Lymphocyte stimulation in urologic cancer patients

Immunological parameters in peripheral blood of patients with renal cell carcinoma before and after nephrectomy

OBJECTIVE

To determine the effects of nephrectomy on the immune response of patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

Five patients with RCC were monitored before and over a period of up to 3 months after nephrectomy. The aspects measured were the phenotypic expression of markers on circulating lymphocytes, circulating concentrations of cytokines, markers of inflammatory and immune responses, and natural killer (NK) cell and lymphokine-activated killer (LAK) cell activity in peripheral blood mononuclear cells (PBMC). The suppressive activity of patients' plasma on NK activity and ability to generate interleukin-2 (IL-2) induced LAK cells in PBMC of normal volunteers was also investigated.

RESULTS

The results indicated that high CD4/8 ratios were present pre-nephrectomy with evidence of inflammatory responses and immune activation in some patients, particularly those with metastatic disease.

CONCLUSION

The effect of nephrectomy was to decrease the inflammatory response and increase immune activation. Various defects in NK cell activity and LAK cell generation were demonstrated pre-surgery which slowly improved once the primary tumour had been removed and it is suggested that such defects could have contributed to tumour growth and development due to an ineffective immune response.

Clinical studies on cell-mediated immunity in patients with renal cell carcinoma: interleukin-2 and interferon-gamma production of lymphocytes

The authors examined interleukin-2 (IL-2) production and interferon gamma (IFN gamma) production of peripheral blood mononuclear cells in 28 patients with renal cell carcinoma and 17 control subjects. The peripheral blood was obtained prior to the initiation of therapeutic procedures. The patients were divided into two groups according to tumor size, less than or equal to 5 cm and greater than 5 cm. The production of IL-2 and IFN gamma was measured by immunoradiometric assay. As a result, in the patients with tumors greater than 5 cm, IL-2 and IFN gamma production was impaired. However, in the patients with tumors less than or equal to 5 cm, IFN gamma production was enhanced, though IL-2 production was not significantly different from that of the control subjects. There was no significant correlation between IL-2 production and IFN gamma production.

Analysis of natural killer activity and natural killer cell subsets in patients with bladder cancer

In order to analyze the state of the natural resistance system of bladder cancer patients in vivo, we measured natural killer (NK) activity and NK cell subsets of peripheral blood lymphocytes (PBL) from 46 patients with bladder cancer and 25 age- and sex-matched healthy volunteers. The mean NK activity in patients with low-stage bladder cancer was similar to that in the controls, while NK activity in patients with high-stage bladder cancer was significantly depressed. The mean proportions of Leu7+ cells in patients with both low-stage and high-stage bladder cancer were significantly higher than that in the controls. The mean proportion of Leu11 a+ cells in patients with low-stage bladder cancer was similar to that in the controls, while in patients with high-stage bladder cancer it was significantly higher. This study demonstrates the abnormal immunological state of bladder cancer patients: namely, abnormalities exist not only in NK activity but also in the proportions of circulating NK cell subsets.

Immunosuppressive factor derived from renal cancer cells

An immunosuppressive factor derived from conditioned medium of a human renal cancer cell line, KU2, was analyzed, using mitogen-activated normal peripheral blood lymphocytes. Addition of conditioned medium to lymphocyte cultures resulted in suppression of [3H]-thymidine incorporation to DNA of lymphocytes in a dose-dependent manner. This effect was cytostatic and reversible. This factor inhibited lymphocyte activation stimulated by mitogen at an early stage, and it also suppressed Interleukin-2 production by activated lymphocytes. This factor was non-dialyzable and heat sensitive at 56 degrees C. DNA replication of the cells was necessary for the production of this factor.

Bladder instillation of adriamycin in the treatment of bladder cancer

Intravesical Adriamycin instillation was used in 10 patients with transitional cell carcinoma of the bladder as postoperative prophylactic treatment against recurrence. The protocol for bladder instillation was 20 mg/10 ml of Adriamycin twice weekly for a total of eight doses. One patient developed recurrence in 3 months and three, in 6 months. The main local side-effects were frequency and dysuria which occurred in four cases. Leukopenia and increased SGOT and SGPT values each occurred in one case. No cases of cardiotoxicity, fibrosis, or atrophy of the bladder mucosa were found. Further studies are necessary to achieve the best possible results.

