Autocrine over expression of fibronectin by human transitional carcinoma cells impairs bacillus Calmette-Guerin adherence and signaling

PURPOSE

Bacillus Calmette-Guerin (BCG) binds to the tumor cell as a result of mycobacterial receptors for fibronectin (FN). Cell surface bound FN serves as a bridge through which BCG attaches to the tumor cell. Despite the importance of FN studies have demonstrated an idiosyncratic decrease in BCG adherence in response to exogenous FN. We evaluated the effect of exogenous and autocrine FN on the ability of BCG to adhere to the tumor cell surface and initiate cellular signaling.

MATERIALS AND METHODS

BCG adherence to parental 253J and FN over expressing 253JTGFbeta1-8 cells as well as to the intrinsic FN expressing cell line 647V was quantified using green fluorescent protein-BCG. Experiments were performed to assess the effect of FN on BCG initiated signal transduction through nuclear factor kappaB and AP1. Finally, the integrity of the BCG activated signaling pathway in transforming growth factor-beta1/FN over expressors was assessed using antibody mediated cross-linking of the FN receptor.

RESULTS

BCG adherence was decreased in cell lines with high autocrine expression of FN. Exogenous FN prevented BCG induced transactivation of nuclear factor kappaB and AP1 reporter constructs. No BCG stimulated signaling to these reporters could be detected in FN over expressing 253J cells. NonFN dependent alpha5beta1 cross-linking initiated signal transduction in FN over expressing cells.

CONCLUSIONS

We propose that by saturating cellular and BCG receptors excess FN expression decreases the ability of cellular or mycobacterial bound FN to bind vacant receptors on BCG or on the cell. Excess FN inhibits BCG adherence and BCG initiated signal transduction.

Antineoplastic effect of immunostimulatory DNA (CpG-ODN) in a murine C57-BL6/MB-49 transitional cell carcinoma model

BACKGROUND

Intravesical BCG installation is the standard of care in the prophylaxis of recurrent intermediate and high-risk transitional cell carcinoma (TCC), but its mode of action has not yet been elucidated. However, a Th-1 biased immune response is postulated Cell culture and animal models demonstrated the efficacy of synthetic CpG-oligodeoxynucleotides (ODN) as inducer and adjuvant for a strong Th1-response. The purpose of our study was to evaluate the antineoplastic effect of locally administered CpG ODN in a subcutaneous murine bladder cancer model.

MATERIALS AND METHODS

A subcutaneous murine TCC model was established in female C57/BL6 mice using the corresponding syngeneic MB49 TCC cell line. Three groups of 5 animals received a cell suspension, standardized for 1x10(6) cells/50 microl, injected s.c. into the right and left flank. Group I received 10 nmol of CpG-ODN only into the right cell depot. Group II received 10 nmol of GpC ODN. Group III served as untreated control and received only PBS. The animals were examined at various time points after injection until sacrifice on day 14. Tumor or scar tissue were excised, weighed and examined histopathologically (HE-stain).

RESULTS

Tumor sizes and weights showed no side differences. The average tumor weight on day 14 was 171 mg (SD +/- 8.9), 110 mg (SD +/- 19.2) and 18 mg (SD +/- 6.1), respectively, in groups III, II and I (p<0.05). Histopathology revealed solid vital epithelial tumors in group III and reduced vital tumor mass with central necrosis and moderate mononuclear infiltration in group II. Group I showed almost complete tumor necrosis and a considerable mononuclear inflammatory response.

CONCLUSION

Immunostimulatory DNA has promising antineoplastic activity in a murine subcutaneous TCC-model. The histological findings suggest an immunologically-mediated mode of action. Further investigations are necessary to elucidate the immunological response.

Interleukin-12 immunotherapy of murine transitional cell carcinoma of the bladder: dose dependent tumor eradication and generation of protective immunity

PURPOSE

The antitumor activity of interleukin (IL)-12 has been demonstrated in a number of tumor models but barely tested in bladder cancer models. We evaluated the antibladder cancer activity of this cytokine in syngeneic mice bearing subcutaneous, metastatic and orthotopic tumors.

MATERIALS AND METHODS

Mice were implanted subcutaneously, intravenously or orthotopically with syngeneic transitional cell carcinoma (TCC) of the bladder. The tumor bearing mice were then treated with IL-12 locally or systemically and monitored for tumor regression and survival.

RESULTS

In the subcutaneous model dose dependent suppression of tumorigenesis was observed when IL-12 was administered subcutaneously at a distal site with the MB49 line being more sensitive than MBT-2. IL-12 (10 days) above 50 ng daily was tumor inhibitory, while doses of 500 or 1000 ng daily prolonged survival and cured 70% and 75% of subjects, respectively. Upon re-challenge with parental tumor cells mice previously cured with IL-12 (1000 vs 500 ng daily) exhibited specific protection (70% vs 35% rejection) that was dependent on the earlier dose of cytokine. IL-12 administered intraperitoneally at a dose of 250 ng daily was more potent than subcutaneous administration and complete regression was observed. Metastatic TCC in the lungs and orthotopic tumors in the bladder also favorably responded to systemic or intravesical IL-12 therapy, respectively. Addition of IL-2 to IL-12 therapy increased tumor regression, long-term survival and rejection of re-challenged parental tumor.

