Changes in cell-mediated cytotoxicity during the clinical course of patients with bladder carcinoma

The conventional cell-mediated cytotoxicity assay was modified so that more useful estimates of cell-mediated immunity to transitional cell carcimoma of the urinary tract could be obtained. With this modified assay changes in the levels of cell-mediated immunity in transitional cell carcinoma patients to transitional cell carcinoma target cells were measured during the clinical course. Initial results from a small number of patients with invasive and non-invasive tumors showed that anti-transitional cell carcinoma cell-mediated immunity increased after the tumor was removed and during administration of Bacillus Calmette-Guerin.

Suppression of antitumor lymphocyte mediated cytotoxicity by human chorionic gonadotropins

The effect of human chorionic gonadotropin on the in vitro cytotoxicity of lymphocytes against human transitional cell carcinoma cells was studied in 9 patients using the microcytotoxicity assay. Lymphocytes from 6 patients were cytotoxic against transitional cell carcinoma cells. However, in the presence of human chorionic gonadotropin the cytotoxicity of these lymphocytes against transitional carcinoma cells was diminished. Human chorionic gonadotropin alone or in combination with non-cytotoxic lymphocytes did not change the growth of target cells and human chorionic gonadotropin did not have a direct toxic effect on lymphocytes alone. These results demonstrate that human chorionic gonadotropin can inhibit the cytotoxic action of lymphocytes against human tumor cells in vitro. Human chorionic gonadotropin may contribute to the poor prognosis associated with certain human chorionic gonadotropin-secreting human tumors.

Carcinoembryonic antigen and bladder carcinoma

The 24-hour urinary carcinoembryonic antigen determinations were performed on 61 patients with different stages of bladder carcinoma. Elevated titers were found in 81 per cent of the patients with active tumors and falsely positive studies were found in 7 per cent. High stage lesions were found to have high carcinoembryonic antigen levels. Plasma carcinoembryonic antigen determinations were elevated in only 45 per cent of the patients with active tumors but further study may be warranted in advanced bladder cancer cases. The 24-hour urinary carcinoembryonic antigen measurements yield the highest percentage elevations in bladder carcinoma and further investigation is required to better define its clinical application.

Identification of complement-receptor lymphocytes (B cells) in lymph nodes and tumor infiltrates

To monitor the distribution of lymphocyte sub-populations infiltrating tumors, a simplified modification of standard techniques was developed to identify the complement-receptor B lymphocytes in frozen tissue sections. This technique is based on binding of antibody-coated bovine erythrocytes by B lymphocytes in the presence of sub-hemolytic concentrations of mouse complement. B lymphocytes can be identified in frozen tissue sections by adherent sensitized bovine erythrocytes. The specificity of the technique for B lymphocytes was established by 1) absence of spontaneous rosette formation with bovine erythrocytes by human T lymphocytes, 2) specific binding of bovine erythrocyte-antibody-complement complexes to B cell regions of normal lymph nodes and spleen and 3) binding of erythrocyte-antibody-complement to a high proportion of chronic lymphocytic leukemia (a B cell leukemia) lymphocytes. Five transitional carcinomas studied had regions of mononuclear infiltration that were virtually devoid of complement-receptor lymphocytes. The results suggest that lymphocytes infiltrating bladder carcinomas may be predominantly T lymphocytes.

Prognostic value of host immunocompetence in urologic cancer patients

To evaluate the prognostic significance of host immunocompetence in urologic cancer patients, the subsequent clinical course of 95 patients was determined a year after skin testing with dinitrochlorobenzene. A close correlation was demonstrated between dinitrochlorobenzene reactivity and prognosis among 38 transitional carcinoma patients. Of 19 patients with impaired reactivity 13 had tumor recurrences and 11 of these died of cancer within 1 year. Only 5 of 19 patients with normal dinitrochlorobenzene reactivity had recurrences and none died during the same interval. Although not statistically significant, similar results were observed among 10 renal cell carcinoma patients of whom 3 of 5 with impaired dinitrochlorobenzene reactivity had tumor recurrences, while 4 of 5 with normal reactivity remained free of tumor. One testis tumor patient with impaired dinitrochlorobenzene reactivity died of cancer, while 3 of 4 with normal reactivity remained free of tumor. Similarly, 1 patient with carcinoma of the penis with impaired dinitrochlorobenzene reactivity died of cancer, while 2 of 3 with normal reactivity remained free of tumor. In contrast, reactivity to dinitrochlorobenzene did not correlate with the clinical course of 38 prostatic carcinoma patients. Ten of 19 patients with normal dinitrochlorobenzene reactivity and 9 of 19 with impaired reactivity were dead or had symptomatic recurrences within 1 year, while 9 of 19 with normal reactivity and 10 of 19 with impaired reactivity were either free of tumor or asymptomatic. However, a trend toward a correlation between dinitrochlorobenzene reactivity and tumor progression was observed among patients not receiving endocrine therapy. The differences with respect to the prognostic significance of host immunocompetence between transitional carcinoma patients and those with prostatic carcinoma may be explained by fundamental differences in the biologic properties of these tumors, especially the endocrine sensitivity of prostatic carcinoma.

