[Changes of ADAMTS13 Activity and TSP1 Level in Patients with Hematologic Malignancies].

OBJECTIVE: To investigate the changes of thrombospondin 1(TSP1) level and von Willebrand factor cleaving protease(ADAMTS13) activity in the patients with hematologic malignancies before and after treatment and to evaluate their clinical significance. METHODS: Eighty-two patients with hematologic malignancies were enrolled in this study, among them 20 patients were with acute leukemia, 48 patients were with lymphoma and 14 patients were with multiple myeloma. The plasma samples of 82 patients with hematologic malignancies and 45 healthy controls were collected. The activities of ADAMTS13 were evaluated by residue collagen binding assay(R-CBA), the levels of TSP1 and vWF antigen were measured by enzyme-linked immunosorbent assay(ELISA). RESULTS: The activity of plasma ADAMTS13 in patients with hematologic malignancies was lower than that of normal controls(P<0.05). The levels of vWF antigen and TSP1 in the patients with hematologic malignancies were higher than those in normal controls(P<0.05). After standard induction chemotherapy, the ADAMTS13 activity of the patients with hematologic malignancies at the complete remission was higher than that before therapy(P<0.05); the vWF antigen level was significantly lower than that in the patients with hematologic malignancies before therapy(P<0.05), but still higher than that in controls(P<0.05). There were 25 infection patients in 82 cases of hematologic malignancies, and the ADAMTS13 activity in the patients with newly diagnosed hematologic malignancies complicated with infection before therapy was obviously lower than that in the patients with hematologic malignancies without infection(P<0.05), the levels of vWF antigen and TSP1 were significantly lower than that in patients without infection (P<0.05). In the process of treatment, 8 patients have been speculated to suffer from thrombus, and the ADAMTS13 activity in the patients with thrombus was obviously lower than that in the patients without thrombus(P<0.05). CONCLUSION: Low ADAMTS13 activity and high TSP1 level may participate in the progress of hematologic malignancies, the infection and thrombotic events may lead to further reduction of the ADAMTS13 activity. Assaying the level of ADAMTS13 activity in the patients with malignant tumor may be helpful to prevent the infection and thrombosis in the patients with hematologic malignancies.

[Clinical Efficacy of Dendritic Cells and Cytokine-induced Killer Cells Combined with Chemotherapy for Treating Newly diagnosed Multiple Myeloma and their Effect on Function of CD4(+) CD25(+) T Cells in Peripheral Blood].

OBJECTIVE: To investigate the efficacy of dendritic cells and cytokine-induced killer cells (DC-CIK) combined with chemotherapy for treating newly diagnosed patients with multiple myeloma (MM) and their effect on cellular immune functions of CD4(+) CD25(+) Treg cells in peripheral blood after adoptive immunotherapy. METHODS: Fouty two patients with MM were randomly divided into two groups: chemotherapy group and combined therapy group; 20 patients in chemotherapy group were treated by chemotherapy only, 22 patients in combined therapy group were treated by adoptive immunotherapy (DC-CIK) combined with chemotherapy, and the clinical outcomes of patients and the levels of CD4(+) CD25(+) Treg cells in peripheral blood between 2 groups were compared. RESULTS: After treating for 3 weeks, the quality of life, clinical index and survival of patients in combined therapy group were better than those of patients in chemotherapy group (P < 0.05); the ratios of CD4(+) CD25(+)/CD4(+) and CD4(+) CD25(+) FoxP3(+)/CD4(+) CD25(+) of patients in combined therapy group were obviously lower than those of patients in chemotherapy group (P < 0.05). CONCLUSION: The immunotherapy of DC-CIK can strengthen the activities of CD4(+) CD25(+) Treg cells, which combined with chemotherapy can be an effective and promising effects for treatment of patients with MM.

[Effect of Immunotherapy of Dendritic Cells and Cytokine-Induced Killer Cells Combined with Chemotherapy on Secreting Function of T Lymphocytes in Patients with Multiple Myeloma].

