Decreased monocyte function in patients with Hodgkin's disease

Immunologic dysfunction in cancer

The interactions between the tumor and its host are complex, and many aspects of the immune system appear to be adversely affected directly or indirectly by the presence of the tumor. Virtually all of the processes involved in immune induction and action have been implicated in the observed deficient response in tumor-bearing patients. Improved understanding and molecular analysis of the mechanisms underlying the escape of tumors from immune surveillance may lead to the development of novel strategies for the prevention of T-cell immunosuppression in cancer patients, the development of novel immunotherapeutic strategies, and potentially prevention of tumor progression or development.

Increased luminol-enhanced chemiluminescence of blood monocytes and granulocytes in Hodgkin's disease

The oxidative metabolic burst of blood monocytes and polymorphonuclear leukocytes (PMN) from 22 untreated patients with Hodgkin's disease (HD) and 18 healthy subjects were studied. Monocytes and PMN were enriched by density centrifugation and in vitro activated by zymosan. The oxidative metabolism was measured by luminol-enhanced chemiluminescence (CL). The CL of the patients' monocytes and PMN was higher than that of controls (P less than 0.01 and P less than 0.05, respectively). Patients with stage II-IV HD showed an increased blood monocyte CL as compared with stage I patients (P less than 0.05). Furthermore, patients with lymphocytic depletion or mixed cellularity subtype demonstrated an increased CL of PMN as compared with the remainder. Enhanced CL of phagocytes has been observed in chronic inflammatory disease and can be induced by various serum factors such as monokines and immune complexes. The present study demonstrates an increased CL of blood-borne phagocytic cells in untreated HD. Furthermore, CL of blood monocytes and PMN correlated to tumour burden and histologic subtype, respectively.

Ultrastructural morphometry of human leucocytes in health and disease

In this review, the literature on ultrastructural morphometry of each of the main types of human blood leucocytes has been considered, together with the technical and numerical procedures essential for valid analysis. Quantitative data have been reported for these cell types in health and comparisons have been made with those in disease states. In monocytes, and in macrophages developing from them, subtle ultrastructural differences have been detected and quantitated in malignant lymphoma; as the mononuclear phagocytes were not themselves neoplastic, the changes may have related to defects in host defence. Change in the ultrastructural characteristics of leukaemic monoblasts have also been reported. Lymphocytes and malignant lymphoid cells have been extensively investigated: differences between different types and subsets have been shown to be present in both normal lymphocytes and their malignant counterparts in leukemias and lymphomas. Particular attention has been paid to morphometric assessment of nuclear shape and size in these disorders and to its possible value as a diagnostic tool. Granulocytes have so far been the subject of few morphometric studies, although in hypereosinophilic syndrome, cellular changes have been defined and have thrown light on the abnormal pattern of degranulation. There have also been scattered reports on the cells of acute myelogenous leukaemia. The use of computers and sophisticated statistical packages has greatly facilitated the application of multiple comparison procedures and has permitted discriminant analysis to be carried out where appropriate. This review shows that ultrastructural morphometry of leucocytes will have an increasing application in clinical pathology.

Impaired release of colony stimulating activity by monocytes from Hodgkin's disease in response to phorbol myristate acetate activation

We assessed the humoral effect of resting and phorbol esters preincubated monocytes from Hodgkin's disease patients (HDMo) and healthy subjects (nMo), on granulocyte progenitors (CFU-dG) growth using a double diffusion chamber technique. The release of colony stimulating activity and indomethacin-dependent inhibitors by resting HDMo and nMo was found to be cell-concentration dependent. However, phorbol myristate acetate preincubated HDMo (PMA-HDMo) in contrast to nMo at low concentrations (2.5 x 10(4] were unable to increase the CFU-dG growth stimulation. On the other hand, at a higher cell number (5 x 10(4], phorbol treated HDMo stimulated the myeloid colony formation, whereas nMo suppressed the CFU-dG proliferation. Further enhancement of HDMo and nMo concentrations induced a pronounced inhibition of CFU-dG-derived colony formation, caused by an increased PGE2 production. After incubation with the cyclooxygenase inhibitor-indomethacin, PMA-HDMo showed considerably more granulocyte colony formation than nMo. Our results suggest that the observed abnormalities in the function of HDMo could be associated with an excessive production of PGE2 and a general dysfunction of these cells in Hodgkin's disease.