Antigenic deletion and prognosis of patients with stage A transitional cell bladder carcinoma

The mixed cell agglutination reaction was studied in 22 patients with stage A transitional cell bladder tumors. The absence of antigens on the original tumor was found to correlate with development of invasive cancer on followup. The presence of antigens on the original tumor correlated with failure to develop stage B or greater disease within 5 to 14 years of followup.

Cell-mediated tumour immunity in patients with transitional cell carcinoma of the urinary bladder

Some recent data on problems of cell-mediated immune reaction directed against tumour-associated antigens (TAA) of transitional cell carcinomas of the urinary bladder (BTCC) are reviewed. All of the 13 samples of BTCC examined in our laboratory using a lymphocytotoxicity microassay contained the characteristic TAA of urinary bladder carcinomas. TAA were absent in 14 control tissue samples. Forty-seven out of 70 (67%) patients with BTCC developed cytotoxic lymphocytes reacting with BTCC cells. However, cytotoxic lymphocytes were also found in the blood of 8 out of 165 (4.8%) control lymphocyte donors.

Defective monocyte function in patients with genitourinary carcinoma

An assay allowing quantitation of monocyte function, i.e., chemotaxis, was used to study the activity of monocytes in patients with neoplasms of the urinary tract. Twenty-four subjects with various stages of renal carcinoma exhibited a mean chemotactic defect of 34% (P less than 0.005) as compared to normal controls and patients hospitalized with nonneoplastic diseases. Twelve persons with transitional cell carcinoma of the bladder had a 29.8% (P less than 0.01) mean chemotactic defect as compared to the controls. There was no correlation between tumor stage and degree of chemotactic defect;--J Natl Cancer Inst 55: 1047-1054, 1975.

Cellular immunity to transitional cell carcinoma of the urinary bladder. III. Effects of hydrostatic pressure therapy

The effects of hydrostatic pressure therapy on in vitro cellular cytotoxicity responses have been studied in 19 patients with transitional cell carcinoma of the bladder (TCC). Cytotoxicity was quantitated against allogeneic targets in a microplate assay or by 51chromium isotope release. Two types of reactivity were detected, the most common being a differential cytotoxicity for targets derived from TCC, in either short-term or long-term tissue culture. This reaction is operationally termed "tumor-specific". Less frequently, a general cytotoxicity for targets of diverse histogenic origins was observed. For the present, this is termed "non-specific". Nine patients were tested before pressure therapy and of these only two gave a specific reaction and one a non-specific reaction, while six were non-reactive. Eighteen patients were tested at varying intervals after treatment and of these 11 gave a specific reaction and one a non-specific effect, while six were non-reactive. Three individuals who were non-reactive prior to therapy had a specific reaction post therapy. Two who reacted specifically before therapy became non-reactive post therapy. The results of serial in vitro testing for cytotoxicity are presented with individual case histories, tumor staging and grading and the clinical outcome of hydrostatic pressure therapy.

Glomerular antigen complexes associated with transitional cell carcinoma

An immunofluorescent pattern consistent with glomerular complexes of tumor antigen bound to IgM antibody has been observed in a patient without clinical or pathologic evidence of renal disease. The findings support the thesis that tumors may shed antigen capable of eliciting an immune response which may or may not be associated with clinically evident glomerulopathy.

