[Prospective study on using of autologous LAK cell reinfusion in the treatment of chronic hepatitis B]

The results of a prospective controlled randomized clinical study on using of autologous LAK cell reinfusion in the treatment of chronic hepatitis B (including CAH and CPH) were reported. The study was based on the criteria formulated by the National Conference of Viral Hepatitis in 1984 and patients were randomly assigned in two groups (39 cases in treated group and 25 in control group). Patients in the treated group received autologous LAK cell reinfusion treatment alone for 6 weeks and the control group 10% glucose solution intravenous drip also for 6 weeks. HBeAg seronegative rate anti-HBe seropositive rate and normalization rate of ALT after completion of the therapy were 53.8%, 28.2% and 33.3% respectively in the treated group and 20.0%, 8.0% and 4.0% respectively in the control group. The difference of parameters between the treated group and control group as described above was of statistical significance, but definite evaluation of the efficacy of this therapy can only be made after a more extended controlled randomized clinical study.

Crescentic IgA glomerulonephritis following interleukin-2 therapy for hepatocellular carcinoma of the liver

A patient who developed crescentic IgA nephropathy following treatment with recombinant interleukin-2 (rIL2) and lymphokine-activated killer (LAK) cell therapy for hepatocellular carcinoma was reported. Cessation of rIL2 and LAK cell treatment plus plasmapheresis and steroid therapy was successful in achieving partial improvement and stabilization of renal function. This is the first case report of biopsy-documented glomerulonephritis developing after IL2 and LAK cell therapy. This provides indirect in vivo evidence for the role of IL2 in mediating glomerular injury in IgA nephropathy.

The in vivo distribution of murine lymphokine activated killer cells in splenectomized host

The in vivo distribution of intravenously injected lymphokine activated killer (LAK) cells, generated in vitro with rIL-2 from normal murine splenocytes, was studied in BALB/c mice and compared with that of normal splenocytes. Both normal splenocytes and LAK cells were labeled with 51Cr, and the results were analyzed at 6, 24, and 48 hours after injection by localization index as the parameter. After injection through tail veins of mice, LAK cells were found to migrate to the spleen, lungs, liver, lymph nodes, bones and the kidneys. The apparent increased distribution pattern of LAK cells to the lung at 6 and 24 hours after injection was not detected when normal splenocytes were injected. Since almost one third of the injected LAK cells were found to localize in the spleen, it was postulated that splenectomy would affect the in vivo organ distribution of LAK cells. Accordingly, the in vivo distribution of LAK cells in splenectomized mice was further investigated. Results indicated that splenectomy enhanced the convergence of LAK cells to the lungs, liver, lymph nodes and bones. Therefore, splenectomy may augment the therapeutic effect of the adoptive transfer of LAK cells in pulmonary, hepatic, lymph node and bony metastases.

[The influence of anticancer agents at various stages to induce LAK cell on its cytotoxicity and cell yield. Examination in vitro]

To establish the combination of chemotherapy with adoptive immunotherapy (AIT), using lymphokine activated killer cells (LAK) and/or interleukin-2 (IL-2), author examined the following: 1) Pretreatment with anticancer agents for peripheral blood mononuclear cells (PBMC) and its effect on LAK cell cytotoxicity and cell yield. 2) The addition of anticancer agents in the induction phase to LAK cell and its effect on LAK cell cytotoxicity and cell yield. 3) Pretreatment with anticancer agents to induced LAK cell and its effect on LAK cell cytotoxicity and cell yield. 4) The cytotoxicity of LAK cell against tumor cells treated with anticancer agents. Our experiment has shown that when we take peripheral blood mononuclear cells (PBMC) to induce LAK cells, there is no influence on its LAK cell yield or its cytotoxicity after being harvested as LAK cells, even if there is a maximum concentration of anticancer agents, but in the case of the LAK cell induction phase VDS, CDDP, ADM and MMC have a significant effect on LAK cell yield and on cytotoxicity of LAK cell after being harvested as LAK cells. And it has also been shown that, if there is a maximum concentration of anticancer agents, it has an effect on the induced LAK cell cytotoxicity and on the LAK cell yield after being recultured with IL-2. On the other hand, LAK cell cytotoxicity makes no difference to tumor cells whether they are treated or not with anticancer agents. These results suggest that we can take peripheral blood mononuclear cells to induce LAK cells unrelated to the administration of anticancer agents, and that if we use a combination of chemotherapy with adoptive immunotherapy (IL-2 administration and/or LAK cell adaptation), we should start with the administration of anticancer agents and then administer IL-2 and/or transfer LAK cells after the concentration of anticancer agents decreased under 1/10 of maximum concentration in the blood level of our conventionally clinical use.

