Autologous lymphokine-activated killer cell therapy of lymphoproliferative disorders arising in organ transplant recipients

Lymphoreticular malignancies, collectively called posttransplant lymphoproliferative disorders (PTLD), eventually develop in 2–5% of organ transplant recipients. They frequently undergo regression when immunosuppression is reduced or stopped. This feature has been associated with a previous or de novo Epstein-Barr virus (EBV) infection. We herein describe immunotherapy with autologous lymphokine-activated killer (LAK) cells in seven patients with PTLD (four EBV-positive patients and three EBV-negative patients). Autologous peripheral blood mononuclear cells were obtained by leukapheresis, depleted of monocytes, and cultured in the presence of interleukin 2 for 10 to 11 days. A single dose of 5.2 × 109 to 5.6 × 1010 LAK cells was given intravenously. Systemic interleukin 2 was not administered.

The four patients with EBV+ PTLD had complete tumor regression; two of them developed controllable rejection. Three patients are well 13–16 months after treatment; the fourth patient died of pneumonia 41 days after infusion. Three patients with EBV− lymphomas had no response despite prior evidence that their tumors also were subject to immune surveillance. Two of these three patients died after being given other treatment, and the third patient has persistent tumor.

In conclusion, autologous LAK cell infusion was effective for treatment of four EBV+ organ transplant recipients. LAK cell efficacy for three patients with EBV− PTLD was not evaluable under the management circumstances in which this treatment was utilized.

Cholangiocarcinoma: delayed CT contrast enhancement patterns

PURPOSE

To determine the usefulness of delayed post-equilibrium-phase contrast material-enhanced images in evaluation of intrahepatic cholangiocarcinoma.

MATERIALS AND METHODS

Review of surgical, pathologic, and radiologic records revealed 47 patients with proved cholangiocarcinoma with delayed (6-36 minutes) post-equilibrium-phase contrast-enhanced computed tomographic (CT) scans. Unenhanced, dynamic contrast-enhanced, and delayed images were retrospectively reviewed, and enhancement patterns for cholangiocarcinoma lesions were recorded. Degree of delayed enhancement was compared with that of surrounding liver parenchyma. Patterns of delayed enhancement were characterized as homogeneous or heterogeneous. Enhancement characteristics were correlated with histologic findings.

RESULTS

Thirty-five (74%) of 47 patients had tumors with mild or marked hyperattenuating delayed contrast enhancement, of which 18 had tumors with homogeneous hyperattenuating enhancement. In three patients, the only evidence of tumor was on the delayed images. In one patient, the tumor was not definable at any imaging phase. Tumors with delayed enhancement tended to be fibrous; however, degree of contrast material retention did not always correlate with the fibrous content of tumors at histopathologic analysis.

CONCLUSION

Delayed tumoral contrast enhancement is a typical feature of intrahepatic cholangiocarcinoma and may aid in the detection and characterization of such lesions at CT.

Characterization of ductular hepatocytes in primary liver allograft failure

Liver regeneration after massive hepatic necrosis is characterized by the presence and formation of ductular hepatocytes (DHs). Several studies suggested that these structures might serve as bipotential progenitor cells, as demonstrated by phenotypic features characteristic of both hepatocytes and biliary epithelial cells. In this investigation, 33 liver allograft explants after primary graft failure 1 to 14 days after orthotopic liver transplantation were examined to study the formation and differentiation of DHs. As demonstrated by earlier studies, antibody to CK-19 defines the biliary epithelial cell lineage, whereas HepPar 1 is hepatocyte specific. Antibodies to CK-19, vimentin and alpha-fetoprotein, HepPar 1, and AE-1 were used for immunoperoxidase staining of 33 failed liver allograft specimens with regeneration. DHs were seen along the limiting plates at Day 1, but reactivity to HepPar 1 started only at Day 4 post injury. Vimentin and alpha-fetoprotein were not detectable in the DHs. The DHs reacted with AE-1 and anti-CK-19 starting at Day 1, but reactivity to HepPar 1 started only at Day 4 post injury. DHs are formed along the limiting plates and acquire phenotypic characteristics of bile duct epithelium as early as Day 1 after liver injury and of hepatocytes only at Day 4 after liver injury. We conclude that DHs might represent bipotential progenitor cells in regenerating liver.