Dysfunction of monocytes in Hodgkin's disease by excessive production of PGE-2 in long-term remission patients

The candidacidal activity and the production of oxygen radicals by monocytes were investigated in untreated and long-term remission patients with Hodgkin's disease (HD). Both groups showed a decreased candidacidal function of monocytes with a chemiluminescence (CL) response significantly lower and delayed with respect to normal controls. Indomethacin at 1 microgram/ml corrected the monocyte deficiency increasing the CL response to normal values and normalizing the kinetics in the untreated patients. However, in patients in remission, the peak was delayed and followed by a significant increase in the production of oxygen radicals compared with untreated patients. A direct linear correlation was found between the percentages of lysed Candida and maximum CL peak of stimulated monocytes. When prostaglandin E2 (PGE-2) levels, measured in supernatants of cultured mononuclear cells, were plotted against the percentages of killed Candida, an inverse linear correlation was found. Therefore, monocytes from HD patients have a dysfunction in the generation of oxygen radicals and a decreased candidacidal activity associated with excessive production of PGE-2. Indomethacin can correct the oxidative metabolism in the untreated patients while in apparently "cured" patients the disorder persists.

Morphometry of blood monocytes in malignant lymphoma

Morphometric methods were used to study the ultrastructure of blood monocytes in 23 patients with Hodgkin's disease, 12 patients with non-Hodgkin's lymphoma, and 20 normal subjects. The results were analysed using both univariate and multivariate methods. Both analyses supported the interpretation that the total mitochondrial contribution to the cellular ultrastructure was less in Hodgkin's disease than in the other two groups, with smaller mitochondrial volume fractions, volumes, and surface areas being found. In the patients with non-Hodgkin's lymphoma univariate analysis suggested that monocyte nuclei were larger, with more euchromatin and a relatively smaller heterochromatin-euchromatin interface; the cell profile area was larger and the surface to volume ratio was smaller compared with normal subjects. Morphological changes have not previously been described in blood monocytes in malignant lymphoma, but they may be the counterpart of the known mononuclear phagocyte dysfunction.

Increased production of mononuclear cell procoagulant activity in Hodgkin's disease

Procoagulant activity of peripheral blood mononuclear leucocytes was studied in 24 consecutive patients with Hodgkin's disease. Mononuclear cells, tested immediately after isolation, expressed very low activity which was, however, somewhat higher than that of cells from a matched control group (P = 0.063). Procoagulant activity generated by patients' mononuclear cells following stimulation with bacterial endotoxin was significantly higher than that produced by control cells (P less than 0.01). There was no apparent relation between procoagulant activity and pathological staging. The increased capacity of mononuclear phagocytes to produce procoagulant activity might help explain activation of blood coagulation and subsequent fibrin deposition in patients with Hodgkin's disease.

Evaluation of methods using adherence to substrate and density gradient for the isolation of human monocytes

A new method for monocyte isolation based on cell adherence to gelatin-coated plastic and dislodgement of the adhering monocytes at low temperature was compared with 5 other methods based on cell adherence to substrate and density gradient separation. All methods produced yields of monocytes ranging approximately between 50-70% with about the same degree of purity (less than 90%) except for the method using Percoll density gradient centrifugation where the purity of monocytes was about 80%. When lidocaine at different concentrations was used for cell dislodgement or Percoll density gradient for separation, phagocytosis, Fc receptor function and cytotoxicity were adversely affected, unlike in methods using EDTA or low temperature for dislodgement of the adherent cells. In monocyte chemotaxis assays the rate of migration was affected but not the number of migrating cells for all the isolation procedures investigated. Cell spreading function was apparently well maintained only when gelatin coated plastic was used for adherence and low temperature for cell dislodgement. These data indicate that the newly described method, similar to methods using EDTA for cell dislodgement, yielded relatively intact monocytes but unlike the latter method with better preserved cell spreading. Thus, this method can be considered for standardization to obtain pure monocyte populations from peripheral blood which then can be submitted for comprehensive biochemical and physiologic studies.

