[Retinal S-antigen and retinoblastoma--an immunohistochemical study]

A strain of monoclonal antibody, MabAgC6, which defines an epitope in S-antigen, was used to study S-antigen expression in 10 cases of retinoblastoma, where S-antigen immunoactivity was observed in different patterns: the "normal" photoreceptor elements incorporated in 3 cases of growing tumors, 3 of 4 fleurettes and E-W rosettes, and scattered tumor cells in 50% of the cases were stained positive. The results suggest that the expression of S-antigen in retinoblastoma may be used to assess the degree of tumor differentiation, as another of the tumor markers.

[Anti-retinoblastoma reaction developed in vivo through immunization of retinal ganglion neuronotrophic factor]

Isolated retinal ganglion neuronotrophic factor (RGNTF) was used as an antigen to immunize Group A Balb/c mice intraperitoneally prior to the inoculation into the anterior chamber of eye with human retinoblastomal cell line Y-79 (Rb). In Group B mice, Rb cells were inoculated into the eyes before RGNTF immunization. In Group C mice, empty gel without RGNTF was used in immunization 10 days after the Rb inoculation, to serve as a control. The results revealed that the inhibitory rate of Rb tumor development in Group A was 65% (13/20); in Group B only 10% (2/20); and in Group C 0% (0/20). The T-test for difference in the inhibitory rate between Group A and B was statistically significant (T > 2.58; P < 0.01). Sera were collected from these mice and their content of the anti-RGNTF antibody was quantified by ELISA method. The results showed that the anti-RGNTF antibody titer in Group A antisera at 1:600 dilution was measured with an average optical density of 0.156 +/- 0.015; that in Group B 0.103 +/- 0.016; and that in Group C only 0.048 +/- 0.018. Those of controls for normal mouse serum and culture medium were 0.050 +/- 0.008 and 0.043 +/- 0.014, respectively. The t test for difference in the antibody titer measurements between Group A and B was statistically significant (t > t0.05; p < 0.05). Therefore, the above results indicated that active immunization of RGNTF can enhance the specific immunity against the development of retinoblastomal tumor in Balb/c mice, which may have clinical significance in treating human retinoblastoma.

Dual immunologic property of S-100 protein in normal eyes and eyes with retinoblastoma: a histopathological and immunohistochemical study of 88 cases

To ascertain the cell types expressing S-100 protein in eyes with retinoblastoma, a follow-up study was made on 88 formalin-fixed and paraffin-embedded retinoblastoma specimens histopathologically and immunohistochemically, using antibodies against S-100 protein. In normal retinas and morphologically normal retinas with retinoblastoma, both astrocytes and ganglion cells were stained positively for S-100 protein. In the retinoblastomas, not only the reactive astrocytes in most cases, but also large tumor cells with large cell bodies, prominent nucleoli and well-differentiated figures were positive for S-100 proteins in 2 cases. These large tumor cells were thought to be neuronal and were called ganglion-like cells because they were morphologically and immunohistochemically compatible with the large ganglion cells in normal retina. The results indicate that in eyes with retinoblastoma, S-100 protein has both neuronal and glial immunologic properties and could have a limited value as a glial marker for the histogenesis study of retinoblastoma.

[Immunodiagnosis of retinoblastoma]

To improve the accuracy of early diagnosis of retinoblastoma, the authors have examined a number of cellular and humoral immunity parameters in 188 children with retinoblastomas, in 57 ones with nontumorous conditions of the eyes, and in healthy controls. Stages III-IV retinoblastoma was found associated with reduced blood levels of IgG and IgA and a still more marked reduction of both in the lacrimal fluid (4-fold), with reduced blood T lymphocyte count (by 1.5 times), decreased lymphocyte blastogenesis response to phytohemagglutinin (by 8-9 times), reduced leukocyte migration activity (MI = 79 +/- 10%), reduced serum thymic activity (by 2.5 times). The early (I-II) stage of the disease involves a lowering of only lacrimal fluid IgA (2-fold) and of the leukocyte migration index (MI) (89 +/- 2%). This index was found to be an important specific indicator for the early preoperative diagnosis of retinoblastoma. Leukocyte migration inhibition (MI less than 95%) by retinoblastoma antigens was observed only if this tumor was present. In cases with the nontumorous conditions and in health retinoblastoma antigens as a rule stimulated the leukocyte migration (MI over 95%).

