Changes in T-cell subpopulations induced by autonomic neurotransmitters and hormone

In our previous studies, we found that changes in T-cell subpopulations were induced by restraint stress. To determine how this influence on the immune system was mediated pharmacologically, we studied the effects of autonomic agonists and antagonists and hydrocortisone on T-cell subpopulations in C3/H mice. These agents induced changes in the subpopulations of T-cells and modulated the receptors on T-cells. These drugs, however, did not have the same effect as restraint stress. This suggests that the effect of restraint stress on the immune system is mediated by other mechanisms. We found autonomic agents and hydrocortisone to affect differently T-cells in various organs. In general, acetylcholine and hydrocortisone affected T-cells in the thymus and adrenaline affected those in the spleen. By the double staining method, the maturity of these T-cells was found to be affected by these drugs. Remarkable changes were as follows. Thy 1, 2-positive T-cells were decreased in the blood and increased in the spleen while Lyt 2-positive T-cells were increased in the spleen by adrenaline. Thy 1, 2-positive T-cells were decreased in the thymus and increased in the blood while L3T4-positive T-cells and Lyt 2-positive T-cells in the blood were increased by acetylcholine. L3T4-positive T-cells were decreased in the thymus by atropine. Finally, Lyt 2-positive T-cells in the thymus were decreased and L3T4-positive T-cells in the blood were increased by hydrocortisone.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical effect of granulocyte colony-stimulating factor on neutrophils and leukemic cells in myelogenous leukemia: analysis

Clinical experiences with recombinant granulocyte colony-stimulating factor (rhG-CSF) in 13 acute (AML) and four chronic (CML) myelogenous leukemia patients are reported. Sixteen patients received rhG-CSF in support of treatment for life threatening infections and one CML patient in support of induction chemotherapy. After their first induction chemotherapy, six out of eight AML patients showed a rapid increase of neutrophils, recovered from infections and achieved complete remission (CR). One patient, in whom both neutrophils and blasts had increased during rhG-CSF administration, achieved CR through the next administration of chemotherapy (CR rate 87.5%). The last of the eight AML patients showed no increase of neutrophils, and died of interstitial pneumonitis. Two of five AML patients who received rhG-CSF after reinduction chemotherapy for relapsed or refractory leukemia achieved CR, a rate of 40%. In one of the two, the administration of rhG-CSF prior to induction chemotherapy seemed advantageous in achieving CR. During rhG-CSF administration, an increase of blastic cells in peripheral blood was observed in four out of all 13 AML patients. One of three CML patients, with a lymphoid crisis, showed an increase only of neutrophils, and recovered from infection. The other two showed increases of both neutrophils and blasts. One patient with CML in blastic crisis, undergoing induction chemotherapy with rhG-CSF administration, returned to the chronic phase. These clinical experiences suggest rhG-CSF to be effective in supporting infection therapy and in possibly enhancing the sensitivity of myelogenous leukemic blasts to antileukemic agents.

[Augmentative effect of sizofiran on the immune functions of regional lymph nodes in patients with cervical cancer]

Twenty mg of sizofiran (Schizophyllum glucan: SPG) was i.m. administered one day prior to surgery, or the same dose was injected 8 days and one day before surgery to 40 patients with cervical cancer and 15 with a benign tumor. Frozen sections of fresh pelvic lymph nodes from these patients obtained during surgery were stained by the ABC (Avidin-biotin-peroxidase complex) method with several monoclonal antibodies to define the surface phenotype of mononuclear cells. SPG led to a great increase in the number of cells stained with interleukin-2 receptor (IL-2R) and Leu 3a antibodies, mainly in PC, but with only a slight increase in the number of cells stained with Leu 2a, 7, 11, and M3 antibodies. This augmenting effect was more prominent in patients receiving two SPG injects that in those with a benign tumor. These results suggest that stimulus with some antigen (cancer antigen in the present study) may be required to induce immuno-augmentation by SPG which has no antigenicity. Interestingly, the above augmenting effects could be seen even in metastatic lymph nodes from advanced cervical cancer patients. SPG was thus revealed to be a potent biological response modifier leading to augmented helper T (Th) cell functions of pelvic lymph nodes in cervical cancer patients, among which an enhanced IL-2/IL-2R system was noted.

