Quantitative change of serum protein and immunoglobulin in patients with solid cancers

Potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation

Thermal ablation is a promising alternative treatment for lung cancer. It disintegrates cancer cells and releases antigens, followed by the remodeling of local tumor immune microenvironment and the activation of anti-tumor immune responses, enhancing the overall effectiveness of the treatment. Biomarkers can offer insights into the patient's immune response and outcomes, such as local tumor control, recurrence, overall survival, and progression-free survival. Identifying and validating such biomarkers can significantly impact clinical decision-making, leading to personalized treatment strategies and improved patient outcomes. This review provides a comprehensive overview of the current state of research on potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation, including their potential role in lung cancer management, and the challenges and future directions.

IgG+ Extracellular Vesicles Measure Therapeutic Response in Advanced Pancreatic Cancer

(1) Background: Pancreatic ductal adenocarcinoma (PDAC) is expected to be the second-leading cause of cancer deaths by 2030. Imaging techniques are the standard for monitoring the therapy response in PDAC, but these techniques have considerable limits, including delayed disease progression detection and difficulty in distinguishing benign from malignant lesions. Extracellular vesicle (EV) liquid biopsy is an emerging diagnosis modality. Nonetheless, the majority of research for EV-based diagnosis relies on point analyses of EVs at specified times, while longitudinal EV population studies before and during therapeutic interventions remain largely unexplored. (2) Methods: We analyzed plasma EV protein composition at diagnosis and throughout PDAC therapy. (3) Results: We found that IgG is linked with the diagnosis of PDAC and the patient’s response to therapy, and that the IgG+ EV population increases with disease progression and reduces with treatment response. Importantly, this covers PDAC patients devoid of the standard PDAC seric marker CA19.9 expression. We also observed that IgG is bound to EVs via the tumor antigen MAGE B1, and that this is independent of the patient’s inflammatory condition and IgG seric levels. (4) Conclusions: We here propose that a population analysis of IgG+ EVs in PDAC plasma represents a novel method to supplement the monitoring of the PDAC treatment response.

Molecular Origin of Blood-Based Infrared Spectroscopic Fingerprints*

Infrared spectroscopy of liquid biopsies is a time- and cost-effective approach that may advance biomedical diagnostics. However, the molecular nature of disease-related changes of infrared molecular fingerprints (IMFs) remains poorly understood, impeding the method's applicability. Here we probe 148 human blood sera and reveal the origin of the variations in their IMFs. To that end, we supplemented infrared spectroscopy with biochemical fractionation and proteomic profiling, providing molecular information about serum composition. Using lung cancer as an example of a medical condition, we demonstrate that the disease-related differences in IMFs are dominated by contributions from twelve highly abundant proteins-that, if used as a pattern, may be instrumental for detecting malignancy. Tying proteomic to spectral information and machine learning advances our understanding of the infrared spectra of liquid biopsies, a framework that could be applied to probing of any disease.

Bottom-up sample preparation for the LC-MS/MS quantification of anti-cancer monoclonal antibodies in bio matrices

Therapeutic monoclonal antibodies (mAbs) are rapidly taking over the treatment of many malignancies, and an astonishing number of mAbs is in development. This causes a high demand for quantification of mAbs in biomatrices both for measuring therapeutic mAb concentrations and to support pharmacokinetics and pharmacodynamics studies. Conventionally, ligand-binding assays are used for these purposes, but LC-MS is gaining popularity. Although intact (top-down) and subunit (middle-down) mAb quantification is reported, signature peptide (bottom-up) quantification is currently most advantageous. This review provides an overview of the reported bottom-up mAb quantification methods in biomatrices as well as general recommendations regarding signature peptide and internal standard selection, reagent use and optimization of digestion in bottom-up quantification methods.

