic location) were identified as the dominant prognostic variables. Other factors examined simultaneously that did not provide additional predictive influence on survival included the level of invasion, pigmentation, growth pattern, lymphocyte infiltration, pathological state, sex, and age. Melanoma thickness was the most important factor for predicting survival in patients with stage I melanoma (P less than 10(-8). This parameter is easy to measure and provides a quantitative estimate of clinically occult regional and distant metastases. Contrary to other reports using single factor analysis, the type of initial surgical treatment, in fact, did influence survival after other variables were taken into consideration. Thus the multifactorial analysis supports the observation that patients with intermediate thickness melanoma thickness of 1.5 to 3.99 mm had a 78% 8-year survival rate with wide excision of the melanoma and elective node dissection, while none survived more than 8 years if a melanoma of the same thickness was only widely excised. Multifactorial analysis is a useful and important statistical method when comparing treatment alternatives and prognostic factors in patients with melanoma.

Recent advances in human cellular immunobiology

Several recent advances in human cellular immunology will have increasing impact on surgical science. First, lymphocytes are composed of diverse subpopulations with different biological properties. Second, lymphocytes and phagocytes expressed distinctive cell surface markers that reflect the specialized function of each cell. Third, different subpopulations of lymphocytes probably have one or only a few specific functions rather than being multipotential. Despite the seemingly complex heterogeneity of the immune system, the component parts collaborate in a highly integrated fashion. The recent elucidation of suppressor cells and their interaction with effector cells, for example, is a major conceptual advance. Fourth, the technology of immunologic science has advanced significantly. More discriminating methods for detecting lymphocyte markers and the ability to physically separate and analyze lymphocyte subpopulations will permit increasingly more refined insights into normal and abnormal immune responses. A number of important advances at the molecular level involving the disciplines of immunogenetics and immunochemistry have also been described but are beyond the scope of this review. Much work remains, however, in correlating these in vitro observations in the laboratory with in viro activity in the patient. It is now evident that the outcome of an immune response (or lack of it) represents a net balance of different components in the immunologic network that determine the time course, intensity of response, and the actual mechanisms of antigen elimination. A better understanding of these component parts of a normal immune response, and their deviations in disease states, is essential for designing more sophisticated therapeutic manipulations of the immune system. Attempts at "immune manipulation" aimed at stimulating or depleting the entire system are no more likely to be successful or reproducible than are attempts to "manipulate" the entire endocrine system. More meaningful results will occur when one can deal with individual components of an immune response (such as suppression or killing) and can precisely monitor the consequences of altering them.

A methodological approach to the prediction of anticancer drug effect in humans

Tumor cells from animals and humans were treated with drugs under tissue culture conditions. Tumor cells from the sensitive L1210 model were studied first. A dose-response curve was derived between drug exposure and subsequent cytotoxicity in L1210. The concentration of drug and duration of exposure were factors critical to the subsequent development of in vitro cytotoxicity. The in vitro dosage which effected 50% leukemic cell death in L1210 cells correlated with reported in vivo drug levels. Other tumor models and human neoplastic cells were studied at this dosage level. A good correlation was noted in these studies between the in vivo responsiveness and the in vitro chemotherapy results in both animals and humans. It was suggested by these results that it may be possible to predict cancericidal drug activity for individual neoplasms by assaying the tumor cells in vitro for drug sensitivity.

The preparation and immunosuppressive properties of equine antihuman thymocyte membrane immunoglobulin G

Human thymocytes separated by a Ficoll gradient produced a cell population that was 99% pure thymocytes and free of platelets, leukocytes, and epithelial cells. These cells, disrupted by a nitrogen bomb, produced a membrane-ribosome antigen fraction confirmed by enzyme analysis. Equine antithymocyte membrane-immunoglobulin G (ATM-IgC) prepared against this antigen in four of five horses contained immunosuppressive properties capable of prolonging monkey skin allograft survival longer than 21 days. No adverse effects were noted by the intramuscular and intravenous administration of this antisera to primates, and autopsy examination showed marked depletion of paracortical lymphocytes in the spleen and mesenteric lymph nodes. A moderate thrombocytopenia occurred during a 4 hour intravenous administration of ATM-IgG to primates with a marked decrease in the peripheral lymphocyte count. The deposition of ATM-IgG upon monkey glomerular basement membrane could not be demonstrated by immunofluorescent techniques. The specificity of this globulin to contain anti-T-cell antibody was confirmed by an immunofluorescent assay in that ATM-IgG reacted with both human thymocytes and peripheral blood thymus-dependent cells, but was nonreactive when tested against a panel of human cells free of thymus-dependent antigens.