Natural cytotoxicity in humans: susceptibility of freshly isolatd tumor cells to lysis.

The cytotoxic potential of blood lymphocyters from healthy donors was tested against freshly isolated lung cancer cells and the erythroleukemia K562 cell line in short-term 51Cr release assays conducted at an effector:target ratio of 50:1. Most donors exhibited significant activity against K6-562 cells. By contrast, fresh tumor cells were refractory, only 6 of 30 showing significant cytotoxicity. The low susceptibility of these tumor cells was confirmed in third-party cold inhibition assays in which they interfered minimally with killing of K562 targets under conditions in which unlabeled K562 cells efficiently blocked cytotoxicity. Cells prepared from normal lung tissue and Raji cells also failed to inhibit killing. Although in comparison to the K562 cell line freshly isolated tumor cells were resistant, their susceptibility may not be so low as to be biologically irrelevant, inasmuch as boosting of natural killing activity by interferon induced levels of cytotoxicity against both types of target cell that were unattainable by unstimulated effectors. Interferon-boosted killers were lytic for "normal" lung cells and the Raji cell line.

Leukocyte migration inhibition in human pulmonary neoplasia.

Peripheral blood leukocytes from 65 lung cancer patients, 69 healthy donors, 33 patients with malignant disease outside the lung, and 24 patients with nonmalignant pulmonary conditions were examined for immune reactivity, as measured by the leukocyte migration inhibition assay, to antigens in homogenates of lung tumor tissue and material derived from tumor-free lung areas and a nonmalignant lung lesion. A low level of reactivity with apparent specificity was detected in the lung cancer patient group, with 17/52 showing migration inhibition with extracts of lung tumor tissue. Reactivity was also detectable in this group against homogenates of tumor-free lung and nonmalignant lung lesion. The data supported the conclusion that sensitization at least in some patients with lung cancer might be directed not only against tumor-specific antigens but also against antigens of less confined disease association.

Human tumor-lymphocyte interaction in vitro. VI. Specificity of primary and secondary autologous lymphocyte-mediated cytotoxicity.

A T-cell-enriched lymphocyte subset of samples from 15 tumor patients was tested for primary cytotoxicity against autologous tumor cell preparations and against 1-3 different allogeneic tumor cell preparations from biopsy material. Allogeneic cytotoxicity occurred in only 1 of 10 patients with autologous reactivity. The lymphocytes of 14 patients were cultured with autologous cells from biopsy material for 6 days. These lymphocytes killed autologous targets, but only 1 patient's lymphocytes were cytotoxic against 1 of the 4 allogeneic tumors tested. Cocultivation with allogeneic cells from biopsy specimens generated cytotoxicity toward the sensitizing allogeneic cells in 3 of 9 test combinations. In 2 of 3 instances the effectors were also active against the autologous tumor cells. Cytotoxicity in primary and secondary tests occurred thus only rarely against allogeneic targets. This indicated either the presence of individual tumor-related antigens on the cells from biopsy material or reflected the histocompatibility restriction of T-cell-mediated cytotoxicity.

Human tumor-infiltrating lymphocytes: a marker of host response.