[Second solid tumors in childhood. Review based on three cases]

As children with cancer survive longer, the incidence of second malignant neoplasms has increased considerably. We describe here three cases of second solid tumors after 12, 8 and 2 years of initial diagnosis of cancer: one osteosarcoma of left maxilla in a previously treated child with bilateral retinoblastoma, a temporal astrocytoma associated with acute lymphoblastic leukemia and a glioblastoma multiforme in a girl with neurofibromatosis de Von Recklinghausen, after Non Hodgkin lymphoma, respectively. We review the literature about the influence of genetic, immunologic and therapeutic factors involved in the appearance of these second tumors.

Cytokine-induced modulation of cellular proteins in retinoblastoma. Analysis by flow cytometry

Cytokines are a group of specialized, hormone-like proteins that can exert profound influences on cellular development and on a variety of cellular functions. Retinoblastoma cells are an important model for exploring human malignancy and differentiation. These multipotent embryonic cells are capable of differentiating into neuronal, glial-like and retinal pigment epithelium (RPE)-like elements. This report shows that flow cytometric analysis can be used to measure the expression of both cytoplasmic and cell surface proteins in retinoblastoma cells. The authors used this technique to monitor changes in the expression of selected cellular proteins after exposure to specific cytokines and found that MHC class I molecules were augmented by interferon-alpha (IFN-alpha) and interferon-gamma (IFN-gamma), but not by tumor necrosis factor (TNF). However, the MHC class II molecules were augmented by IFN-gamma but not by IFN-alpha or TNF. The neuronal markers, IRBP and PR-6, the glial-like marker, GFAP, and the RPE cell markers, RPE-9 and RPE-15, were not altered by any of the cytokines tested. Furthermore, IFN-gamma induced a striking enhancement of the expression of the photoreceptor cell protein, S-antigen. In contrast, IFN-alpha and TNF did not affect the expression of S-antigen. These studies show that the cytokine, IFN-gamma, can enhance a distinct cellular protein associated with cells committed to a specific cell lineage.

Effect of lymphokine-activated killer cells on human retinoblastoma cells (Y-79) in vitro: enhancement of the activity by a polysaccharide preparation, krestin

Peripheral blood mononuclear cells (PBMC) cultured in a medium containing interleukin 2 (IL 2) develop the ability to kill fresh tumor cells. This function has been termed lymphokine activated killing (LAK). Recently, cord LAK cell activity was demonstrated to be equally as cytotoxic against similar in vitro targets as adult (peripheral) LAK cells. We investigated the future therapeutic use of LAK adoptive immunotherapy by examining LAK in vitro cytotoxicity from both cord and peripheral blood mononuclear cells against pediatric malignant tumor cell lines Y-79 (retinoblastoma). Cord LAK cells show higher levels of cytotoxicity toward Y-79 targets than do adult LAK cells. Attempts to enhance the rIL 2-induced LAK activity by addition of rIFN-gamma or PSK (krestin) were successful. Furthermore, we found that PSK has a function to enhance rIL 2-induced IFN-gamma and TNF-alpha production. These findings suggest that combined administration of cord LAK cells and PSK may account for the improvement of advanced retinoblastoma in the neonatal period.

Recurrent disseminated retinoblastoma treated by high-dose chemotherapy, total body irradiation, and autologous bone marrow rescue

A case of recurrent, disseminated retinoblastoma is presented. The primary intraocular tumor, a metastatic mass at recurrence, and the tumor cells infiltrating bone marrow were all positive for the anti-GD2 monoclonal antibody (Mab) 3A7. Indirect immunofluorescence using the monoclonal antibody 3A7 was an effective method of detecting residual disease in the marrow. After remission was achieved by conventional therapy, the patient underwent autologous bone marrow transplantation (ABMT). The preparative regimen consisted of VP-16, cisplatinum, high-dose melphalan, and total body irradiation. The autologous marrow inoculum was clean of tumor cells at the detection level of 1:10,000. The transplant course was uneventful, and the patient is well and disease-free 17 months after ABMT. We conclude that high-dose chemotherapy and total body irradiation in an ABMT setting is feasible and a potentially curative approach to disseminated retinoblastoma.

In vitro differentiation of human retinoblastoma cells into neuronal phenotypes

In order to characterize the cell type(s) of origin of human retinoblastoma cells by immunophenotyping, primary cells from seven retinoblastomas and of the corresponding cell lines (RBL lines), as well as four retinoblastoma (RB) lines established by other groups, were compared with rat and human retina cells, and with the adenovirus E1A-transformed human retinoblast cell line HER-Xho1-CC2. Analyses using monoclonal antibodies (Mabs) RB13-2 and RB21-7, originally raised against prenatal rat brain cells and recognizing neural cell surface antigens expressed in a developmental-stage-dependent manner, and three cell-type-specific Mabs (Q211, M501, Mab directed against vimentin) developed by other groups, gave the following results: (i) Retinoblastomas consist of cells expressing differentiated neuronal phenotypes during cultivation in vitro; (ii) All of the newly established RBL lines express neuronal phenotypes; and (iii) Cell lines such as Y79, which have been propagated in vitro for extended periods, do not express antigens specific for the neuronal pathway and cannot, therefore, be considered phenotypically representative of retinoblastoma cells.