Endoscopic therapy for gastric cancer in patients more than 80 years old

We prospectively studied 17 gastric cancer patients who were more than 80 yr old, in whom endoscopic therapy was performed. The patients were divided into two groups: the first group included 13 patients in whom curative treatment was attempted, and in 11 (85%) a curative response was achieved. Two patients in this group showed a positive gastric biopsy after 1 and 2 yr, respectively, of therapy: one patient is under current treatment with laser therapy, and the other patient underwent surgery with resection of the stomach. The second group included four patients in whom treatment was aimed at prolonging survival or palliation, and in all four patients, a successful response was obtained. Therefore, our results demonstrate that endoscopic therapy is effective for the treatment of gastric cancer patients over 80 yr old.

[Control of graft-versus-host disease and infection associated with immunosuppression]

Graft-versus-host disease (GVHD) in leukemia patients following allogeneic bone marrow transplantation (BMT) has a lot of demerits but it also has a merit, namely graft-versus-leukemia effect. We reported the results of our recent trials on prevention, treatment and induction of GVHD, and prevention of viral infection after BMT. The results were as follows: 1) Twenty-four percent of patients who received prophylactic administration of cyclosporine and short term methotrexate still developed II degree-IV degree acute GVHD. 2) Patients with I degree or II degree acute GVHD showed good clinical courses. But, most patients with III degree GVHD gradually developed chronic GVHD. All patients with IV degree GVHD died of GVHD or infection. 3) Mizoribine and deoxyspergualin were effective for steroid-resistant GVHD. 4) Bestatin was administered to recipients who did not develop GVHD until day 30 after BMT. An interim report suggests that bestatin may induce chronic GVHD and suppress the relapse of leukemia. 5) Oral administration of gamma-globulin may prevent viral enteritis. Intravenous administration of anti-cytomegalovirus monoclonal antibody may prevent cytomegalovirus pneumonia.

Hemorrhagic cystitis after bone marrow transplantation: importance of a thin sectioning technique on urinary sediments for diagnosis

We used a thin-sectioning technique for the electron microscopic detection of viral particles within the cells of urinary sediments in three recipients who developed hemorrhagic cystitis after allogeneic bone marrow transplantation. Results of viral cultures of urine and electron microscopic (EM) observations on urinary sediments were consistent in only one recipient. In this recipient, EM observations revealed many viral particles within the cells of urinary sediments with diameter of about 80 nm corresponding to adenovirus, of which type 11 was produced in viral cultures. In one of the other two recipients many viral particles with a mean diameter of 41.6 nm corresponding to papovavirus were observed, but viral cultures using conventional cells were negative. Re-cultures using HEK cells produced polyomavirus BK. EM observation was a clue to the correct diagnosis. In the remaining recipient, no viral particles were observed within the cells of urinary sediments, suggesting the hemorrhagic cystitis to be of non-viral origin, despite a positive result of viral culture. These results suggest that a thin-sectioning technique on the cells of urinary sediments is important for the differential diagnosis between a viral-induced and non-viral hemorrhagic cystitis.

Influence of stress on the maturity of T-cells

Stress is known to influence the immune function via an effect on the central nervous system. We previously presented data showing that stress alters the population of T-cell subsets in mice. The variations of T-cell subsets in the thymus, peripheral blood, and spleen in mice similarly stressed by immobilization or by unavoidable and opioid-dependent stress were measured by flow cytometry using the monoclonal antibodies anti-L3T4, anti-Lyt 1, anti-Lyt 2 and anti-Thy 1, 2. Immobilization stress was applied for three days and T-cell subsets were measured on the days 1, 2 and 3, as well as on day 7 after release from immobilization. Lyt 2-positive cells in the thymus were the most sensitive to stress, showing significant variations. The proportion of immature T-cells increased in the thymus, blood and spleen of the stressed mice. When diazepam or naloxone were administered 30 min before the initiation of stress, these variations tended to decrease. Thus, the ratio of T-cell subsets varied with the duration of immobilization stress. This appeared to be partly mediated by the opioid system and the central nervous system.