CONCLUSIONS

IL-12 is exceptionally effective for treating murine bladder TCC in subcutaneous, metastatic and orthotopic models. The antibladder cancer activity of this cytokine should be tested in human bladder cancer therapy.

The essential role of interferon-gamma during interleukin-12 therapy for murine transitional cell carcinoma of the bladder

PURPOSE

Recombinant interleukin (IL)-12 and adenoviral IL-12 gene therapy have been shown to be potent therapeutic interventions for murine transitional cell carcinoma (TCC) of the bladder in vivo. We investigated the mechanisms through which IL-12 induces antibladder cancer immunity.

MATERIALS AND METHODS

The ability of IL-12 to enhance interferon-gamma (IFN-gamma) expression, a major T-helper type 1 cytokine, was analyzed in murine serum, urine and splenocyte cultures. MB49, a murine TCC line, was treated with IFN-gamma and evaluated for its proliferation, surface molecule expression and sensitivity to splenocyte mediated cytotoxicity. Neutralizing antiIFN-gamma antibody was applied to test the role of IFN-gamma in the IL-12 therapy of MB49 tumor.

RESULTS

IL-12 was observed to significantly increase IFN-gamma concentrations in serum and urine as well as in splenocyte cultures. While IL-12 had no direct activity against TCC in vitro, IFN-gamma showed potent dose dependent antiproliferative and pro-apoptotic activity, which was further enhanced by supplementation of tumor necrosis factor-alpha. In addition, IFN-gamma substantially up-regulated the expression of surface immune molecules on TCC cells, including MHC-I, MHC-II, ICAM-I, B7.1, B7.2 and Fas. Maximum splenocyte mediated cytotoxicity against TCC was enhanced by pretreatment of target bladder cancer cells with IFN-gamma plus tumor necrosis factor-alpha. Furthermore, IL-2 in combination with IL-12 further enhanced splenocyte mediated cytotoxicity. The in vivo antibladder cancer activity of IL-12 was abolished by concurrent treatment with antibodies to IFN-gamma.

CONCLUSIONS

This study strongly suggests that IFN-gamma has an essential role in IL-12 induced antibladder tumor immunity. Activation of host effector immune cells by IL-12 is also required for induction of optimal tumor destruction in IL-12 therapy.

Polarisation of a T-helper cell immune response by activation of dendritic cells with CpG-containing oligonucleotides: a potential therapeutic regime for bladder cancer immunotherapy

Intravesical bacillus Calmette–Guerin (BCG) is a treatment for transitional cell carcinoma (TCC) and carcinoma in situ (cis) of the urinary bladder, but some patients remain refractory. The mechanism of cancer clearance is not known, but T cells are thought to play a contributory role. Tissue dendritic cells (DCs) are known to initiate antigen-specific immune responses following activation of receptors, which recognise molecular patterns on the surface of microorganisms. A family of these receptors, the toll-like receptors (TLRs), are also crucial for activating DC to produce cytokines that polarise the T-cell response towards a T helper (Th)1 or Th2 phenotype. This study compared the potential of intact BCG to activate DC with that of the defined TLR4 ligand lipopolysaccharide (LPS) and the TLR9 ligand CpG-oligonucleotide. It was found that all three stimuli efficiently activated normal DC, but cells expressing a mutant TLR4 responded poorly to stimulation with LPS. Importantly, stimulation with BCG induced both IL-12 and IL-10, suggesting subsequent development of a poorly focused T-cell immune response containing both Th1 and Th2 immune function. By contrast, LPS- and CpG-oligonucleotides induced only IL-12, indicating the potential to produce a Th1 response, which is likely to clear cancer most efficiently. Given the toxicity of LPS, our data suggest that CpG-oligonucleotides may be beneficial for intravesical therapy of bladder cancer.

Immunotherapy for Bladder Cancer Using Recombinant Bacillus Calmette-Guerin DNA Vaccines and Interleukin-12 DNA Vaccine

PURPOSE

We investigated the efficacy of recombinant bacillus Calmette-Guerin (BCG) DNA (poly-rBCG) and murine interleukin (IL)-12 (mIL-12) vaccines in inducing T helper 1 polarized cytokines and suppressing bladder tumor growth in mice.

MATERIALS AND METHODS

Four mycobacteria candidate genes (Ag85A, Ag85B, Mpt64 and PstS3) were cloned, fused with ESAT6 and ligated into eukaryotic expression vectors. Combined poly-rBCG and mIL-12 vaccines were transferred into a murine bladder tumor model. The efficiency of gene expression was detected using Western blotting, flow cytometry and semiquantitative reverse transcriptase-polymerase chain reaction. Systemic cytokine responses, tumor growth and cumulative survival rates were monitored.

RESULTS

Transfected bladder cancer cells showed high in vitro and in vivo expression of the recombinant subcomponents. Mice with tumors injected with poly-rBCG plus mIL-12 produced serum interferon-gamma significantly within 21 days but no significant elevations in tumor necrosis factor-alpha, IL-2, IL-4 or IL-5 were found. On day 28 after electroporation the growth of MBT-2 implants treated with poly-rBCG, mIL-12 or poly-rBCG plus mIL-12 was significantly inhibited. The cumulative survival of mice treated with poly-rBCG plus mIL-12 was significantly higher than that of the other 3 groups.