There is continuing interest in the possibility of immunologic intervention in the therapy of malignant disease. By employing a range of different techniques, it has been possible to show the presence of activated helper, suppressor, and cytotoxic T cells, B cells, NK precursors, and macrophages at the tumor site. The overwhelming impression from our data is that tumors may be subject to immunologic attack by heterogeneous effectors and that there is selective trapping of these effectors with corresponding depletion at the periphery. Like all inflammatory sites, however, the tumor contains both positive and negative regulatory mechanisms with the coexistence of cells with effector and suppressor functions, eg, T suppressors that modulate the proliferative response of T helpers and macrophages suppressing NK function contribute to the dynamic interplay in situ. Additional complexity is indicated by immunohistologic studies that clearly show that the stroma rather than foci of tumor cells are the site of infiltration, thereby further limiting effector function. We are now at the end of the descriptive stage of our investigations and further studies must approach the more difficult problem of modifying the host response in such a way as to alter the balance between effector and suppressor activity. A promising area of research would appear to be the use of cloned helper T cells or their products in the immunotherapy of cancer. The demonstration, by us, of selective trapping at tumor sites suggests that administration of the patients' own T cells with antitumor reactivity may serve as an efficient delivery vehicle to activate host effectors in situ. Studies in animal systems have shown the feasibility of this approach, although the failure of cultured T cells to undergo normal recirculation represents a considerable unresolved problem. Effector function by each of the tumor-infiltrating cell types described is under T cell control, and preliminary studies have already indicated the ability of helper T cells to accelerate allograft and tumor rejection. The increasing availability of gene-cloned materials with potent biologic activity opens new areas of research in cancer therapy. The lymphokines IL-2 and interferon are already undergoing clinical trials. Studies by Hersey demonstrate that administration of conditioned medium containing impure IL-2 results in the appearance of antitumor effectors in previously nonreactive melanoma patients, and Rosenberg, among others, has shown IL-2 to be a potent enhancer of alloimmune responses. Lymphokine-activating macrophages also augment antitumour responses.(ABSTRACT TRUNCATED AT 400 WORDS)

Cultured human T-cell lines kill autologous solid tumours.

Lymphocytes from peripheral blood, lymph node, spleen and tumour of 7 patients with various carcinomas (2 lung, 3 colon, 1 gastric and 1 parotid tumour) were cultured for 15 days in conditioned media containing T-cell growth factor (TCGF; Interleukin 2) after which their cytotoxic activity against autologous tumour (and in some instances, autologous normal) cells and allogeneic tumour targets was evaluated in a short-term 51Cr-release assay. Significant cytotoxicity against autologous tumour targets was detected in at least one effector preparation from all of the patients, under conditions where, in some cases, other autologous cells (normal lung, PHA-transformed lymphocytes) were resistant. This cytotoxicity also generally extended to allogeneic tumour targets, but lysis of K562, a cell line sensitive to natural killing, occurred in only 3 of 19 effector cell preparations. The data are consistent with a polyclonal expansion of cytotoxic T-cells of tumour-bearing patients which includes the amplification of a population recognitive of antigens expressed on autologous neoplastic cells.

[Development of molecular targeting drugs for the treatment of cancer-therapeutic potential and issues to be addressed in global development].

A survey of cancer treatment in a sample of hospitals > 100 beds conducted in 1998 compared with experience in the US showed that good progress has been achieved in Japan in the screening and early treatment of gastric cancer, and that the prognosis for breast cancer is better than in the West. Although in the past, the cytotoxic therapies available to physicians in Japan vs the West have been different, recent acceleration of regulatory review will result in a convergence of treatment paradigms and some improvement in acute response in many tumour types. However, world wide there is a need for new improved therapies in all cancers evaluated. Particular needs are in the management of NSCLC, advanced disease and cancers which form micrometastases. The eventual hope is that cancer can be turned from a lethal disease into a chronic disease where patients maintain a good QOL. Apart from anti hormonal therapies, the usual approach has been to kill the cancerous cells. However, the new approaches to intervening in the growth and migration of cancerous cells or the host tissue response by molecular targeting offer the promise of achieving a step change in therapy. Although EGF tyrosine Kinase inhibitors such as ZD 1839 have been shown to cause a conventional tumour response in NSCLC, many of these new approaches are unlikely to show a short term response even if they have the capacity to affect tumour development and increase disease free survival. Some compounds will require combination therapy with a conventional cytotoxic or radiotherapy to show their full benefit. For conventional cytotoxics, the usual approach to development has been to select the maximum tolerated dose and then evaluate the efficacy in advanced disease. However, for the new approaches which will not have such severe dose limiting toxicities, it will be necessary to select a surrogate marker of the intended biological effect to select the optimal biological dose (OBD) and dose regimen in phase I/II studies for further evaluation in phase II or III studies which are designed to show the expected patient benefit. The tumour target, the stage of the disease and the possible need for concomitant therapy will also have to be considered according to the mechanism of action of the product.