Application of psychoimmunotherapy in patients with alopecia universalis

Mental stress and immunological abnormality have recently been listed as causes of alopecia universalis. This disease is difficult to treat with only ordinary pharmacotherapy. Thus, from the standpoint of psychoneuroimmunology, stress was relieved by relaxation and image therapy, and administration of small doses of a strong immunosuppressant was effective, leading to clinically favorable results. In addition, changes were recognized in the subpopulation of peripheral lymphocytes and in beta-endorphin before and after relaxation and image therapy. The treatment of alopecia universalis favorably changed the subpopulations of T cells. A patient suffering from alopecia is always under stress. Alleviating this stress facilitates recovery of immunological competence. Our method was effective in 5 of 6 cases with refractory alopecia universalis.

[Effective continuous intraarterial chemotherapy for a patient with FIGO stage IIIb cervical adenocarcinoma invasing the bladder wall]

A patient with FIGO stage IIIb adenocarcinoma of the uterine cervix (moderately differentiated, endocervical type) underwent an exploratory laparotomy because of a direct cancer invasion to the bladder wall, and then she was treated with consecutive intraarterial (IA) CDDP (10 mg/day) combined with continuous IA 5-FU (250 mg/day). Six weeks after, CR (complete response) was obtained by this IA chemotherapy (total dose; 5-FU: 10,500 mg, CDDP: 300 mg). Further 5-weeks-IA chemotherapy was added to keep the "CR" effect (final total dose; 5-FU: 19,250 mg, CDDP: 500 mg). The only toxic sign was a mild nausea. The patient's PS (performance status) was 0 (normal activity) and thereafter she could undergo a "curative" radical hysterectomy. The cancer invasion to the bladder wall observed at the first exploratory surgery completely disappeared histologically as well as macroscopically. In obtained material, small "viable" cancer focus was found in the cervical canal but the margin was free, and all nodes were negative. Postoperatively, the patient has receiving a continuous IA 5-FU (125 mg/day) for 13 months as a maintenance and she is free of disease (NED) with a normal activity (PS = 0). The present treatment modality is considered to be promising for advanced cervical adenocarcinoma having a poor prognosis due to its low sensitivity to radiotherapy.

[Pulmonary infiltration with eosinophilia possibly induced by cefotiam in a case of steroid-dependent asthma]

A 37-year-old female with refractory asthma taking betamethasone orally (1 mg/d), showed a fever of 38.5 degrees C, productive cough and dyspnea. The chest X-ray demonstrated diffuse infiltration in the left lower lung field. The WBC count was 16,000/mm3 with 6% eosinophils. She was treated with intravenous drip infusion of antibiotics (Cefotiam 2 mg/d and Sisomicin 150 mg/d) for 2 weeks, and her symptoms and the chest X-ray findings improved. However, at the end of the therapy eosinophilia was noticed. Sixteen days after the completion of antibiotic therapy, she again experienced fever, cough and dyspnea. The chest X-ray again demonstrated diffuse infiltrations in the left lower lung field. The total IgE level, histamine and circulating immune complex titers were elevated. The WBC count was 14,700/mm3 with 34% eosinophils. Although a sputum culture yielded no organisms, many eosinophils were observed in the sputum. There were no clinical or laboratory findings compatible with allergic broncho-pulmonary aspergillosis. After the administration of oral prednisolone (40 mg/d), the patient showed rapid improvement with resolution of all symptoms and normalization of the IgE, histamine and circulating immune complex levels. The chest X-ray revealed marked regression of the pulmonary infiltrations. A microscopic examination of a transbronchial biopsy specimen demonstrated moderate eosinophilic infiltrations. It was compatible with the diagnosis of pulmonary infiltration with eosinophilia. Treatment was performed with prednisolone. The result of a lymphocyte stimulation test was positive for Cefotiam. An in vitro test was performed to evaluate the diagnosis of drug allergy in this case.(ABSTRACT TRUNCATED AT 250 WORDS)

Effective therapy with low dose of oral cyclosporine A and prednisolone for alopecia universalis

Although alopecia universalis is an incurable disease, we have obtained favorable results using a low dose of 2.5 mg/kg of cyclosporine A and 5 mg/day of prednisolone without adverse effects. We report our clinical experience of the treatment of two cases of alopecia universalis. Immunological examinations showed marked changes in the ratio of T cell subsets in peripheral blood. There was an increase of OKT8 positive cells and NK cells, reduction of IL-2R positive cells. These immunological changes following recovery from alopecia suggest a correlation between immunological disorders and the pathogenesis of this disease (alopecia universalis).