CONCLUSIONS

Highly immunopotent recombinant vaccines of bacillus Calmette-Guerin DNA were produced that elicited T helper 1 immune responses with a high serum interferon-gamma level, inhibited tumor growth and prolonged the survival of tumor bearing mice. Thus, electroporation immunogene therapy using poly-rBCG plus mIL-12 may be an attractive regimen for the treatment of bladder cancer.

Expression of CD44 protein in bilharzial and non-bilharzial bladder cancers

OBJECTIVES

To investigate the expression of CD44 protein in bilharzial and non-bilharzial bladder carcinomas, and to relate the results of immunohistochemistry to the established prognostic factors, as studies clearly show that altered adhesive function of tumour cells is important in the metastatic process and CD44 is assumed to be critical in the malignant progression of many human tumours.

PATIENTS AND METHODS

The study included 55 patients with bladder carcinoma confirmed by cystoscopy and biopsy. Of the 33 patients with transitional cell carcinoma (TCC), 19 were bilharzial and 14 non-bilharzial, and of 22 with squamous cell carcinoma (SCC), 12 were bilharzial and 10 non-bilharzial. CD44 expression was measured by immunohistochemical analysis of paraffin-embedded tissue obtained from these patients after appropriate treatment (transurethral resection, partial or radical cystectomy).

RESULTS

There was significantly less CD44 expression in invasive TCC than in normal urothelium and pre-invasive TCC (P = 0.05). The expression of CD44 was inversely related to the tumour grade and depth of invasion (P = 0.05). However, there was no such relation for SCC; there was no significant difference between CD44 expression in metaplastic squamous epithelium, pre-invasive and invasive SCC. The presence or absence of bilharzial ova had no apparent effect on the expression of CD44, with no significant difference between CD44 expression in bilharzial and non-bilharzial bladder carcinomas.

CONCLUSIONS

These data confirm that there is a reduction in CD44 expression with increasing tumour grade and stage of TCC, and may provide an additional aid in predicting the progression of this tumour. There was no such relationship with SCC, and no difference between CD44 expression in bilharzial and non-bilharzial bladder carcinomas.

Cytokine gene expression in a mouse model: the first instillations with viable bacillus Calmette-Guerin determine the succeeding Th1 response

PURPOSE

Bacillus Calmette-Guerin (BCG) therapy for superficial bladder cancer is immune dependent and activation of a Th1 immune response is probably required for clinical efficacy. Given the empirical approach to improving BCG therapy we investigated in a mouse model the consequences of modifications in BCG therapy with regard to Th1 and Th2 cytokine responses in the bladder. These studies may provide a rationale for possible modifications of the established clinical treatment protocol.

MATERIALS AND METHODS

The dynamics of Th1 (interferon-gamma, interleukin [IL]-2, IL-12p40 and tumor necrosis factor-alpha) and Th2 (IL-10 and IL-4) cytokine responses during and after 6 once weekly intravesical BCG instillations in mice was determined by a semiquantitative reverse transcriptase-polymerase chain reaction based method.

RESULTS

During 6 weekly BCG instillations a dose and time dependent induction of the various Th1 as well as Th2 cytokines was observed. The response pattern was comparable to urinary cytokine induction patterns in patients. Electrocauterization prior to BCG instillations led to lower and more variable levels of cytokine polymerase chain reaction products compared with noncauterization. Lowering the dose of BCG seemed to affect the Th1 cytokine response most, whereas the Th2 response was less influenced by dilution of the BCG preparation. Six instillations with nonviable BCG induced Th2 but failed to induce Th1 cytokines, which may explain the necessity of BCG viability for antitumor activity. However, when mice were first treated 3 times with viable BCG and subsequently received 3 instillations with killed BCG, the Th1 and Th2 cytokine pattern was comparable to the standard 6-week regimen with viable BCG.

CONCLUSIONS

The model seems an appropriate one in which to investigate changes in Th1 and Th2 cytokine gene expression levels in bladders resulting from modifications in intravesical BCG treatment. It was possible to induce a local Th1 cytokine response with nonviable BCG provided that local sensitization to BCG antigens had occurred during preceding instillations with a viable BCG preparation. Whether such an approach could decrease BCG therapy toxicity, while maintaining antitumor efficacy, remains to be further investigated in patients.

Lymphocyte subsets, lymphocyte reactivity to mitogens, NK cell activity and neutrophil and monocyte phagocytic functions in patients with bladder carcinoma

OBJECTIVE

Assessment of immunocompetence in bladder transitional cell carcinoma (TCC) patients.

PATIENTS AND METHODS

In 34 untreated patients with bladder TCC, lymphocyte subsets were measured together with lymphocyte reactivity to mitogens, NK cell activity and neutrophil and monocyte phagocytic functions. The data obtained were correlated with both the tumor spread and the grade.

