Immunological studies of Aging. III. Cytokinetic basis for the impaired response of lymphocytes from aged humans to plant lectins.

The basis for the age-associated defect in the response of lymphocytes to plant lectins has been studied. Using three independent assays we have shown that the number of mitogen-responsive cells is markedly reduced in lymphocyte preparations from old persons. In addition, studies using colchicine bloock and thymidine pulse techniques have revealed a failure of mitogen-responsive cells from old persons to expand into a proliferating pool of lymphocytes as is observed when lymphocytes from young persons are cultured with phytohemagglutinin. Thus, the impaired response of lymphocytes from old persons to mitogens is attributable to a reduced number of mitogen responsive cells and their failure to undergo clonal expansion.

Interferon as a mediator of human lymphocyte suppression.

Evidence is presented that interferon (IF) is a major mediator of the human concanavalin A (Con A) suppressor cell. The suppressive effects of Con A-activated lymphocytes on the mitogen responses of normal responder cells were largely abrogated by addition of anti-human leukocyte IF serum. Similar suppressor activity was generated by coculture of peripheral blood leukocytes (PBL) with a melanoma cell line (MeWo) and a HeLa cell line persistently infected with measles virus that induced the production of IF by lymphocytes. A human mammary carcinoma line (MCF-7) and two bladder carcinoma lines (T24 and TCCSUP) failed to induce IF or suppression. Addition of anti-human leukocyte IF serum to suppressor cells and supernates from tumor cell-lymphocyte cocultures largely abolished suppression and neutralized the antiviral activity of such supernates. Exposure of PBL from purified protein derivative (PPD)-positive donors to PPD caused the production of suppressor activity and IF. PBL from PPD-negative donors failed to produce significant amounts of IF or to suppress on exposure to PPD. Supernates from PBL treated with virus (Newcastle disease virus [NDV]) contained IF and suppressed the mitogen responses of responder PBL. Both the suppressive and the antiviral activities of this material were eliminated after treatment with anti-IF serum. To ascertain whether antiviral and suppressive activities were mediated by the same types of IF, supernates from PBL cultured with Con A, PPD, NDV, and tumor cells were treated with anti-IF serum or acid pH. In all cases antiviral activity was neutralized in parallel with abrogation of suppressor activity. These results provide strong evidence for the role of IF as a mediator of human suppressor cell activity.

Natural killer cytotoxic factor induction by K562 cells in patients with advanced cancer: correlation with production of interferon.

Advanced cancer patients were studied for their ability to produce natural killer cytotoxic factor (NKCF). Of 23 patients with advanced epithelial cancers, 8 showed deficient natural killer (NK) activity, as measured in a standard 51Cr release assay. Lymphocytes from these patients did not generate NKCF (nonproducers) in the presence of K562 cells. In addition, 7 other patients whose NK activity was in the normal range did not generate NKCF. Thus the deficiency in NKCF production was only partially correlated with the level of NK activity. Supernatants generated for NKCF were also assayed for antiviral activity. Mean interferon (IFN) titer of supernatants generated from peripheral blood lymphocytes (PBL) of cancer patients was significantly lower than that of supernatants generated by PBL from normal donors. Supernatants from 10 of 15 NKCF nonproducers contained no detectable IFN, whereas the remaining 5 contained up to 100 U IFN. NKCF was never generated in the absence of IFN. The defect in NKCF production by PBL from cancer patients could be corrected by the incubation of effector cells with exogenous IFN-alpha or IFN-alpha inducers, such as other tumor cells or viruses. The relationship among NKCF, IFN, and NK activities is discussed.

Deficient mitogen-induced virus plaque-forming cells in patients with localized cancer.

The virus plaque assay (VPA), an assay capable of enumerating mitogen- or antigen-sensitive T-lymphocytes in a given cell population, was applied to the study of mitogen responses of peripheral blood leukocytes (PBL) in 50 patients with localized, solid cancers and in 29 normal controls. Concanavalin A (Con A)-responsive virus plaque-forming cells (V-PFC) were significantly reduced in the patients as compared with those of the controls. PBL from 20 of the patients but only 2 of the controls failed to show significant increments in V-PFC over background when cultured in the presence of Con A. This deficient response was also present in the patients when phytohemagglutinin was used as the mitogenic agent. Mitogen-stimulated uptake of [3H]thymidine (TdR) in parallel cultures failed to show a statistically significant difference between the patients and the controls, though some patients showed diminished stimulation in this assay. The VPA thus appeared to detect a defect of T-lymphocyte function not found in the [3H]TdR incorporation assay.