A new approach to the treatment of malignant effusion

Lymphocytes isolated from malignant effusion were induced to become LAK cells after in vitro culture with rIL-2. 28 patients with malignant effusion were treated by i.p. or intrapleural administration of autologous LAK cells combined with rIL-2 or by rIL-2 alone. The effusion disappeared in 13 patients and significantly decreased in another 13. Two patients did not respond to the treatment. Tumor cells in effusion disappeared or significantly decreased and lymphocytes significantly increased in all responses. Except for transient fever in 9 patients, no serious side effects were found.

Interleukin-2 therapy for human cancer

The concept of immunotherapy is evolving from nonspecific, haphazard stimulation of the immune apparatus to more specific and controlled manipulation of the immune system. IL-2 gives the opportunity to exert influence on the cellular immune system. Why LAK cells are able to lyse tumor cells and leave normal cells intact is not known. How LAK cells behave after reinfusion is not known; are they able to migrate to tumor sites? Can improvements be made in scheduling in order to decrease toxicity and to enhance efficacy? But first of all, the question arises whether the tremendous efforts required by adoptive transfer, in terms of toxicity, logistics, and money, are outweighed by the therapeutic results. For clinical practice inside the frontier of oncology, continuous infusion of IL-2 at an intermediate dose is a quite attractive option in finding a balance between efforts and results.

Adoptive immunotherapy of human pancreatic cancer with lymphokine-activated killer cells and interleukin-2 in a nude mouse model

A pancreatic cancer cell line was grown in orthotopic and heterotopic positions in young Swiss/NIH nude mice, which were tested with adoptive immunotherapy. Mice were injected with 1 x 10(7) human cancer cells in the subcutaneous tissue and duodenal lobe of the pancreas. The mice were randomly divided into four groups: group IA (LAK + IL-2) (N = 25) received 2 X 10(7) human lymphokine-activated killer (LAK) cells from normal donors by tail vein injection followed by 10,000 units of human recombinant interleukin-2 (IL-2) given intraperitoneally every 12 hours for 28 days; group IB (IL-2) (N = 27) was given the same dose of IL-2 alone; group IC (RPMI-1640) (N = 18) received a placebo consisting of 1 ml of RPMI-1640 intraperitoneally every 12 hours; and group ID (LAK) (N = 14) received 2 X 10(7) LAK cells but no IL-2. Toxicity was significantly higher in group IB, with a mortality rate of 45.5% (10/22 animals) versus a 0% mortality (0/25) in group IA. None of the group IA or IB animals died of pancreatic cancer during the experiment. The animals that did not receive IL-2 died before 28 days in 14.2% of group IC and in 16.7% of group ID. The area under the growth curve of subcutaneous tumors during the course of treatment and the pancreatic tumor weight at the end of treatment were compared in each group. Subcutaneous tumors had a reduced rate of growth in group IA animals compared to all the other treatments. Pancreatic tumor growth was slowed in group IA. The animals treated with IL-2 alone (group IB) showed some slowing of tumor growth that was intermediate between group IA, group IC, and group ID. A similar experiment was done with irradiated (375 rad) mice. Nine nude mice with tumors were treated with LAK + IL-2 (group IIA), eight received IL-2 alone (group IIB), and seven received placebo (group IIC). The antitumor effect of IL-2 alone was not present in the irradiated mice. A highly significant difference persisted between group IIA and all other groups. There was no difference in the histologic characteristics of tumors in control mice and in mice with inhibited tumor growth treated with IL-2 or IL-2 and human LAK cells. These results show that adoptive immunotherapy with human LAK cells and human recombinant IL-2 is effective against human pancreatic cancer growing in nude mice. This effect is independent from antitumor activity from IL-2 administrations alone.

