Coley's toxins, tumor necrosis factor and cancer research: a historical perspective

As far back as the 1700s, it was recorded that certain infectious disease processes could exert a beneficial therapeutic effect upon malignancy. Most prominent among the numerous deliberate efforts made to take advantage of these observations was that of a pioneering New York surgeon, William B. Coley, active career 1891-1936. Using a bacterial vaccine to treat primarily inoperable sarcoma. Coley accomplished a cure rate of better than 10%. This review examines the history of these efforts and presents a discussion of their corresponding relevance to present day immunotherapy.

The CD14+CD16+ monocytes in erysipelas are expanded and show reduced cytokine production

In human peripheral blood the classical CD14(++)DR(+) monocytes and the pro-inflammatory CD14(+)CD16(+)DR(++) monocytes can be distinguished. In erysipelas we found strongly increased numbers of CD14(+)CD16(+) monocytes on the day of diagnosis (day 1) in 11 patients with an average of 150.5+/-76.0 cells/microl, while 1 patient had low levels (35 cells/microl, control donors 48.8+/-19.8 cells/microl). The classical monocytes were only moderately elevated in the erysipelas patients (factor 1.7 as compared to controls). Patients exhibited increased body temperature, erythrocyte sedimentation rate and increased serum levels for C-reactive protein (CRP), IL-6 and macrophage-colony-stimulating factor. Among these, body temperature and CRP showed a significant correlation to the numbers of CD14(+)CD16(+) monocytes. In 4 of 4 patients with high levels of CD14(+)CD16(+) monocytes, these levels returned to that seen in controls by day 5 of antibiotic therapy. Determination of intracellular TNF was performed by three-color immunofluorescence and flow cytometry after ex vivo stimulation with lipoteichoic acid, a typical constituent of streptococci. Here, patient CD14(+)DR(++) pro-inflammatory monocytes showed a twofold lower level of intracellular TNF. By contrast, expression of TNF was unaltered in the classical CD14(++) monocytes. These data show that in erysipelas the pro-inflammatory CD14(+)CD16(+)DR(++) monocytes are substantially expanded and selectively tolerant to stimulation by streptococcal products.

Transient absence of C5a-specific neutrophil function in inflammatory disorders of the skin

Chemotactic migration, production of superoxide anion (O2-), and the release of beta-glucuronidase from azurophilic granules were determined in polymorphonuclear leukocytes (PMN) from 135 patients with infectious (e.g., pyoderma, acne conglobata, erysipelas) as well as noninfectious (psoriasis) skin diseases. Purified C5a and the formylated tripeptide FMLP were used as stimuli. In addition, longitudinal profiles of PMN activities were performed at daily intervals in several patients. There was a complete absence of PMN responses (chemotaxis, O2--production, and enzyme release) specifically induced by C5a in 25 patients suffering from various inflammatory diseases of the skin. In these patients PMN responsiveness for the tripeptide FMLP was either normal or increased. The C5a-dependent defect of PMN was transient and correlated with disease activity. When normal PMN were incubated with sera from C5a-defective patients, no inherent stimulatory or inhibitory activities compared to control sera were seen. Pretreatment of normal PMN in vitro with various concentrations of C5a failed to completely deactivate PMN without affecting FMLP dependent functions. These observations demonstrate the presence of a functional defect in circulating PMN during acute cutaneous inflammation. The in vitro experiments suggest transient blocking of C5a-dependent PMN functions by a cell-bound factor which seems not to be C5a or C5adesarg.

Regulating effects of porcine interleukin-6 gene and CpG motifs on immune responses to porcine trivalent vaccines in mice

