Dominant T cell receptor rearrangements in interleukin 2 expanded lymphocytes from rheumatoid nodules suggest antigen driven T cell activation in situ

OBJECTIVE

To study at a molecular level the clonality of interleukin 2 (IL-2) expanded T cell lines derived from rheumatoid nodules. Such cell lines were reported in earlier studies with flow cytometry and antiidiotypic monoclonal antibodies (MAb) to be obligoclonal.

METHODS

T cell lines were derived from rheumatoid nodules in 2 patients with rheumatoid arthritis (RA) and expanded in medium containing IL-2. Clonality was assessed by flow cytometry and T cell receptor (TCR) idiotype specific Mab and by polymerase chain reaction with primers for V alpha and V beta gene families. Sequence analysis was performed in selected cell lines.

RESULTS

In one patient, one cell line was identified with marked overexpression of V alpha 2 cells. Eleven V alpha 2 CDR3 sequences were derived from this cell line: 8 of these clones had an identical CDR3 sequence and one other clone showed a related sequence. Five cell lines derived from a second patient displayed a marked clonal bias to V beta 8 cells. One cell line with strong V beta 8 expression was chosen for further sequence analysis. Twelve V beta 8 sequences were obtained; 11 showed identical CDR3 sequences.

CONCLUSION

Molecular analysis of TCR rearrangements in IL-2 expanded T cell lines from rheumatoid nodules strongly suggests that in situ T cell activation is related to classical antigen induced immune activation.

Intratumoral PEG-interleukin-2 therapy in patients with locoregionally recurrent head and neck squamous-cell carcinoma

BACKGROUND

An enhanced efficacy of local as compared to systemic administration of interleukin-2 (IL-2) has been demonstrated in several experimental tumors. We previously reported that guinea pigs with palpable tumors and regional micrometastases could be cured by intratumoral injections of polyethylene glycol-modified IL-2 (PEG-IL-2). In the present study this treatment schedule was applied in a clinical situation.

PATIENTS AND METHODS

Nineteen patients with 11 local and 11 regional recurrences of head and neck squamous cell carcinoma (HNSCC) were treated with intratumoral injections of 200,000 U of PEG-IL-2 3 times weekly in courses of 4 weeks.

RESULTS

Treatment was given on an out-patient basis, and was well tolerated. Temporary regional swelling and redness developed in 10 patients, and in 9 of them systemic eosinophilia was documented. Median duration of treatment was 4 weeks (range 2-14 weeks). Seventeen patients were evaluable for response. One complete response (CR; 6%; duration 91 weeks), and 6 stable diseases (SDs; duration 8-57+ weeks) were recorded. The CR and the 3 best SDs (23, 40, 57+ weeks) occurred in patients with a single regional tumor recurrence of relatively small size. During treatment, all 4 developed locoregional edema and redness, and high levels of circulating eosinophils. Median survival was 23 weeks for all patients, and 45+ weeks for the patients with SD.

CONCLUSION

Intratumoral injection of PEG-IL-2 in patients with HNSCC is feasible. This treatment appears beneficial for highly selected patients. The objective response rate is insufficient to justify wide clinical application.

Stapedius reflex and EABR thresholds in experienced users of the Nucleus cochlear implant

Evoked auditory brainstem responses (EABR) and stapedius reflex thresholds were established in 7 experienced users of the Nucleus cochlear implant. Even using biphasic 400 microseconds/phase clicks for the EABR, responses were observed in only 5 patients; no stapedius reflex (SR) was seen in 3 patients, 2 of whom had a history of middle-ear disorder. The EABR threshold varied widely between subjective threshold and uncomfortable loudness level (ULL) for the same stimulus. The average SR threshold was found somewhat more consistently at 66% of the dynamic range between threshold and ULL, but grossly overestimated the most comfortable level (MCL) in most cases. To obtain equal loudness at the same current level we suggest that broad clicks (300 microseconds/phase) be used for EABR measurements, thus compensating for the lower repetition rate of EABR stimulus compared with the device fitting stimulus.

