Relationship of cell-mediated cytotoxicity against melanoma cells to prognosis in melanoma patients

Smoking and the risk of early metastases from uveal melanoma

Smoking is suspected of altering host immunity and may therefore hasten the development of metastases among cancer patients. The authors followed 946 patients with melanomas of the choroid and/or ciliary body who had been treated with proton beam irradiation and who had provided a smoking history during their evaluation before treatment. After a mean follow-up of 33 months, 98 patients were diagnosed with metastatic disease. Metastasis-free survival rates 3 years after irradiation were similar in association with never, past, and current cigarette smoking (86%, 89%, and 90%, respectively; P = 0.90). Rates also were similar with increasing pack-years of exposure and when the product smoked was cigarettes versus pipes or cigars only. Estimates for smoking effects were unchanged after adjusting for established prognostic factors for metastases. Results suggest that smoking does not alter the risk of metastases during the first few years after irradiation of choroidal melanomas.

Preoperative cell-mediated immune function and the prognosis of patients with gastric carcinoma

The cell-mediated immune function of 83 patients with gastric carcinoma was assessed preoperatively and the results were compared to that of 52 patients with benign lesions. The data were subjected to an analysis in order to evaluate their prognostic significance. The abilities to induce allogeneic cytotoxicity and to produce interleukin 2 (IL2) in patients with stage IV carcinoma were significantly depressed, as compared to those in patients with benign lesions, whereas natural killer (NK) cell activity was not significantly impaired. There was no significant correlation among these immune functions. When the patients were stratified into two groups, those who had high (greater than the mean value in patients with benign lesions) and low (less than the same value) values of these immune reactivities, the survival of patients with high NK activity (greater than or equal to 43%) was significantly better, as compared to that of patients with low cytotoxicity (less than 43%). However, there was no correlation between the survival and allogeneic cytotoxicity in these patients. The high ability to produce IL2 (greater than or equal to 1.3 U/ml) correlated with the better survival in the patients, but not in the group of patients who underwent curative resection.

Effects of radiolabelled monoclonal antibody infusion on blood leukocytes in cancer patients

This study was undertaken to investigate the effects of a single infusion of radiolabelled murine monoclonal antibody (MAb) on peripheral blood leukocytes in cancer patients. Eleven patients with disseminated colon cancer, malignant melanoma, or lung adenocarcinoma were infused with 111In-labelled anti-ZCE 025, anti-p97 type 96.5c, or LA 20207 MAb, respectively. Blood samples were obtained before infusion, immediately after infusion (1 hr), and at 4 and 7 days postinfusion. Flow cytometry analysis of CD3+, CD4+, CD8+, CD16+, and CD19+ lymphocytes showed increasing CD4:CD8 ratios in seven patients after infusion. This phenomenon was not restricted to antibody subclass or to type of cancer. Two of the remaining patients exhibited a marked post-infusion increase in CD8+ cells. In all three patients with malignant melanoma, decreasing levels of CD16+ lymphocytes were noted after infusion and natural killer cell cytotoxicity showed fluctuations which paralleled the changes in the CD16+ subpopulation. Oxygen radical production by phagocytic cells was markedly affected in three subjects. These results suggest that a single infusion of radiolabelled murine MAb may alter the balance of critical lymphocyte subpopulations and modulate other leukocyte responses in cancer patients.

Transfusion history, T cell subsets and natural killer cytotoxicity in patients with colorectal cancer

Blood transfusions are associated with clinical phenomena which are attributable to immune suppression. Since suppression of immune function is associated with a high risk of spontaneous malignancies, we studied T cell subsets and natural killer (NK) cytotoxicity in colorectal cancer patients and correlated the results with patients' transfusion histories. Twelve percent (14) of the 115 patients had been transfused an average of 19 years previously. Recipients of blood transfusions had low levels of peripheral lymphocytes (p = 0.191), T cells (p = 0.015), helper cells (p = 0.016) and suppressor cells (p = 0.2651) compared to previously untransfused patients. NK cytotoxicity was also significantly reduced in transfusion recipients although NK cell numbers were comparable in both groups. These results support previous studies indicating that blood transfusions cause lifelong immune modulation in the recipient. Since blood transfusions have numerous beneficial effects and immune modulation is often beneficial, longitudinal studies are necessary to define the lifetime risks and benefits.