In order to develop novel immunoadjuvants to boost immune response of conventional vaccines, experiments were conducted to investigate the regulating effects of porcine interleukin-6 gene and CpG motifs as the molecular adjuvants on immune responses of mice that were co-inoculated with trivalent vaccines against Swine fever, the Pasteurellosis and Erysipelas suis. Synthetic oligodeoxynuleotides containing CpG motifs were ligated into pUC18, forming recombinant pUC18-CpG plasmid. Eukaryotic plasmid expressing porcine interleukin-6 (VPIL-6) were also constructed as molecular adjuvants in an attempt to enhance levels of immune responses of mice co-administered with the trivalent vaccines in this paper. The cellular and humoral immune responses of mice were systematically analysed, and the experimental results were observed that the number of white blood cells, monocytes, granuloytes and lymphocytes significantly increased, respectively, in the mice immunized with VPIL-6, compared with those of the control; the IgG content and titre of specific antibodies to the trivalent vaccine mounted remarkably in the sera from the VPIL-6 vaccinated mice; the proliferation of lymphocytes and induced IL-2 activities were significantly increased in the vaccinated groups. The above-mentioned immune responses of mice co-inoculated with pUC18-CpG plasmid were significantly stronger than those of co-inoculated with pUC18 plasmid, suggesting that the immunostimulatory effect of oligodeoxynuleotides CpG is closely connected with the number of CpG motifs. These results suggest that the porcine IL-6 gene and CpG motifs could be employed as effective immunoadjuvants to elevate immunity to conventional vaccines.

Outbreak of idiopathic erysipelas in a psychiatric hospital

In an outbreak of idiopathic erysipelas ten women patients, aged 42-74, in a long-stay unit of a psychiatric hospital were simultaneously affected. Group A streptococci M-type 1 were isolated from two isolated from two patients with erysipelas and 18 carriers, but subsequent serological tests for type-specific antibody, antistreptolysin O, and anti-deoxyribonuclease B showed that the infection had been widespread in the unit. Treatment with ampicillin proved ineffective and to prevent relapse it was substituted by a standard course of intramuscular penicillin. This seems to be the first epidemic of this type to be reported and certainly the first outbreak of idiopathic erysipelas to be investigated by modern serological techniques.

Streptococcal DNase B is immunologically identical to superantigen SpeF but involves separate domains

The previous suggestion that streptococcal superantigen SpeF might be identical to DNase B was confirmed in this study. Polyclonal SpeF-specific antisera were able to inhibit depolymerization of methyl-green DNA by DNase B. However, T-cell mitogenicity and nuclease activity appear to involve separate immune epitopes on SpeF, since sera with the capacity to neutralize the mitogenic activity of SpeF did not always inhibit the DNase activity.

Isolation of a high-molecular mass glycoprotein from culture supernatant of an arthritogenic strain of the bacteria Erysipelothrix rhusiopathiae reacting with "inductive" monoclonal antibodies derived from rats with erysipelas polyarthritis

A glycoprotein exhibiting a relative molecular mass of about 1000 kDa was purified to homogeneity from culture supernatant of arthritogenic bacteria (Erysipelothrix rhusiopathiae, strain T28) by ultrafiltration, ammonium sulfate precipitation, molecular mass exclusion, and ion exchange chromatography. Fractions obtained were analysed for their antigenic content by an enzyme linked immunosorbent assay (ELISA) using rabbit immune serum raised against this strain of Erysipelothrix rhusiopathiae. Distinct monoclonal antibodies obtained from rats suffering from erysipelas polyarthritis display a unique property by inducing very efficiently protective and regulatory mechanisms while being unable to generate classical "passive immunity". These "inductive" monoclonal antibodies recognize most likely linear epitopes on the purified glycoprotein. This makes it a prime source for analysing the target structure of these in vivo "inductive" antibodies.

Extremely high titers of serum antibodies against the streptococcal exoenzyme deoxyribonuclease B

In sera from 4 of 25,000 individuals tested for antibodies against streptococci, extremely high antideoxyribonuclease B titers ( > 10(6) U/ml) were found. Two of the cases were diagnosed as monoclonal gammopathies. The M-components were shown to possess the anti-deoxyribonuclease B activity. The other two cases were diagnosed as relapsing erysipelas. The high serum titers of deoxyribonuclease B antibodies were accompanied by a very inflammatory reactivity in the patients' sera and by an oligopolyclonal pattern of immunoglobulin G. In routine diagnoses of streptococcal infections with the anti-deoxyribonuclease B test, patients with extremely high serum titers should be examined for the possible occurrence of gammopathies.

