Antibody-dependent cell-mediated cytotoxicity in human cancer: characterization of patient leukocyte activity and treatment effects

Antibody-Dependent Cellular Cytotoxicity in Some Lymphoreticular Diseases

Antibody-dependent cellular cytotoxicity mediated by K cells against chicken erythrocytes was measured in 113 patients with malignant lymphoreticular disorders and compared with 230 controls. The results were expressed as the specific cytotoxicity of a fixed number of cells and also by cytotoxic capacity, which measures the number of cytolytic units in 1 ml of blood. The values for cytotoxic capacity were normal in the group of untreated patients with non-Hodgkin's lymphomas, multiple myeloma or chronic lymphocytic leukemia and in most of the patients with Hodgkin's disease or acute lymphoblastic leukemia. However, decreased specific cytotoxicity was observed in these same lymphoid leukemia patients, which may be due to dilution of effector cells. The effect of chemotherapy in reducing K-cell activity is more evident in patients with multiple myeloma, followed by patients with Hodgkin's disease, and finally by patients with non-Hodgkin's lymphomas. No case of K-cell neoplastic disease was observed in this series.

m17-1A-, c17-1A- and cSF25-mediated antibody-dependent cell-mediated cytotoxicity in patients with advanced cancer

The anti-tumour antibody-dependent cell-mediated cytotoxicity (ADCC) capacity of the conventional antibody m17-1A was compared with its chimerised analogue c17-1A and a newer chimeric antibody, cSF25, specific for colonic adenocarcinoma. The results (AUC units +/- s.e.m., control versus cancer) show that mononuclear cells from patients with adenocarcinoma mediate ADCC as efficiently as those from controls for m17-1A (143 +/- 14 vs 153 +/- 14), c17-1A (174 +/- 16 vs 189 +/- 14) cSF25 (215 +/- 18 vs 237 +/- 13) and effectors and targets alone (57 +/- 9 vs 51 +/- 8). Both chimeric antibodies mediated ADCC more effectively than m17-1A with cSF25 consistently producing the highest lysis. Furthermore, more efficient ADCC was found to correspond with monocyte activation examined flow cytometrically. The results (mean channel fluorescence) show that HLA-DR expression is increased with c17-1A (1436 +/- 200) and cSF25 (2252 +/- 298) above that observed when effectors and targets were incubated alone (1157 +/- 168) or with m17-1A (1286 +/- 170). Similarly, interleukin 2 receptor (IL-2R) expression (percentage of positive cells) was augmented in the presence of m17-1A (15 +/- 3), c17-1A (14 +/- 3) and cSF25 (25 +/- 3) when compared with no antibody (9 +/- 2). We discuss the possibility that the superior ADCC activity of chimeric antibodies, especially cSF25, may be due to increased monocyte activation.

Phase II study of vindesine and dacarbazine with or without non-specific stimulation of the immune system in patients with metastatic melanoma

A single dose of dacarbazine (DTIC), followed by a 5-day intravenous infusion of vindesine (VDS) was administered every 3 weeks to 103 patients with metastatic melanoma. One half of the patients were randomised to receive intravenous methanol extraction residue (MER) of bacillus Calmette-Guerin (BCG) in addition to chemotherapy, on days 7 and 14 of each course. 98 patients were evaluable. The response rates in treatment groups were 16 and 17%, respectively (confidence interval 9-24%). Neither the response rate nor the survival improved when MER was added to chemotherapy. Toxicity was moderate except for a significant granulocytopenia. The combination of DTIC and VDS is not more effective than DTIC alone and has added neurotoxicity.

Antibody-dependent cell-mediated cytotoxicity using a murine monoclonal antibody against human colorectal cancer in cancer patients

Antibody-dependent cell-mediated cytotoxicity (ADCC) mediated by a murine monoclonal antibody against human colorectal carcinoma, antibody 19-9, with human effector cells was tested in 33 patients with various carcinomas, 16 patients with benign lesions, and 13 normal controls, using a 12-h 51Cr release assay using human colorectal cancer cells as targets. Peripheral blood mononuclear cells (PBM) from these groups of patients and normal controls achieved moderate levels of target cell lysis in the presence of the monoclonal antibody at the high effector to target cell ratio of 200:1. The ADCC activity of PBM in cancer patients was significantly higher than that in either normal persons or patients with benign lesions. Since the ADCC was shown to be mainly mediated by adherent monocytes in the PBM, ADCC activity of monocytes from cancer patients was compared to those from control groups at an effector to target cell ratio of 30:1. The results also showed that the lytic capacity of monocytes was significantly higher in cancer patients than that in the control populations.