RESULTS

In patients with superficial carcinoma, the proportion of CD4+ cells, the reactivity of lymphocytes to mitogens and NK cell activity was significantly lower than in controls. In patients with invasive disease, the CD4/CD8 ratio, lymphocyte reactivity to mitogens and NK cell activity was significantly diminished when compared with the controls and with patients with superficial carcinoma. Neutrophil and monocyte killing was significantly lower than in controls. Patients with high-grade tumors had a significantly lower CD4/CD8 ratio and lymphocyte reactivity to mitogens than patients with low-grade tumors.

CONCLUSION

These findings indicate gross immunological abnormalities in TCC patients which correlate with stage and grade of tumor.

Androgen Dependent Regulation of bacillus Calmette-Guerin Induced Interleukin-6 Expression in Human Transitional Carcinoma Cell Lines

PURPOSE

Autocrine expression of interleukin (IL)-6 by transitional cell carcinoma (TCC) in response to bacillus Calmette-Guerin (BCG) may have an important role in promoting BCG adherence to TCC and consequently in BCG treatment efficacy. IL-6 expression in response to BCG requires nuclear factor (NF)-kappaB mediated signal transduction. We evaluated the influence of androgens on BCG induced, NF-kappaB mediated IL-6 expression.

MATERIALS AND METHODS

Reverse transcriptase-polymerase chain reaction was used to confirm androgen receptor expression in the human TCC lines 253J and T24. A reporter construct containing an androgen response element was used to establish the integrity of androgen mediated signal transduction. Subsequently the dose dependent effect of dihydrotestosterone (DHT) on BCG induced IL-6 expression and NF-kappaB signaling was evaluated. Two pharmacological androgen receptor blockers were used to determine if receptor blockade inhibited the effect of DHT on activation of the androgen response element, NF-kappaB signaling and BCG induced IL-6 expression.

RESULTS

The 2 human TCC lines expressed androgen receptor and demonstrated intact androgen stimulated signaling pathways. DHT suppressed BCG induced, NF-kappaB mediated signaling and IL-6 expression in a dose dependent manner. DHT decreased mRNA levels of IL-6, expression of the full-length IL-6 promoter construct and expression of an NF-kappaB specific reporter construct in response to BCG relative to controls. Competitive pharmacological blockade of androgen receptor inhibited the effect of DHT on BCG induced signaling in dose dependent fashion.

CONCLUSIONS

DHT down-regulates NF-kappaB mediated IL-6 expression by human TCC lines in response to BCG. This effect depends on a functional androgen receptor signaling pathway and it can be blocked by the inhibition of androgen/androgen receptor binding.

Intratumoral vaccination with vaccinia-expressed tumor antigen and granulocyte macrophage colony-stimulating factor overcomes immunological ignorance to tumor antigen

Using a murine transitional cell carcinoma tumor model, MB49, which naturally expresses the male antigen HY, we evaluated whether tumor ignorance as determined by lack of a systemic immune response could be overcome by immunization with vaccinia expressed tumor antigen and granulocyte macrophage colony-stimulating factor. Systemic tumor ignorance of MB49 was demonstrated by the lack of a splenic HY-specific CTL response in MB49-bearing female mice. In contrast, we demonstrated HY-specific CTL priming in the draining lymph nodes. MB49-bearing female B6 mice were immunized with VVHY+VVGMCSF intratumorally or in the contralateral flank. Intratumoral VVHY, VVGMCSF, and keyhole limpet hemocyanin (to produce CD4 help) generated splenic HY-specific CD8 CTLs, whereas immunization with the combination in the contralateral flank or single agents given intratumorally failed to yield a splenic response. Purified male T cells injected intratumorally, as a source of HY antigen, also generated a HY-specific response, whereas contralateral immunizations did not. These finding expand the understanding of tumor immunological ignorance and support intratumoral vaccination as a strategy for immunotherapy of established tumors.

Nonviral cytokine gene therapy on an orthotopic bladder cancer model

PURPOSE

The purpose is to assess cytokine gene transfection in tumor cells and its therapeutic efficacy in an orthotopic mouse bladder cancer model after liposome-mediated gene transfer.

EXPERIMENTAL DESIGN

A total of 1 x 10(5) MB49 cells was instilled into the bladder of C57BL/6 mice after electrocautery to establish the tumor model. The plasmids were constructed by inserting the coding sequences for murine IFN-alpha1 and granulocyte macrophage colony-stimulating factor into a plasmid vector pBudCE4.1. Transient transfection was performed using a cationic lipid N-[1-(2,3-dioleoyloxyl)propyl]-N,N,N-trimethylammoniummethyl sulfate and methyl-beta-cyclodextrin-solubilized cholesterol. The in vitro expression of cytokines was checked by ELISA. The expression of the transgene in situ was confirmed by immunohistochemistry and 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside staining. Mice bearing orthotopic tumors were treated with plasmid DNA/liposome complex by intravesical instillation twice a week for 3 weeks.

RESULTS

Superficial bladder tumors were established by intravesical instillation of MB49 into cauterized bladders. The expression level of cytokines in transfected cell lines was increased significantly. In situ gene transfer to bladder tumors was accomplished via intravesical instillation of plasmid DNA/N-[1-(2,3-dioleoyloxyl)propyl]-N,N,N-trimethylammoniummethyl sulfate/methyl-beta-cyclodextrin-solubilized cholesterol after a single 2 h in situ transfection. The tumor incidence in the treatment groups was dramatically decreased from 76.9% in the control group to 15.4-30.8% in the treatment groups.