[The dynamics of the immunological indices during the treatment of recurrent erysipelas with the new immunostimulant bemitil]

Bemitil, administered orally in a dose of 0.25-0.5 g a day for 5-7 days at the acute period of the relapse of erysipelas as an immunostimulant, enhanced the effectiveness of the basic therapy including antibiotics, anti-inflammatory and antiallergic drugs, vitamins, plasma-substituting fluids and saline solutions, as well as ultraviolet irradiation of the focus of lesion. Bemitil therapy was associated with an increase in the number of T-lymphocytes, normalization of the balance between the peripheral lymphocyte preparations, an increase of blood serum levels of IgA and IgM.

[The level of IgM, IgG and IgA antibodies and total antibodies to the low-molecular, cell-wall protein of Streptococcus group A without type specificity in the serum of patients with a streptococcal infection]

The levels of IgM, IgG and IgA antibodies, as well as total antibodies, to group A streptococcal low-molecular cell-wall protein without type specificity were studied in the sera of patients with primary erysipelas, rheumatism in the active and inactive phases, seronegative rheumatoid arthritis, as well as in the sera of healthy donors. The average level of antibodies to low-molecular protein in the sera of all groups of patients was significantly higher than the sera of healthy donors. The analysis of the distribution of antibodies in accordance with their isotypes revealed the specific features of response, characteristic of each group of patients. For rheumatism patients, the positive correlation between response to low-molecular protein and response to group-specific polysaccharide A was established. This correlation was most pronounced in patients with rheumatism in the inactive phase.

Potency testing of inactivated erysipelas vaccines by ELISA--influence of the adjuvant on antibody development

The humoral immune response after vaccination may be greatly influenced by the type of adjuvant used. In this study we investigated the influence of three different adjuvants on the serological response in laboratory mice after immunisation with commercial erysipelas vaccines.

[Characteristics of cytoplasmic antigens of cells from differentiated epidermal layers in human thymic epithelium]

It was found that donor's serum and serum of patients with rheumatic fever, erysipelas and myasthenia gravis contained autoantibodies to the cytoplasmic antigens and to the antigen of perinuclear zone of differentiated layers cells of human epidermis. Using the serum with different level of autoantibodies to these epidermal antigens it's localization in the human thymus epithelium was determined. It was shown that perinuclear antigen of differentiated epidermis cells is localized in the cytoplasm of cortical and medullar thymus epithelial cells and in the perinuclear zone of some cells in Hassall's corpuscles. The cytoplasmic antigen of differentiated epidermal cells is detected only in the cytoplasm of the Hassall's corpuscle cells. The ability of many tissues (possibly all of them) and in the first turn of epidermis to produce lymphokine along with immunomodulating properties of thymus hetero-organic antigens enables to consider these thymus antigens as a complex of immunomodulating factor proper for other tissues. These factors may provide the competence of certain T-cell subpopulations to different organ's tissues necessary for proceedings them the immunological survey both in normal and pathological conditions.

[Antibodies to group A streptococcal polysaccharides in erysipelas]

In determination (in the precipitation reaction in agar gel) of antibodies to the polysaccharide (streptococcus, group A) in the sera of patients suffering from erysipelas there were revealed antibodies against the specific determinant of polysaccharide A. An increase in antibodies in the patients with primary and repeated erysipelas was observed from the second week of the disease; in patients suffering from relapsing erysipelas their titre was increased from the first days of the disease and persisted at this level during the whole observation period (4 weeks). The majority of the patients suffering from relapsing erysipelas 4 weeks and 6 to 12 months after the relapse displayed no changes in the serum antibody level, or its slight fall was seen. The duration of persistence of antibodies to polysaccharide A in testing at the remote periods after the relapse apparently depended on slow reduction of their level and was not associated with any new infection with streptococcus, since the great percentage of the patients studied at this period were subjected to bicillin-5 therapy. The data obtained served as an additional confirmation of participation of hemolytic streptococcus of group A in the development of erysipelas.