Subcutaneous implantation of human post-transplant lymphoproliferative disease lesions in SCID mice

The tumorigenic potential of six post-transplant B-cell lymphoproliferative disease (PTLD) lesions was evaluated in SCID mice. Three animals developed local subcutaneous B cell tumours, two of which contained Epstein-Barr virus (EBV) DNA. Two animals developed CD3 positive thymic neoplasms, and one mouse developed an uncharacterized spontaneously regressing subcutaneous tumour. Immunoglobulin gene rearrangements studies with a JH probe, and EBV clonality studies with a Bam NJ fused terminal probe, showed only one mouse tumour to be genealogically related to the corresponding clinical lesion. It is concluded that lymphoid clones which constitute human PTLD are not autonomous, but sustained by host-derived growth stimuli distinct from those operating in the SCID mouse mileu.

Expression of HGF mRNA in human rejecting kidney as evidenced by in situ hybridization

In situ hybridization was performed to demonstrate hepatocyte growth factor (HGF) mRNA in two patients with normal kidney and in 23 patients with allograft nephrectomy. In situ hybridization was combined with immunohistochemistry to identify HGF-producing cells. In the two patients with normal kidney, no HGF mRNA was obtainable. In 15 of the 23 allograft patients, signals of HGF mRNA were detectable. In six of these 15 patients, the signals were present mainly at the medullocortex junction, and in the other nine patients at the cortex and/or medulla. Strong and frequent signals were present in gland-like structures in 15 cases. Some scattered signals were also present in the fibrosed glomeruli in five cases, in the thickened intimas of large arteries in three cases, and in the arterial muscle coats of two cases. Combined immunohistochemistry and in situ hybridization showed that HGF mRNA-positive cells in gland-like arrangements were also positive for cytokeratin and negative for factor VIII. Cells with HGF mRNA signal and located in the arterial media were also positive for actin. These findings suggest that HGF mRNA is transcribed both in the urinary tubular epithelium and in the mesenchymal cells (fibroblasts, and smooth muscle cells in chronic vascular rejection and endothelial cells and/or mesangial cells in transplant glomerulopathy) in human rejecting kidney.

Identification of bipotential progenitor cells in human liver regeneration

Recent studies, including our own, suggest that intermediate filament proteins, particularly bile duct-specific cytokeratin 19 (CK19) and the hepatocyte-specific HepPar1 antigen define the developmental stages of hepatic progenitor cells during liver morphogenesis. We hypothesized that the HepPar1+ CK19+ progenitor cells are activated during human liver regeneration after massive hepatic necrosis and proliferate with the formation of so-called ductular hepatocytes or neocholangioles. We demonstrated previously that the ductular hepatocytes proliferate and share phenotypic characteristics with hepatocytes and biliary epithelial cells. In this investigation, we compared the expression pattern of intermediate filament proteins and HepPar1 antigen in ductular hepatocytes with that of bipotential hepatic progenitor cells. CK14, CK19, vimentin, and HepPar1 antigen were localized by immunoperoxidase staining in 13 human livers with regeneration after massive hepatic necrosis. Double immunostaining of three cases for CK14/CK19 and HepPar1/CK19 was also performed. CK19 reaction exhibited diffuse staining of the cytoplasm of many ductular hepatocytes and bile ducts in all cases. CK14 was expressed in the cytoplasm of ductular hepatocytes and few bile ducts in 5 of 12 specimens. HepPar1 staining was positive in many ductular hepatocytes in 11 of 13 cases. Vimentin was detected in the perinuclear cytoplasm of ductular hepatocytes and some bile duct epithelial cells in all regenerating livers. Double immunostaining for HepPar1/CK19 demonstrated that the ductular hepatocytes contained either HepPar1 or CK19 and that some ductular hepatocytes coexpressed both antigens. CK14, CK19, vimentin, and HepPar1 expression in ductular hepatocytes in human liver regeneration resembles the pattern seen in the developing human liver from 4 to 16 weeks' gestation. This suggests that the ductular hepatocytes recapitulate the developmental stages of bipotential liver progenitor cells and differentiate in steps marked by the acquisition or loss of specific phenotypic characteristics.