Endonuclease and redox activities of human apurinic/apyrimidinic endonuclease 1 have distinctive and essential functions in IgA class switch recombination

The base excision repair (BER) pathway is an important DNA repair pathway and is essential for immune responses. In fact, it regulates both the antigen-stimulated somatic hypermutation (SHM) process and plays a central function in the process of class switch recombination (CSR). For both processes, a central role for apurinic/apyrimidinic endonuclease 1 (APE1) has been demonstrated. APE1 acts also as a master regulator of gene expression through its redox activity. APE1's redox activity stimulates the DNA-binding activity of several transcription factors, including NF-κB and a few others involved in inflammation and in immune responses. Therefore, it is possible that APE1 has a role in regulating the CSR through its function as a redox coactivator. The present study was undertaken to address this question. Using the CSR-competent mouse B-cell line CH12F3 and a combination of specific inhibitors of APE1's redox (APX3330) and repair (compound 3) activities, APE1-deficient or -reconstituted cell lines expressing redox-deficient or endonuclease-deficient proteins, and APX3330-treated mice, we determined the contributions of both endonuclease and redox functions of APE1 in CSR. We found that APE1's endonuclease activity is essential for IgA-class switch recombination. We provide evidence that the redox function of APE1 appears to play a role in regulating CSR through the interleukin-6 signaling pathway and in proper IgA expression. Our results shed light on APE1's redox function in the control of cancer growth through modulation of the IgA CSR process.

Preliminary Evaluation of the Potential Prognostic Value of Serum Levels of Immunoglobulins (IgA, IgM, IgG, IgE) in Patients with Gastric Cancer

Sixty patients with advanced gastric carcinoma who refused to receive cytotoxic chemotherapy were examined for serum immunoglobulin levels (IgG, IgM, IgA, IgE). Three samples were obtained every two months thereafter. The group of patients who had above-normal values of one or more of the examined immunoglobulins had a longer survival than the other (p<0.024). Immunoglobulin values were independent of the Helicobacter pylori antibody titer and of acute phase reactants. It is concluded that survival potentially correlates with serum immunoglobulin levels. Further studies including larger numbers of patients and correlating serum immunoglobulin levels with specific clinical parameters are needed to establish the prognostic role of serum immunoglobulins in patients with gastric carcinoma.

Comparative evaluation of serum and salivary immunoglobulin G and A levels with total serum protein in oral submucous fibrosis patients: A case control study

AIM AND OBJECTIVE

The objective of this study is to estimate and compare the serum and salivary immunoglobulin G and A (IgG, IgA) levels in various stages of oral submucous fibrosis (OSMF) patients and relate it to total serum protein (TSP) and hemoglobin (Hb) levels.

MATERIALS AND METHODS

The sample for the present study comprised a total of 20 healthy controls, 20 OSMF patients. About 5 ml of blood and 2 ml of saliva were collected. Quantitative analysis of serum and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hb were estimated by Biuret and cyanmethemoglobin methods, respectively.

RESULTS

Serum and salivary IgA and IgG levels were statistically significantly increased (P < 0.001) in OSMF patients when compared to controls. Also serum and salivary IgG and IgA levels showed significantly increased (P < 0.01) in all the three staging of OSMF when compared to control group. Hb levels and TSP levels were significantly decreased (P < 0.001) in OSMF patients when compared to controls. One-way ANOVA, Pearson's correlation, and unpaired t-test were used for statistical analysis.

CONCLUSION

The elevated levels of IgG and IgA are also in favor of polygammapathy, which are nonspecific and nondiagnostic objective reflections of an underlying disease. Decreased TSP is a result of host response and Hb, acts as an indicator of nutritional status plays an important role. It is also observed from the present study that the severity of OSMF was directly proportional to the estimated elevated levels of the major IgG and IgA. A need is also felt for the knowledge of immunoprofile estimation in etiology and pathogenesis that would prove a great asset in the proper assessment of this condition.

Stage-specific analysis of plasma protein profiles in ovarian cancer: Difference in-gel electrophoresis analysis of pooled clinical samples

INTRODUCTION

Ovarian cancer is the leading cause of death from gynecological cancer. Non-specific symptoms early in disease and the lack of specific biomarkers hinder early diagnosis. Multi-marker blood screening tests have shown promise for improving identification of early stage disease; however, available tests lack sensitivity, and specificity.