CONCLUSIONS

We demonstrated in the orthotopic mouse bladder cancer model that successful inhibition of tumor cell growth could be obtained with cytokine gene therapy. The results suggest that our liposome transfection system appears to be a promising method for gene therapy of bladder cancer in vivo.

Morphological features correlation with serum tumour markers in prostatic carcinoma

OBJECTIVE

To find out Gleason grades, scores and to see the correlation of these morphological features with tumour markers in prostatic carcinoma.

DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

The study was conducted at the Departments of Histopathology and Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, over a period of one year.

MATERIALS AND METHODS

Fifty cases of prostatic carcinoma were studied. Gleason grades and score of tumour were determined by doing haematoxylin and eosin (HE) staining. Pre-operative serum prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) assays were carried out in these cases.

RESULTS

The patients seen were between 50-102 years of age with an average of 70.9 years. There were 49 cases of adenocarcinoma and 01 case of mixed adeno and transitional cell carcinoma of prostate. Twenty-eight (56%) patients had Gleason score of 5-7. Twenty-nine (58%) patients were having serum PSA levels between 10.0 ng/ml and 50.0 ng/ml. Thirteen (26%) cases showed PSA assays >50 ng/ml. The sensitivity of PSA test was 84 % in these cases. Thirty-five (70%) patients were having PAP values >3.7 U/l (sensitivity 70 %).

CONCLUSION

The Gleason grading system is a specific morphological predictor. The serum PSA showed better sensitivity and specificity with Gleason grades and scores as compared to serum PAP. The serum PAP levels showed better correlation with morphological features as compared to serum PSA.

[A case of CA19-9 producing transitional cell carcinoma of the ureter]

We report a case of CA19-9 producing urothelial carcinoma of the right ureter. A 61-year-old male patient who had an extremely high value of serum CA19-9 (1,185 U/ml) with right hydronephrosis was referred to us. Magnetic resonance urography and retrograde ureterography revealed a long irregular filling defect in the right distal ureter. Under the diagnosis of right ureteral tumor, we performed right total nephroureterectomy and pelvic lymphadenectomy. The tumor was histologically diagnosed as grade 1 transitional cell carcinoma and pelvic lymphnodes were positive (pT1N2M0). The tumor cells showed positive immunostaining for CA19-9. The serum CA19-9 level was normalized after the operation and successive adjuvant chemotherapy (M-VAC 2 course). No recurrence was found for 15 months after operation. In this case, the serum CA19-9 level was useful as a tumor marker.

Bladder preserving approach for muscle invasive bladder cancer--role of mycobacterium w

Mycobacterium w (immuvac), a new potent immunomodulator was evaluated as concomitant therapy in the management of muscle invasive bladder cancer along with external beam radiation therapy. There was no residual tumour in all the five patients after two months of therapy. All patients remained disease free for an observation period of more than 2 years.

Evaluation of a bladder tumor antigen test as a screening test for transitional cell carcinoma of the lower urinary tract in dogs

OBJECTIVE

To evaluate the veterinary version of the bladder tumor antigen (V-BTA) test as a screening test for transitional cell carcinoma (TCC) of the lower urinary tract of dogs.

ANIMALS

229 client-owned dogs.

PROCEDURE

Urine samples from dogs were shipped overnight to a single laboratory to facilitate testing within 48 hours of collection by use of the V-BTA rapid latex agglutination urine dipstick test. Groups of dogs included the following: 1) dogs with TCC of the lower urinary tract, 2) healthy control dogs, 3) unhealthy control dogs with non-TCC urinary tract disease, and 4) unhealthy control dogs without urinary tract disease. Test sensitivity and specificity were calculated by use of standard methods. Logistic models were developed to assess the effect of disease status, test conditions, urine composition, and signalment on the performance of the V-BTA test.

RESULTS

A total of 229 urine samples were analyzed, including 48 from dogs with suspected (n = 3) or confirmed (45) TCC. Test sensitivities were 88, 87, and 85% for all dogs with (suspected and confirmed) TCC, dogs with confirmed TCC at any site, and dogs with confirmed TCC of the urinary bladder, respectively. Test specificities were 84, 41, and 86% for healthy control dogs, unhealthy control dogs with non-TCC urinary tract disease, and unhealthy control dogs without urinary tract disease, respectively. The test performed slightly better on centrifuged urine samples than on uncentrifuged urine samples.

CONCLUSIONS AND CLINICAL RELEVANCE

Our results indicate that the V-BTA test is useful in screening for urinary tract TCC in dogs.

Increased expression of sialyl-Lewis A correlates with poor survival in upper urinary tract urothelial cancer patients

BACKGROUND

We have previously shown that both sialyl-Lewis A (sLe(a)) and sialyl-Lewis X (sLe(x)) antigens are involved in E-selectin-mediated adhesion of some urothelial cancer cells to the endothelium in vitro. The present study was undertaken to determine whether these antigens could serve as prognostic parameters.

MATERIALS AND METHODS

We immunohistochemically examined the expression of sLe(a) and sLe(x) in 90 human upper urinary tract urothelial tumours.