Increased antibody-dependent cytotoxicity mediated by purified monocytes in Hodgkin's disease

Monocyte antibody-dependent cytotoxicity was studied in 19 patients with Hodgkin's disease and 14 normal controls. This function was investigated after isolation of the monocytes by means of a modified elutriation technique. Direct sizing and counting of the cells present in the effluent enabled individual adjustment during each separation procedure. The absolute monocyte count in the peripheral blood of patients with Hodgkin's disease was higher (P less than 0.002) than in normal controls. Nearly 90% pure monocyte suspensions, representing 82% of all elutriated monocytes, were obtained. The elutriation characteristics of the monocytes in both groups were essentially the same, irrespective of marked interindividual differences. Kill of antibody-coated chicken red blood cells was measured by DNA flow cytometry. In comparison to normal controls, a significantly increased (P less than 0.0004), stage-independent, monocyte antibody-dependent cytotoxicity was found in patients with Hodgkin's disease. The percentage of kill in symptomatic patients tended to be higher than in the asymptomatic group; no correlation was found with the absolute number of circulating monocytes.

[Adenosine deaminase activity in Hodgkin's disease (author's transl)]

The activity of adenosine deaminase (ADA) (EC3.5.4.4.) was determined in the blood plasma, erythrocytes, and lymphocytes of 23 patients with Hodgkin's disease and partly also in 99 control subjects. The enzyme activities were measured using adenosine as substrate and by analysis of ammonia. No correlation was found between the ADA activities in lymphocytes, erythrocytes, and blood plasma. The lymphocytes of the patients revealed lower ADA activities (U/g protein) than the lymphocytes of control subjects. The ADA activity is not reduced in plasma or erythrocytes. The lower activities of ADA in the lymphocytes of patients may be related to the impaired cell-mediated immunity of the Hodgkin's disease.

Neutrophil function in advanced Hodgkin's disease: effect of therapy

Whole-blood techniques were used to study neutrophil migration and uptake and killing of Candida in patients with advanced (Stages IIIB and IV) Hodgkin's disease (HD). In order to assess the effect of therapy on neutrophil function, 17 patients were studied either before treatment or on days 1, 8 and 14 of successive cycles of chemotherapy. Neutrophil migration was reduced in 20% of patients, and was largely corrected by normal control plasma. Phagocytosis was normal but killing was reduced in most patients; this reduced killing was not corrected by normal control plasma. Neither chemotherapy nor previous splenectomy had any effect on neutrophil function. It is concluded that defective neutrophil killing, attributable to an intrinsic defect of the cell, is a consistent feature of advanced HD and that a similar defect is present before and after therapy.

Macrophage-histiocyte lysozyme activity in relation to the clinical presentation of Hodgkin's disease. An immunohistochemical study

The clinical presentation of 71 untreated patients with Hodgkin's disease was studied in relation to immunohistochemically demonstrable lysozyme in the lymph node biopsy material. Sixty-one patients (86%) showed a positive staining reaction of varying degree, while ten (14%) showed no demonstrable lysozyme. The clinical features of lysozyme-positive patients differed markedly from those of lysozyme-negative patients. Stain-positive patients were younger (29 vs. 46), were more often in clinical Stage I or II disease (69% vs. 10%, P less than 0.001), and less frequently had constitutional symptoms (34% vs. 70%, P less than 0.02). Moreover, within the stain-positive group, patients who had the most intense staining reaction (mottling pattern) also had the most favorable clinical and histopathologic features at the time of diagnosis. The observations suggest that in Hodgkin's disease the lysozyme secretory activity of macrophage-histiocytes may be an important element of host resistance to neoplasia and that a depression of this secretory activity corresponds with disseminated disease.