Expansion of autorecognitive cytotoxic effectors in human cancer by T cell growth factor (Interleukin 2)1.

Conditions for the production of supernates from mitogen stimulated human lymphocytes with the capacity to induce proliferation in long term MLC or PHA stimulated cultures which no longer respond to PHA have been investigated. These supernates can be used to maintain lymphocytes in continuous growth with a doubling time of approximately 48 hours. Cells grown from MLC stimulated cultures show less than 80% SRBC rosetting cells, are Fc-, do not show ADCC activity and induce reduced lysis of K562 compared with freshly isolated effectors. Cultured T cells (CTC) show high lytic activity against the inducing PHA blasts but not autologous or third part targets. Similar experiments have been performed with lymphocytes from the blood, lymph node, spleen and tumour of cancer patients and CTC tested for cytotoxicity against autologous and allogeneic tumour cells and the K562 compared with freshly isolated effectors. Cultured T cells (CTC) show high lytic activity against the inducing PHA blasts but not autologous or third part targets. Similar experiments have been performed with lymphocytes from the blood, lymph node, spleen and tumour of cancer patients and CTC tested for cytotoxicity against autologous and allogeneic tumour cells and the K562 cell line. Cytotoxicity for autologous tumour was found in all samples. This was accompanied by killing of allogeneic cells in most instances but killing of K562 was only rarely demonstrable. These data would be consistent with a polyclonal expansion of cytotoxic effectors in the samples. The finding of autologous reactivity suggests the presence of autorecognitive cytotoxic T cells in cancer patients with specificity for tumour. Cloning experiments are currently in progress to investigate this possibility further.

Activation of lymphocyte anti-tumour responses in man: effector heterogeneity and the search for immunomodulators.

Data continues to accumulate on the immunological reaction against solid human cancers. The evidence at the present time supports the view that rather than being immunologically invisible, tumour cell antigens are recognised by at least three lymphocyte subsets. Helper T cells can be induced to proliferate upon exposure to cells of the autologous tumour and to secrete detectable levels of interleukin 2 (IL-2). Cultured T cell lines and clones can be shown to respond in primed lymphocyte tests not only to autologous tumour cells but also to allogeneic tumour cells of the same histology and anatomic location. Cytotoxic T cells manifest specific reactivity against cells of the autologous tumour which is distinguishable from natural killing (NK) on the basis of specificity and organ distribution. Natural killer cells can lyse freshly isolated autologous tumour cells after purification on Percoll gradients or when activated by IL-2. There is thus a demonstrable heterogeneity of response to human cancer in unseparated lymphocyte populations and at the clonal level. In limiting dilution assays lymphocytes at the tumour site respond more frequently to autologous tumour relative to NK targets. For at least some tumours there is evidence that the expression of auto-tumour reactivity but not NK correlates with the clinical course of the disease and is a favourable prognostic indicator. The finding of these auto-tumour reactivities has important implications for the search for immunomodulating drugs for cancer treatment. However, it must be recognised that the response is heterogeneous and that the immune system comprises multiple interactive elements that exhibit both positive and negative control. Any treatment modality must take this into account and seek to focus on specific activation of the tumour lytic populations or the inhibition of negative regulatory elements as opposed to seeking a more general augmentation of immune reactivity which may, by stimulating suppressor cells, have a counterproductive effect.

Quantitation of proliferative and cytotoxic precursor cells directed against human tumours: limiting dilution analysis in peripheral blood and at the tumour site.

Blood and tumour-infiltrating lymphocytes (TIL) from 16 cancer patients have been examined under limiting dilution conditions to determine the frequency of cells responding in mixed tumour-lymphocyte cultures (MLTC) to autologous tumour and Interleukin-2 (IL-2). Tumour-derived lymphocytes showed a high spontaneous response to IL-2 alone 1/1,900 in TIL; 1/6,000 in PBL suggesting the presence of "activated" T cells in situ. Proliferative frequencies were increased in MLTC in both blood (1/3,779) and TIL (1/1,084). Phenotypic analyses showed that total T-cell contents of the responder populations were comparable but TIL were enriched for the OKT8+ subset with a corresponding reduction in OKT4+. TIL showed increased numbers of OKMI+ and Tac+ lymphocytes. The major cytotoxic precursor expanding under these conditions was reactive against autologous tumour. K562 (NK) were present at a lesser frequency--particularly in TIL. The data show a concentration and activation of reactive lymphocytes at the tumour site and establish conditions for the clonal expansion of specifically cytotoxic T cells.