RESULTS

Fifty-eight (64%) tumours were found to express sLe(a), while sixty-one (68%) expressed sLe(x). The expression between sLe(a) and sLe(x) was correlated positively (p < 0.0001). Neither sLe(a) nor sLe(x) expression was correlated with any other pathological parameter. The cause-specific survival rate was significantly worse in sLe(a)-positive patients than in sLe(a)-negative patients (5-year survival rates 64% and 93%, respectively: p = 0.023), while the survival rates were not statistically different between sLe(x)-positive and sLe(x)-negative patients. By Cox's multivariate analysis, sLe(a) expression as well as lymph node involvement and venous invasion was an independent risk value to predict survival (p < 0.05). In 24 high-risk patients having lymph node metastasis or having both venous invasion and sLe(a) expression, the 5-year survival rate was 29%, while it was 93% in the other 66 patients (p < 0.0001).

CONCLUSION

These results indicate that increased expression of sLe(a) antigen as well as lymph node metastasis and venous invasion may be associated with shorter cause-specific survival in upper urinary tract urothelial cancer. The combination of these factors offers a better prediction of prognosis.

Human urinary bladder transitional cell carcinomas acquire the functional Fas ligand during tumor progression

The interaction between FasL on tumor cells and Fas on lymphocytes may represent a tumor immune escape mechanism. We explored FasL expression and function in human urinary bladder transitional cell carcinomas (TCCs). FasL expression was observed in situ in 45% of TCCs (n = 45) and was absent in normal urothelium (n = 20). A correlation existed between FasL expression and high tumor grade (0% in G1, 14% in G2, and 75% in G3; P < 0.0001) and stage (13% in superficial Ta-T1 versus 81% in invasive T2-T4; P < 0.0001). FasL function was shown by the ability of two FasL-positive primary culture TCC cell lines (established from two FasL-positive invasive TCCs) to induce Fas-mediated killing not only of conventional Fas-sensitive targets (such as Jurkat cells or phytohemagglutinin-lymphoblasts), but also of autologous T lymphocytes generated in a mixed lymphocyte tumor-cell culture. In addition, an association between FasL expression by TCC cells and activated caspase-8, -9, and -3 expression by interferon-gamma-producing CD8-positive tumor-infiltrating lymphocytes was observed in situ. Our results show a functional expression of TCC-expressed FasL that correlates with tumor progression. These results suggest that TCC-expressed FasL may induce apoptosis of anti-tumor T lymphocytes in vivo, providing new insights on the mechanisms involved in bladder TCC progression.

Immunoprophylactic intravesical application of bacillus Calmette-Guerin after transurethral resection of superficial bladder cancer

AIM

To evaluate the effect of intravesical instillation of Bacillus Calmette-Guerin (BCG) in the prevention of recurrence and progression of the superficial bladder cancer.

METHODS

Between February 1989 and May 1994, 170 patients with histologically proven superficial transitional cell carcinoma of the bladder stage Ta and T1 were assessed as eligible for 6-week + 6-month protocol of intravesical BCG instillation at the Split University Hospital. All patients underwent complete transurethral resection of the tumor, which established tumor size, histology, stage, and absence of muscle invasion. Out of 170 patients offered to receive intravesical BCG instillations, 80 agreed to undergo the treatment (BCG group), and 90 refused it (control group). The median duration of follow-up was 64 months (range, 16-128).

RESULTS

The BCG group had lower incidence rates of recurrence (12 vs 26 events per 100 patient-years in controls, p<0.001) and progression (3.0 vs 6.6 events per 100 patient-years in controls, p=0.017, large-sample one-sample binomial test in both cases) than the control group, but similar mean intervals to first recurrence or progression. The 5-year recurrence-free rates were 55% in BCG patients and 31% in controls, and in case of progression, 86% and 70%, respectively. Cox regression showed that the independent predictors of recurrence were tumor size (p<0.001), absence of BCG treatment (p=0.002), and patient age (p=0.05). The single independent predictor of tumor progression was absence of BCG treatment, but only in case of tumor grade III (roughly doubling the relative risk of the event).

CONCLUSION

Our data suggest that BCG intravesical instillation, using 6 week + 6 month scheme, prevents against recurrence and progression of superficial bladder tumors. This treatment should be especially advocated in patients with advanced grade tumors, but the scheme remains to be evaluated against other BCG treatment schemes.

[Non-invasive urine tests in diagnosis and as prognostic markers for urinary bladder carcinoma. Comparison of the BTAstat and NMP 22 tests with immunocytology using monoclonal antibodies against Lewis X and 486p3/12]

INTRODUCTION AND OBJECTIVES

The non-invasive detection of urothelial carcinoma remains challenging. The aim of this study was the prospective evaluation of urine markers for bladder carcinoma. We compared the NMP 22 and BTAstat tests with immunocytology (IC) using monoclonal antibodies against the Lewis X antigen and against 486p3/12.