Lymphocyte antibody interaction in cytotoxicity against human transitional cell carcinoma

The interaction of antibodies and lymphocytes in their immune reaction against human transitional cell carcinomas was studied using the in vitro microcytotoxicity assay. A non-complement dependent, IgG antibody was detected in the serum of occasional transitional cell carcinoma patients, which induced cytotoxicity against transitional cell carcinoma target cells by lymphocytes from donors with and without transitional cell carcinoma. The observation that lymphocytes from transitional cell carcinoma donors were more sensitive to activation by this anti-transitional cell carcinoma, lymphocyte dependent antibody is compatible with the hypothesis that the surface of lymphocytes from some transitional cell carcinoma donors is coated in vivo with an anti-transitional cell carcinoma lymphocyte dependent antibody and that this antibody may be a significant factor in immunity to transitional cell carcinomas of the urinary tract.

Urinary carcinoembryonic antigen (CEA)-like molecules and urothelial malignancy: a clinical appraisal

A total of 190 patients being treated or followed up for urothelial carcinoma have been studied by the serial estimation of their urinary and plasma CEA levels. Only 46% of patients with a urothelial neoplasm present have a raised urinary CEA level. Infection or ileal conduit urine vitiate the result as they produce high CEA levels in the urine in the absence of any neoplastic disease. The accuracy of urinary CEA estimations is compared with that of cytology. Plasma CEA levels do not serve as a useful guide to the presence of extra-urinary tract tumour spread if taken as isolated readings. However, serial plasma CEA estimations may indicate that metastatic disease is present several months before its detection by the more usual clinical methods in a minority of patients.

Immunologic evaluation of human bladder cancer: in vitro studies

Human bladder cancer tissue were obtained from 31 patients with the histologic diagnosis of transitional cell cancer. Attempts to grow these tumors in tissue culture resulted in 18 primary cultures but only 2 long-term cell lines. Cell-mediated and serum cytotoxicity was demonstrated in both autochthonous and allogeneic experiments. This would suggest a cross-reacting common antigen. In the patients showing positive cytotoxicity, no recurrence of tumor could be demonstrated with up to 3 years' followup after therapy.

A role for the macrophage in in vivo and in vitro resistance to murine bladder tumor cell growth

Studies were performed to determine the role of macrophages in inhibition of growth of the same tumor cell type both in vitro and in vivo. Bladder transitional epithelium tumor cells were injected s.c. into Toxoplasma-infected mice, previously shown to contain activated macrophages, and into uninfected controls. The subsequent growth of a solid tumor was significantly less in the Toxoplasma-infected animals. Bladder tumor cells from the same cell line were grown in vitro either alone or in the presence of peritoneal lymphocytes and/or macrophages from oxoplasma-infected and control, uninfected mice. [3H]Thymidine incorporation by the tumor cells was inhibited only in the presence of macrophages from the Toxoplasma-infected animals. Lymphocytes alone did not appear to be cytotoxic under the conditions used. Moreover, lymphocytes from Toxoplasma-infected mice did not convey cytotoxicity to macrophages from control animals under the experimental conditions used.

Observations on possible autoimmune therapeutic effects in experimentally produced rat bladder tumors

Autoimmune response to normal and tumor bladder tissues in Fisher/Furth rats were obtained. The reaction consisted mainly of severe pericystitis and hemorrhagic lesions. The cellular infiltrate was predominantly lymphocytic including also plasma cells and histiocytes. Serological tests indicated development of host immunological response. 15 of 33 rat bladder tumors involuted entirely in the course of the autoimmune reaction.

Neuraminidase-mediated augmentation of in vitro immune response of patients with solid tumors

Host blood lymphocytes undergo accentuated blastic transformation when cultured with tumor cells pretreated with neuraminidase. The effect has been observed in 38 patients with such common solid tumors as bronchus carcinoma, skin melanoma, hypernephroma, or adenocarcinoma of the breast, lung, colon, or rectum. Individual response varied but often exceeded response to allogeneic cells. Three patients with glioblastoma of the brain did not respond. Lymphoblastic transformation was not observed in three of four cultures containing benign tumor or in any cultures containing normal tissue analogues of the malignant tumors. A factor in host blood serum inhibiting lymphoblastic transformation correlated to abnormal elevation of serum-bound sialic acid. This blocking factor differed in specificity from enhancing antibody or serum blocking complexes described by other investigators. Blocking effects were observed when the tumor-cell type of a serum donor differed from the cell type of the culture test tumor. Serum with abnormal elevation of bound sialate from a cancerfree human also non-specifically blocked host response to tumor. The blocking effect could be eliminated by partial enzymatic removal of bound sialic acid from serum glycoproteins.