Lymphoepithelial carcinoma of the larynx and hypopharynx: study of eight cases with relationship to Epstein-Barr virus and p53 gene alterations, and review of the literature

Eight cases of lymphoepithelial carcinoma (LEC) of the larynx and hypopharynx were evaluated for clinicopathologic features, and the presence of the Epstein-Barr virus (EBV) and p53 alterations. The seven men and one woman, all of non-Asian descent, averaged 64 years of age. Eighty-eight percent had histologically confirmed cervical lymph node metastasis at diagnosis. None had systemic disease. Seven of eight patients available for follow-up (mean, 17.7 months) were alive and free of disease, although one did develop recurrent tumor in the neck. Four tumors were composed, histologically, of pure LEC. Four others had foci of both LEC and conventional squamous cell carcinoma. All eight tumors exhibited alterations in p53 expression, but none was positive for EBV. Combining these 8 cases with the 15 previously published cases in the English literature indicate that LEC in this site is a rare, rather aggressive tumor, primarily of older adults (mean, 62 years) with a propensity for early cervical lymph node metastasis and eventual distant dissemination and death from disease in about one third of patients. Although p53 alterations are common and of no apparent prognostic significance, LEC at this site seems to have little, if any, relationship to the EBV in patients of non-Asian origin.

Hepatocyte growth factor mRNA in human liver cirrhosis as evidenced by in situ hybridization

BACKGROUND

Hepatocyte growth factor (HGF) is a strong mitogen of hepatocytes, and HGF-producing cells have been reported to be Ito cells or endothelial cells in the sinusoid of the liver. No reports have been published about the localization of HGF mRNA in human liver cirrhosis.

METHODS

In situ hybridization (ISH) for HGF mRNA was performed in 5 normal liver and 16 human liver cirrhosis specimens, using 1 RNA probe and 3 oligonucleotide probes labeled with 35S.

RESULTS

A positive signal was obtained in 15 of these cases. In five normal liver specimens, signals of HGF mRNA were not obtainable. In 13 of the 15 cases of liver cirrhosis, HGF mRNA was present in the periphery of the regenerative nodules. This peripheral pattern was seen in regenerative nodules with irregular nodule to septal interfaces. Combined immunohistochemistry and ISH showed that vimentin and CD 68-positive cells consistent with macrophages expressed HGF mRNA in such cases. In three specimens with diffuse signal for HGF mRNA in the hepatic nodules, signals localized to the sinusoidal spaces. HGF mRNA-positive cells were spindled and polygonal in shape, suggesting endothelial, Kupffer, and/or Ito cells of origin. In the diffuse pattern the peripheral margins of the regenerative nodules appeared well-defined. In one case regenerative nodules with both diffuse and peripheral signal patterns were present in the same section. There was no relationship among HGF mRNA, etiology, and macroscopic appearance of liver cirrhosis.

CONCLUSIONS

HGF gene transcription in human liver cirrhosis nodules may be heterogeneous, probably related to the degree of activity of the regenerative nodules. HGF appears to be produced by the mesenchymal cells, including Ito cells, macrophages (Kupffer cells), and endothelial cells in human liver cirrhosis.

Oxygen free radical content and neutrophil infiltration are important determinants in mucosal injury after rat small bowel transplantation