MATERIALS AND METHODS

In this study, pooled deeply-depleted plasma from women with Stage 1, 2 or 3 ovarian cancer and healthy controls were used to compare the 2-dimensional gel electrophoresis (2-DE) protein profiles and identify potential novel markers of ovarian cancer progression.

RESULTS/DISCUSSION

Stage-specific variation in biomarker expression was observed. For example, apolipoprotein A1 expression is relatively low in control and Stage 1, but shows a substantial increase in Stage 2 and 3, thus, potential of utility for disease confirmation rather than early detection. A better marker for early stage disease was tropomyosin 4 (TPM4). The expression of TPM4 increased by 2-fold in Stage 2 before returning to "normal" levels in Stage 3 disease. Multiple isoforms were also identified for some proteins and in some cases, displayed stage-specific expression. An interesting example was fibrinogen alpha, for which 8 isoforms were identified. Four displayed a moderate increase at Stage 1 and a substantial increase for Stages 2 and 3 while the other 4 showed only moderate increases.

CONCLUSION

Herein is provided an improved summary of blood protein profiles for women with ovarian cancer stratified by stage.

Effect of exposure to solid wastes in relation to employment duration on some important markers of health and disease in waste management workers of Ogun State in southwest Nigeria

Waste management workers (WMWs) around the world are at risk of work-related health disorders. The influence of employment duration on individuals occupationally exposed to solid waste was investigated in this study. The study comprised (n = 280) 180 WMWs and 100 controls. Employment duration was obtained from questionnaire survey and categorized into three groups: group I (0.5-2 years), group II (>2-4 years) and group III (>4-6 years). Blood sample (10 ml) was collected from the antecubital vein of subjects for analysis. WMWs exhibited significantly (p < 0.001) elevated inflammatory markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ceruloplasmin (Cp)) relative to control. While Cp increased, ESR and CRP decreased with increasing WMWs' employment duration. Alteration in oxidant/antioxidant markers was characterized by significant (p < 0.001) decrease in ferric-reducing ability of plasma (FRAP) and catalase activity together with marked (p < 0.01) elevation of thiobarbituric acid reactive substances (TBARS) and uric acid (UA). TBARS, UA and FRAP increased while catalase decreased with WMWs' employment duration. In addition, WMWs exhibited significantly (p < 0.01) elevated immunoglobulin A (IgA) and IgG, which also increased and decreased, respectively, with job duration. The significantly (p < 0.01) decreased haemoglobin and haematocrit levels as well as the significantly (p < 0.001) elevated total leukocytes in WMWs increased with employment duration. Alanine aminotransferase increased and albumin decreased significantly (p < 0.05) in WMWs, and these changes also increased and decreased, respectively, with job duration. Data suggest that levels of alteration of important systemic markers of health/disease are related to WMWs' employment or exposure duration.

Adenosine deaminase activity and immunoglobulin levels as potential systemic biomonitors of occupational hazards and health status in municipal solid waste management workers

Immune status of waste management workers (WMW) with underlying systemic inflammation was assessed to identify useful immune-related biomarkers of occupational health and safety. Clinical history of WMW revealed high prevalence of respiratory symptoms alongside gastrointestinal and musculoskeletal complaints relative to control. Systemic inflammation, characterized by significant (p<0.001) elevation of erythrocyte sedimentation rate and C-reactive protein, was associated with marked increase in concentration and prevalence of IgA (p<0.05), IgG (p<0.01) and adenosine deaminase activity (ADA) (p<0.01) in WMW. Haematological changes include significant (p<0.01) increase in lymphocytes, monocytes and total leukocytes. Eosinophils also increased significantly (p<0.001) while haemoglobin, packed cell volume and neutrophil decreased significantly (p<0.05). Receiver operating characteristic curve and multivariate analyses revealed ADA (p<0.002) and IgG (p<0.05) as important immune markers respectively for assessing sub-clinical effects of occupational exposure. Our data suggest ADA and IgG as useful immune health and safety indicators in WMW.

