Evaluation of different methods for detecting circulating immune complexes. Studies in patients with lung cancer

Circulating immune complexes in intracranial neoplasms

The levels of circulating immune complexes (CIC) were assayed in the sera of 109 patients with intracranial space occupying lesions. The CIC levels were significantly increased in all the brain tumours. After treatment, the CIC levels were still significantly increased when compared to the controls but showed no change when compared to their respective pre-operative values. Further, no change was observed in the CIC levels between the malignant and benign tumour case. Moreover, in brain tumours, 90% of the CIC precipitate consisted of IgG. However, the CIC levels fail to prognosticate the process of the disease in these patients.

Prognostic significance of circulating immune complexes in cancer patients

Circulating immune complexes (CIC) were estimated in 100 cancer patients and 25 healthy control volunteers by means of the polyethylene glycol (PEG) precipitation test and latex agglutination inhibition (LAI) test. Pathological levels of CIC were found in 47% of the patients by PEG precipitation test and in 59% of the patients by LAI test; both tests were positive in 33% of the patients. Consequently, the use of the two assays resulted in 73% seropositivity for CIC. The PEG precipitation test detects antigen-antibody complexes formed in the ratio of 2:1 (Ag2Ab), while the LAI test could detect immune complexes formed over an extended range of antigen-antibody ratio including complexes as small as 8S. CIC values were significantly higher by combined assays (P less than 0.001) as compared to individual assays (P less than 0.01) when compared with the control group. It was found that 75% of post-operative follow-up patients became seronegative for CIC in the combined assays, whereas the 25% of post-operative patients who remained seropositive for CIC showed recurrence within three months after surgery. Immune-complex deposition was demonstrated on malignant cells in vitro by direct immunofluorescence studies in 73.3% of patients, while 60% of patients revealed complement-fixing antigen-antibody complexes. It was found that 20% of patients showing positive immunofluorescence with anti-C3-antisera had decreased levels of CIC. Complement-mediated cytotoxic injury results in reduction of tumor cell mass and subsequent decrease in CIC. Necrotizing and leucocytoclastic vasculitis in the tumor mass was initiated by raised CIC levels in vivo in 71% of patients. Necrosis of malignant tumors was seen in 58% of patients, and hemorrhage in 36% of patients. These changes were considered to be an aftermath of immuno-complex vasculitis initiated by CIC.

Primary lung cancer. A controlled study of preoperative and postoperative levels of circulating immune complexes

Three complement-dependent and one rheumatoid factor-dependent immune complex assays were used to analyze the sera taken before surgery from 70 unselected and previously untreated lung cancer patients, from 30 of them after surgery, and from 31 healthy controls. Plasma levels of complement split product C3d were also analyzed. The levels of circulating immune complexes (cIC) and C3d were essentially the same in samples taken from lung cancer patients before surgery and from healthy controls. By the four immune complex assays, increased levels were found in 0 to 10% of the preoperative lung cancer patients compared to 3% of the healthy controls (not significant). The postsurgical tumor, lymph node, metastasis (pTNM) stage of the lung cancer was not reflected in the levels of cIC or C3d. Paired comparisons of the cIC and C3d levels before and after surgery did not show significant differences. Thus, we found no evidence for the occurrence of cancer-related cIC in lung cancer patients.

Problems in the detection of complement-fixing immune complexes

In the application of the anti-Clq, the anti-C3, or the conglutinin-binding assay for the detection of complement-fixing circulation immune complexes in patients with ankylosing spondylitis or healthy blood donors, antibodies cross-reacting with the solid-phase bound agent were observed in several sera, resulting in erroneous interpretation of the tests. Corrections for the interfering antibodies were made by testing for the binding to conglutinin both in the presence and in the absence of Ca++, while the anti-Clq and the anti-C3 assays included the application of F(ab')2 fragments of normal IgG to check for anti-F(ab)2 anti-bodies.

Evaluation of circulating immune complexes in lymphomas and leukemias using two different assays

Circulating immune complexes (CICs) have been detected in the sera of patients with non-Hodgkin's lymphoma (NHL), Hodgkin's disease, chronic myeloid leukemia, and acute lymphoblastic leukemia by using C1q-binding and L1210-binding assays. Both assays gave broadly similar patterns of reactivity in terms of frequency and magnitude, though there are some differences. Significantly elevated CIC levels were observed in all pathologic groups. However, sera from NHL patients with an unfavorable prognosis consistently exhibited the highest frequency of positive values and mean CIC levels in both these assays. The two tests showed concordance in 66.6% of the NHL patients' sera and were significantly correlated. Of the sera from NHL patients 12.7% were positive in the C1q-binding assay only and 15.9% in the L1210-binding assay only. Both the assays gave positive results in some patients, and a degree of overlap indicates the presence of different types of CIC in cancer patients' sera. The combined use of two methods for detecting CICs may be useful for evaluation of the activity, the extent, and the prognosis of the malignant disease.