Immunorestorative effect of lipid emulsions during total parenteral nutrition

This prospective in vivo cross-over study investigated the effect of Intralipid on immune responses. Twenty-three patients were randomly allocated to receive one of two alternative total parenteral nutrition (TPN) regimens for the first 7 days and the other regimen for the second 7 days. Only one of the regimens included a fat emulsion to provide 50 per cent of the calorific requirement. Immunological studies were performed on days 0, 7 and 14. These included peripheral blood T cell subsets, antibody dependent cellular cytotoxicity and basal and maximal Interleukin 2 production. All immunological parameters were significantly augmented during total parenteral nutrition using the lipid based regimen. No such change was seen during intravenous feeding with carbohydrate based TPN. It is concluded that, far from being immunosuppressive, the incorporation of a fat emulsion into a TPN regimen has immunostimulatory properties.

Monocyte-mediated-antibody-dependent cellular cytotoxicity in malignant lymphoma and solid tumors

Monocyte-mediated-antibody-dependent cellular cytotoxicity (MO-ADCC) was studied in 21 patients with Hodgkin's disease (HD), 15 patients with a long-lasting remission of HD, 11 patients with non-Hodgkin's lymphoma (NHL), 11 patients with solid tumors, and 15 normal controls. Lymphocyte ADCC (LY-ADCC) was evaluated in 12 patients with HD and 9 normal controls. Monocytes lymphocytes were isolated with cell-scatter monitored counterflow centrifugation providing high purity and yield. Antibody-dependent cellular cytotoxicity was evaluated by means of DNA flowcytometry, using antibody-coated chicken erythrocyte targets (CRBC). In comparison with normal controls MO-ADCC was significantly increased in HD (P less than 0.0005), NHL (P less than 0.005), and solid tumors (P less than 0.005). In patients in long-lasting complete remission of HD, MO-ADCC was in the normal range. Lymphocyte-ADCC of 12 patients with HD was similar to that of 9 normal controls. In all experiments LY-ADCC was invariably lower than MO-ADCC of the same donor, indicating the monocyte as the most potent effector cell towards CRBC targets. Results indicate the following: (1) purified cell suspensions of both lymphocytes and monocytes are essential to unravel their role as effector cells; (2) LY-ADCC in HD is similar to normal controls; (3) MO-ADCC enhancement is not uncommon in malignant lymphoma and several solid tumors; (4) normal MO-ADCC in a group of successfully treated patients with HD suggests a disease-related induction of enhanced MO-ADCC.

Peripheral K-lymphocyte population in head and neck cancer

Peripheral K-lymphocytes in head and neck cancer were measured by assay of plaque forming-cells. In the cancer patients, the percentage (4.37 +/- 0.87%, mean +/- SD, N = 42, P less than 0.01) and absolute counts (68 +/- 28/mm3, P less than 0.01) of K-lymphocytes were significantly lower than those in normal controls (8.04 +/- 1.41%; 175 +/- 53/mm3, N = 29). The untreated group showed decreased K-lymphocyte counts (63 +/- 22/mm3, N = 13) as compared with the treated, disease-free group (83 +/- 27/mm3, N = 13, P less than 0.05). There were significant correlations between absolute counts of K-lymphocytes and T-cells or B-cells within the untreated group (r = 0.79 in T-cells, P less than 0.01; r = 0.64 in B cells, P less than 0.01). Moreover, absolute counts and percentage of K-lymphocytes in the patients having regional lymph node metastasis (58 +/- 25/mm3; 4.14 +/- 0.77%, N = 22) were significantly lower than those in the negative node group (80 +/- 26/mm3, P less than 0.01; 4.63 +/- 0.91%, P less than 0.05; N = 20). In a total of 25 patients with squamous cell carcinoma who were grouped into grade I, II, and III according to classification of the histologic differentiation of the World Health Organization, the absolute counts and percentage of K-lymphocytes in the grade I group (93 +/- 33/mm3; 5.14 +/- 1.08%, N = 7) showed significant increases in comparison to those in the grade II group (62 +/- 19/mm3, P less than 0.02; 4.06 +/- 0.62%, P less than 0.02, N = 14). Moreover, the change of the K-lymphocyte population in the treated, disease-free eight patients revealed a gradual increase of K-lymphocytes. These results led us to suggest that the measurement of peripheral K-lymphocytes is a useful method of characterizing host defense in head and neck cancer.

Characterization of cell-mediated immunity in long-term survivors of gastric or colorectal cancer

Cell-mediated immunity was assessed in 12 patients who were long-term survivors of gastric and colorectal adenocarcinomas. A slight decrease in the T-lymphocyte count was accompanied by preserved proliferative reactivity to mitogens (phytohemagglutinin) or alloantigens in 75 percent of the patients. The influence of autologous patient serum on in vitro lymphoproliferative test results was not significant. Selected sera from both study groups showed values of immune complexes that were within the normal range. The colorectal cancer group had antibody-dependent cellular cytotoxicity within the ranges already established for the normal control subjects. Cellular immune mechanisms seem to have been well preserved in long-term survivors of gastric or colorectal carcinoma.