Intraperitoneal lymphokine-activated killer-cell and interleukin-2 therapy for malignancies limited to the peritoneal cavity

Autologous lymphokine-activated killer (LAK) cells and recombinant human interleukin-2 (rIL-2) were administered intraperitoneally (IP) to 24 patients with malignancies limited to the peritoneal space. Ten patients had ovarian cancer, 12 had colorectal cancer, and one patient each had endometrial carcinoma and primary small-bowel adenocarcinoma. All ovarian cancer patients, three of twelve colorectal cancer patients, and one patient with endometrial carcinoma had received prior therapy. Patients received IL-2 100,000 U/kg every 8 hours intravenously (IV) for 3 days, and 2 days later underwent daily leukapheresis for 5 days. LAK cells were generated in vitro by incubating the peripheral blood mononuclear cells in IL-2 for 7 days and were then administered IP daily for 5 days through a Tenckhoff catheter (Davol, Inc, Cranston, RI) together with IL-2 25,000 U/kg IP every 8 hours. All but one patient completed at least one cycle of therapy. Toxic side effects included minor to moderate hypotension, fever, chills, rash, nausea, vomiting, abdominal pain and distension, diarrhea, oliguria, fluid retention, thrombocytopenia, and minor elevations of liver function tests; all of these rapidly improved after discontinuation of IL-2. One patient had a grand mal seizure, and one suffered a colonic perforation; these were felt to be treatment-related. IP fibrosis developed in 14 patients and limited repeated cyclic administration of this therapy in five patients. Two of 10 (20%) ovarian cancer patients and five of 12 (42%) colorectal cancer patients had laparoscopy- or laparotomy-documented partial responses. We conclude that LAK cells and rIL-2 can be administered IP to cancer patients, resulting in moderate to severe short-term toxicity and modest therapeutic efficacy. Further investigation of this form of adoptive immunotherapy modified to address the problem of IP fibrosis and with lower IP IL-2 doses is justified by these initial results.

Therapy of renal cell carcinoma with interleukin-2 and lymphokine-activated killer cells: phase II experience with a hybrid bolus and continuous infusion interleukin-2 regimen

Forty-seven patients with metastatic or unresectable renal cell carcinoma were treated with interleukin-2 (IL-2) and lymphokine-activated killer (LAK)-cell therapy, using a hybrid IL-2 regimen. IL-2 was administered initially by intravenous bolus (10(5) U/kg [Cetus Corp, Emeryville, CA] every 8 hours for 3 days) during the priming phase, and subsequently by continuous infusion (3 x 10(6) U/m2 for 6 days); during this second treatment period, in vitro-generated LAK cells were administered. Despite selection of patients for good performance status (PS) (29, PS 0; 18, PS 1) prior nephrectomy (43 of the 47 patients), and low tumor burden, the response rate was low (two complete [CRs] and two partial responses [PRs], for an overall objective response rate of 9%). Toxicity was comparable to that experienced with the high-dose bolus regimen. These results suggest that the dose and schedule of IL-2 administration may influence the likelihood of response to IL-2 in renal cell carcinoma.

Preparative cytoreductive surgery in patients with metastatic renal cell carcinoma treated with adoptive immunotherapy with interleukin-2 or interleukin-2 plus lymphokine activated killer cells

A total of 63 patients with metastatic renal cell carcinoma with the primary kidney tumor in place was accepted as candidates for immunotherapy at the Surgery Branch of the National Cancer Institute. Of the 63 patients 54 underwent nephrectomy and 9 were treated with the primary kidney tumor in place. Many of the patients underwent associated procedures, such as regional lymphadenectomy (11), venacavotomy with extraction of tumor thrombus (9), hepatic resection (2), pulmonary wedge resection (2), cholecystectomy (2), splenectomy (2), distal pancreatectomy (1), omentectomy (1) and contralateral adrenalectomy (1). Of the 54 patients 20 were not able to enter therapy because of tumor-related (17) or other medical (3) reasons that developed between the operation and therapy, while 34 were able to receive immunotherapy postoperatively. The 20 patients who were treated with either high dose interleukin-2 or interleukin-2 plus lymphokine activated killer cells soon postoperatively (mean 2.1 months) were able to tolerate roughly the same amount of interleukin-2 as the 74 who had undergone nephrectomy before referral to our institute and who were treated for a mean of 22 months after nephrectomy. Further studies, including a prospective, randomized trial, will be required to define the role of nephrectomy in patients with advanced renal cell carcinoma before treatment with interleukin-2 based immunotherapies.