OBJECTIVE: To evaluate the treatment value of adoptive immunotherapy (dendritic cells and cytokine-induced killer cells, DC-CIK) combined with chemotherapy on patients with multiple myeloma (MM) and its effect on secreting function of T lymphocytes in MM patients. METHODS: A total of 36 patients with MM were randomly divided into two groups, among them 28 patients in chemotherapy group were treated by chemotherapy only, 28 patients in combined therapy group were treated by adoptive immunotherapy (DC-CIK) combined with chemotherapy, and the clinical outcomes and the levels of IL-2, IFN-γ, IL-4, IL-10 secreted by T lymphocytes between two groups were compared. RESULTS: After treatment, the quality of life, clinical index and survival in combined therapy group were better than those in chemotherapy group (P <0.05); the levels of IL-2 and IFN-γ in combined therapy group was higher than these in chemotherapy group (P <0.05), and the levels of IL-4 and IL-10 in combined therapy group were lower than those in chemotherapy group (P <0.05). CONCLUSION: DC-CIK combined with chemotherapy can be an effective and promising treatment for patients with MM, and it maybe strengthen the anti-tumor action of bodies by regulating the balance between Th1 and Th2 reaction.

[Clinical Efficacy of DC and CIK Immunotherapy Combined with Chemotherapy and Its Impact on Treg Cells in Newly Diagnosed Multiple Myeloma].

OBJECTIVE: To investigate the clinical efficacy and immune mechanism of immunotherapy of dendritic cells (DC) and cytokine-induced killer cell (CIK) combined with chemotherapy in patients with newly diagnosed multiple myeloma (MM). METHODS: twenty-two newly diagnosed MM patients were chosen and divided into two groups, out of them,12 patients in single chemotherapy group were treated by chemotherapy only, 10 patients in combined group were treated by adoptive immunotherapy (DC-CIK) combined with chemotherapy. Using flow cytometry, the CD4 Treg cells in the peripheral blood of 22 MM patients were detected before and after treatment. And the clinical outcomes between two groups were also compared. RESULTS: After treatment the overall response rate(ORR) of patients in the single chemotherapy group was 50% (6/12), among them 2 cases were in complete remission (CR) (16.67%), 2 cases very good partial remission (VGPR) (16.67%), 2 cases were in partial remission (PR) (16.67%). However, the ORR of patients in immunotherapy combined with chemotherapy group was 70.% (7/10), including in 3 cases of CR (30%), 2 cases of VGPR (20%), 2 cases of PR (20%). Compared to healthy volunteers, the proportion of Treg cells in peripheral blood of two groups before treatment was significantly higher (P<0.05). In contrast, the proportion of Treg cells in the peripheral blood of above-mentioned 2 groups after treatment was reduced significantly (P<0.05). In addition, compared to chemotherapy group, the proportion of Treg cells in the combined group decreased significantly (P<0.05). The further analysis found that the proportion of Treg cells in the peripheral blood of the 2 groups was not significant changed (P>0.05) in the patients with ineffictive clinical treatment, but the proportion of Treg cells significantly decreased (P<0.05) in the patients with effective clinical treatment. CONCLUSION: DC-CIK immunotherapy can synergize or enhance the effect of chemotherapeutics, alleviate the immune dysfunction in MM; and DC-CIK immunotherapy combined with chemotherapy can elevate the clinical efficacy in patients with newly diagnosed multiple myeloma.

Immunomodulatory effect of DC/CIK combined with chemotherapy in multiple myeloma and the clinical efficacy.

To investigate the clinical efficacy of adoptive immunotherapy using dendritic cells (DC) and cytokine-induced killer (CIK) cells combined with chemotherapy in multiple myeloma. The immunomodulatory effect of the therapy was discussed by detecting the levels of peripheral blood T cell subsets and CD4(+)CD25(+) regulatory cells (Treg). Fifty MM patients were randomly divided into two groups: 24 cases in the simple chemotherapy group and 26 cases in the combined therapy group (chemotherapy plus DC/CIK immunotherapy). The therapeutic efficacy and the proportions of peripheral blood T cell subsets and Treg cells were compared between the two groups. The cellular immunity indicators were also compared, including IL-2, IFN-γ, IL-4, IL-10, AgNORs ratio and TGF-ß. After 3 weeks of treatment, the life quality and clinical efficacy of the combined therapy group were superior to those of the simple chemotherapy group (P<0.05). CD3(+)CD8(+) ratio, CD4(+)CD25(+) ratio, CD4(+)CD25(+)/CD4(+) ratio, CD4(+)CD25(+)FoxP3(+)/CD4(+)CD25(+) ratio, IL-4, IL-10 and TGF-ß levels of the combined therapy group were obviously lower than those of the simple chemotherapy group (P<0.05). The CD3(+)CD4(+)/CD3(+)CD8(+) ratio, AgNOR ratio, IL-2 and IFN-γ level and positive rate of NKG2D in the combined therapy group were significantly higher than those of the simple chemotherapy group (P<0.05). These results indicated better immunomodulatory effect of the combined therapy. DC/CIK immunotherapy combined with chemotherapy has a good clinical efficacy and prospect for MM, reversing the Th1 to Th2 shift and increasing the anti-tumor capacity of the immune system.