Post-operative depression of antibody-dependent lymphocyte cytotoxicity following minor surgery and anaesthesia.

Leucocytes taken 1 day post-operatively from patients who had undergone surgery under general anaesthesia for benign breast disease showed a significantly diminished capacity to induce lysis of antibody-coated target cells compared with those taken pre-operatively from the same patients. No significant fall in PHA responsiveness was observed in these leucocytes in the post-operative period. This indicates a high sensitivity of the cell types involved in the antibody-dependent cell-mediated cytotoxicity reaction to the suppressive effect of surgery and anaesthesia. Plasmas taken post-operatively from these patients were effective in diminishing the capacity of leucocytes from healthy untreated donors to initiate antibody-coated target cell lysis compared with pre-operative plasmas although the plasma cortisol levels in these samples did not differ significantly. Possible mediators of this suppressive effect and its significance are discussed.

Effect of surgery on tumour-directed leucocyte responses.

Leucocytes from 22 out of 26 patients with mammary carcinoma were significantly cytotoxic in vitro for cells cultured from mammary tumours though only two out of 17 of these preparations were cytotoxic for cells cultured from tumours arising at other sites. In the immediate postoperative period reactivity of patients' leucocytes with mammary tumour cells was undetectable but returned within one week of surgery. Leucocyte cytotoxicity may therefore offer a model in which the mechanism of postoperative depression of immunological competence may be investigated.

Embryonic antigen expression on 2-acetylaminofluorene induced and spontaneously arising rat tumours.

2-Acetylaminofluorene induced mammary and ear duct carcinomata and spontaneously arising mammary carcinomata and sarcomata were shown to express embryonic antigens at the cell surface by their reaction with serum from multiparous female rats. These observations with essentially non-immunogenic tumours are comparable with early findings showing that embryonic antigens are also expressed on aminoazo dye induced rat hepatomata, and sarcomata induced with 3-methylcholanthrene. Re-expression of embryonal components, therefore, may be a concomitant of neoplastic transformation.

Extravascular natural cytotoxicity in man: Anti-K562 activity of lymph-node and tumour-infiltrating lymphocytes.

A major distinction is reported between the cytolytic activity of peripheral blood lymphocytes (PBL) and that of lymph-node and tumour-infiltrating lymphocytes (TIL) against targets of the NK-sensitive K562 cell line in short-term 51Cr release assays. In the PBL of normal donors and lung cancer patients in whom disease was advanced anti-K562 reactivity, though variable, was consistently detectable and this activity could be augmented to a similar extent in patients and controls by treatment of effectors with exogenous interferon (IF). By contrast anti-K562 activity in lymph-node cells (LNC) and TIL was virtually absent and significant levels could not be induced by exposure to IF. This activity was not attributable to coexistent suppressor cells for NK function since admixture of LNC and TIL with normal PBL failed to modulate K562 killing by the latter. The results imply that K562-reactive NK cells and their precursors may frequently be present at sub-threshold levels in the lymph nodes of tumour-bearing patients and a similar explanation could account for the inactivity of TIL. However, in the latter situation, actively-induced NK dysfunction in situ incapable of regeneration by IF, and attributable to as yet undefined tumour-associated factors, may also be involved.

Limiting dilution analysis of the frequency of human T cells and large granular lymphocytes proliferating in response to interleukin 2. I. The effect of lectin on the proliferative frequency and cytotoxic activity of cultured lymphoid cells.