Natural killer cells

It is proposed that this article will encompass a review of primarily the human natural killer cell. The following parameters of the human natural killer (NK) cell will be reviewed: its ontogeny; surface membrane characteristics including monoclonal antibody reactivity, cell lineage, the natural killer sensitive targets, and the proposed mechanism of action of natural killer cells cytotoxicity against these NK sensitive targets; the status of natural killer cell in relationship to clinical disease; the alteration of natural killer cells both in vitro and in vivo; and finally postulate relevance of the natural killer cell in context of the evolution or pathophysiology of human disease. There will be an attempt through this review to encompass the more recent publications that pertain to the various sections.

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.

Prospective study of natural cytotoxicity in peripheral blood of patients with nonlymphoid solid malignancies

Natural killer (NK) cells have been implicated as an initial immunosurveillance mechanism for carcinogenesis in humans. Work in the murine system as well as the findings of depressed NK activity in patients with advanced malignancies and the discovery of increased incidences of cancer in humans congenitally deficient in NK ability have supported this. Few prospective studies have demonstrated a prognostic change in NK activity with respect to malignant disease course. In 32 healthy donors, NK activity against K562 was determined. No race or sex difference existed with respect to NK cell function. Esophageal (5), bronchogenic (3), breast (3), cervical (3), and endometrial (1) cancer patients who had received no prior chemotherapy were compared to controls. All patients subsequently received radiotherapy. Prior to such treatment NK activity could not be associated with stage of malignancy. Of the 15 patients studied, 11 were sequentially followed. Five of eight patients with stable or improving clinical courses as assessed by weight and Karnofsky scores were found to have increasing NK activity. Two of three patients with poor clinical courses presented with subnormal killing which never rose to normal while the third declined to subnormal before expiring. Esophageal, cervical, and endometrial carcinoma patients all presented with low or subnormal NK activity. Of these, only cervical and endometrial cancer patients exhibited an increase to normal levels.

Adoptive autoimmunotherapy. Cytotoxic effect of an autologous long-term T-cell line on malignant melanoma

The in vitro and in vivo cytotoxic effects of an autologous long-term T-cell (LTTC) line were evaluated in a 65-year-old man with metastatic malignant melanoma. The patient's own T-cells were grown from a peripheral blood sample in a lymphocyte-conditioned medium. The cytotoxic effect of the LTTC against the patient's cultured melanoma cells was determined in vitro using the method of 51Cr release. Long-term T-cells produced specific lysis of 34% at an effector:target ratio of 30:1. Using allogeneic melanoma target cells, comparable or greater lysis was obtained in vitro. Long-term T-cells were injected into the infratumor and peritumor regions of two subcutaneous melanoma metastases of a lower extremity. A second injection of one of these lesions was followed 3 days later by an excisional tumor biopsy. Histologic examination showed many lymphocytes and necrotic areas in the injected lesions. Electron microscopic examination revealed numerous areas of lymphocyte-melanocyte membrane contact, membrane thickening, disintegration, hydropic cytoplasmic changes, and irreversible nuclear degenerative changes of melanocytes. Dividing lymphoblasts were also seen. These changes did not occur in noninjected tumor nodules. Long-term T-cell cultures yield immunologically functional cells capable of cytotoxic activity against allogeneic and autochthonous melanoma in vitro and against autochthonous melanoma in vivo. In vivo use after in vitro expansion of autologous immunocompetent cells (adoptive autoimmunotherapy) appears to be a feasible new approach to the study of human tumor immunology and treatment.