Therapeutic effect of placenta-derived mesenchymal stem cells on hypoxic-ischemic brain damage in rats.

BACKGROUND: Oxidative stress is involved in the development of hypoxic-ischemic brain damage (HIBD). In this study, we investigated the therapeutic effects of placenta-derived mesenchymal stem cells (PD-MSCs) and explored the NF-E2-related factor-2/heme oxygenase-1 (Nrf2/HO-1) signaling pathway in treating HIBD. METHODS: P7 rats were subjected to hypoxic-ischemic brain injury and randomly divided into four groups (control, HIBD, HIBD+PD-MSCs, and HIBD+fibroblasts). Forty-eight hours after the induction of HIBD, 5×10(5) of PD-MSCs were injected into cerebral tissue in the HIBD+PD-MSCs group, while the same dose of fibroblasts were injected in the HIBD+fibroblasts group. Morris Water Maze, gross and pathological changes were tested at P28. The level of malondialdehyde (MDA) was detected in rats' hippocampus. RT-PCR and western blot analysis were used to evaluate the changes of Nrf2/HO-1. RESULTS: The HIBD group showed significantly longer escape latency and a lower frequency of original platform crossing in the Morris Water Maze compared with the control group. Rats receiving PD-MSCs showed significant improvement of HIBD. The pathological changes were evident after HIBD, but ameliorated in the PD-MSCs group. Compared with the control group, HO-1 and Nrf2 were up-regulated at gene and protein levels in the HI brain, beginning at 6 hours and peaking at 48 hours (P<0.05). The expression of HO-1 and Nrf2 in the PD-MSCs treatment group was more pronounced than in the HIBD group (P<0.01). PD-MSCs also decreased MDA production in the brain tissue. CONCLUSION: These results demonstrate that PD-MSCs have neuroprotective effect during the treatment of HIBD and that the mechanism may be partly due to alleviating oxidative stress.

[Imbalance of treg/th17 in bone marrow of patients with multiple myeloma].

The purpose of this study was to detect the distribution of Treg and Th17 cells in bone marrow and to investigate the relationship of Treg/Th17 imbalance with the pathogenesis and progression of multiple myeloma (MM). The Bone marrow was collected from 37 MM patients and 12 healthy volunteers, the ratio of Treg and Th17 cells was detected by flow cytometry. The expression of Treg and Th17 cells simultaneously was examined in peripheral blood of 19 MM patients with same method. The results indicated that the frequency of Treg cells was higher in MM patients than that in control group (P < 0.05), there was a trend of increasing of Treg cell number in the ISS stage from I+II to III (P < 0.05). Furthermore, in the patients with MM, the Treg cell number in bone marrow was higher than that in peripheral blood (P < 0.05). Th17 cell rate was not statistically different between MM patients and control group (P > 0.05), and at different ISS stage (P > 0.05). Th17 cell number between bone marrow and peripheral blood was not significantly different (P > 0.05).The ratio of Treg/Th17 in patients with MM was higher than that in control group (P < 0.05), and increased gradually from ISS stage I+II to stage III (P < 0.05). It is concluded that the Treg/Th17 immune imbalance is presenced in bone marrow of patients with MM, this imbalance may promote the progression of MM.

[In vitro effects of mesenchymal stem cells on secreting function of T lymphocytes and CD4⁺CD25⁺ T cells from patients with immune thrombocytopenia].