METHODS

NMP 22 and BTAstat were performed on urine samples, and IC with 486p3/12 and Lewis X staining was performed on urine samples as well as bladder wash specimens ( n=146) in patients ( n=115) undergoing transurethral resection on suspicion of bladder cancer (70 specimens) or follow up cystoscopy because of a history of bladder cancer (76 specimens). Bladder cancer was detected in 54 patients (pTa: n=25, pT1: n=20, pT2: n=8, CiS: n=1). Cut-off levels were 10 U/ml for the NMP 22, 30% positive cells for 486p3/12, and 5% positive cells for the Lewis X test.

RESULTS

The BTAstat test was positive in 65 (44.5%) cases, the NMP 22 in 69 (47.3%) cases, IC with 486p3/12 and the Lewis X was positive in 52 (35.6%) and 109 (74.7%) cases, respectively. Sensitivity was 70.3% (BTAstat), 68.5% (NMP 22), 94.4% (Lewis X), and 68.5% (486p3/12), respectively. The specificity was 70.6% (BTAstat), 65.2% (NMP 22), 36.9% (Lewis X), and 83.6% (486p3/12), respectively. Among the patients with a false positive test 2/22 (9.0%) patients (BTAstat), 2/25 (8%) patients (NMP 22 test), 4/43 (9.3%) patients (Lewis X), and 3/11 (27%) patients (486p3/12), respectively, suffered from tumor recurrence. In contrast, among the patients with a correct negative test 2/39 (2.0%) (BTAstat), 2/36 (0.5%) (NMP 22), 0/18 (0%) (Lewis X), and 1/50 (2.0%) (486p3/12), respectively, suffered from tumor recurrence.

CONCLUSIONS

IC with the Lewis X revealed a higher sensitivity than all of the tested, commercially available methods. Because of its high sensitivity and its high negative predictive value, the Lewis X test may be useful for screening a high-risk population. Patients with a false positive 486p3/12 test have an increased risk of tumor recurrence when compared with patients with a correct negative test.

Evaluation of DD23 as a marker for detection of recurrent transitional cell carcinoma of the bladder in patients with a history of bladder cancer

OBJECTIVES

To determine whether DD23 increases the sensitivity of urinary-based detection of transitional cell carcinoma (TCC) recurrence. The murine monoclonal antibody DD23 recognizes a 185-kDa tumor-associated antigen that is expressed in human bladder cancer cells in vitro and in vivo but is not detected in normal urothelium.

METHODS

Using alcohol-fixed urinary cytology, matched voided urine and bladder wash specimens were evaluated for the contribution of DD23 antigen expression in the detection of recurrent TCC. The selected patient population had a history of bladder cancer, and urine cytology analysis was performed in a single commercial reference laboratory. DD23 antigen expression in a cohort of 81 patients was compared with urine cytology findings, and the sensitivity and specificity for each urine-based test was determined. The presence of recurrent disease was determined by positive pathologic biopsy.

RESULTS

The 81-patient cohort produced 151 urine specimens for which both biopsy and cytology information were obtained. Of these specimens, 64 were confirmed by a tissue diagnosis for TCC recurrence. These biopsy-proven recurrences were used as the dependent variable to assess the accuracy of cytology testing. For the detection of TCC, the DD23 antigen had a sensitivity of 70.3% and a specificity of 59.8%. Combined with cytopathologic findings, DD23 enhanced the sensitivity for the detection of TCC from 43.8% (cytology alone) to 78.1%. For low-grade TCC (n = 20) DD23 enhanced the sensitivity from 20.0% (cytology alone) to 55.0%. For high-grade TCC (n = 25), DD23 enhanced the sensitivity from 64.0% (cytology alone) to 76.0%. In patients with a prior history of intravesical treatment, DD23 had a sensitivity of 94.7% and a specificity of 33.3% compared with a sensitivity of 52.6% and a specificity of 83.3% for cytology.

CONCLUSIONS

DD23 antigen expression can be used as an adjunct to cytopathologic evaluation to enhance the sensitivity of urinary cytology detection of TCC. In addition, DD23 does not appear to lose sensitivity in patients with a prior history of bladder cancer treated with intravesical agents.

The prognostic value of proliferating cell nuclear antigen, Ki-67 and nucleolar organizer region in transitional cell carcinoma of the bladder

OBJECTIVES

To investigate the value of proliferating cell nuclear antigen (PCNA), Ki-67 antigen labelling indices and nucleolar organizer region (NOR) score in relation to histological grade, stage, recurrence and progression of the bladder tumor.

MATERIALS AND METHODS

Tissue specimens from 77 bladder cancer patients (43 superficial, 34 invasive) were immunostained with PCNA and Ki-67 and stained with AgNOR. Thirteen specimens of normal bladder mucosa served as controls.

RESULTS

In comparison to normal bladder mucosa the values of the three indicators were significantly greater (p < 0.001). There was a significant relationship between PCNA, Ki-67 indices, AgNOR scores and grade and stage of the tumor (p < 0.001). All indicators also correlated with each other (p < 0.001). The Kaplan-Meier curves for recurrence-progression free survival revealed that patients with a PCNA labelling index >36.22%, Ki-67 labelling index >29.68% and AgNOR score > 3.34 had a worse prognosis than those with <36.22%, <29.68% and <3.34, respectively.

CONCLUSIONS

PCNA, Ki-67 indices and AgNOR scores correlated with each other and with tumor grade and stage. These proliferation markers may give objective and accurate information about the biological behavior of bladder transitional cell carcinoma.