Pediatric selective IgM immunodeficiency

Objective. Limited information exists on features of pediatric Selective IgM immunodeficiency (SIgMID). Previously published pediatric cases and 2 new cases are reviewed. Methods. English literature from PubMed and references from relevant articles were reviewed. Previously reported cases and 2 new cases from an allergy/immunology practice were analyzed. Results. Forty-nine reported cases of SIgMID presented with respiratory infections (77.6%), gastrointestinal disease (16.3%), skin disease (12.2%), and meningitis (8.2%). Mean serum IgM level was 16.5 ± 13.8 mg/dL. Two patients were identified with SIgMID among 6300 active pediatric patients (0.03%) presenting with asthma, vasomotor rhinitis, and recurrent respiratory infections. In the 51 cases reported, none developed lymphoproliferative disease nor evolved into panhypogammaglobulinemia; four fatalities were reported. Conclusions. The prevalence of SIgMID in our pediatric population was 0.03%. In general, respiratory infections are the common comorbid conditions. Death and autoimmune disease are uncommon complications of pediatric SIgMID.

Selective IgM immunodeficiency: retrospective analysis of 36 adult patients with review of the literature

OBJECTIVE

To review and compare previously reported cases of selective IgM immunodeficiency (SIgMID) with the largest adult cohort obtained from a retrospective analysis of an allergy and immunology practice.

DATA SOURCES

Publications were selected from the English-only PubMed database (1966-2005) using the following keywords: IgM immunodeficiency alone and in combination with celiac disease, autoimmune disease, malignancy, and infection. Bibliographic references of relevant articles were used.

STUDY SELECTION

Reported adult SIgMID cases were reviewed and included in a comparative database against our cohort.

RESULTS

Previously described patients with SIgMID include 155 adults and 157 patients of unspecified age. Thirty-six adult patients were identified with SIgMID from a database of 13,700 active adult patients (0.26%, 1:385). The mean +/- SD serum IgM level was 29.74 +/- 8.68 mg/dL (1 SD). The mean +/- SD age at the time of diagnosis of SIgMID was 55 +/- 13.5 years. Frequency of presenting symptoms included the following: recurrent upper respiratory tract infections, 77%; asthma, 47%; allergic rhinitis, 36%; vasomotor rhinitis, 19%; angioedema, 14%; and anaphylaxis, 11%. Serologically, 13% of patients had positive antinuclear antibodies (ANAs), 5% had serologic evidence of celiac disease, and nearly all had non-AB blood type. Patients also had low levels of IgM isohemagglutinins. No patients developed lymphoproliferative disease or panhypogammaglobulinemia, and none died of life-threatening infections, malignancy, or fulminant autoimmune-mediated diseases during a mean follow-up period of 3.7 years.

CONCLUSIONS

The prevalence of SIgMID in our adult population was 0.26% and may be more common than previously thought. Non-life-threatening respiratory disorders were common comorbid conditions.

Technical and prognostic outcomes of double-balloon pericardiotomy for large malignancy-related pericardial effusions

OBJECTIVE

To investigate both the use of immediate or elective double-balloon pericardiotomy (DBP) in patients with a large amount of malignancy-related pericardial effusion, and the prognosis of this subgroup.

DESIGN

Observational study after DBP intervention.

SETTING

Tertiary referral center.

PATIENTS AND INTERVENTIONS

Fifty patients with malignancy, mainly lung and breast cancer, who were admitted to our critical care unit with a large amount of pericardial effusion. All received echocardiographic-guided pericardiocentesis. Group 1 consisted of 12 patients (24%) who received immediate DBP, and group 2 consisted of 38 patients (76%) who received delayed DBP 2.5 +/- 1.7 days later (mean +/- SD) after emergency pericardiocentesis with pigtail catheter drainage.

MEASUREMENTS

After the procedure, and at 1 month, 3 months, and 6 months, echocardiography and chest radiography were performed to check for pneumothorax, pericardial effusion reaccumulation, or the appearance of pleural effusion after pigtail catheter removal.