Monoclonal antibody therapy of murine lymphoma: enhanced efficacy by concurrent administration of interleukin 2 or lymphokine-activated killer cells

Lymphokine-activated killer (LAK) cells have recently been shown to be very efficient effector cells for antibody-dependent cellular cytotoxicity. Thus, we explored, in a murine lymphoma model, administration of LAK-inducing doses of interleukin 2 (IL-2) or adoptive transfer of LAK cells as a means of enhancing therapy with tumor-specific monoclonal antibody (mAb). AKR/Cum (Thy-1.2+) hosts were inoculated on day 1 s.c. with the SL-2 thymoma of AKR/J origin (Thy-1.1+) and developed palpable tumor on day 4. Tumor-specific anti-Thy-1.1 IgG2a mAb, 1A14, was given on days 4 and 8 with 50,000 units/day IL-2 i.p. divided in two doses on days 4-12. Therapy with IL-2 or mAb alone had minimal activity, prolonging control median survival of 22 days to 25 and 29 days, respectively, whereas therapy with IL-2 plus mAb significantly prolonged median survival to 40 days. However, combined therapy did not result in cures and long term survival. The efficacy of combined therapy did not result from alterations in the biodistribution of mAb by concurrent IL-2 infusions, as determined by studies with radiolabeled mAb. The combined effect of in vitro generated LAK (10(8) cells) adoptively transferred i.v. with 1A14 on days 4 and 8 following SL-2 inoculation was also evaluated. This regimen had no detectable toxicity, and treatment of mice with LAK and mAb resulted in 60% long term survival compared with 17% or 0% for mice treated with mAb or LAK alone. Thus, the therapeutic effects of tumor-specific mAb was enhanced by in vivo administration of IL-2 or by adoptively transferred LAK, which may represent means to provide the host with increased antibody-dependent cellular cytotoxicity effector cells. Adoptively transferred LAK has the additional benefit of augmenting mAb therapy of tumor without the toxicity associated with the induction of such cells in vivo with high dose IL-2.

[Experimental study on the optimal treatment schedule for combination of BRM (immunostimulators, cultured killer cells or interleukin-2) and chemotherapy]

In the present study we tried to reevaluate the optimal combination timing in the experimental treatment with BRM and chemotherapeutic agents. BALB/c mice with advanced malignant ascites tumor (MOPC 104 E) were treated with cyclophosphamide (CPA, 2 mg/kg) and BRM such as immunostimulator (OK-432, Lentinan or Bestatin), interleukin-2 (IL 2) or cultured killer cells. The survival of mice was prolonged when immunostimulators were given before CPA. However, no combined effect was seen when immunostimulators were administered after CPA. Treatment with cultured killer cells and in vivo IL 2 after immunochemotherapy (immunostimulator followed by CPA) was the most effective protocol in which immunostimulator, chemotherapy, killer cells and IL 2 respectively seemed to induce, regulate, supplement and amplify anti-tumor effector cells.

[Tumoricidal biological response modifiers (BRM)]

TNF, IFN, LT and IL-1 are well-known biological response modifiers (BRM) with cytocidal activity. Whereas carcinostatic agents generally derive their cytocidal action from their direct mutual reaction with target molecules (e.g., DNA, RNA), the cytocidal action of BRM resides in the enzyme response which ensures upon their binding to receptors. Accordingly, concomitant use of these drug of differing mechanism of action has a rationale. Considering that a certain kind of counteracting protein is present in cancer cells which are refractory or resistant to such cytokines, combination therapy with carcinostatic agents with inhibitive activity against such protein is also justified. In the same context the effects of TIL and LAK activated by IL-2 could be enhanced if the immune system should be modulated by combined use of BRM and carcinostatic agents such as CY. This paper discusses the results obtained with BRM and carcinostatic agents in combination in animal models and clinical cases.