Natural killer cell activity and response to phytohaemagglutinin compared with the histological diagnosis of patients with transitional cell carcinoma of the bladder

In vitro tests of immune reactivity in patients with transitional cell carcinoma (TCC) of the urinary bladder were compared with the clinical and histological diagnosis. Response of peripheral blood lymphocytes to the mitogen phytohaemagglutinin (PHA) tended to be reduced in patients with more advanced disease, although the difference between patients with advanced disease and those with early disease or controls was not statistically significant (P greater than 0.05). Assessment of natural killer (NK) cell activity in the same patients showed no change in levels of reactivity at any stage of the disease. There was no difference between the NK cell activity of patients with TCC of the bladder and normal controls.

The immune response to prostate cancer: an evaluation and a review

The effects of stage and therapy of prostate cancer on the immune response were evaluated in 193 patients with an histologic diagnosis of prostatic malignancy. There was little or no effect, as measured by these generally non-specific tests, on the immune response. The host-tumor immune interaction is difficult to evaluate in prostate cancer. The complexities of measuring prostate tumor immunity are discussed and the literature is reviewed.

Search for blocking factors in sera of patients with prostatic cancer

Sera from patients with carcinoma of the prostate were screened for the presence of blocking factors by measuring the inhibition of phytohemagglutinin-induced blastogenesis of normal lymphocytes. The blastogenic index obtained in cancer sera is not significantly different from that obtained in sera of patients with benign prostatic hypertrophy (control group). Determination of alpha-2-globulins in the cancer sera by cellulose acetate electrophoresis revealed slightly elevated levels in patients with metastatic disease but it did not correlate with the inhibitory blocking activity of the serum.

Study of nonspecific lymphocyte transformation in urologic cancer patients

Blast-cell transformation of lymphocytes in response to phytohaemagglutinin was examined in patients with urologic tumours and with nonmalignant urologic processes. A significant depression of immune reactivity was found in the malignant cases. The practical aspects of the findings are discussed.

Cell-mediated immune competence in patients with prostatic carcinoma

The immune competence of 65 patients with prostatic cancer was evaluated by 2 in vivo and 2 in vitro tests to study the contribution of host factors to the progress of the disease. Patients with benign prostatic hypertrophy served as controls. Our results indicate that the delayed skin hypersensitivity response to common microbial recall antigens (streptokinase/streptodornase, purified protein derivative, dermatophytin 0 and dermatophytin) is unaltered in advanced stages of malignancy. The ability to be sensitized by dinitrochlorobenzene declines significantly in patients with metastatic disease. Blastogenic response of peripheral blood lymphocytes to phytohemagglutinin stimulation is not depressed in late stages of malignancy, although in the circulating T cells per cent and absolute values are somewhat lower in patients with metastases. Herein we show that immune competence (measured by the 4 tests) of patients with prostatic carcinoma does not decrease markedly even in the late stages of the disease. Primary sensitization to dinitrochlorobenzene is the only test showing a decline in responsiveness related to the tumor stage.

Adenosine deaminase activity in patients with carcinoma of the bladder

Adenosine deaminase is an important enzyme in purine metabolism, and patients with abnormal lymphocyte and erythrocyte adenosine deaminase levels have been shown to have impaired immune competence. Since immune factors have been shown to be important in patients with transitional cell carcinoma of the bladder we studied adenosine deaminase activity in the hemic cells of 48 patients with this tumor. Lymphocyte adenosine deaminase levels were elevated in patients with transitional cell carcinoma and correlated with stage, activity, clinical course and tumor resection but not with tumor grade. Erythrocyte adenosine deaminase levels also were elevated in patients with transitional cell carcinoma but did not correlate with other disease parameters. Lymphocyte adenosine deaminase activity in patients with transitional cell carcinoma may be a sensitive indicator of disease activity and further studies may provide insight into the host-tumor relationship at the enzyme level.

T and B lymphocyte levels in renal cancer patients: influence of preoperative transcatheter embolization and radical nephrectomy

The mean percentage of T and B lymphocytes in peripheral blood was tested in 6 patients with renal cancer before and after preoperative transcatheter embolization and radical nephrectomy. While no significant difference was found in B lymphocyte levels compared to those in healthy control subjects a clear impairment in circulating T lymphocyte levels was observed in renal cancer patients who had not been treated. This reduction in T lymphocyte levels persisted after embolization but there was a significant increase after radical nephrectomy.