MAIN RESULTS

The procedure was successful and without recurrence in 44 patients (88%). Procedural complications were fever in 4 patients (33%) and 10 patients (26%) in group 1 and group 2, respectively (p = 0.72), and mild pneumothorax in 2 patients (17%) and 1 patient (3%) in group 1 and group 2, respectively (p = 0.14). Fifty percent of the patients died within 4 months, while 25% survived to 11 months. High serum calcium, a low albumin/globulin ratio, and positive results on pericardial effusion cytology were poor prognostic factors for long-term survival.

CONCLUSION

Both immediate and delayed DBP are a safe and effective method of relieving large pericardial effusions in patients with cancer. Successful DBP without recurrence of pericardial effusion was achieved in 88% of all patients. Survival was related to the extent of the disease.

Serologic determinants of survival in patients with squamous cell carcinoma of the head and neck

Specific circulating serum proteins may reflect unique properties governing the growth and progression of head and neck cancers. One hundred three previously untreated patients with squamous cell carcinoma of the head and neck were prospectively evaluated for serum IgA, IgG, and IgM and C1q-binding macromolecules. Immunoglobulins were assessed by the immunoturbidimetric technique. C1q-binding macromolecules (C1qBM) were measured utilizing the iodine-125 assay of Zubler et al (J Immunol 1976; 116: 232-5). Neither the level of serum immunoglobulins nor C1qBM values were correlated with the primary site, AJC (American Joint Committee on Cancer) stage of disease, or size of primary lesion. Likewise, comparison of serum IgA with C1qBM values demonstrated that these laboratory parameters were independent variables (r = 0.15 by Pearson linear regression). Univariate statistical analysis, utilizing the Cox proportional hazard model, showed serum IgA and C1qBM values to each contribute significantly to the ability to predict survival in patients with advanced squamous cell carcinoma of the head and neck (p = 0.01 and 0.003, respectively). Furthermore, multivariate analysis reveals that both C1qBM and serum IgA levels contribute significantly to the hazards model beyond staging in predicting survival (p less than 0.001). Predictive results were most apparent in patients with stage IV disease and related to the probability of both regional and distant metastatic recurrences. Conversely, serologic analysis provided no information in patients who were staged early. These results support pretreatment multiparametric serologic analysis of patients with squamous cell carcinoma of the head and neck.

Serum immunoglobulins in patients with carcinoma of the oral cavity, uterine cervix and breast

Serum immunoglobulin levels (IgG, IgA, IgM, IgD and IgE) were estimated in 196 patients with carcinoma of the oral cavity, 172 patients with cervical cancer and 166 patients with breast cancer. The values were compared with those of 50 patients with benign lesions of the breast and cervix and 100 healthy adult controls. Only the serum IgE levels were found to be elevated in the benign group. Serum IgA, IgD and IgE levels were found to be elevated in all the three types of cancers and the levels were found to increase with clinical stage. In carcinoma of uterine cervix IgG levels were also found to be elevated. Immunoglobulins A and D returned to normal after clinical cure whereas IgE remained slightly elevated. IgD and IgE remained high in patients who had residual cancer.

Biochemical and hematological tests in patients with breast carcinoma: correlations with extent of disease, sites of relapse, and prognosis

The value of serial biochemical and hematological tests of blood in differentiating stages and in detecting recurrence of breast carcinoma was studied in 500 patients. Patients who had mastectomy and were with no evidence of disease (NED group) had higher hemoglobin, albumin, total protein, and lower LDH than patients with any amount of breast carcinoma. These four tests became more abnormal in patients with metastatic disease (group IV). In addition, peripheral lymphocyte count was significantly decreased, and SGOT, AP, alpha-1 globulin, and CEA significantly increased, when patients developed recurrent or metastatic disease. Patients with disseminated soft tissue or lung metastasis had less abnormality of such blood tests than those with metastasis in bone or other visceras. Immunoglobulins (IgG, IgA, IgM) were not different between early or late stages, nor specific sites of metastatic involvement. Among patients with a greater amount of loco-regional disease (group III) and patients with metastatic disease (group IV), those who had hemoglobin greater than or equal to 12.5 gm%, lymphocyte count of 15-2,500/cmm, albumin greater than or equal to 4 gm%, AP less than or equal to 25 units, or LDH less than or equal to 400 units had significantly better 5-year survival rates.