[Cytotoxic effect of lymphocytes on autologous blood monocytes in the presence of streptococcal group A antigens in patients with primary erysipelas]

The present work deals with a modification of the cytotoxic test for the determination of the cytotoxic activity of lymphocytes in infectious diseases. This modification is based on the use of the suspension of mononuclear blood cells, simultaneously containing effector cells (sensitized lymphocytes) and target cells (autologous monocytes). The cytotoxic effect on monocytes is observed after the preliminary incubation of nonadhering cells (lymphocytes) with the antigen of microorganisms causing the infectious process. A statistically significant increase in the cytotoxic activity of lymphocytes was recorded in patients with primary erysipelas at the acute period of the disease. The cytotoxic effect has been found to persist at a high level for two weeks. By the end of the disease this effect drops to the level characteristic of clinically normal persons. An elevated level of the cytotoxic activity of lymphocytes in the presence of streptococcal antigens of one type has been detected in 72% of patients with primary erysipelas. This indicates that type-nonspecific streptococcal antigens take part in the formation of delayed hypersensitivity, which is also confirmed by the data obtained in animal experiments.

[Treatment of phlegmonous and necrotic forms of erysipelas]

Clinical observations, bacteriological examinations in 220 patients operated upon for phlegmonous and necrotic erysipelas and investigation of the immunological background (in 48 of them) have shown that phlegmono-necrotic erysipelas develops due to the displacement of streptococci from the inflammatory center of the secondary infection against the background of the venous and lymphostasis with reduced local immunity.

[Determination of antibodies to Streptococcus group A polysaccharide in human sera by an immunoenzyme method]

Use was made of the ELISA to develop a highly sensitive quantitative method for detection of antibodies against Streptococcus group A polysaccharide (polysaccharide A) in human sera. The main advantage is that one can use only one optimal dilution of the sera together with the reference serum. Sera of 53 healthy volunteers and 77 patients with a history of Streptococcus group A infections were screened for the presence of polysaccharide A antibodies. Highly reproducible results were obtained in 97% of cases. The specificity of the method was shown with the polysaccharide A-induced inhibition of the reaction. Positive reactions obtained with the tested sera in gel immunodiffusion correlated with the data derived by the ELISA. Using the latter high level of specific antibodies was found in some of the sera that yielded negative reactions when tested by gel immunodiffusion. This may be associated with the presence of non-precipitating antibodies.

[Autoimmune reactions in diseases of streptococcal etiology]

In this work 98 cases of streptococcal tonsillitis and 361 cases of erysipelas were studied. As revealed in this study, in relapsing forms of streptococcal infection antibodies to cross-reacting antigens of the infective agent appear in the blood. The synthesis of antibodies to the basal layers of skin epithelium was accompanied by an increase in the concentration of medium-size immune complexes, 0-cell population and by a decrease in the number of T suppressors. The mechanism of the development of the autoimmune process in relapsing forms of streptococcal infection is discussed.

[Capacity of mononuclear cells to produce a factor that promotes E-rosette formation in different clinical forms of erysipelas]

The author has examined the capacity of mononuclear cells in peripheral blood samples obtained from erysipelas patients for the in vitro secretion of E-rosette formation promoting factor (E-RPF) in response to polyclonal stimulation with phytohemagglutinin (PHA) P or antigenic stimulation with hemolytic streptococcal allergen. At the acute stage of the disease, mononuclear cells spontaneously secreted E-RPF in a half of the examined patients; at the same time, a statistically significant decrease in the PHA-induced secretion of E-RPF was observed, especially in patients with the primary bullous form and relapses of erysipelas. The optimum lymphokine production in response to PHA in patients with primary erysipelas was observed simultaneously with a low level of spontaneous lymphokine production, while in relapses it was significantly suppressed at all levels of the spontaneous secretion of E-RPF. The antigen-stimulated secretion of E-RPF was observed more frequently in patients with primary bullous erysipelas, while in bullous relapses it was completely absent. At the early stage of convalescence the intensity of the spontaneous secretion of E-RPF decreased, while the PHA-induced secretion of E-RPF enhanced. In relapses the secretion of E-RPF in response to stimulation with the specific allergen remained at a low level, while in convalescents having had primary erysipelas the level of this secretion was high. These data indicate that mononuclear cells in the peripheral blood essentially differ in their capacity to secrete E-RPF in response to polyclonal and antigenic stimulation in various clinical forms of erysipelas.