Lymphoproliferative responses to human papillomavirus (HPV) type 16 proteins E6 and E7: outcome of HPV infection and associated neoplasia.

BACKGROUND: Infection with human papillomavirus (HPV) type 16 (HPV16) is a major cause of high-grade cervical intraepithelial neoplasia (CIN). Experiments were planned to evaluate the role of cell-mediated immunity (e.g., lymphocyte proliferation) against HPV in the natural history of HPV-associated neoplasia and to identify antigenic sequences of the HPV16 proteins E6 and E7 against which an immune response may confer protection. METHODS: Forty-nine women with abnormal cervical cytology and biopsy-confirmed CIN were followed through one or more clinic visits. Lymphoproliferative responses of peripheral blood mononuclear cells to HPV16 E6 and E7 peptides were assessed in long-term (3-week) cultures. HPV DNA was detected in cervicovaginal lavage by means of polymerase chain reaction and Southern blotting. Disease status was determined by cervical cytologic examination and colposcopy. Reported P values are two-sided. RESULTS: Subjects with positive lymphoproliferative responses to E6 and/or E7 peptides were more likely to be HPV negative at the same clinic visit than were nonresponders (P = .039). Subjects who were negative for HPV and those with a low viral load were more likely to be responders than were those with a high viral load (P for trend = .037). Responses to N-terminal E6 peptide 369 were associated with absence of HPV infection at the same clinic visit (P = .015). Subjects with positive responses to E6 or E7 peptides at one clinic visit were 4.4 times more likely to be HPV negative at the next visit than were nonresponders (P = .142). Responses to E6 peptide 369 and/or E7 C-terminal peptide 109 were associated with an absence of HPV infection (P = .02 for both) and an absence of CIN (P = .04 and .02, respectively) at the next visit. CONCLUSIONS: Lymphoproliferative responses to specific HPV16 E6 and E7 peptides appear to be associated with the clearance of HPV infection and the regression of CIN.

Persistent genital human papillomavirus infection as a risk factor for persistent cervical dysplasia.

BACKGROUND: Cervical dysplasia, also referred to as squamous intraepithelial lesion (SIL) in cytology or cervical intraepithelial neoplasia in histopathology, is thought to have the potential to advance in progressive stages to cervical cancer. However, not all cases of SIL progress, and most of the mild lesions spontaneously regress. Factors that govern regression, persistence, and progression of SIL are poorly understood. PURPOSE: Our analysis sought to identify factors that determined persistence or regression of SIL. METHODS: Seventy subjects with histopathologically confirmed cervical dysplasia were followed at 3-month intervals for 15 months. At each visit, the cervix was evaluated by Pap smear and colposcopy, and exfoliated cervicovaginal cells were analyzed for human papillomavirus (HPV) DNA. For each subject, data from every two consecutive visits were grouped as a pair. Persistent SIL was considered present if a lesion was detected at a visit (t) as well as at the next visit (t + 1) and absent if a lesion was detected at visit t but not at visit t + 1. A statistical model for time-dependent data correlated persistent SIL with various risk factors. RESULTS: Age, ethnicity, education, sexual behavior, smoking, and the use of oral contraceptives did not correlate with persistent SIL. The risk of persistent SIL was associated with continual HPV infection in visits t and t + 1 (HPV positive by Southern blot analysis: odds ratio [OR] = 3.91, and 95% confidence interval [CI] = 1.58-9.65; HPV positive by polymerase chain reaction [PCR]: OR = 2.42, and 95% CI = 1.03-5.67) and a persistent high viral load (OR = 4.07, and 95% CI = 1.35-12.30). When typed by PCR, individuals with type-specific persistent infection in visits t and t + 1, and particularly those with a continual high viral load (OR = 4.97; 95% CI = 1.45-17.02), had the highest risk for persistent SIL compared with those with a low level of type-specific persistent infection or non-type-specific persistent infection. The presence of persistent HPV infection in visits t-1 (the preceding time interval) was also predictive of persistent SIL in visits t and t + 1, although the strength of association was weaker, suggesting that persistent HPV and SIL occur synchronously. CONCLUSION: HPV infection and its associated cervical lesions tend to occur concurrently, and type-specific persistent HPV infection, particularly with a high viral load, produces chronic cervical dysplasia. IMPLICATIONS: The natural history of genital HPV infection directly influences the prognosis of cervical dysplasia as measured by persistence of the lesion. Testing for HPV infection may be valuable in the clinical management of women with cervical dysplasia.