Mucosal injury is an immediate event following revascularization of small intestinal grafts in the context of transplantation (SBTx). The generation of oxygen free radicals (OFR) and tissue infiltration by activated neutrophils are consequences of ischemia and reperfusion and known causative factors of tissue injury; to delineate their role in the reperfusion injury occurring after cold preservation of the intestine and subsequent transplantation was the aim of this study. Prior to orthotopic SBTx in Sprague-Dawley rats, grafts were stored in cold (4 degrees C) Ringer's lactate solution for 1 (n=6), 2 (n=7), and 4 hr (n=7). Small bowel biopsy specimens were obtained before harvesting, at the end of the (cold) ischemic period and immediately before unclamping (i.e., before revascularization) and 30, 60, 120 min, and 24 hr after transplantation to evaluate tissue injury by histology, OFR production, (measured by luminol-enhanced chemiluminescence [LCL]), and the degree of neutrophil infiltration by myeloperoxidase staining. Reperfusion of the graft significantly worsened the histologically graded mucosal injury compared with that seen before unclamping. However, 24 hr after engraftment, mucosal morphology was restored almost completely. OFR production increased significantly during the early phases of reperfusion (30, 60, and 120 min) and returned to control values after 24 hr. Reperfusion of the graft was associated with a marked increase in the number of mucosal neutrophils. The present study indicates that OFR production and neutrophilic infiltration commence and progressively increase with graft reperfusion. These changes parallel the mucosal injury. Ischemic intervals of 4 hr were not associated with a statistically significant greater ischemic-injury patterns compared with 1- and 2-hr intervals. The profound changes associated with reperfusion probably overshadow the minor, yet likely, progressive injury patterns associated with longer ischemia times.

Identification of bipotential progenitor cells in human liver development

Intermediate filament proteins have been reported to be expressed in a cell lineage-specific manner during morphogenesis. We studied the expression of cytokeratin (CK)14, CK19, and vimentin and of the hepatocyte-specific HepPar1 antigen during the development of human liver. Nineteen fetal livers (gestational ages 4 to 40 weeks), 3 normal infant livers, and 3 normal adult livers were studied by immunoperoxidase staining of paraffin sections with monoclonal anti-CK19, anti-vimentin, and HepPar1 antibodies and polyclonal anti-CK14 antibodies. Double-immunostaining for CK14 and CK19 as well as bile duct cytokeratin and HepPar1 antigen was also done. CK19 and HepPar1 antigen were the first markers detected in immature progenitor cells of the liver primordium at 4 weeks' gestation. During subsequent liver development, the progenitor cells expressed HepPar1 antigen, CK14, and CK19, from 8 to 14 weeks' gestation. As hepatocyte differentiation progressed, expression of HepPar1 antigen increased, and CK14 and CK19 were abrogated from hepatoblasts at 14 to 16 weeks' gestation. In contrast, as progenitor cells transformed into ductal plate cells, CK19 expression increased and persisted in differentiated bile ducts, whereas CK14 and HepPar1 antigen were lost. Vimentin was detected in ductal plate and biliary epithelial cells from 9 to 36 weeks' gestation, but not in hepatoblasts or hepatocytes. Double-immunostaining confirmed coexpression of CK14 and CK19 in the progenitor cells for a short time (8 to 14 weeks' gestation) during early development. Double immunostaining for bile duct CK and HepPar1 antigen clearly demonstrated the divergence of the hepatocyte and bile duct epithelial cell lineages. Our findings suggest that hepatic progenitor cells differentiate in steps marked by the acquisition or loss of specific phenotypic characteristics. Commitment of the HepPar1+CK19+ progenitor cells to either hepatocyte or bile duct epithelial cell lineages results in increased expression of one marker and loss of the other marker. These characteristics clearly identify bipotential hepatic progenitor cells in the developing human liver.

Posttransplantation lymphoproliferative disorders (PTLD): current perspectives

Posttransplant lymphoproliferative disorders (PTLDs) are a family of lymphoid hyperplasias and neoplasias that occur in the context of organ transplantation and immunosuppression. A strong association exists with Epstein-Barr virus (EBV) infection of the B lymphocyte. This review summarizes clinical and pathological aspects of these lesions and explains the terminology used to describe them. Clinical diagnosis and therapy, including experimental approaches, are outlined. Patient outcomes from published series are given. The clinical heterogeneity and the need to individualize therapy for these patients are stressed.