Immune inhibitory effects of renal cell carcinoma extract on lectin and alloantigen-induced peripheral blood and tumor infiltrating lymphocyte blastogenesis

The presence of tumor infiltrating lymphocytes (TIL) has been attributed to the host cell mediated immune response against the evolving malignancy. However, due to specific evasive and escape mechanisms, the immune competent cells are rendered ineffective. One such mechanism may be the production of immune suppressor substance(s), inhibiting lymphocyte proliferation, and subsequently, their transformation into effector cells. To evaluate a possible impact of RCC extract on lectin and alloantigen-induced proliferation of TIL and peripheral blood lymphocytes (PBL) from renal cell carcinoma (RCC) patients and from healthy control human subjects. Tumor extract and TIL were derived from 13 patients with RCC undergoing radical nephrectomy. Tumor infiltrating lymphocytes and PBL from these patients were activated with Concanavalin A (Con-A), Phytohemoglutinine (PHA) or Pokeweed (PW) and the rate of blastogenesis was measured by (3)H Thymidine incorporation. The same procedure was used in assay with PBL from control healthy blood donors. There was a significant reduction (88.6%) in the proliferative response to ConA of TIL compared to PBL from the same patients (P = 0.007). A similar decrease was seen following stimulation by PHA (85.8%, P = 0.01) and PW mitogen (78.5%, P = 0.001). A 79.5% decrease in response level of TIL to alloantigens compared to PBL from RCC patients (P = 0.021), was observed. Lectin induced proliferative response of RCC patients was significantly lower in the presence of RCC extract (82.9%) compared to normal kidney extract (P = 0.008). Alloantigenic stimulation of healthy individual PBL was also decreased significantly in the presence of RCC extract (92.9%, P = 0.0001) compared to normal kidney extract. Similarly, lectin induced stimulation of healthy control PBL in the presence of RCC extract was significantly lower (83.2%, P = 0.003). Our data suggest that RCC extract contains an immune suppressive substance(s), capable of inhibiting lymphocyte proliferative response of tumor infiltrating lymphocytes as well as of PBL from patients and healthy individuals alike. This may be one of the mechanisms by which the tumor evades the transformation of lymphocytes into effector killer cells, and thus affects the biological inter-relationship between tumor and host. Identification of this substance and its gene may provide an effective anti-tumoral treatment modality.

The outcome of post-transplant transitional cell carcinoma in 10 renal transplant recipients

At our clinic we followed 320 renal transplant recipients, 16 of whom developed malignancies within 15 yr. Ten of the 16 malignancies were transitional cell carcinoma (TCC) of the urinary tract. The modalities of treatment included standard nephroureterectomy with bladder cuff removal for upper tract tumor, transurethral resection for superficial bladder tumor and partial cystectomy for one case of invasive bladder tumor, as requested by the patient. Post-operative intravesical chemotherapy with epirubicin, or immunotherapy with bacillus Calmette-Guerin (BCG) were carried out for superficial bladder tumor. Cyclosporine (CsA) used as post-transplant immunosuppressant was switched to low dose azathioprine (Aza) at the initial diagnosis of TCC. Four patients experienced tumor recurrence despite conversion of immunosuppressant from CsA to Aza. Among these 10 patients, five maintained normal renal function, three returned to hemodialysis without tumor recurrence, and two patients died of cancer.

In vitro activation of cancer patient-derived dendritic cells by tumor cells genetically modified to express CD154

PURPOSE

Triggering of CD40 on antigen-presenting cells via its ligand CD154 is an important event in the initial phase of an immune response against cancer cells. In this study, we investigated the effects of adenoviral CD154 immunomodulatory gene therapy on the activation of human dendritic cells (DCs) in a well-defined in vitro system.

EXPERIMENTAL DESIGN

Human bladder cancer cell lines and tumor cells from patients with renal cell carcinoma (RCC) were transduced with Ad-CD154 vectors or control vectors. Activation of human in vitro generated DCs after coculture with transduced tumor cells was analyzed. Therapeutic efficacy and cytotoxic T-lymphocyte (CTL) activity were assessed in a subcutaneous (s.c.) murine bladder cancer model.

RESULTS

Human bladder cancer cell lines expressing CD154 showed a decreased growth rate, increased apoptosis, and modulated expression of molecules important for recognition by cytotoxic lymphocytes. Further, CD154-expressing allogeneic bladder tumor cell lines and autologous tumor cells from patients with renal cell cancer induced maturation of DCs and stimulated IFN-gamma production from lymphocytes cocultured with mature DCs. In vivo studies showed that CD154 gene therapy was highly effective in wild-type mice but only minimally effective in nude mice. Consequently, strong tumor-specific CTL activity was detected in mice vaccinated with tumor cells expressing CD154.

CONCLUSIONS

Using tumor cell lines as well as patient-derived material, we could show that tumor cells expressing CD154 efficiently induce maturation and activation of DCs as well as activation of lymphocytes. Our murine in vivo studies demonstrate that lymphocytes contribute to the observed antitumor effect in a s.c. bladder tumor model. These studies should stimulate CD154 gene therapy approaches for the treatment of urologic malignancies.