Induction of transforming growth factor beta-1 in cervical intraepithelial neoplasia in vivo after treatment with beta-carotene.

Transforming growth factor (TGF) beta1 is a potent growth inhibitor of epithelial cells. Loss of responsiveness to TGF-beta1 and/or loss of TGF-beta1 itself may be important in the progression of cervical intraepithelial neoplasia to invasive cervical cancer. Retinoids have antiproliferative effects on epithelial cells and have been used as chemopreventive and chemotherapeutic agents for several human cancers. There is evidence that retinoids exert their effects by promoting the induction of TGF-beta. The aim of this study was to determine whether the expression of TGF-beta1 was altered in patients enrolled in a clinical trial designed to test the therapeutic efficacy of beta-carotene, a carotenoid metabolized to retinol, in cervical intraepithelial neoplasia. Using an immunohistochemical technique, tissues were stained with two types of antisera that react with the intracellular and extracellular forms of TGF-beta1. Matched cervical biopsies taken from 10 patients before and after treatment with beta-carotene were immunostained simultaneously to allow direct comparison of relative staining intensity. A significant increase in intracellular TGF-beta1 immunoreactivity was noted in cervical epithelial cells in patients with cervical intraepithelial neoplasia after treatment with beta-carotene (P = 0.003). These results demonstrate regulation of a TGF-beta isoform in vivo in humans in response to beta-carotene administered as a chemopreventive agent.

Increased carcinoembryonic antigen expression in cervical intraepithelial neoplasia grade 3 and in cervical squamous cell carcinoma.

Carcinoembryonic antigen (CEA) is a highly glycosylated cell surface protein that is overexpressed in a variety of human tumors and has been used as a tumor marker for disease progression in colorectal cancer patients. Recently, CEA has been used as a target for vaccine therapy against advanced CEA-expressing colonic adenocarcinomas. Previous reports have found elevated serum CEA levels in patients with cervical cancer, although this did not correlate with disease progression. In this study, cervical biopsy specimens from patients with normal histology, cervical intraepithelial neoplasia (CIN) grades 1 to 3, cervical squamous cell carcinoma (SCC), and adenocarcinoma were evaluated for CEA expression by immunohistochemistry by using the monoclonal antibody COL-1. Staining intensity was graded on a scale of 0 to 3 and was correlated with histologic diagnoses. CEA staining intensity was significantly increased in high-grade squamous lesions (CIN III and SCC) compared with normal cervical mucosa and CIN grades I or II (P <.0001). There was a linear correlation between grade of lesion and staining intensity (r = 0.71). CEA expression increased most significantly between CIN grades 2 to 3. Only 1 of 7 primary cervical adenocarcinomas expressed CEA. Only 1 of 10 patients with high CEA expression in their tumors by immunohistochemistry had elevated serum CEA. We thus have shown that lesional CEA expression increases in CIN 3 and SCC without elevations in serum CEA. CEA expression may be a useful diagnostic tool and a useful marker for identifying those at risk for progressive cervical neoplasia. HUM PATHOL 31:1357-1362.

Stringent criteria for histological diagnosis of koilocytosis fail to eliminate overdiagnosis of human papillomavirus infection and cervical intraepithelial neoplasia grade 1.

Overdiagnosis of HPV infection in cervical biopsies results in increased health care costs and unnecessary surgical procedures. Stringent criteria for histological diagnosis of koilocytosis were evaluated, using molecular detection of HPV DNA (polymerase chain reaction and Southern blot hybridization) as gold standard. Colposcopic biopsy specimens from 511 patients were studied, including 76 with referral diagnoses of negative cervix and 241 with CIN 1 or koilocytosis. Referral diagnoses for low-grade lesions failed to distinguish between HPV-infected and uninfected patients. False-positive rate for prediction of HPV infection was 74.8%. Biopsy specimens reevaluated using stringent diagnostic criteria showed increasing prevalence of HPV infection among patients whose biopsy specimens showed negative (43.7%), minimal (52.4%), or definite (69.5%) features of koilocytosis (P = .001). Similarly, subjects infected with high viral load or oncogenic HPV infection were more likely to be identified (P = .004 and .04, respectively). Despite increased predictive value of stringent diagnostic criteria, significant number of patients diagnosed as having CIN 1/koilocytosis (34.0%) did not in fact have HPV infection. Because most low-grade lesions spontaneously regress, patients with histological diagnosis of CIN 1 or HPV infection should be observed for a period of several months before definitive ablative treatment is undertaken.