[Bases on timing of combined modality of chemotherapy and immunotherapy]

Chemoimmunotherapy with anticancer drugs and immunoregulatory drugs and cytokines is a logical combination of 2 forms of therapy that have different mechanisms of action and no overlapping toxicity. Generally, anticancer drugs show rapidly the strong suppressive effect on tumor growth but also on host hemato-immunological functions. On the other hand, immunotherapy demonstrate the potential of restoring the hemato-immunological dysfunction of chemotherapy as well as the gradual antitumor effect through activating host defense mechanisms against cancer, indicating that these therapeutic modalities are complementary. On these biological rationale of chemoimmunotherapy mentioned above, we have demonstrated that immunostimulant, Nocardia-CWS is capable of producing tumoricidal macrophages being different from anticancer drugs in cytotoxic mechanism against cancer, and also that macrophage tumoricidal activity is significantly suppressed by exposure to anticancer drug, mitomycin C. Another beneficial activity of immunostimulant showed in our previous studies is a capability of production of colony stimulating activities. In a cooperative study with lung cancer patients it has been shown that recovery of leucopenia after chemotherapy is accelerated by administration of immunostimulant, MDP-Lys. Recently, immunomodulatory lymphokine, IL-2, has been clinically used for induction of activated killer lymphocytes (LAK cells) with tumoricidal activity. According to our studies, however, anticancer drug, when administered to cancer patients or added directly to culture of lymphocytes with IL-2 for LAK induction, shows significant suppressive effect on LAK induction. Considering these experimental and clinical studies, it can be concluded that immunotherapy, when employed as adjuvant after chemotherapy, play the important roles not only in eradication of tumor cells being escaped from chemotherapy but also in prevention of infections complication by activating host defense mechanisms common to cancer and infection.

Adoptive immunotherapy with adherent lymphokine-activated killer (A-LAK) cells in glioblastoma multiforme

Adherent lymphokine-activated killer (A-LAK) activity has been recently differentiated in recombinant interleukin-2 (rIL-2) activated PBL. A pilot study on A-LAK + rIL-2 injection into the post-surgical cavity of glioblastoma-operated patients is ongoing. Preliminary data support the feasibility of this technique, which may improve the antitumor response of the host.

[Receptor-mediated cancer therapy--tumoricidal cytokines, adoptive therapy of LAK, TIL]

Three modes of receptor-mediated cancer therapy were reviewed presenting our own data. Employment of tumoricidal cytokines (IFN, TNF, LT) to this type of therapy has been expected to be the most promising approach. However, preclinical and clinical results so far obtained, revealed that they were useful only for the very limited diseases including renal cancer or some hematological malignancies. Second approach is to utilize growth factors conjugated with toxin or carzinostatin which are readily internalized into tumor cells. In this context, transferrin-neocarzinostatin was examined in our laboratory both in vitro and in vivo for its anticancer activity and was found to suppress tumor growth more significantly than neocarzinostatin alone on the basis of molar ratio. Thus this approach may be worthy to be clinically investigated. Adoptive therapy of lymphokine activated killer (LAK) or tumor infiltrating lymphocyte (TIL) may also be categorized into receptor mediated cancer treatment since both are activated by signals through IL-2 receptor. Although clinical evaluation is still on going, the therapy appears to be effective only when effector cells are administered locally to tumors.

Cure of murine Ehrlich ascites tumors with chronic oral indomethacin therapy combined with intraperitoneal administration of LAK cells and IL-2

We have shown that prostaglandin E2-(PGE2) mediated inactivation of all killer lineage cells is a common event in the tumor-bearing host, so that chronic indomethacin therapy (CIT) combined with multiple rounds of IL-2 cures spontaneous and experimental metastases of a variety of murine tumors by activating killer cells in situ. Ehrlich ascites tumor (EAT) is fatal for any mouse strain even with a small i.p. inoculum. We compared the therapeutic efficacy of chronic indomethacin therapy (CIT), CIT + interleukin-2 (IL-2), IL-2 + lymphokine activated killer (LAK) cells and CIT + IL-2 + LAK cells on EAT grown in CBA mice. CIT alone retarded tumor growth and stimulated cytotoxic activity in splenocytes as well as tumor-infiltrating lymphocytes against YAC-1 lymphoma and EAT targets but resulted in no cure. The therapeutic efficacy in prolonging the median survival improved in the following order: CIT less than IL-2 + LAK cells less than CIT + IL-2 less than CIT + IL-2 + LAK cells. The last regimen cured 90% of mice and resulted in a short-lasting immunity against a second tumor challenge in some of the animals. Thus, this triple combination therapy may hold promise for eradicating carcinomatous ascites in the human.