Identification of bipotential progenitor cells in human liver development

Intermediate filament proteins have been reported to be expressed in a cell lineage-specific manner during morphogenesis. We studied the expression of cytokeratin (CK)14, CK19, and vimentin and of the hepatocyte-specific HepPar1 antigen during the development of human liver. Nineteen fetal livers (gestational ages 4 to 40 weeks), 3 normal infant livers, and 3 normal adult livers were studied by immunoperoxidase staining of paraffin sections with monoclonal anti-CK19, anti-vimentin, and HepPar1 antibodies and polyclonal anti-CK14 antibodies. Double-immunostaining for CK14 and CK19 as well as bile duct cytokeratin and HepPar1 antigen was also done. CK19 and HepPar1 antigen were the first markers detected in immature progenitor cells of the liver primordium at 4 weeks' gestation. During subsequent liver development, the progenitor cells expressed HepPar1 antigen, CK14, and CK19, from 8 to 14 weeks' gestation. As hepatocyte differentiation progressed, expression of HepPar1 antigen increased, and CK14 and CK19 were abrogated from hepatoblasts at 14 to 16 weeks' gestation. In contrast, as progenitor cells transformed into ductal plate cells, CK19 expression increased and persisted in differentiated bile ducts, whereas CK14 and HepPar1 antigen were lost. Vimentin was detected in ductal plate and biliary epithelial cells from 9 to 36 weeks' gestation, but not in hepatoblasts or hepatocytes. Double-immunostaining confirmed coexpression of CK14 and CK19 in the progenitor cells for a short time (8 to 14 weeks' gestation) during early development. Double immunostaining for bile duct CK and HepPar1 antigen clearly demonstrated the divergence of the hepatocyte and bile duct epithelial cell lineages. Our findings suggest that hepatic progenitor cells differentiate in steps marked by the acquisition or loss of specific phenotypic characteristics. Commitment of the HepPar1+CK19+ progenitor cells to either hepatocyte or bile duct epithelial cell lineages results in increased expression of one marker and loss of the other marker. These characteristics clearly identify bipotential hepatic progenitor cells in the developing human liver.

Recurrent Epstein-Barr virus-associated lesions in organ transplant recipients

Posttransplant lymphoproliferative disorders (PTLD) are related to Epstein-Barr virus (EBV) and range from lymphoid hyperplasias to lymphomas. The authors report 11 transplant recipients with recurrent EBV-associated lesions. Four patients presented with EBV-positive mononucleosis-like lymphadenitis. One had recurrence of a similar lesion and the other three developed polymorphic PTLDs. Matched clonal studies in one patient showed clonal lymphoid and EB viral populations in the recurrent lesion, but not in the initial lesion. Six patients presented with polymorphic PTLDs. Five later developed histologically dissimilar tumors that resembled non-Hodgkin's lymphoma (two B-cell and one T-cell origin), Hodgkin's disease (one patient), or smooth muscle tumor (one patient). Matched clonal studies were available from one patient and showed that the primary and recurrent lesions were clonally distinct. The sixth patient had recurrence of histologically and clonally identical polymorphic PTLD. One patient presented with monomorphic PTLD and developed recurrence of a clonally identical tumor after a 6-month remission. This study shows that a few patients with EBV-associated lesions have clinical recurrence, which may be either a relapse of the original process or a new EBV-associated lesion. In some patients, the new lesion appeared to represent a more fully developed malignancy that did the antecedent lesion.

Long-term results after liver transplantation for primary hepatic epithelioid hemangioendothelioma

BACKGROUND

Hepatic epithelioid hemangioendothelioma (PHEHE) is a multifocal, low-grade malignant neoplasia characterized by its epithelial-like appearance and vascular endothelial histogenesis. The outcome of 16 patients treated with orthotopic liver transplantation (OLT) is the subject of this report.

METHODS

A retrospective study of 16 patients with HEHE (7 men, 9 women) with ages ranging from 24 to 58 years (mean 37 +/- 10.6 years). Follow-up intervals ranged from 1 to 15 years (median of 4.5 years).

RESULTS

Actual patient survival at 1, 3, and 5 years was 100, 87.5, and 71.3%, respectively. Disease-free survival at 1, 3, and 5 years was 81.3, 68.8, and 60.2%, respectively. The 90-day operative mortality was 0. Involvement of the hilar lymph nodes or vascular invasion did not affect survival. The 5-year survival of HEHE compares favorably with that of hepatocellular carcinoma at the same stage (stage 4A): 71.3 versus 9.8% (p = 0.001)

CONCLUSIONS

The long-term survival obtained in this series justifies OLT for these tumors even in the presence of limited extrahepatic disease.