Natural cytotoxicity of lymphocytes and monocytes and its augmentation by OK432 in melanoma patients

Lymphocytes and monocytes from the peripheral blood of 30 patients with malignant melanoma were tested for natural cytotoxicity against K562 cells in a 3-h 51Cr-release assay, and the effects of OK432 (a streptococcal preparation) on the cytotoxicity were examined. The lymphocyte cytotoxicity of melanoma patients was similar to that of normal donors and control patients with benign skin disease. Furthermore, the lymphocyte cytotoxicity of melanoma patients was not correlated to the stage of the disease. Similarly, lysis of K562 cells by monocytes isolated by adherence to autologous serum-coated plastic dishes in melanoma patients was comparable to that of controls and not associated with the stage of the disease. Positive monocyte reactions were recorded in 10 of 30 (33%) melanoma patients, seven of 21 (33%) normal donors and three of 10 (30%) control patients. There was no correlation between lymphocyte cytotoxicity and monocyte cytotoxicity. Overnight treatment of monocytes and lymphocytes with OK432 resulted in an increase in cytotoxicity. Significant augmentation of cytotoxicity by OK432 was observed in 28% of the monocyte samples and 86% of the lymphocyte samples, while partially purified human interferon augmented cytotoxicity in 63% of the monocyte samples and all the lymphocyte samples. These results suggest that neither lymphocyte nor monocyte cytotoxicities are depressed in melanoma patients as compared with normal donors and patients with benign disease and that OK432 has a stronger stimulatory effect on lymphocytes than on monocytes.

Human spleen cells mediating natural killing: altered natural cytotoxicity of spleen effector cells from patients with carcinoma

Spleen cells from eight patients with abdominal carcinoma and six patients undergoing major surgery for a variety of disease entities were assayed for natural cytotoxicity towards 51Cr-labelled K 562 target cells. Patients with abdominal cancer were shown to have relatively weak splenic natural cytotoxicity compared with the reactivity of effector cells from non-carcinoma patients. Nylon wool non-adherent spleen effector cells from cancer patients showed reduced cytolytic capacity compared with effector cells prepared from the spleens of other patients or peripheral blood mononuclear cells (PBMC) obtained from healthy individuals, whereas the splenic reactivity of non-cancer patients showed the same nylon wool separation profile as PBMC, high cytolytic activity being associated with nylon wool non-adherent effector cells. Splenic effector cell cytotoxicity from cancer and non-cancer patients was enhanced following exposure to human interferon, and inhibited by treatment with cholera toxin and simple sugars. Furthermore, fractionation of spleen cells on Percoll discontinuous density gradients demonstrated natural cytotoxic activity to reside predominantly in the low density cell fractions, similar to that found with NK cells from peripheral blood. Thus the properties described here for human cytotoxic spleen cells are similar to those described for peripheral blood NK cells, suggesting these two effector cell populations to be closely related, if not identical.

The biology of the human natural killer cell

Natural killer (NK) cells in the human are a population of large granular lymphocytes (LGL) with at least one unique surface antigen not expressed on cells of other lineages. NK-target-cell interaction appears to involve carbohydrate recognition and, following binding, the NK cells are induced to generate O2-, transmethylate membrane phospholipids, and activate phospholipase A2. Some or all of these activities trigger a cascade of events which ultimately leads to the secretion of a substance toxic to the target cell. A variety of genes controls various steps in this cytolytic pathway. There is a good deal of evidence in the mouse, and some in the human, that NK cells play a role in host surveillance against tumor development, resistance to viral infections, and, possibly, hematopoietic regulation.

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.

Deficient natural killer cell activity in a patient with Fanconi's anaemia and squamous cell carcinoma. Association with defect in interferon release

A child with Fanconi's anaemia diagnosed at 7 years of age presented in adult life with lymphopenia, recurrent warts and Bowen's disease. The latter resulted in the development of multiple cutaneous squamous cell carcinomas which metastasized to the skeleton. Investigation of her immune function revealed selective defects in natural killer (NK) cell activity. Humoral immunity and several tests of cell-mediated responses were within normal or became normal after treatment with levamisole or transfer factor. Analysis of the defect in NK activity revealed that low levels could be induced in vitro by fibroblast interferon. Stimulation of blood lymphocytes from the patient with the interferon inducer poly (I)-poly (C) resulted in an increase in NK activity but incubation of her lymphocytes on tumour cells did not result in an increase in NK activity or the release of interferon. This contrasted with the marked increase in NK activity and interferon release observed when lymphocytes from normal controls were incubated on tumor cells. These findings suggested the absence of NK activity in this patient was secondary to a defect in interferon release from lymphocytes on exposure to tumour antigens. It is considered that these defects may have been an important predisposing factor in the development of malignancy in this patient and possibly other patients with Fanconi's anaemia.