Human peripheral blood LGL that mediated NK and small T cells were isolated in high purity (98% by morphology) by density sedimentation on discontinuous Percoll gradients. The proliferative frequency of these subpopulations in the presence of lectin-free conditioned media containing IL 2 was determined by limiting dilution analysis. LGL showed a 20-fold greater frequency of proliferative cell precursors than small T cells (1/200 and 1/4970, respectively). The NK-like nature of cells expanded from LGL preparations in IL 2 was confirmed by parallel testing of the cytotoxicity against K562. Whereas T cell microcultures showed no lytic activity against K562 (cytotoxic precursor frequency less than 1/10,000), LGL cultures showed frequencies of cytotoxic precursors (1/170) comparable to those of proliferative precursors. Neither responder cell type gave rise to detectable lytic activity against NK-insusceptible mouse lymphoma RL male 1 or alloblasts. LGL proliferation was only minimally affected by the presence of PHA at the onset of culture (rise to 1/74 with 2 micrograms/ml PHA). By contrast, small T cells showed a dose-dependent increase of proliferative frequency, to reach 1/11 with 2 micrograms/ml PHA, provided accessory cells in the form of PBMC, monocytes, or LGL but not T cells were present. The cytotoxic activity of LGL and small T cells expanded in IL 2 was confirmed in bulk cultures. LGL-CLC showed high lytic activity against NK-susceptible cell lines and a majority of freshly isolated allogeneic human tumor targets. T cell-CLC showed little activity against cell line targets (K562, Raji, L1210, RL male 1) but were lytic for some fresh tumor cells. These data establish optimal conditions for the growth of human LGL in IL 2-dependent culture and suggest that a major contributor to lysis of allogeneic human tumors by CLC is likely to be NK cells. The data indicate that large numbers of activated T cells cannot be detected in vivo and that in vitro induction of IL 2 receptors by lectin/antigen is necessary for the establishment of antigen-reactive T cell lines. In contrast, a proportion of LGL appear to be spontaneously activated and susceptible to IL 2-dependent growth. Thus, in the absence of stimulation, culture of unfractionated lymphoid cells in the presence of IL 2 is likely to select for the growth of LGL with NK activity.

T-cell control of IgA production. I. Distribution, activation conditions and culture of isotype-specific regulatory helper cells.

The capacity of T cells from different sites to augment IgA production by LPS-stimulated B cells has been investigated. Peyer's patch T lymphocytes activated with Con A induced up to a 20-fold increase in IgA production. The effect was isotype-specific, in that no consistent effect on IgG and a diminution of IgM synthesis were observed. Less activity was recorded in spleen and mesenteric lymph node T cells. Optimal activation of the Thy 1+ Lyt 1+2- helper cells required the addition of splenic adherent cells and the elimination of Thy 1+ Lyt 2+ suppressor cells prior to activation. T lymphocytes maintained regulatory activity for several months after expansion in medium supplemented with IL-2 and are now being cloned. We conclude that IgA production is under control of T cells sited preferentially, but not exclusively, in gut-associated lymphoid tissue, and that these T cells can augment IgA production by B lymphocytes from sites with low commitment to production of this isotype.

Tumour-reactive lymphocytes stimulated in mixed lymphocyte and tumour culture. Clonal analysis of effector cells in cytotoxic and proliferative assays.