Hodgkin's disease: pathology and pathogenesis

The pathogenesis of Hodgkin's disease has been the subject of intensive investigation for nearly a century. Numerous lines of inquiry have been pursued and the resulting quantity of literature on the subject attests to the enigmatic nature of the disease. Periodically, it becomes prudent to review progress in the study of a disease such as this, in light of recent methodologic and conceptual advances. By so doing, a more integrated view of the disease process may emerge, thereby guiding future research endeavors. The present report is undertaken to explore, in depth, recent advances in the study of the pathology and pathogenesis of Hodgkin's disease. Contemporary classifications, clinicopathologic and epidemiologic studies, cellular and humoral derangements, and the controversial nature of the Reed-Sternberg cell are considered.

Cytotoxicity to tumor cells of monocytes from normal individuals and cancer patients

This study was aimed at characterizing the parameters which regulate human monocyte-mediated cytotoxicity to tumor cells as well as characterizing the target cell specificity, kinetics, etc., of the cytotoxic mechanism. Normal human peripheral blood monocytes were cytotoxic to tumor cells in an in vitro assay, measuring release of [3H] thymidine from human target cells. Monocyte cytolysis was observed with several adherent tumor lines including T24, a bladder cancer line; LR, a melanoma line; and an SV40-transformed W138 fibroblast line, with maximal cytolysis observed at 72 h. Lymphokines were not required to induce and only infrequently enhanced monocyte cytotoxicity. Prolonged exposure of monocytes to lymphokines or in vitro culturing of monocytes prior to lymphokine exposure did not alter the monocytes response to lymphokine signals with respect to cytotoxicity. Lymphokines induced monocytes to exhibit enhanced spreading, suggesting that monocytes were susceptible to lymphokine signals but that the development of cytolytic function was independent of lymphokines. In contrast to the cytolysis of adherent tumor cells, monocytes were less effective in killing the non-adherent lymphoid target cells K562, Raji, and CEM. Monocytes were selectively cytotoxic to tumor cells and generally did not kill normal human fibroblast cell lines or PHA-stimulated lymphocytes. Monocytes from cancer patients exhibited normal cytotoxicity to several human tumor lines. Plasmas from some cancer patients were inhibitory to cytotoxicity mediated by both autologous monocytes and normal monocytes.

Effect of antineoplastic drugs on human leukocyte-mediated cytotoxicity against herpes simplex virus infected cells

We evaluated the effect of five antineoplastic drugs on the ability of human leukocytes to destroy herpes simplex virus (HSV) infected target cells in the presence of antibody (antibody-dependent cellular cytotoxicity) and in its absence (natural killer cytotoxicity). Leukocytes from healthy volunteers were separated into macrophages, polymorphonuclear leukocytes, and lymphocytes. Adriamycin, cyclophosphamide, prednisone, procarbazine, and vincristine, at various concentrations and incubation periods, were tested for their effects on the natural killer and antibody dependent cellular cytotoxicity of macrophages, lymphocytes, and polymorphonuclear lymphocytes in a 51Cr release microcytotoxicity assay against HSV-infected cells. All drugs at therapeutic concentrations inhibited natural killer and antibody dependent cellular cytotoxicity; an exception was cyclophosphamide, which did not inhibit the natural killer cytoxicity of lymphocytes. The antibody dependent cellular cytotoxicity of macrophages and polymorphonuclear leukocytes appeared to be more than that of lymphocytes. The results of short incubation (2 hours) of the drug with either effector cells or target cells, followed by drug removal, suggests that the drug effect occurred early and predominantly at the effector cell level. Antineoplastic drugs had an inhibitory effect on natural killer and antibody dependent cellular cytotoxicity against HSV-infected cells. This inhibitory action may partially explain the increased susceptibility of patients receiving chemotherapy to developing viral infections.

Increased monocyte-mediated antibody-dependent cellular cytotoxicity (ADCC) in Hodgkin's disease

Monocyte-mediated antibody-dependent cellular cytotoxicity (ADCC) was tested in 23 patients with histologically proven Hodgkin's disease and 29 healthy normal controls. Seven patients presented with active and 16 with inactive disease. The lytic capacity of the individual monocytes was significantly (P < 0.02) higher in patients with Hodgkin's disease than in normals. However, no significant difference was found between the numbers of monocytes in both groups of individuals, as determined by non-specific esterase staining. No correlation was found between the lytic capacity of monocytes and the activity of the disease.