Commentary on the immunobiology of bladder cancer

This review is an attempt to integrate the conflicting studies that constitute the literature on immunobiology of bladder cancer and to indicate areas that need further investigation. It is clear that immune reactivity directed at antigens expressed on bladder cancer cells and general host immunologic competence decline with progressive tumor growth. This immunodepression correlates with patient prognosis, even within a given stage of disease. The mechanisms underlying this decline in host immune reactivity are poorly understood. A better understanding of these mechanisms may provide fundamental insight into the host-tumor relationship that possibly could be exploited for preventive, diagnostic and therapeutic purposes.

Responsiveness of lymphocytes to soluble extracts of prostatic tumors and abrogation by serum-blocking factor(s)

Preliminary evidence is presented suggestive of antitumor immunity, cross reactive with allogeneic extracts from tumors of the same type, and serum-blocking factor(s), which appear to be specific to autologous tumor only, in patients with prostatic cancer employing the method of leukocyte adherence inhibition.

Effect of thymosin in vitro on T cell levels during radiation therapy: correlations with radiation portal and initial T cell levels

The effect of thymosin in vitro on percent T cells was determined in 388 blood specimens from patients with head and neck, mediastinal, and pelvic malignancies during radiation therapy, in 94 untreated patients with these malignancies, and 277 normal adults. Changes in percent T cell levels after incubation of lymphocytes with thymosin did not correlate with tumor histology or cumulative radiation dose, but in all groups correlated with radiation portal and initial T cell levels. T cell levels increased by a similar increment in normals and in the untreated patients. During irradiation, the mean levels after incubation with thymosin did not change in patients with head and neck and pelvic malignancies, but in patients with mediastinal malignancies the levels increased significantly more than in normals. For a given T cell level, the increase in patients with mediastinal malignancies was greater than in patients with pelvic malignancies, and as a group was greater than in patients with head and neck malignancies. The results can be explained by an increase in circulating thymosin-responsive lymphocytes during mediastinal irradiation due to suppression of a function of the thymus important for maturation of these cells, and a decrease in these cells during pelvic irradiation due to a deleterious effect on precursors in pelvic bone marrow. The results thus provide a rationale for clinical trials to assess the efficacy of thymosin in averting declines of T cell levels in patients receiving mediastinal irradiation.

Thymosin reconstitution of T cell deficits in vitro in cancer patients

Thymosin, a soluble extract of fetal calf thymus, has increased cellular immunity in children with thymic deficiency. Prior to therapy, an increase in thymus-dependent lymphocyte (T cell) levels in vitro after incubation with thymosin correlated with a rise in peripheral blood T cell levels and improvement in other parameters of cellular immunity. These correlations constituted the basis for a study of the effects of thymosin on T cell levels in vitro in cancer patients. Groups studied were 350 untreated patients with local-regional solid malignancies, 157 patients cured of these tumors, 340 patients studied at 523 intervals during radiation therapy, 80 patients receiving chemotherapy for disseminated solid malignancies, and 427 normal volunteers. Although there were significant differences among the groups in mean leukocyte, lymphocyte and T cell levels, among those with low T cell levels in each group there was a significant inverse relation between T cell levels after incubation with thymosin in vitro and initial T cell levels, with the exception of patients receiving chemotherapy. In patients receiving chemotherapy, T cell levels increased independently of initial T cell levels. These in vitro observations are consistent with evidence that a major effect of thymosin is maturation of T cell precursors; however, the effect is that of reconstitution at low T cell levels, and not of elevation to levels significantly above normal. The results provide a rationale for clinical trials with thymosin to maintain immune competence during radiation therapy and chemotherapy, and for a two-phase approach to immunotherapy of cancer utilizing thymosin for reconstitution of cellular defects followed by administration of agents that potentiate cellular immunity.

Immunologic reactivity of lymph nodes regional to prostatic cancer: preliminary observations

Regional pelvic lymph nodes from 9 patients with prostatic carcinoma were investigated for in vitro immunologic reactivity to T and B cell mitogens. Regional lymph node lymphocytes were significantly more reactive when obtained from nodes morphologically displaying T and B lymphocyte hyperplasia than from nodes that histologically appeared normal or depleted the lymphocytes. The data suggest that a morphologic evaluation of lymph nodes regional to prostate cancer may reflect the patient's antitumor immune response.