Cryoglobulinemia and decreased monocyte chemotaxis is malignant melanoma

The sera fromm 13 patients with malignant melanoma were evaluated for immune complexes by cryoprecipitation and the 125I Clq binding assay. Cryoprecipitates were identified in 12/13 patients (92%) and cryoimmunoglobulins in 7/13 patients (54%). Either cryoimmunoglobulin or elevated Clq binding was identified in 8/13 patients (62%). Incubation of normal monocytes with the resuspended cryoimmunoglobulin of 7 melanoma patients produced greater than 50% reduction in the ability of th monocytes to respond to chemotactic stimuli (p < .01). Similar inhibition was seen with cryoimmunoglobulin from erythema multiforme patients, but not with 'medium alone, albumin, heat aggregated albumin or heat aggregated-IgG in similar concentrations. No soluble factors produced in vitro could be demonstrated to produce this inhibition. Inhibition of monocyte function by immune complexes may be an important component of impaired host response to malignant melanoma, or alternatively may represent an important mechanism for the accumulation of monocytes at sites of inflammation, analogous to migration inhibition factor.

Tumour-related changes in natural killer cell activity in melanoma patients. Influence of stage of disease, tumour thickness and age of patients

The influence of tumour growth on the natural killer (NK) activity of melanoma patients was examined by analysis of NK activity in 51Cr release assays before and at intervals after surgical removal of localized melanoma. In patients with Stage I and II melanoma, removal of the tumour was associated with changes in the level of NK activity which were not detected in patients who had surgery for skin graft after previous removal of the primary melanoma. The changes in NK activity after removal of melanoma were however different in patients with Stage I compared to Stage II melanoma. In the former, NK activity which appeared specifically directed toward melanoma cells was maximal 2-4 weeks after removal of the tumour and then decreased to normal levels. The NK activity after surgery was directly related to the thickness of the tumour. In patients with Stage II melanoma, NK activity did not increase but fell to low levels after removal of the tumour. The level of NK activity in these patients was not related to the thickness of their primary melanoma. In patients with Stage I and II melanoma the NK activity against melanoma cells showed a significant increase with age. The reason for the different sequence of changes in NK activity after removal of melanoma in the two patient groups is unknown. It is suggested however that the differences observed in patients with Stage II melanoma may reflect differences in the tumour or host response which contributed to the spread of the tumour to regional lymph nodes in these patients.

Low natural-killer-cell activity in familial melanoma patients and their relatives

Patients with melanoma who had one or more close relatives with melanoma were studied for their natural-killer-cell (NK) activity against cultured melanoma cells and Chang cells. A high proportion of the patients and their relatives were found to have low NK activity against these target cells. In most of the patients this could not be attributed to general depression of their immune function, since B- and T-cell numbers and the mitogenic response to PHA were within normal limits. The levels of NK activity of the patients and their relatives were found to be significantly correlated, suggesting that the NK activity in these families may have been genetically (or environmentally) determined. Several genetic markers were examined in the patients and their relatives for association with the disease state and NK activity. No association with HLA antigens or ABO blood groups was detected, but there was a low incidence of the Rhesus negative phenotype in the patients (the Rh phenotype had previously been associated with high NK activity). The present results indicate that NK activity has a familial association in families with a high incidence of melanoma, and raise the question whether low NK activity may be one of the predisposing factors in the development of familial melanoma.

Relationship of natural killer-cell activity to rhesus antigens in man

A number of previous studies have shown that the level of natural killer (NK) cell activity in humans is relatively constant for a given individual but varies widely between individuals. The factors which determine this variability are largely unknown, but genetic factors appear to be involved. In the present study it was found that Rh- normal subjects and melanoma patients had significantly higher natural cytotoxicity to target cells than Rh+ patients. This difference did not appear to be due to sensitization against Rh antigens on the target cell and may indicate that genes determining NK-cell activity are associated with those determining the expression of Rh antigens. Analysis of the survival data for Rh- and Rh+ patients did not reveal any increase in survival attributable to the higher natural cytotoxicity in Rh- patients.