[A study on the improvement of denture base resin. Epoxy dimethacrylate-polybutadiene dimethacrylate-MMA monomers as the liquid of denture base resin]

The dimethacrylates, EpDMA and BdDMA, which have a bisphenol type epoxy chain and butadiene chain in their main chains, respectively, were synthesized. The properties of the terpolymer composed of EpDMA, BdDMA and MMA monomers were examined. The monomer mixture of EpDMA, BdDMA and MMA was used as the liquid of denture base resin, and the properties of the cured resin were examined. The polymerization shrinkage of the terpolymer of EpDMA-BdDMA-MMA decreased with the increase in the EpDMA concentration in the cured resin, and the transverse strength and the elastic modulus were greatest at the BdDMA concentration of 0.3-1 vol%. The denture base resin produced using a monomer mixture as the liquid, the transverse strength and the impact strength showed the highest values of about 110 MPa and 14 KJ/m2, respectively, at the liquid composition of 10 vol% EpDMA, 1 vol% BdDMA and 89 vol% MMA.

[Sizofiran and recombinant interferon gamma stimulate peritoneal macrophages obtained from patients with gynecologic malignancies--increased secretion of tumor necrosis factor, IL-1 and interferon-gamma]

TNF, IL-1, IFN-gamma and PGE2 secretion of peritoneal macrophage obtained by peritoneal washing at the first day after laparotomy from 19 patients with cervical cancer and 19 with ovarian cancer, who were treated with sizofiran (SPG) intramuscularly before laparotomy or with recombinant interferon gamma (rIFN) intraperitoneally at the day of laparotomy, were studied. Treatment with SPG and rIFN significantly increased the number and secretion of TNF, IL-1 and IFN-gamma (p less than 0.05) but not that of PGE2. A high correlation between secretion of TNF and IFN-gamma (r = 0.99, p less than 0.01) was observed. These data suggest that potent tumoricidal activity of peritoneal macrophage obtained from the patients with gynecological malignancies could be expected by the treatment with SPG and rIFN due to the increased secretion of TNF, IFN-gamma and IL-1 and inhibition of increased secretion of PGE2.

Endoscopic therapy in patients with inoperable early gastric cancer

The efficacy and safety of endoscopic therapy was investigated prospectively in 42 patients with 44 early gastric cancers who were not candidates for surgery. Thirty-five of the 44 lesions (80%) were treated by endoscopic therapy alone. Adequate tumor resection was possible in lesions less than 2 cm in diameter, in those of the protruding, flat, and erosive types, and in those located in the antrum. None of the 35 patients who were judged completely cured by the initial therapy developed recurrence or lymph node metastases in the follow-up period (range, 3-114 months; mean, 37 months). Therefore, endoscopic therapy appears effective in the treatment of patients with early gastric cancer when the risks of surgery are too high.

Multiplicative effect of hyperpepsinogenemia I and non-secretor status on the risk of duodenal ulcer in siblings

In a search for genetic markers of duodenal ulcer, serum pepsinogen I level, ABO blood groups and secretor status were determined in 89 siblings of 34 duodenal ulcer families. Duodenal ulcer patients were likely either to have hyperpepsinogenemia I or to be non-secretors on a familial basis, but not to have an increased frequency of blood group O. The frequency of duodenal ulcer in the siblings was highest in hyperpepsinogenemia I/non-secretor and lowest in normopepsinogenemia I/secretor. Therefore, the influence of two genes, hyperpepsinogenemia I and non-secretor, on the risk of duodenal ulcer is multiplicative. These results provide evidence on the hypothesis of polygenic inheritance of duodenal ulcer.