Human papillomaviruses of different types in precancerous lesions of the uterine cervix: histologic, immunocytochemical and ultrastructural studies.

In a prospective study of 34 women with abnormal Papanicolaou smears, biopsy and cervicovaginal lavage specimens were analyzed for the presence of human papillomaviruses (HPVs) by Southern blot analysis and probes for HPVs 6, 11, 16, and 18. In 22 of the 23 patients with cervical lesions (96%), HPV DNA was identified in one or more specimens. All patients in whom HPV DNA was found had either koilocytotic or dysplastic lesions on biopsy or Papanicolaou smear. Immunocytochemical demonstration of HPV in biopsy samples was associated with the presence of large amounts of HPV DNA and with the ultrastructural identification of viral particles. The presence of HPV DNA in cervical biopsy specimens was limited to discrete geographic areas of the cervix with histologic abnormalities. Although HPV 16 and other related HPV types were found in all cases of severe cervical intraepithelial neoplasia, the type of HPV present in a given specimen could not be predicted on the basis of morphologic, immunocytochemical, or electron microscopic findings. It is concluded that virtually all dysplastic lesions of the cervix contain HPV DNA, that HPV is thus likely to be a major etiologic agent in the pathogenesis of cervical dysplasia, and that histopathologic features are not predictive of HPV type.

Biologic characteristics of specific human papillomavirus types predicted from morphology of cervical lesions.

Human papillomavirus (HPV) DNA was detected by Southern blot hybridization in cervicovaginal lavage samples from 199 of 329 (60.5%) women attending a municipal hospital colposcopy clinic. Human papillomavirus was identified in 195 of 264 (73.9%) patients with a squamous intraepithelial lesion or cancer on biopsy or Papanicolaou smear (Bethesda system) compared with 11 of 65 (16.9%) without squamous intraepithelial lesion (P < .0001). The most common HPV type identified was HPV 16 (20.6% of positive samples), and 36.7% of isolates contained uncharacterized HPVs. Of women with cervical intraepithelial neoplasia (CIN) grade III or cancer, 23.4% were infected with HPV 16 compared with less than 4% with any other single HPV type. Based on biopsy diagnosis in patients infected with specific HPV types, HPVs 6 and 11 had low oncogenic potential; HPVs 18, 31, 35, and 45 had intermediate oncogenic potential; and HPVs 16 and 33 had high oncogenic potential. Hyperchromatic, unusually enlarged nuclei ("meganuclei"), and/or abnormal mitoses were found significantly more often in lesions infected with HPVs 16, 33, and 35 than in those infected with HPVs 6, 11, 18, 31, and 45, even in low-grade lesions, and may represent a histologic marker for HPVs with significant oncogenic potential. Human papillomavirus capsid protein was detected significantly less often by immunocytochemical staining in CIN I and CIN II lesions infected with HPVs 16 and 33 (8.3%) than in those infected with HPVs 6, 11, 18, and 31 (60%; P = .007), suggesting early abnormalities in cellular differentiation in lesions infected with highly oncogenic HPVs.

Breast carcinoma-associated antigen. An immunocytochemical study.

An antiserum raised against a high molecular weight fraction of a medullary carcinoma of the breast was used to study breast carcinomas by means of an indirect unlabeled antibody peroxidase-antiperoxidase (PAP) technic. Strong cytoplasmic staining was demonstrated in all of 30 breast cancers tested and in one of three intraductal papillomas. Weak cytoplasmic staining was detected in four of nine fibroadenomas, two malignant melanomas, and one of six carcinomas of the colon. No cytoplasmic staining was seen in 24 other specimens of breast tissue, including 12 specimens from patients who had fibrocystic disease and five fibroadenomas, or in 17 extramammary malignant tumors. The antiserum appears to identify a breast carcinopma-associated antigen.

Natural cytotoxicity in patients undergoing radiation therapy.