Hodgkin's disease

During the past two decades, new approaches to the diagnosis and treatment of Hodgkin's disease have contributed to improved rates of survival and probable cure. Currently, patients with Hodgkin's disease are treated according to the stage and symptoms of their disease. The degree of certainty necessary for determining stage depends on the potential effectiveness of the therapeutic options available in a given case. Certain cases have been identified where treatment with a single modality has been disappointing, and the use of both radiotherapy and chemotherapy may be considered for these. Such decisions can be made only by evaluating the effectiveness of salvage after relapse following single-modality treatment and assessing the added hazards of initial treatment with both modalities.

The immunopathology of Hodgkin's disease

Answers are beginning to emerge to the questions posed in the introduction to the preceding section. In vitro techniques that allow characterization of malignant cells have particular relevance when, as in Hodgkin's disease, the precise identity of the cells remains in doubt. Monolayer tissue cultures derived from Hodgkin's disease tumours and maintained as established cell lines have proven amenable to a variety of cytogenetic, immunological, enzymatic, and ultrastructural studies. Tissue culture experiemnts, in conjunction with meticulous immunological studies of individual Reed-Sternberg cells from non-cultured tumours, suggest that neoplastic cells of Hodgkin's disease are related to, and possibly derived from, cells of the monocyte-macrophage system. The lymphocytes that comprise an integral part of the cellular proliferation and form the basis for histological subclassification of the tumour could be a manifestation of cell-mediated immunity against this non-lymphoid malignant cell. The immunodeficiency of patients with untreated Hodgkin's disease of limited anatomical extent is not the primary event of the disorder and probably not related to the site at which the aetiological agent acts. The deficit does not result solely from impaired T-cell function and appears to arise as a consequence of excessive suppressor cell activity. Inhibitory monocyte-lymphocyte interactions may be one of the causes of defective cell-mediated immunity in Hodgkin's disease. The possible significance of elevated levels of circulating immune complexes in the serum of patients with Hodgkin's disease is indicated by the finding that such complexes react with cells of long-term monolayer tissue cultures derived from the tumour. Circulating immune complexes may be one source for intracellular immunoglobulin in non-cultured Hodgkin's disease cells. The presence of polyclonal immunoglobulin G on the membrane and within the cytoplasm of Reed-Sternberg cells could be due to in vivo binding and ingestion of immune complexes by such cells. The specificity of the interaction between soluble complement-containing immune complexes and neoplastic cells of Hodgkin's disease depends on the nature of the complexed antigen. The complexes could non-specifically attach via an Fc receptor or, if the complexed antigen is identical to a tumour cell antigen, the binding could be specific. If the immune complexes are tumour specific they could provide a source for isolation and identification of tumour-associated antigens. However, the aetiological significance of antigens and putative oncogenic viruses thus far identified in association with Hodgkin's disease remains to be clarified.

Pathophysiological aspects of Hodgkin's disease

Hodgkin's disease is characterized by unique features setting it apart from other malignancies. Clinically, systemic symptoms are often prominent and spontaneous remissions may be seen. As major immunological aberrations, a reactive humoral response with hypergammaglobulinemia and a depression of cell-mediated immunity are observed. Pathologically, the diagnosis is based on the presence of pleomorphic morphology; this consists of an infiltrate of reactive inflammatory cells sometimes forming granulomatous lesions with or without varying numbers of the cells presumed to be malignant. The nature of these malignant cells remains undefined, with data supporting mainly B-cell, but also macrophage origin. Clear-cut evidence for monoclonality is available only in prognostically unfavourable histological forms.

[Hodgkin's disease. Results in diagnosis and treatment (author's transl)]

Optimal treatment in Hodgkin's disease requires the knowledge of the stage the disease has reached. Laboratory tests, x-ray and scintigraphy, usually, are not sufficient, but biopsies of bone marrow and liver are necessary, in special cases supplemented by laparoscopy or explorative laparotomy with splenectomy. As treatment of choice, irradiation is favored for disease restricted to lymph nodes, and cytostatics for disease complicated by severe symptoms or by organ involvement. Diagnosis and therapy should be adapted to the individual patient. New therapeutic approaches must be compared with the sometimes excellent results obtained by several institutions.