[Stump recurrence after radical hysterectomy for patients with uterine cervical cancer]

Of a total of 1,025 cases of radical hysterectomy for histological squamous cell carcinoma (543 stage I cases and 482 stage II cases), we examined 50 cases of recurrence of the carcinoma (4.9 percent; 24 stage I cases and 26 stage II cases) at the site of the vaginal stump. The percentage of recurrence at the site of the vaginal stump was significantly higher in stage I and stage II cases, in which metastases to the lymph nodes or vascular invasion was observed (p less than 0.01). The length of vagina excised during the radical hysterectomy was measured and its relationship to recurrence at the site of the vaginal stump was investigated. In stage I cases that did not exhibit metastases to the lymph nodes, the shortest vaginal length excised in cases with a positive recurrence at the site of the vaginal stump was 2.5 +/- 0.9 cm; the shortest vaginal length in cases with a negative recurrence at the site of the vaginal stump was 1.8 +/- 0.8 cm. A significant difference (p less than 0.05) was observed between them. Furthermore, in stage I cases with no metastases to the lymph nodes, one recurrence at the site of the vaginal stump was observed when the vaginal length excised was 3 cm. In stage I cases with metastases to the lymph nodes and in stage II cases, no significant difference was discovered between the length of vagina excised in cases with positive and those with negative recurrences of the carcinoma at the site of the vaginal stump.

[Evaluation of UFT administration in patients with ovarian cancer who had no evidence of disease after the initial therapy]

Twenty nine patients with ovarian cancer of common epitherial origin who had no evidence of disease proved by computed tomography after the initial operation and chemotherapy were studied. The patients were randomized into two groups; (A) administration of UFT (1-(2-tetrahydrofuryl)-5-fluorouracil mixed with uracil) orally at a daily dose of 300 mg, 12 cases, (B) no further therapy, 17 cases. The therapeutic efficacy of UFT was assessed pathologically at the second look laparotomy (SLL). Plasma levels of 5-FU, tegafur and uracil were determined once a month to check whether patients intake UFT regularly or not. There were no significant difference in the mean age, in the distribution of numbers of patients in FIGO stage and histological cell type, in the mean total doses of CDDP and doxorubicin given at the initial chemotherapy [CDDP: (A) 352 +/- 152 mg, (B) 464 +/- 192 mg, doxorubicin: (A) 118 +/- 76 mg, (B) 119 +/- 92 mg] and in the duration between the initial operation and the SLL [(A) 484 +/- 154 days, (B) 414 +/- 274 days] between the two groups. The mean periods in the administration of UFT were 484.3 +/- 154 days. Recurrence was identified at the SLL in 1 case (8.3%) at paraaortic lymph nodes in (A) and 3 cases (17.6%) at the mesenterium, cul-de-sac and ascitic fluids in (B). No significant difference of recurrence ratio was observed between the two. Further long-term observation is required to assess the advantage of administration of UFT.

[Effect of sizofiran or recombinant interferon gamma on the activation of human peritoneal macrophage function; an approach for the prophylaxis of intraperitoneal recurrence of ovarian cancer]

Sixty-two patients with gynecological disease, who were treated with sizofiran (SPG) intramuscularly before laparotomy or with recombinant interferon gamma (IFN) intraperitoneally on the day of the laparotomy, were studied to investigate the change on the number and function of peritoneal macrophages (PM) obtained by peritoneal washing on the day and on the 1st and 4th days after the laparotomy. SPG significantly increased the number of PM by the 1st day, and IFN by the 4th day (p less than 0.05). However, IL-1 and IFN-gamma secretion by PM were not activated by SPG or IFN treatment, respectively. When patients were treated with these two agents simultaneously, the number of PM was significantly increased by both the 1st and the 4th day (p less than 0.05), and IL-1 and IFN-gamma secretion by PM were also significantly activated by the 1st day (p less than 0.05). These data suggest that SPG and IFN had a synergistic effect on increasing the number of PM and on activating the secretion of cytokines by PM, and that the priming with SPG played an important role in the activation of PM function by IFN.

Prevention of immunosuppression in stressed mice by neurotropin(NSP)

It is well known that the immune function can be compromised by stress. To investigate immune function in mice stressed by experimental restraint or unavoidable and opioid dependent stress, we evaluated the changes in total body weight and in organ weights (liver, spleen and thymus) of these animals, as well as the phagocytic activity of macrophages, the cytotoxicity of T cells and inhibitory effects on tumor growth and changes in T cell subset populations. At the same time we evaluated the effects of Neurotropin (NSP), a substance extracted from the inflamed skin of rabbits inoculated with the vaccinia virus and which appears to possess neuroimmunomodulating activity. The experimentally stressed group exhibited a reduction of phagocytic activity of macrophages, cytotoxicity of T cells and inhibitory effects on tumor growth. In addition there were changes in the population of T cell subsets. In those animals pretreated with NSP, the immunosuppression induced by stress was ameliorated. As compared with several agents which influence phagocytosis, neurotropin exhibited effects similar to that of agents that blocked the adrenaline receptor and an opioid antagonist rather than tranquilizer (diazepam) and a cholinergic receptor blocker. The pharmacologic effects of neurotropin support a relationship between the actions of the central nervous system and the immune system.