Combination chemotherapy and immune capacity in advanced ovarian carcinoma

The effects of chemotherapy with either Chap-5 (a drug regimen consisting of adriamycin, cis-dichlorodiammine platinum (II), hexamethylmelamine and cyclophosphamide) or Hexa CAF (a drug regimen consisting of methotrexate, 5-fluorouracil, hexamethylmelamine and cyclophosphamide) on the immunocompetence of 22 patients with advanced ovarian carcinoma were studied. Both primary and secondary humoral and cellular immune responses in vivo were studied. In addition, the numbers of granulocytes, lymphocytes and monocytes in peripheral blood were determined, as well as the levels of immunoglobulins and complement proteins. Furthermore, the proliferative capacity of lymphocytes, cytotoxic T-cell function, and K- and NK-cell activities were measured. The results indicate a depression of the primary humoral immune response in vivo in patients receiving Chap-5. Furthermore, a decrease of several parameters in vitro was observed. However, these alterations were only moderate and rapidly reversible.

Monocyte antibody-dependent cellular cytotoxicity in cancer patients

Antibody-dependent cellular cytotoxicity (ADCC) mediated by peripheral blood monocytes was determined in 120 patients who had gastrointestinal tract (GIT), lung and breast cancer, melanoma, or Hodgkin's and non-Hodgkin's lymphoma. Results were expressed in terms of maximum cytotoxicity and cytotoxicity at E:T = 1:10 and were compared with the results obtained in 63 normal subjects. There was a significant decrease in maximal cytotoxicity for both the GIT cancer and the melanoma patient groups, but not for any of the other groups. These differences were not confirmed when results were expressed at low effector: target cell ratios, e.g., cytotoxicity at E:T = 1:10. The relationship between monocyte ADCC and disease extent was examined in those groups with sufficient numbers. Monocyte ADCC was higher in patients with GIT cancer of limited extent than in patients with extensive GIT cancer and in the control group.

Depressed levels of granular lymphocytes with natural killer (NK) cell function in 247 cancer patients

The HNK-1 (Leu-7) monoclonal antibody was used to enumerate and characterize the level of blood granular lymphocytes in 247 cancer patients. The results were compared to 146 control individuals. A fluorescence-activated cell sorter was used to purify blood HNK-1+ cells from cancer patients. The monoclonal antibody identified a homogeneous population of granular lymphocytes with greater than 95% purity. Conversely, virtually 100% of HNK-1- cells from cancer patients were agranular lymphocytes. These results were the same as previously observed in normal individuals, where the HNK-1+ cell fraction contained all the lymphocytes with spontaneous cytotoxicity in natural killer (NK) and killer (K) cell assays. The level of HNK-1+ cells in cancer patients correlated significantly with the patient's age and sex, with older individuals having higher levels and male patients containing a higher proportion than female patients. The levels in the cancer patients were significantly lower than normal controls (p = 0.04). When the results were subdivided by the histologic type of cancer, additional differences were noted. Compared to age and sex-matched controls, significantly depressed levels of HNK-1+ granular lymphocytes were observed in 49 patients with colon cancer (9.7% vs. 15.8%, p = 0.0001), 18 patients with lung carcinoma (11.7% vs. 27.0%, p = 0.0001), 24 patients with breast carcinoma (12.0% vs. 15.5%, p = 0.04) and 64 patients with head and neck carcinoma (15.9% vs. 19.1%, p = 0.05). However, there were no significant differences overall in the average HNK-1+ cell level of 66 patients with melanoma (13.0% vs. 13.5%, p = 0.75) and nine patients with sarcomas (15.8% vs. 14.3%, p = 0.71). Thus, this important subpopulation of granular lymphocytes with NK and K cell function was significantly depressed in most cancer patients. Accounting for the patient's age and sex and the histologic type of cancer was critical to interpreting the results.

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.

Clinical and immunological study of beta interferon by intramuscular route in patients with metastatic breast cancer

Partially purified human beta interferon (HuIFN-beta) was administered to six patients with metastatic breast carcinoma by the intramuscular route at doses of 3 X 10(6) and 6 X 10(6) units on a daily schedule. Objective antitumor effects were observed in three patients (one partial remission, two minor responses) in soft tissue and lymph node metastases. Systemic side effects (fatigue, fever, pruritus, nausea, etc.) attributable to the treatment occurred in all patients. Augmenting effects by IFN-beta on cell-mediated immunity in vivo (delayed-type hypersensitivity) and in vitro natural killer cell and antibody-dependent cell-mediated cytotoxicity were observed in several patients. The clinical and immunological effects were considered evidence of systemic biological activity despite very low or undetectable serum antiviral activity following administration of this agent.