OBJECTIVE: To analyze in vitro the effect of mesenchymal stem cells (MSCs) on secreting cytokines by T lymphocytes and ratio of CD4⁺CD25⁺ T cells from patients with immune thrombocytopenia (ITP). METHODS: Human bone marrow-derived MSCs were isolated by Ficoll Hypaque and cultured for proliferating to passage cells. Allogeneic T lymphocytes of health adults and ITP patients were isolated from peripheral blood by Ficoll Hypaque and nylon cotton column, and the ratio of CD4⁺CD25⁺ T cells was detected by flow cytometry. Then the different amounts of 1 × 104, 5 × 104, 2 × 105 MSCs per well treated with mitomycin as stromal feeder layers were co-cultured with above-mentioned T lymphocytes, 5 days after cocultivation, the ratio of CD4⁺CD25⁺ T cells was detected by flow cytometry and the levels of IL-2, IFN-γ, IL-4, IL-10 were measured by enzyme- linked immune sorbent assay (ELISA). RESULTS: After co-cultured with 2 × 105 MSCs for 5 days, the ratio of CD4⁺CD25⁺ T cells and CD4⁺CD25⁺/CD4⁺ were significantly higher than of separate T lymphocytes in ITP patients [(4.56 ± 0.70)% vs (2.24 ± 0.81)%, (9.91 ± 1.18)% vs (4.08 ± 1.17)%, respectively] (P<0.05). To compare with separate T lymphocytes in ITP patients, the cytokine concentrations of IL-2 and IFN-γ from the culture supernatants significantly reduced from (280.47 ± 17.33) pg/ml to (97.21 ± 12.07) pg/ml and from (129.33 ± 16.34) pg/ml to (72.75 ± 7.81) pg/ml, respectively. In contrast, the cytokine concentrations of IL-4 and IL-10 increased from (16.34 ± 2.60) pg/ml to (37.98 ± 4.05) pg/ml and from (54.78 ± 5.62) pg/ml to (113.77 ± 5.68) pg/ml, respectively. CONCLUSION: MSCs significantly inhibited the cytokine levels of IL-2 and IFN-γ secreted by Th1 cells and promoted the releases of IL-4 and IL-10 by Th2 cells in ITP , thereby regulating the balance between Th1 and Th2 reaction, as well as up-regulating the expression of CD4⁺CD25⁺ T cells in vitro,then induced the immunologic tolerance of ITP.

[The efficacy and safety of autologous cryopreserved platelet transfusion in management of thrombocytopenia after chemotherapy in hematological malignancy].

OBJECTIVE: To investigate the efficacy and safety of autologous cryopreserved platelet transfusion in the management of thrombocytopenia after chemotherapy in hematological malignancy. METHODS: A total of 40 patients diagnosed as hematological malignancy with complete remission were equally assigned into study group and control group. During chemotherapy interval in the study group, when platelet counts exceeded 120 × 10(9)/L, autologous platelets were collected with CS3000 Cell Separator and cryopreserved at -80°C with 5% dimethylsulfoxide. When platelet counts dropped below 15 × 10(9)/L after chemotherapy, autologous platelets were thawed with 40°C water bath and transfused back to each patient. In the control group, when platelet counts dropped below 15 × 10(9)/L after chemotherapy, allogeneic fresh platelets were transfused. Median loss during the freeze-thaw-wash procedure in study group was observed, and the 1 h, 24 h corrected count increments (CCI) were calculated in the both groups. The hemostatic effects and adverse reactions were also observed. RESULTS: In the control group, 1hCCI and 24h CCI were (19.3 ± 6.1) × 10(9)/L and (12.2 ± 7.0) × 10(9)/L, respectively, with the effective rate of 80% and the transfusion reaction rate of 45%. Totally 20 collection and transfusions were finished in the study group. A total of (3.4 - 8.5) × 10(11) platelet were obtained in each collection. Platelet recovery after freezing and thawing was (73.51 ± 9.03)% (62% - 83%). 1hCCI was (17.4 ± 7.6) × 10(9)/L, 24h CCI was (10.5 ± 5.8) × 10(9)/L and the effective rate was 85%. There was no significant different between the two groups (P > 0.05). The transfusion reaction rate was 15%, which was significantly lower than that of the control group (P < 0.05). Meanwhile, adverse reactions were occurred less in the study group. CONCLUSION: This study demonstrates that autologous cryopreserved platelet transfusions can be safely administered for supporting thrombocytopenia in hematological malignancy patients undergoing chemotherapy.