[Clinical study of the vulvar Paget's disease: report of 8 cases]

Between 1949 and 1987, 8 cases of the vulvar Paget's disease were treated at the Cancer Institute Hospital. These cases constituted 9.5% of the total number of the vulvar malignancies at our hospital during the same period. The clinicopathological findings were described. The average age was 73.3 years. The most frequent symptom was vulvar eczematous change with itching, which was seen in 7 cases (87.5%). About 5 years was required from onset of the disease until diagnosis. Vulvar cytologic examination revealed positive for cancer in 5 out of 8 cases (62.5%). One patient developed squamous cell carcinoma of the face. All patients underwent operation. Two patients had preoperative adjuvant chemotherapy by Bleomycin which was not effective histologically. Five patients had a underlying invasive tumor (62.5%) at initial therapy. The 5-year survival rate was 50.0%. Prognosis of the vulvar Paget's disease appears to be poor.

Increased serum pepsinogen I and recurrence of duodenal ulcer

To determine whether the serum pepsinogen I (PG I) level would be a suitable marker for selecting patients at risk for duodenal ulcer recurrence and, thus, would benefit from maintenance therapy, we treated duodenal ulcer patients with H2-receptor antagonists. After healing 140 ulcer patients we assessed the recurrence rate at 1 year with and without maintenance therapy. The annual recurrence rates in duodenal ulcer patients with hyper-PGI (95 ng/ml or more), with 66 ng/ml less than or equal to PGI less than 95 ng/ml, and with PGI less than 66 ng/ml were 87.0%, 27.3%, and 17.9%, respectively, when they did not receive maintenance therapy. In patients with hyper-PGI the recurrence rate was significantly lower in patients receiving maintenance therapy than in patients not receiving maintenance therapy, whereas in patients with PGI less than 66 ng/ml the recurrence rate was as low as 20% regardless of maintenance therapy. These results indicate that maintenance therapy with half the dose of H2-receptor antagonist is not required by patients with PGI less than 66 ng/ml, whereas those with hyper-PGI may be good candidates for long-term maintenance therapy.

Granulocyte colony-stimulating factor in allogeneic bone marrow transplantation

A Phase II study of recombinant granulocyte colony-stimulating factor (G-CSF) in allogeneic bone marrow transplantation (BMT) was performed. The recovery of leukocytes and neutrophils was markedly accelerated in G-CSF-administered recipients. The days to WBC count greater than 1,000/microliters (11.5 +/- 1.9) and the days to neutrophil count greater than 500/microliters (11.5 +/- 1.4) were significantly shorter than those of the monocyte-CSF (M-CSF) and CSF(-) groups. In the G-CSF group the WBC count at nadir was higher than in other groups, and neutrophil recovery preceded monocyte recovery. After the discontinuation of G-CSF, the WBC count first decreased for a few days and then increased again slowly. The short duration of leukopenia brought about a reduction in the number of febrile (greater than 38 degrees C) days which, until day 30, were 1.8 +/- 1.9 in the G-CSF group, also significantly shorter than in others. Acute graft-versus-host disease (greater than grade II) appeared in two of eight patients from the G-CSF group, this incidence being comparable to those found in the other groups. A side effect of G-CSF-mild bone pain-was observed in one patient, but it was tolerable. Six of eight patients in the G-CSF group survived for between five and 13 months after BMT with a Karnofsky score greater than 90%. No relapses were observed in the six, including one patient with chronic myelogenous leukemia and two with acute non-lymphoblastic leukemia. To determine the final influence of G-CSF on myeloid leukemia, further long-term follow-up studies are needed. G-CSF was well tolerated and seemed promising against allogeneic BMT.