Dissociation of Rb-binding and anchorage-independent growth from immortalization and tumorigenicity using SV40 mutants producing N-terminally truncated large T antigens

The large T antigen of SV40 is both necessary and sufficient for conversion of primary mouse cells to cells with fully transformed phenotype. In this investigation, the influence of the N-terminal portion of T antigen on individual transformed cell characteristics was probed by using mutants bearing deletions in the 5'T antigen coding sequence. Specifically, DNA constructs expected to produce T antigens missing the first 109, 127, 150, or 176 amino acids or internal amino acid segments between 117 and 250 were tested for the ability to immortalize C57Bl/6 mouse embryo fibroblasts. The transformed cell properties displayed by clonally derived cell lines were then examined. The results indicated that neither the first 127 amino acids nor amino acids 127-250 of T antigen were necessary for efficient immortalization of primary cells or for their tumorigenicity. Functions mapped within these regions, including binding of the retinoblastoma susceptibility gene product (Rb) and transactivation of heterologous promoters, therefore, were not required to confer either of these growth properties. In addition the results showed that anchorage-independent growth was separable genetically from tumorigenicity and that removal of amino acids within the first 250 residues of T antigen compromised other transformed cell growth properties.

Interferon-gamma enhances the expression of retinal S-antigen, a specific neuronal cell marker

Interferon-gamma (IFN-gamma) is a potent lymphokine which can modify a variety of cellular processes. One of the mechanisms involved in these processes is the ability of IFN-gamma to alter the regulation and expression of cellular proteins. Using analytical flow cytometry, we show that recombinant human IFN-gamma can enhance the expression of retinal S-antigen in retinoblastoma cells. This enhancement was selective since two other retinal cell proteins, interphotoreceptor binding protein (IRBP) and photo-6, were not affected by IFN-gamma treatment. Retinal S-antigen plays an important role in vision and is one of the retinal proteins capable of inducing an inflammatory eye disease called experimental autoimmune uveitis. These studies therefore demonstrate an important role for this lymphokine, that is, the enhanced expression of a neuronal cell protein. This finding may also identify additional mechanisms by which IFN-gamma may participate in immunopathologic events in nervous tissue.

Immunohistological characterisation of retinoblastoma and related ocular tissue

The immunohistological reactivity of six retinoblastomas was investigated by means of 18 monoclonal antibodies and compared with that of adult and fetal retina. The antigenic profiles were found to be characteristic for each cell type studied and indicated that a panel of monoclonal antibodies could achieve a specific immunolocalisation not afforded by any single antibody. Immunohistological comparison between retinoblastoma and adult and fetal retinal cells provided evidence of the histogenesis of the tumour. The data suggest that the tumour arises from an early multipotential cell, which retains the capacity to develop differentiation characteristics associated with inner or outer retinal cell types, resulting in a heterogeneous tumour cell population. A cell with such differentiation potential predominates in the retina prior to the primitive neuroepithelial layer division at eight weeks' gestation.

Unusual sinonasal small-cell neoplasms following radiotherapy for bilateral retinoblastomas

Two patients developed sinonasal small-cell neoplasms that arose 22 years and 37 years, respectively, following radiotherapy for bilateral retinoblastomas. The tumors were composed of small cells with scant cytoplasm and had a few scattered Homer-Wright rosettes. Immunohistochemically, one tumor was positive for keratin (CAM 5.2 and AE1/AE3), epithelial membrane antigen, and neuron-specific enolase. The other neoplasm was immunoreactive for keratin (CAM 5.2 only) and neuron-specific enolase; it also had focal immunopositivity for S-100 protein, desmin, and muscle-specific actin. Both were negative for CEA, vimentin, melanocyte-specific antigen (HMB45), chromogranin A, synaptophysin, Leu-7, 200 kd neurofilament, and retinal S-antigen. Despite aggressive multimodal therapy, the patients died of metastatic tumor 7 months and 10 months following their initial diagnosis, respectively. Although osteosarcoma is the most frequent second cancer following bilateral retinoblastomas, some patients develop clinically aggressive sinonasal small-cell tumors that are difficult to place into conventional classifications. Both of our cases showed evidence of multidirectional differentiation; one tumor labeled with epithelial and neural markers, and the other expressed epithelial, neural, and myogenous antigens.