Immunological abnormalities in oral carcinoma and oral keratosis

Examination of serum concentrations of IgG, IgA, IgM, IgE, and IgD in oral carcinoma and oral keratosis confirmed a rise in serum IgA concentration in oral carcinoma and revealed a rise in IgE. In oral carcinoma, other serum immunoglobulins were present in normal concentrations. Serum IgA and IgE were not increased in oral keratosis but IgM was reduced, with normal levels of other immunoglobulins. The results may reflect changes in cell-mediated immunity rather than simply changes in humoral immunity.

Biochemical evaluation of patients with breast cancer

Peripheral blood specimens were obtained from 50 patients with various stages of breast cancer (I-II = 7, III = 6, IV = 24, treated and NED = 13), and 20 biochemical tests were performed. There are significant differences of hemoglobin, LDH, SGPT, serum protein, albumin, and alpha globulin values between patients with early (I, II, NED) and late (III, IV) lesions. Among patients with stage IV diseases, those patients with bony metastases had significantly higher values of alkaline phosphatase, alpha-1 globulin, IgA, and C-reactive protein than those with nonosseous lesions. Neither CEA nor pregnancy-associated alpha-2 glycoprotein showed any correlation with different stages or sites of breast cancer in these small series of patients.

Serum protein changes in women with early breast cancer

Lowered serum concentrations of albumin, IgG, IgM, and transferrin have been identified preoperatively in a population of otherwise healthy white women over age 40 with early stage breast cancer. Definition of low values for each of the four serum proteins has been arrived at via comparison with age-matched controls, consisting of disease-free women and women with benign breast lesions. Thus defined, low values for the individual serum proteins have been found to occur in malignant/control study subjects at the following frequencies: albumin 68%/4.7% (P less than 0.0001); IgG 56%/21% (P less than 0.02); IgM 59%/19% (P less than 0.001), and transferrin 50%/4.7% (P less than 0.0001). Among the relevant historical and pathologic data evaluated in addition to the presence or absence of malignancy, only age has been found significant in influencing serum protein concentrations, and this has been taken into account in analyzing results. Forty-four percent of study subjects subsequently found to have breast cancer have low concentrations of at least three of the four discriminant proteins simultaneously in the pre-operative sample. None of the controls have these findings. Twenty-nine percent of women with a malignant breast lesion and 9% of controls have simultaneously low concentrations of two of the four discriminant proteins. Using these measurements of serum proteins it thus becomes possible to assign risk of malignancy when a woman is found to have a breast mass.

Chemical and hematological screening in patients with malignant and non-malignant conditions

The value of multiphasic automated laboratory tests in differentiating stages of malignancy and in detecting recurrence of cancer was studied. Chemical SMA-12 tests (including calcium, phosphate, glucose, BUN, uric acid, cholesterol, total protein, albumin, total bilirubin, alkaline phosphatase (AP), lactic dehydrogenase (LDH) and SGOT) and hematological SMA-4 tests (including hematocrit, hemoglobin, WBC and RBC counts) were performed in 1,578 patients. Baseline data obtained from 582 patients with benign, and 996 patients with malignant, lesions were subdivided according to age, sex, primary site, and extent of cancer. With advancing stages of cancer, there was a significant increase of AP and LDH, but decrease of albumin and hemoglobin. Among patients who had sequential tests, there was a significant decrease of uric acid and LDH with control of cancer, and increase of AP with development of distant dissemination.

Preoperative and postoperative immunological evaluation of patients with colorectal cancer

Twenty-two patients with cancer of the colon and rectum were studied: preoperative and postoperative cell-mediated and humoral immune factors were assessed, and local concentration of immunoglobulins in tumor tissue and in normal mucosa were measured. Lymphocyte function was found to be reduced in 50% of stage A and B and 66% of stage D patients. On the other hand, when the lymphoblastogenesis was performed in the presence of normal AB plasma, a partial restoration of lymphocyte function was noted, indicating the presence of a serum blocking factor in the blood of these patients. While there was no apparent decrease of B cell subpopulation, 57% of the tested patients showed significant reduction of T lymphocytes. Marked reduction of serum immunoglobulin levels, specifically IgG and IgM, was observed preoperatively followed by a gradual return toward normal values after surgical resection of neoplastic growth. It is noteworthy that tumor tissue contained more IgG and IgA than normal mucosa. However, IgM was below detection level both in normal and tumor tissues.