Clinical and immunopathological results of a phase II study of perilymphatically injected recombinant interleukin-2 in locally far advanced, nonpretreated head and neck squamous cell carcinoma

Fifteen patients with locally far advanced, nonpretreated head and neck squamous cell carcinoma were treated with low-dose recombinant interleukin-2, using 10 daily perilymphatic injections. The therapy was well tolerated. No tumor regression was observed. Tumor biopsies were taken before and after treatment. Histopathological studies including evaluation of the mononuclear cell infiltrate and immunohistochemical detection of human leukocyte antigen (HLA) expression on tumor cells were performed. HLA class I was not detectable in 1 of 10 samples, and HLA class II expression was seen in 2 of 10 samples. As compared to pretreatment biopsies, no changes were found after treatment. This is in agreement with the lack of a clinical response.

Surgical and prosthesis-related complications using the Groningen button voice prosthesis

Prosthesis-assisted tracheoesophageal speech has advanced speech rehabilitation appreciably. However, the surgical technique and the use of a prosthesis may give rise to complications. In a retrospective study on 132 consecutive patients rehabilitated with a Groningen button voice prosthesis, the complications were assessed, the average follow-up being 21 months. Surgical complications were not observed. Prosthesis-related complications, which were encountered in 28%, were all of a minor nature and mainly consisted of granulation formation and hypertrophic scarring; these appeared to be easily treatable. The complications found were few and insignificant in comparison with reports in the literature. This may be attributed to the uncomplicated surgical procedure for the insertion of the Groningen button. Moreover, the prosthesis is self-retaining and requires hardly any care from the patient. Permanent removal of the prosthesis usually requires surgical closure, which is a simple procedure performed under local anaesthesia.

The occurrence of otitis media with effusion in Dutch pre-school children

Published data on the frequency of otitis media with effusion in pre-school children do not give a uniform view about the age-specific rates. A cohort of 1439 2-year-old children in the Netherlands was followed using serial tympanometry on 9 consecutive occasions up to 4 years of age. The screening rate decreased from 87% on the first occasion to 73% on the last round. The prevalence rates in this study are high compared to results quoted in the literature. At least 80% of the children had otitis media with effusion on at least one occasion before the age of four. Distinct seasonal variation was found in the rates. It is postulated that middle ear effusion is a 'physiological' phenomenon at pre-school age with some pathological exceptions.

Modulation of proliferation of a human head and neck squamous carcinoma cell line (HN-1) by catecholamines and histamine

The effects of catecholamines and histamine on the HN-1 human head and neck squamous carcinoma cell line were determined by analyzing binding of (-)125 I-iodocyanopindolol (delta-adrenergic antagonist), clonogenicity in soft agar, and cell cycle effects by dual-parameter flow cytometry. Binding studies revealed the presence of delta-adrenergic receptors with an affinity between 11-13 pM and a capacity between 5.8.-8.5 fmol/10(5) cells. A clonogenic assay demonstrated that both isoproterenol and histamine gave a minor inhibition of clonogenicity which could be reversed with propranolol and cimetidine respectively. Pretreatment with propranolol followed by isoproterenol treatment abolished the inhibitory effect of isoproterenol on clonogenicity. Catecholamines and histamine modulated the proliferation of HN-1 cells which was generated through receptor binding.

Growth characteristics of head and neck squamous cell carcinoma in nude mice

Growth behaviour of human squamous cell carcinoma from the head and neck region was studied in nude mice. Tumour growth was observed in 10 out of 13 tumours transplanted with a primary take rate of 77 and 100% for serial passaging. The take rate percentage related to the number of tumour inocula used, varied from 10 to 90% in the first passage and from 70 to 100% in the subsequent passages. No significant difference could be established in the growth character, except from the first to the second passage. Histological studies demonstrated preservation of the original histopathological features, micro- and macroinvasion of two tumour lines into the fibrous capsule and cyst formation. Comparison of growth curves with histological features demonstrated that growth curves are not a reliable measure for the number of vital tumour cells present.

Pulmonary complications of methotrexate therapy

Diffuse interstitial pulmonary infiltration was first reported in 1969, occurring during intermittent methotrexate therapy and it is suggested that it represents an adverse reaction to this drug. Despite the severity of the clinical and radiological changes, the disease is usually self-limiting. An additional case is presented and the previous 28 reported cases of this syndrome are summarized. Since intermittent methotrexate therapy is becoming more widely used, the importance of recognizing this respiratory illness as a possible complicating reaction to the drug is stressed.