Detection of circulating immune complexes by a Clq/protein A-ELISA during the preneoplastic stages of feline leukemia virus infection

A microscale ELISA immune complex assay which utilized a solid phase C1q and a Protein A-peroxidase enzyme conjugate is described. This ELISA was used to detect and quantitate circulating immune complexes (CIC) during the initial feline leukemia virus infection. Significant increases in CIC were seen in the cats which were transiently infected at weeks three through eight after viral exposure. A persistent elevation in CIC was observed in the one cat which developed a persistent viremia. The addition of EDTA to the serum strongly interfered with this assay.

Comparison of pathologic and normal sera by immune complex determination: five disease groups within 190 samples are discriminated by computer-selected combinations of 13 methods. Report of the Italian committee for the study of immune complexes (WIC)

Pathological (190) and normal (33) sera were tested for their content of circulating immune complexes (CIC) by a battery of 13 assays performed in 11 laboratories. Statistical processing was done both by pooling all pathological samples and by extracting those falling into well-defined disease groups, i.e., rheumatoid arthritis, diabetes, lupus, melanoma, and glomerulonephritis. Highly significant correlations between methods--taken two at a time--for each disease differed in proportion (ranging from 6 to 30%) and in the pattern displayed on a checkerboard. Disease-linked patterns were also found when a function maximizing discrimination between pathological and normal samples was derived by combining the information from all methods. Here the order and the weight attributed by the computer to the methods differed for each of the disease groups. Taken together these results are interpreted as an indication that all assays may not determine the same classes of CIC, and thus vary in sensitivity depending on the prevailing properties of the complexes present in the serum, which in turn may depend on the etiology, pathogenesis, and stage of the disease.

Decrease of the OKT8 positive T cell subset in polymyalgia rheumatica. Lack of correlation with disease activity

Peripheral T cell populations were investigated in 35 patients suffering from polymyalgia rheumatica. The total number of T cells was low compared with those of a control group of similar age (P less than 10(-3). This decrease was demonstrated by using both classic E-rosette and monoclonal antibody techniques (OKT3, and OKT4 + OKT8) and was shown to be secondary to a selective T8 defect (P less than 10(-9). There was no correlation between the decrease in T8 (a cytotoxic suppressor T cell subset) and steroid therapy, disease activity, and temporal arteritis, nor between this decrease and the T gamma percentage and the presence of circulating immune complexes (CIC). The T gamma cell percentage was low in the patient group (P less than 10(-5) and correlated with the presence of detectable CIC (P less than 0.05). In contrast to the T8 and T gamma defects, concanavalin A-stimulated cells from 5 selected patients were found capable of suppressing in vitro anti-trinitrophenyl response. This suppression was found in both autologous and allogeneic experiments. From these data one can assume that an immune anomaly (T8 defect) could be the origin of CIC and the disease occurrence.

Adaptation of a protein a binding assay for measurement of immune complexes in sera of rats

We describe a simple and sensitive method for the detection of circulating immune complexes (CIC) in rats and have applied the method to test sera from tumor-bearing rats. CIC were precipitated preferentially with 6% polyethylene glycol, dissolved, and then bound to Staphylococcus aureus that are Protein A (PA) positive. Rabbit-anti-rat IgG (RARG) antibodies were then added and followed by 125I-PA. The RARG sandwich antibody enhanced the sensitivity of detection of CIC in rats at least 5 fold compared to that observed using 125I-PA without RARG.

Circulating immune complexes in chronic myeloid leukemia patients at various stages of the disease

Circulating immune complexes (CICs) in sera from patients suffering from chronic myeloid leukemia (CML) at initial diagnosis, in 'remission', at relapse and in blastic crisis have been quantitated using fluid [125I]Clq binding assay in terms of per cent binding activity and microgram/ml aggregated human globulin (AHG) equivalents. The Clq binding activity (Clq-BA) has been compared within the groups of CML patients in different phases of the disease as well as with sera obtained from normal healthy donors. The results showed that the mean Clq-BA was significantly increased in CML patients at initial diagnosis (25.74 +/- 3.48, p less than 0.001), in relapse (53.36 +/- 6.9, p less than 0.001) and in blastic crisis (60.5 +/- 8.7, p less than 0.001) when compared to control sera. Sera of 'remission' patients showed significant decrease in Clq-BA when compared to sera collected in active phases of the disease, however, the values were still significantly higher (12.87 +/- 1.58, p less than 0.02) than those of normal healthy donors. When the levels of CICs as assessed by Clq-BA were compared with the WBC/blast counts of CML patients in chronic as well as blastic phase, it was noted that the variations in numbers of circulating leukemic cells do not correlate with the CIC levels. The significance of assessment of CIC levels in monitoring the disease in CML patients is discussed.