[Effects of T cell subsets on mouse herpetic keratitis]

Immune splenocytes were obtained from C3H/He mice, which had been inoculated with herpes simplex virus (HSV) type 1 by the corneal route 6 or 12 days previously, and restimulated by lipopolysaccharide-induced lymphoblasts infected with HSV. These cells were either not treated or treated with anti-L3T4 antibody plus complement/anti-Lyt-2 antibody plus complement, and were transferred to subconjunctiva of mice with HSV corneal infection. Adoptive transfer of non-treated cells diminished corneal ulcers, when the splenocytes were transferred from mice inoculated 12 days previously. This effect was reduced by depletion of Lyt-2 bearing cells, but not reduced by depletion of L3T4 bearing cells. Adoptive transfer of splenocytes from mice inoculated 6 days previously did not diminish corneal++ ulcers. These findings demonstrate that HSV specific cytotoxic T lymphocytes (CTL) play an important role in the late phase of recovery from HSV corneal infection.

A high density cell culture system for generation of human lymphokine-activated killer (LAK) cells for clinical use in adoptive immunotherapy

A high density cell culture system has been developed for large-scale production of lymphokine-activated killer (LAK) cells from peripheral blood lymphocytes (PBLs) of malignant tumor patients. The system consists of a culture bag, which has two compartments separated by a semipermeable membrane, and an external rotator. The system allows for a long-term, at least 4 weeks, culture of LAK cells at high cell density in the inner compartment. The collected PBLs were first divided between the two culture bags and cultured without harvesting for 7-10 days to obtain LAK cells. Half of the LAK cells from each bag was administered to patients twice a week for clinical trials. Culture of the remaining half was continued following addition of a fresh culture medium. LAK cells were transferred to patients alternatively from each bag for the following 2-3 weeks. The total number of LAK cells administered amounted to 3.9-9.8 (mean 5.8) times more than the PBLs collected by leukapheresis (n = 10). The 5 x 10(6)/ml of PBLS of the initial concentration reached a maximum of 2 x 10(7)/ml. Our system does not need for a CO2 incubator. Cytotoxicity of the LAK cells was evaluated in 4 hr 51Cr release assays. Mean cytotoxicity at maximum cell density was 95.4 +/- 3.2% against ONS-12 (a human glioma cell) and 84.8 +/- 3.0% against Daudi cells (n = 10), but gradually decreased to about 50% at the end of fourth week of the culture period. Cell viability of the LAK cells was normally over 80% through the entire culture period.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation between clinical response to interleukin 2 therapy and sustained production of tumor necrosis factor

Twenty-five previously untreated patients with metastatic renal cell carcinoma were treated with 5-day cycles of continuous infusion of interleukin 2 (IL2) and lymphokine-activated killer cell reinfusion. Five achieved a partial response. Three patients were found to have detectable tumor necrosis factor (TNF) in serum before initiation of therapy. On the fifth day of therapy, 24 patients had circulating TNF with immunoradiometric assay whereas 13 had detectable biological activity. Two days after the end of IL2 therapy, TNF concentration (immunoradiometric assay) decreased in most cases but was still detectable in 17 patients. Thirteen patients had still circulating TNF bioactivity. Although there was no significant difference between TNF levels observed on the fifth day of therapy in the responder and nonresponder groups, 48 h after the end of IL2 infusion, both the TNF concentration and the biological activity were significantly higher in the group of responder patients. This result suggests that the clinical response to IL2 therapy in patients with metastatic renal cell carcinoma is correlated to a sustained production of TNF after the end of IL2 infusion.

An explanation of the variable clinical response to interleukin 2 and LAK cells

Adoptive immunotherapy for the treatment of cancer has met with limited but, for some, encouraging success. A minority of malignant melanoma and renal cell carcinoma patients respond to therapy with interleukin 2 (IL-2) or IL-2 plus lymphokine-activated killer (LAK) cells. The mechanism of response, and the reasons for the variation within disease groups, is not clear. In this article, Giorgio Parmiani proposes that successful adoptive therapy is dependent on the recruitment of activated host antitumor T lymphocytes and suggests that this explains the greater efficacy of tumor-infiltrating lymphocytes in combating melanoma and renal cell carcinoma.