Specific antitumor immunologic reactivity in patients with retinoblastoma

Retinoblastoma antigen (RbAg) and retinal tissue antigen (RAg) were made from allogeneic retinoblastoma tissues and normal retinal tissue using the 3M KCl method. We have examined leukocyte migration inhibition test (LMIT) and enzyme-linked immunosorbent assay (ELISA) to RbAg and RAg in normal controls and the patients with retinoblastoma, including two spontaneously regressed cases. In LMIT, six out of the 11 patients tested against RhAg showed positive reactivity, in which 4 cases reacted only with RbAg, but not with RAg. All nine control subjects had negative reactivity to the two antigens. In ELISA, 40% of the retinoblastoma patients and 5.56% in normal controls showed positive reaction against RbAg. It was suggested that not only retinal antigens but also retinoblastoma specific antigens present in human retinoblastoma cells. The results also suggested that patients with retinoblastoma and those with spontaneous regression of Rb had both cell-mediated immunologic reactivity and humoral immune response toward retinoblastoma antigen in vitro. These immune responses to RbAg may be responsible for spontaneous regression of retinoblastoma.

Collagen-induced alterations in intercellular adhesion and antigen expression in retinoblastoma cells

Y79 human retinoblastoma cells, which typically grow as suspension cultures in vitro, show increased intercellular and cell-substratum adhesion, and form compact cellular aggregates when cultured on a collagen substratum. Concomitant with collagen-induced formation of compact cellular aggregates, is an increase in the binding of peanut lectin, especially at points of intercellular apposition. In addition, increases in the binding of antibodies against neuron-specific enolase and the cone-specific monoclonal antibody CSA-1 are noted following attachment and growth on collagen. In contrast, a decrease in the binding of antibodies against the glial marker, glial fibrillary acidic protein, is observed in collagen-attached cells. Thus, both the adhesive properties and the biochemical composition of Y79 retinoblastoma cells are altered by their attachment to and growth upon a collagenous substratum.

Immunohistochemistry of retinoblastoma. A review

Various studies which relate to the immunohistochemical identification of neuronal, glial, carbohydrate and nucleic acid associated antigens in retinoblastoma will be reviewed. The majority of these studies appear to support the concept that retinoblastomas arise, in situ, from neuron committed cells and in some cases specifically into photoreceptor-like cells. In selected cases, however, glial cell differentiation may be a feature of the tumor. In addition, the molecular biology of the retinoblastoma gene and the immunohistochemical characterization of its gene product will be discussed.

Metastatic retinoblastoma successfully treated with immunomagnetic purged autologous bone marrow transplantation

There are no documented cases of long-term, disease-free survival in retinoblastoma (RB) metastatic to the bone marrow. The following study details successful outcome in a 3-year-old child with extensive marrow replacement 7 months postenucleation in an otherwise untreated group V RB. Therapy consisted of combinations of vincristine, doxorubicin, and cyclophosphamide for 3 months. After demonstrating cross-reactivity by a panel of six monoclonal neuroblastoma (NB) antibodies with the patient's RB cells, her marrow was purged by using microsphere-linked monoclonal antibodies, and then reinfused as rescue therapy after ablative doses of etoposide and cyclophosphamide. The authors conclude that short-term induction therapy followed by marrow ablative combination chemotherapy and immunomagnetically purged autologous marrow rescue can (1) effect successful outcome in widely metastatic RB, and (2) eliminate the risk of therapy-induced second malignancies.

Detection of gangliosides as N-glycolylneuraminic acid-specific tumor-associated Hanganutziu-Deicher antigen in human retinoblastoma cells

Gangliosides were shown to bear the tumor-associated N-glycolylneuraminic acid (NeuGc)-specific Hanganutziu-Deicher (HD) antigen expressed in human retinoblastoma cells. HD antigenic gangliosides were detected by thin-layer chromatography/enzyme-immunostaining using affinity-purified chicken antibody against GM3 containing NeuGc and horseradish peroxidase-conjugated anti-chicken IgG. One to four species of the antigenic gangliosides were detected from all of 4 cell lines, Y79, WERI-Rb1, TOTL1, and YK, as well as freshly cultured retinoblastoma cells and isolated tumor tissue. All cases contained GM3(NeuGc) as an HD antigen. No HD antigenic ganglioside was detected in normal retinal tissues by the same procedure.