Natural cytotoxicity against K562 target cells was measured in 51 adults with solid epithelial malignant tumors who were untreated, in 42 patients who were studied within 6 weeks following completion of radiotherapy (4,000-7,000 rads), and in 27 normal subjects. In both the radiated and the nonirradiated groups, mean cytotoxicity for patients with localized cancers was not significantly different from that of the normal controls, whereas mean cytotoxicity for patients with advanced cancers was significantly lower than that for normal controls and patients with localized disease. Twelve percent of nonirradiated patients and 13% of radiated patients with localized tumors, but 46% of nonirradiated patients and 44% of irradiated patients with advanced cancers, failed to exhibit normal NK activity. Mean cytotoxicity for irradiated patients was not significantly different from that of untreated patients. PBL from most patients showed enhanced cytotoxicity after preincubation of PBL with interferon (IFN alpha). Mean cytotoxicities for nonirradiated and irradiated patients after IFN alpha pretreatment of PBL were not significantly different. In both patient groups, IFN alpha-boosted killing was significantly less in patients with advanced disease than in patients with local tumors or normals. These results indicated that radiotherapy has no significant effect on spontaneous or IFN alpha-boosted natural cytotoxicity.

Peripheral T-cell lymphoma presenting as a soft-tissue mass of the extremity.

An 87-year-old man was found to have a lymphoma in the deep soft tissue of the right shoulder with concomitant central nervous system involvement. There was no evidence of cutaneous, peripheral lymph node, mediastinal, abdominal, or bone marrow involvement. Light microscopic, ultrastructural, and immunohistochemical evaluation characterized the neoplasm as a peripheral T-cell lymphoma. Lymphomas presenting in soft tissue are rare, and the few well-documented cases in the literature are of B-cell origin. We report a T-cell lymphoma presenting in the soft tissue of the extremity, and delineate its clinicopathologic features.

Head and neck squamous cell carcinomas associated with human papillomaviruses and an increased incidence of cervical pathology.

Human papillomaviruses (HPVs) have been identified in benign and cancerous epithelial lesions of the female genital tract. They have also been identified in papillomata and cancers of the upper aerodigestive tract. This study investigates the hypothesis that lesions of the cervicovaginal area are more common in women with cancers of the head and neck region. The presence of HPV in lesions of both regions is examined. Seven female patients with cancer of the upper aerodigestive tract had DNA analysis of their carcinoma specimens. HPV type 16 was found in two of the seven (28%). Fourteen female patients with upper aerodigestive tract cancers had Papanicolaou smears to search for cytologic evidence of HPV infection, and cervicovaginal lavages to analyze DNA from exfoliated cervical cells. Five of thirteen (38%) Papanicolaou smears revealed koilocytotic atypia and three of these patients had HPV DNA types 16 or 18 identified in the cervical lavage. The incidence of cervical atypia noted is 13-fold greater than average. One patient had HPV type 16 in both her supraglottic cancer and in her cervicovaginal lavage. Evidence of HPV infection at two separate anatomic sites suggests a systemic susceptibility to HPV infection.

Natural cytotoxicity and interferon production in patients with recurrent respiratory papillomatosis.

The observation that interferon (IFN) therapy causes regression of lesions in some patients with recurrent respiratory papillomatosis (RRP) raises the possibilities that these patients may have abnormalities in endogenous IFN production or in antitumor immune responses stimulated by IFN. We have measured IFN production and natural cytotoxicity (NK activity) in nine patients with RRP, three of whom were receiving exogenous IFN at the time of testing. Production of IFN-gamma induced by the T cell mitogen Staphylococcus enterotoxin A was normal in all patients. Production of IFN-alpha induced by two viruses (Sendai and Newcastle disease viruses) was normal in the six untreated patients, but significantly lower in the patients on IFN therapy. Natural cytotoxicity against K562 target cells, both spontaneous and IFN-stimulated, was normal in all RRP patients tested. Thus, we have shown that the NK-IFN system was intact in untreated patients with RRP. IFN-alpha production in the RRP patients on IFN therapy was low. The significance of these findings is discussed.

Condyloma acuminatum with superficial spirochetosis simulating condyloma latum.

We report a case of a 12-year-old boy with a large perianal condyloma. The lesion was found to contain both spirochetes (Warthin-Starry stain) and human papillomavirus types 6 or 11 (in situ hybridization). Because of persistent negative serologies for syphilis and lack of other clinical stigmata of syphilis, the lesion was diagnosed as condyloma acuminatum with secondary involvement by spirochetes of probable intestinal origin. The case demonstrates the potential histologic similarities between condyloma latum and condyloma acuminatum, as well as the pitfalls of using the Warthin-Starry stain to establish the diagnosis of secondary syphilis.