Serum glycoproteins in cancer patients: first report of correlations with in vitro and in vivo parameters of cellular immunity

Serum levels of proteins previously shown to be elevated [acute-phase proteins (APP)-haptoglobin, alpha 1-acid glycoprotein, alpha 1-antitrypsin] or depressed (alpha 2 HS-glycoprotein, prealbumin, albumin) in cancer patients were correlated with tumor extent, in vitro lymphocyte reactivity (LR) to phytohemagglutinin (PHA), and quantitative delayed hypersensivity (DH) to dinitrochlorobenzene (DNCB) in 147 preoperative patients with operable solid malignancies either confined to the primary site or with regional spread only. Compared to 58 normal controls, levels of the APP were significantly elevated, alpha 2 HS-glycoprotein and prealbumin depressed, and albumin levels unchanged in patients with either local or regional tumors. In patients with normal DH to DNCB, the APP were higher and prealbumin was lower than in controls; in patients with impaired DH to DNCB, haptoglobin and alpha 1-acid glycoprotein were higher and alpha 2 HS-glycoprotein and prealbumin lower than in patients with normal DH to DNCB. Albumin levels did not differ from normals in any of the groups. Serum protein levels appeared to be more related to the immune status of the patient than to tumor extent. The levels of the three APP correlated directly with each other but inversely with alpha 2 HS-glycoprotein and prealbumin; levels of alpha 2 HS-glycoprotein and prealbumin correlated directly with each other. Levels of haptoglobin and alpha 1-acid glycoprotein correlated inversely with LR to PHA; however, levels of alpha 2 HS-glycoprotein correlated directly with LR to PHA, and uniquely the levels of alpha 2 HS-glycoprotein and LR to PHA both showed similar changes for each of the four quantitative levels of DH to DNCB measured in the cancer patients. The data show that the proteins studied, except for albumin, correlate inversely (APP) or directly (alpha 2 HS-glycoprotein and prealbumin) with in vitro and in vivo parameters of cellular immunity. The results provide a rationale for attempts to improve depressed cellular immunity by lowering circulating levels of APP, as is being attempted in ongoing trials using plasmapheresis, and assessing the effect of exogenous alpha 2 HS-glycoprotein or prealbumin in patients with low levels of these glycoproteins and depressed cellular immunity. The correlations between serum glycoprotein levels and in vitro and in vivo parameters of cellular immunity lend rationale to investigations of the interactions of serum glycoproteins and blood cells having immunologic function that determine the level of cellular immunity expressed in vivo.

Steroid receptors study in breast carcinoma

Estrogen receptors (ER) were measured on specimens taken from 27 patients with benign breast conditions and 109 patients with breast cancer. Using sucrose gradient assay, 15% (4/27) of benign lesions and 56% (61/109) of malignant tumors were estrogen receptor-positive (ER-positive means 8S or 8S+4S levels more than 7 fmoles/mg cytosol protein). Progesterone receptors (PR) were tested on specimens from 28 patients and 39% (10/26) of the cancers were PR-positive. ER protein activity was not correlated with stage, histology, size of primary lesions, or extent of axillary or distant metastasis. Tumors with low ER levels are more likely to recur, and recurrent tumors after longer disease-free intervals are more likely to be ER-positive. Detailed analysis showed that ER levels did correlate with age and serum albumin levels. Concentrations of serum alpha1-globulin were decreased, while IgG and IgM were significantly increased among patients with positive ERs. Eighteen evaluable patients with advanced breast cancer had endocrine therapy, 13 had objective response. Twelve of these 13 had 8S receptor above 10 fmoles/mg, or 4S above 15 moles/mg, or 8S+4S above 25 fmoles/mg. The one exceptional patient had tumor with high PR but without detectable ER.