Lymphocytes from cancer patients were stimulated in mixed culture with autologous tumour (MLTC) or pooled allogeneic lymphocytes (MLC). Both protocols induced increased uptake of 3H-thymidine at 5 days and the appearance of lymphoblasts. Blasts were isolated on discontinuous Percoll gradients and either expanded as bulk cultures or cloned directly under limiting dilution conditions in the presence of conditioned medium containing IL-2. Results with MLTC-blast-CTC have been reported elsewhere. MLC-activated cultures lysed autologous tumour but not autologous lymphoblasts. Lysis of some allogeneic tumours, lymphoblasts from members of the inducing pool, and K562 was also apparent. MLC activated cultures did not undergo restimulation in response to autologous tumour or lymphocytes but were restimulated by leukocytes from pool members. MLTC clones showed autologous tumour-specific cytotoxic activity or cross-reactive proliferative responses with tumours of the same site and histology. The majority of MLC clones cytotoxic for autologous tumour were also specific and did not lyse allogeneic tumour, K562, or lymphoblasts from the inducing pool. Two clones lysed autologous tumour and pool members. None of the clones tested proliferated in response to autologous tumour following MLC activation but some were responsive to pool members and one clone was restimulated by autologous monocytes. No association was found between clone phenotype and function. The implication of these data is that the effector cells with activity against autologous tumour induced in MLC arose largely by transstimulation of in vivo-activated tumour reactive lymphocytes by IL-2 release rather than expansion of NK-like effectors or sharing of antigenic specificities between tumour and allogeneic lymphocytes. Since MLC activation of cancer patients lymphocytes does not induce proliferative responses to autologous tumour it is unlikely to be a useful procedure in preparing cells for immunotherapy protocols.

Specific cytotoxicity against autologous tumour and proliferative responses of human lymphocytes grown in interleukin 2.

Peripheral blood lymphocytes of cancer patients were sensitized in vitro to autologous tumour cells in mixed lymphocyte-tumour culture (MLTC). Blast cells were isolated on discontinuous Percoll gradients from MLTC which showed significant stimulation of [3H]-thymidine incorporation. Cultured T cells (CTC) were derived from these blasts by growth in conditioned medium containing interleukin-2 (IL-2) and maintained for up to 51 days by repeated feeding with IL-2 and in some cases by addition of irradiated allogeneic blood mononuclear cells as "fillers". These cultures showed specific cytotoxic reactivity against autologous tumour and in only a few cases was natural killing (NK) of K562 cells apparent. Restimulation of CTC with tumour was measured in primed lymphocyte test (PLT). Increased uptake of [3H]-thymidine was found upon stimulation by autologous tumour and allogeneic tumour of the same site and histology but there was no response to non-related tumours or to a panel of allogeneic lymphocytes. No sensitization to autologous HLA-D/DR could be detected by restimulation or cytotoxicity against monocytes in the majority of cases. These data suggest that, by careful selection of sensitised blasts from MLTC, it is possible to obtain CTC with both helper (proliferative) and cytotoxic T cells and that such CTC have specific reactivity against tumour cells. These cellular reagents will be useful in defining the antigenicity of human neoplasms and possibly in therapy.

Reactivity of peripheral blood leukocytes against human foetal cells. II. Cytotoxic potential of preparations enriched or depleted of different leukocyte populations.

Leukocytes separated initially by Ficoll-Triosil sedimentation from the peripheral blood of 62 healthy donors and 64 patients with a variety of cancers were tested for cytotoxicity against cells from a single human foetal lung, by means of a microplate technique based on visual enumeration of surviving target cells. Under these conditions cytotoxicity was primarily observed to be a function of the granulocyte content of the preparations, which was extremely variable (range 0-60%). When the influence of these cells was greatly diminished through depletion by adherence, residual cytotoxicity was still detectable in the majority of samples tested. Complete abrogation of this cytotoxicity by pretreatment with carrageenan implicated cells of the monocyte-macrophage series, which persisted as a small minority (about 2%) in the already depleted effector cell populations. However some cytotoxicity could also be demonstrated in populations, purified by passage through columns containing nylon fibre or Degalan-coated (human Ig-anti Ig) beads, which consisted almost exclusively (about 98%) of lymphocytes, mainly of thymus (T)-dependent type (greater than or equal to 80%). Under these conditions and those in which T-cells were concentrated by formation of spontaneous E rosettes, cytotoxicity appeared to decline with T cell enrichment, suggesting that the cytolytic effects were attributable to cells of the non T-compartment which were present to a variable extent in the different T-cell-enriched populations. Although the absolute identity of these cells was not established, the experiments illustrate potential sources of non-specific cytotoxicity among different effector cell populations against target cells expressing antigens to which the majority of leukocyte donors--in health or disease--were presumably non-sensitized. As such these data have several implications for the interpretation of in vitro cytotoxicity tests against human neoplasms.