Cancer immunotherapy of established tumors with IL-12. Effective delivery by genetically engineered fibroblasts

IL-12 is a heterodimeric cytokine produced by macrophages, mitogen stimulated- or EBV infected-B lymphocytes, keratinocytes, and probably dendritic cells, with important immunoregulatory functions in vitro and in vivo. It directly stimulates activated NK and T cells to produce high levels of IFN-gamma, enhances their cytolytic activity, and promotes maturation of Th1 cells as well as IL-2-activated B cells. We have tested paracrine delivery of IL-12 using autologous or allogeneic fibroblasts engineered to secrete high levels of IL-12 to treat established tumors. Injection of IL-12-engineered fibroblasts at the site of an established (day 8) MCA207 sarcoma could efficiently eliminate or suppress tumor growth in a dose-dependent manner, requiring delivery of > 150 ng/kg/dose of bioactive IL-12. Weekly inoculations for 3 wk could also be used to effectively treat a day 4 sarcoma located intradermally in the opposite flank (80% protection using autologous fibroblasts), resulting in long-term protective antitumor immunity. In less immunogenic tumors (MCA102, MC38), 7-day established lung metastases could be significantly reduced (p = 0.001) following IL-12 delivery by fibroblasts and systemic administration of low doses of IL-2. Histologic findings included a mixed infiltrate of CD4+ and CD8+ T effectors and macrophages in the regressing sarcoma on day 21. In a day 41 MCA207 sarcoma locally injected in situ, similar findings were observed. No lymphoid hyperplasia or tissue necrosis were noted in liver, spleen, or lungs in mice receiving repeated inocula of IL-12-engineered fibroblasts. Tests of liver and renal function monitored during the repetitive weekly treatments were within the normal range. IL-12-engineered fibroblasts thus seem to serve as a safe and efficient means to deliver IL-12 in these three tumor models.

Cancer immunotherapy of established tumors with IL-12. Effective delivery by genetically engineered fibroblasts

IL-12 is a heterodimeric cytokine produced by macrophages, mitogen stimulated- or EBV infected-B lymphocytes, keratinocytes, and probably dendritic cells, with important immunoregulatory functions in vitro and in vivo. It directly stimulates activated NK and T cells to produce high levels of IFN-gamma, enhances their cytolytic activity, and promotes maturation of Th1 cells as well as IL-2-activated B cells. We have tested paracrine delivery of IL-12 using autologous or allogeneic fibroblasts engineered to secrete high levels of IL-12 to treat established tumors. Injection of IL-12-engineered fibroblasts at the site of an established (day 8) MCA207 sarcoma could efficiently eliminate or suppress tumor growth in a dose-dependent manner, requiring delivery of > 150 ng/kg/dose of bioactive IL-12. Weekly inoculations for 3 wk could also be used to effectively treat a day 4 sarcoma located intradermally in the opposite flank (80% protection using autologous fibroblasts), resulting in long-term protective antitumor immunity. In less immunogenic tumors (MCA102, MC38), 7-day established lung metastases could be significantly reduced (p = 0.001) following IL-12 delivery by fibroblasts and systemic administration of low doses of IL-2. Histologic findings included a mixed infiltrate of CD4+ and CD8+ T effectors and macrophages in the regressing sarcoma on day 21. In a day 41 MCA207 sarcoma locally injected in situ, similar findings were observed. No lymphoid hyperplasia or tissue necrosis were noted in liver, spleen, or lungs in mice receiving repeated inocula of IL-12-engineered fibroblasts. Tests of liver and renal function monitored during the repetitive weekly treatments were within the normal range. IL-12-engineered fibroblasts thus seem to serve as a safe and efficient means to deliver IL-12 in these three tumor models.