General immunocompetence and tumour-directed, cell-mediated hypersensitivity in vitro in patients with renal carcinoma

Thirteen patients with renal carcinoma were examined for tumour-directed, cell-mediated hypersensitivity (TCMH) by means of the leucocyte migration technique, and for general immunocompetence (GIC) by means of quantitation of T- and B-cells in peripheral blood and studies of lymphocyte transformation in vitro using a panel of antigens and mitogens. Eight out of 13 patients had evidence of TCMH, six out of 13 had abnormal GIC. Any correlation between the presence of TCMH and normal/abnormal GIC was not found. There was a trend towards a positive correlation between the absence of distant metastases and evidence of TCMH. If both TCMH and GIC were considered, significant correlation between the presence of distant metastases, lack of TCMH and/or abnormal GIC was demonstrated. It is concluded that the defect TCMH usually found in patients with renal carcinoma and disseminated disease cannot be explained exclusively by defects in GIC.

Immune evaluation with skin testing. A study of testicular, prostatic, and bladder neoplasms

Fifty patients with testicular carcinoma, 45 with prostatic neoplasm, 84 with bladder carcinoma, and 13 with benign bladder papilloma were evaluated for skin reactivity to DNCB and other intradermal antigens. Correlation between pathologic staging and skin-test reactivity was sought. Reaction to DNCB among patients with testis tumors was more significantly depressed by chemotherapy than by the extent of retroperitoneal or distant metastatic disease indicating that skin testing as a means of following the course of disease or of predicting survival may be limited by alterations caused by chemotherapy. DNCB reactivity did not correlate with the prognosis for the different stages of disease, but follow-up studies of individual patient survival are needed for substantiation. Depression of DNCB reactivity exists among patients with prostatic carcinoma whether the disease is localized or widely metastatic. Only lengthy follow-up will determine if there is any correlation of reactivity with survival in individual patients. DNCB reactivity among patients with bladder tumors shows progressive reduction with increasing stage disease and lends support to the evidence suggesting immune deficiency in patients with bladder neoplasm.

Serum proteins in prostatic cancer. III. Relationship of levels of immunoglobulins and complement to clinical stage of disease

The relationship between the level of the three major serum immunoglobulins, IgG, IgA, and IgM and of the third component of complement (C')C'3(B1A-globulin) and the clinical Stage of prostatic cancer was evaluated. While, statistically significant (P less than 0.05) differences in the levels of these proteins compared with their levels in patients with benign prostatic hypertrophy (applied only to the study of C'3) and healthy adults were observed, the levels of these proteins in each of the Stages evaluated were not significantly different from each other. The absence of a correlation between the Stage of disease and the levels of these humorally mediated effectors of immunologic responsiveness is in keeping with observations of cell-mediated effectors of immunologic responsiveness in prostatic cancer patients. Observation of the association of prostatic cancer with a deficiency of B-cell function and of C'3 is noted.

Surgery of prostatic carcinoma

Seven surgical treatments for the management of prostatic cancer are briefly reviewed. A transurethral prostatic resection is of value, not only for the relief of bladder outlet obstruction, but also in the definitive management of Stage A lesions. The long-term survival for patients with Stage C disease treated by radical prostatectomy plus interstitial irradiation demonstrates the efficacy of this mode of therapy. Pelvic lymphadenectomy has yielded valuable information on the stage of the disease; long-term survival was related to the presence of lymph node metastases. Lymphadenectomy may have contributed to the 5-year survival rate of those with regional lymph node involvement, but there is no direct evidence to support this view. The early results in patients treated by cryosurgery indicate that this mode of therapy can be very effective in the ablation of the local lesion and may very well have a useful place in the surgical armamentarium for the management of prostatic cancer.

Serum proteins in prostatic cancer. II. Effect on in vitro cell-mediated immunologic responsiveness

The sera from patients with prostatic cancer have been observed to posses an unidentified factor capable of inhibiting the migration of leukocytes and the proliferative response to the nonspecific mitogen, phytohemagglutinin. Observation of inhibition of these two suggested in vitro correlates fo cell-mediated immunologic responsiveness emphasizes (1) the importance to the adjunctive diagnosis and prognosis of patients with malignancy of identifying the presence of abnormal serum proteins, and (2) the role of humoral inhibitory or "immunoregulatory" factors as potential abrogators of mechanisms of host resistance, for example, immunologic surveillance, and thus the degree to whcih the host may respond to his tumor.