Coexpression of neuronal, glial, and major histocompatibility complex class II antigens on retinoblastoma cells

This study identifies the presence of major histocompatibility complex class II antigens on retinoblastoma cells. In addition, the modulation of HLA-DR by interferon-gamma as well as the preferential expression of this major histocompatibility complex molecule over HLA-DQ is described. Double labeling experiments revealed that HLA-DR antigen is shared concomitantly with cells of glial and neuronal character. Investigations such as these underscore the possibility that expression of major histocompatibility complex class II antigens may function as immunological components in the host or play a role in the cellular differentiation of these tumor cells.

Immunohistochemical characterization of human retinoblastomas in situ with multiple markers

We studied paraffin-embedded specimens from 18 surgically enucleated eyes with retinoblastoma by peroxidase-antiperoxidase immunohistochemistry with antibodies against glial fibrillary acidic protein, S-100 protein, Leu 7 epitopes, neuron-specific enolase, the 200-kilodalton subunit of the neurofilament triplet polypeptide, and retinal S-antigen. We found that (1) glial fibrillary acidic protein, S-100 protein, and Leu 7 epitopes were detected only in well-differentiated glial cells that were interpreted as reactive and not neoplastic, (2) undifferentiated neoplastic cells expressed both neuron-specific enolase and retinal S-antigen immunoreactivity, and (3) differentiated cells forming Flexner-Wintersteiner rosettes were found to express neuron-specific enolase, retinal S-antigen, and, occasionally, neurofilament protein. These results support the view that retinoblastomas are composed of neuron-committed cells and favor the origin of these tumors from photoreceptor progenitor cells. We did not find any morphologic or immunohistochemical evidence of glial differentiation from tumor cells that would support the concept that retinoblastoma arises from a primitive neuroectodermal cell capable of divergent differentiation along neuronal and glial lines.

Electron microscopy and HLA expression of a new cell line of retinoblastoma

A new continuous retinoblastoma cell line (Rb 355-7) derived from a nonfamilial unilaterally-affected child was studied morphologically and with regard to HLA expression. The tumor was compared with two older and widely studied cell lines, the Y-79 and WERI-Rb1 strains. The Rb 355-7 line grew in tissue culture in clusters and chains. Its doubling time was calculated to be 4.4 days. In contrast to the Y-79 and WERI-Rb1 cell lines, the Rb 355-7 showed a paucity of HLA expression.

Retinoblastoma. Immunohistochemistry and cell differentiation

Tumor from eight enucleated eyes was analyzed by immunohistochemistry, using a panel of specific antibodies including interphotoreceptor retinoid-binding protein (IRBP), S-antigen (S-Ag), opsin, neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), laminin, and vimentin. In addition, immunoelectron microscopy and enzyme-linked immunosorbent assay (ELISA) for IRBP were performed. Immunohistochemical staining disclosed the most pronounced labeling of tumor cells with NSE and IRBP antibodies. A correlation was found between the degree of tumor differentiation and amount of IRBP, a protein specifically synthesized by photoreceptor cells. Moderate labeling of the better differentiated tumors was also observed with antibodies against S-Ag and focal labeling in a few tumors with opsin antibodies. Anti-GFAP labeling was limited to a smaller number of reactive glial cells and perivascular glial cells. These data indicate the essential neuronal nature of retinoblastoma tumor cells in situ as well as at least partial photoreceptor-like features, as shown by the presence of recognized photoreceptor cell markers (IRBP, S-Ag, opsin). Tissue culture studies using the human Y-79 retinoblastoma cell line also demonstrate that the tumor cells are primitive multipotential retinoblasts capable of at least partial differentiation along neuronal, glial, or pigment epithelial cell lines.

Heterogenous expression of antigenic markers on retinoblasts

Using a large panel of monoclonal antibodies to antigenic determinants specific for photoreceptor outer segments (S-Ag), for cells of neural (Leu-7) bipolar and/or ganglion cell (A2B5), glial/astrocytic (LN-1) or Muller's cell (M.M.) and two polyclonal antibodies to S-Ag and S-100 protein, the authors studied the expression of these antigenic determinants in four newly established retinoblastoma cell cultures and in cells derived from the Y-79 cell line. All four newly established retinoblastoma cell cultures demonstrated antigenic determinants specific for photoreceptors, astrocyte/glial and Muller's cells. The population of cells derived from the Y-79 cell line reacted mainly with the polyclonal antibody to S-100 protein, reflecting the homogeneity of its cell population mainly harboring antigenic determinants specific for astrocyte/glial cells. The heterogeneic staining of the newly established retinoblastoma cell cultures may reflect the multipotential-embryonic origin of these cells demonstrated by their ability to express antigenic determinants specific for the different cellular elements of the mature neuro-retina while the strictly glial staining of the Y-79 may be the result of cloning of this cell line.