Extramedullary hematopoiesis in the allograft liver

The clinicopathologic correlates of extramedullary hematopoiesis were studied in 77 allograft biopsies from 27 patients who underwent liver transplantation for end-stage liver disease. The patient cohort consisted of 19 men and 8 women, ranging in age from 23 to 75 yr (median 41). The causes of end-stage liver disease included viral hepatitis (n = 20), ethanol abuse (n = 6), and congenital hepatic fibrosis (n = 1). Most patients (23 of 27) had significant septic complications in the postoperative period. The hematocrit was typically low (25 to 31%), and a history of allograft hepatectomy with retransplantation was available in 10 of 27 (37%) patients. Extramedullary hematopoiesis was first diagnosed 5 to 461 days (median 275) post-transplant and persisted 7 days to 36 mo (median 1 mo) thereafter. Pathologic findings concurrent with extramedullary hematopoiesis were acute cellular rejection/central venulitis (n = 7), ischemic preservation injury (n = 10), chronic rejection (n = 5), and chronic hepatitis/cirrhosis (n = 5). The pathogenesis of extramedullary hematopoiesis in these cases is not clear, but a low hematocrit may have been a stimulant for the observed hematopoiesis. In addition, the frequent coexistence of infectious, immunologic, or ischemic injury within the allograft suggests that reparative responses can stimulate intrahepatic stem cells to undergo hematopoietic differentiation. The cytokines likely involved in this process are discussed.

Spindle cell tumor of the portal vein

The authors describe the first reported case of spindle cell tumor of the portal vein (SCTPV) surgically excised in a 28-year-old woman. The tumor had caused portal vein obstruction with extensive collaterals. A side-to-side mesocaval shunt was created to reduce portal hypertension. Six months later the SCTPV could be excised. Radiation therapy (4,500 cGY) was given 2 months later. Although the tumor recurred in the liver 4 years later, the patient is alive and free of symptoms 6 years after the initial diagnosis.

Extramedullary plasmacytoma of the head and neck: use of paraffin sections to assess clonality with in situ hybridization, growth fraction, and the presence of Epstein-Barr virus

The diagnosis of extramedullary plasmacytomas (EMP) is usually easy to conform with immunohistochemical stains for kappa and lambda. In some cases, however, immunostains are problematic. In addition, prognostic features are not well described nor is it known whether EMP are associated with the Epstein-Barr virus. Therefore, 23 EMP of the head and neck (from 20 patients) were studied to (1) compare a non-isotopic paraffin section in situ hybridization technique for kappa and lambda mRNA with standard immunohistochemical techniques for assessing light chain expression, (2) compare the histologic grade to the proliferative fraction using an antibody for the proliferating cell nuclear antigen, and (3) determine the frequency of Epstein-Barr virus (EBV) association using probes for the EBV DNA (EBV NOT 1) and RNA (EBER-1). Light chain class restriction was demonstrated in 22/23 biopsies by in situ hybridization and in 21/23 biopsies by standard immunohistochemical techniques. Five of the six biopsies of well-differentiated EMP had proliferating cell nuclear antigen scores of 0 to 10% positive cells and one had 11 to 25% positive cells compared with greater than 75% in the one poorly differentiated EMP. Of 15 moderately differentiated EMP, 10 had proliferating cell nuclear antigen scores of 11 to 75%, and 5 had scores of greater than 75%. EBV DNA was detected in 1/23 biopsies and EBV RNA in 4/23 biopsies (3 patients). Thus, non-isotopic in situ hybridization is a useful technique to document clonality of plasma cells in routinely fixed, paraffin-embedded sections. Unlike routine immunohistochemistry, in situ hybridization avoids the problem of detecting stromal or nonspecific uptake of immunoglobulin.(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased mucosal IgA levels in ileum of patients with chronic ulcerative colitis

Patients with chronic ulcerative colitis (CUC) are known to have decreased spontaneous IgA secretion by colonic mononuclear cells. The aim of this study was to determine whether a similar alteration exists in the apparently healthy ileum of patients with CUC. The concentration of IgA was measured in the supernatant from homogenized mucosal ileal biopsies using a sandwich-type ELISA. The concentration of IgA was significantly (P = 0.025) decreased in the ileum of patients with CUC (N = 24) in comparison to normal ileum (N = 10). The number of mucosal IgA-containing mononuclear cells (MNC) was also determined using an avidin-biotin-immunoperoxidase technique on paraffin-embedded ileal sections. Although reduced, the number of positive cells and their distribution was not significantly different in the ileum of patients with CUC (N = 20) when compared to normal ileum (N = 10). We suggest that decreased mucosal IgA levels are a panintestinal condition in CUC and that this is a primary alteration rather than a secondary response to the inflammatory process. Considering the role of IgA, we propose that decreased mucosal IgA levels in CUC may predispose to the disease by a reduction of the immune-mediated exclusion mechanism and/or by an impairment of the down-regulation of the inflammatory response.

Concomitant and isolated expression of TGF-alpha and EGF-R in human hepatoma cells supports the hypothesis of autocrine, paracrine, and endocrine growth of human hepatoma

Single and double immunohistochemical staining for transforming growth factor (TGF)-alpha and epidermal growth factor-receptor (EGF-R) was done in order to identify the localization of TGF-alpha and EGF-R in human hepatocellular carcinoma (HCC). Single immunohistochemical staining for TGF-alpha showed immunoreactivity in the cytoplasm of hepatoma cells in 22 of 30 cases of HCC. The localization of TGF-alpha was heterogeneous from HCC cells to HCC cells. In the surrounding regenerative nodules, the hepatocytes were mildly to moderately positive for TGF-alpha. The proliferating bile ductules and peripheral nerves were also immunopositive for TGF-alpha. Single immunohistochemical staining for EGF-R demonstrated a linear localization of EGF-R along the cell membrane of the HCC cells in 21 of the 30 cases of HCC. In the regenerative nodules, the hepatocytes also showed linear staining along the cell membrane. Double staining for TGF-alpha and EGF-R in 12 cases of HCC showed a concurrent localization of TGF-alpha and EGF-R in some hepatoma cells and isolated localization of the two substances of other HCC cells. These combinations either abruptly moved around or intermingled with each other. These immunohistochemical results thus support the theory of an autocrine, paracrine, and endocrine mechanism of TGF-alpha and EGF-R on the proliferation of human hepatocellular carcinoma.

Combined effects of FK506 (tacrolimus) and cyclophosphamide on atypical B220+ T cells, cytokine gene expression and disease activity in MRL/MpJ-lpr/lpr mice

Groups of female MRL/MpJ-lpr/lpr mice received either saline or FK506 (tacrolimus; 2 mg/kg intraperitoneally) three times weekly, cyclophosphamide (CY; 20 mg/kg) once monthly, or both drugs from 8 weeks of age. Median survival for untreated and CY-treated mice was 26 weeks, and for FK506- and FK506 + CY-treated groups was > or = 44 weeks. Severity of skin lesions and lymph node hyperplasia was markedly reduced by the drug combination, whereas either drug alone was less effective. FK506 or CY alone delayed the onset of proteinuria, but by 24 weeks all of these animals were positive. In contrast, drug combination reduced the prevalence of proteinuria to < or = 60% throughout the 44 weeks of study. Sequential monitoring of peripheral blood lymphocytes revealed that combination therapy but not monotherapy markedly reduced the proportion of atypical CD3+ B220+ and CD3+CD4-CD8- T cells. Neither FK506 nor CY affected the reduction in IL-2 and IL-4 mRNA levels observed in lymph nodes of diseased animals compared with normals. Although the drug combination also did not affect IL-2 mRNA levels, IL-4 mRNA transcripts were increased six-fold compared with saline-treated controls. IL-10 and interferon-gamma (IFN-gamma) mRNAs were induced by FK506, CY and by the drug combination. Serum levels of anti-dsDNA antibodies were reduced in all treatment groups. These data demonstrate improved efficacy of combined T and B cell-directed immunosuppression in murine lupus, associated with marked inhibition of atypical T cells and selective augmentation of IL-4 within the affected lymphoid tissue.

The potential role of cytokines in the pathogenesis of Epstein-Barr virus associated post-transplant lymphoproliferative disease

Post-transplant lymphoproliferative disease (PTLD) is a complication of Epstein-Barr virus infection occurring in immunosuppressed transplant recipients. Non-clonal lesions with a polymorphous histology have the potential of regressing, if the degree of immunosuppression is reduced, thereby giving the immune system a chance to recuperate. In contrast, clonal tumors with a monomorphous histology portend a bad clinical outcome. This review summarizes evidence that the biological behavior of PTLD may be predicated on intercellular interactions involving multiple cytokines. With further investigations to clarify the nature of these interactions, it should be possible to design rational strategies for the cytokine therapy of human PTLD.