Vascular targeting of anti-CD40 antibodies and IL-2 into autochthonous tumors enhances immunotherapy in mice.

Current anticancer therapy is a delicate balance between elimination of malignant cells and harmful side effects for the host. In this study, we used a tumor-homing peptide to engineer anti-CD40 agonist antibodies and recombinant IL-2 such that they were selectively delivered into spontaneously arising tumors in a transgenic mouse model of islet cell carcinogenesis. Intravenous injection of these agents, either separately or together, led to accumulation in the vicinity of tumor neovessels without toxic side effects. Although both molecules are critical for adaptive immunity, the most profound effects were seen in endothelial cells. Combined, local anti-CD40 and IL-2 therapy reduced tumor vascularity and significantly delayed tumor growth in mice. Remarkably, tumor-bearing mice remained disease-free long-term when targeted anti-CD40 and IL-2 were combined with transfers of preactivated antitumor immune cells. In this therapeutic setting, triggering of CD40 on endothelial cells induced an inflammatory response of the vessel wall and facilitated effector cell accumulation in the tumor parenchyma while IL-2 promoted antigen-specific immune cell persistence. We believe this is a novel and highly effective anticancer approach, whereby tumor stroma is "conditioned" for enhanced immune cell entry and survival, facilitating immune-mediated tumor destruction and leading to a sustained antitumor response.

Effect of inhibition of vascular endothelial growth factor signaling on distribution of extravasated antibodies in tumors.

Antibodies and other macromolecular therapeutics can gain access to tumor cells via leaky tumor vessels. Inhibition of vascular endothelial growth factor (VEGF) signaling can reduce the vascularity of tumors and leakiness of surviving vessels, but little is known about how these changes affect the distribution of antibodies within tumors. We addressed this issue by examining the distribution of extravasated antibodies in islet cell tumors of RIP-Tag2 transgenic mice and implanted Lewis lung carcinomas using fluorescence and confocal microscopic imaging. Extravasated nonspecific immunoglobulin G (IgG) and antibodies to fibrin or E-cadherin accumulated in irregular patchy regions of stroma. Fibrin also accumulated in these regions. Anti-E-cadherin antibody, which targets epitopes on tumor cells of RIP-Tag2 adenomas, was the only antibody to achieve detectable levels within tumor cell clusters at 6 hours after i.v. injection. Treatment for 7 days with AG-013736, a potent inhibitor of VEGF signaling, reduced the tumor vascularity by 86%. The overall area density of extravasated IgG/antibodies decreased after treatment but the change was less than the reduction in vascularity and actually increased when expressed per surviving tumor vessel. Accumulation of anti-E-cadherin antibody in tumor cell clusters was similarly affected. The patchy pattern of antibodies in stroma after treatment qualitatively resembled untreated tumors and surprisingly coincided with sleeves of basement membrane left behind after pruning of tumor vessels. Together, the findings suggest that antibody transport increases from surviving tumor vessels after normalization by inhibition of VEGF signaling. Basement membrane sleeves may facilitate this transport. Antibodies preferentially distribute to tumor stroma but also accumulate on tumor cells if binding sites are accessible.

Autoaggression and tumor rejection: it takes more than self-specific T-cell activation.

Establishment of self-tolerance prevents autoaggression against organ-specific self-antigens. This beneficial effect, however, may in turn be responsible for tumor immune evasion. Thus, dissecting the mechanisms leading to the breakdown of self-tolerance in autoimmune diseases might provide insights for successful antitumor immune therapies. In a variety of animal models, organ- or tumor-specific immunity has been described, focusing on antigen-specific T-cell activation. Here, we discuss two transgenic mouse models which demonstrate that both autoaggression and tumor rejection require more than activated, self-reactive T cells. TCR transgenic mice, which are tolerant to a liver-specific MHC class I antigen, Kb, can be activated to reject Kb-positive grafts, but fail to attack Kb-expressing liver. However, autoaggression occurs when activated T cells are combined with "conditioning" of the target organ by irradiation or infection with a liver-specific pathogen. Similarly, in a mouse model of islet cell carcinoma, neither co-stimulatory tumor cells nor highly activated antitumor lymphocytes provoke an effective immune response against the tumor. Instead, a combination of activated lymphocytes and irradiation is required for lymphocyte infiltration into solid tumors. Both model systems provide evidence that although activated antigen-specific lymphocytes are a prerequisite for autoaggression, effector cell extravasation and appropriate interaction with the target organ/tumor are equally important. Thus, we propose that the organ/tumor microenvironment is a critical parameter in determining the effectiveness of an anti-self immune response.

Tumor microenvironment can restrict the effectiveness of activated antitumor lymphocytes.

Transgenic mice expressing the oncogene SV40 T antigen (Tag) in the insulin-producing beta cells of the pancreas develop islet cell carcinomas. Expression of the oncogene beginning in adult life leads to autoimmunity and lymphocytic infiltration of premalignant lesions. Nevertheless, Tag-expressing solid tumors escape the immune surveillance and are devoid of infiltrating lymphocytes. Attempting to elicit a tumor inflammatory response, we have both expressed a potent costimulator in oncogene-expressing beta cells and increased the abundance of reactive T cells. Coexpression of the costimulator B7.1 and the Tag oncoprotein leads to destruction of normal and premalignant islets and severe diabetes. Nevertheless, Tag+ tumors eventually develop, evidencing significantly reduced B7.1 expression and no infiltration. Another approach, whereby the abundance of reactive T cells was increased in double transgenic mice expressing Tag and a Tag-specific, CD4+-restricted T-cell receptor, was similarly unable to elicit tumor infiltration and destruction. Thus, neither costimulatory tumor cells nor hyperactivated antitumor lymphocytes were sufficient to produce an effective tumor immune response. In contrast, adoptive transfer of lymphocytes activated ex vivo did result in modest tumor infiltration with a limited induction of high endothelial venules on tumor vasculature, provided that T cells were transferred into irradiated recipients. However, adoptive transfer of ex vivo activated lymphocytes did not produce the dramatic inflammation seen in premalignant lesions. Thus, in addition to the parameters of activation and abundance of antitumor lymphocytes, the tumor microenvironment is evidently a critical parameter that can suppress lymphocyte extravasation and/or function inside tumors, likely in part via distinctive properties of the tumor vasculature.

Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy: a comparative study with proliferating-cell nuclear antigen and progesterone receptor protein immunostaining, mitotic index, and other clinicopathologic variables.

Prediction for malignancy of pancreatic endocrine tumors (PET) is often a formidable challenge for the pathologist. The authors evaluated the role of the proliferative activity and progesterone receptor protein (PgRP) in predicting prognosis and survival of PET. Twenty-three functioning (FT) and 31 nonfunctioning tumors (NFT) were evaluated for mitotic activity and immunostaining for Ki-67 antigen, proliferating cell nuclear antigen (PCNA), and progesterone receptor protein (PgRP) on paraffin sections. The results were expressed as a percentage (index) of immunoreactive or mitosing cells. All 54 cases showed immunostaining for Ki-67 and PCNA, and valuable mitotic index, whereas only a fraction of tumors (25 of 54 cases) exhibited PgRP expression. Ki-67 and PCNA indexes correlated strongly between themselves and to mitotic index, whereas an inverse relationship was observed between cell proliferation and PgRP status in both FT and NFT. Although univariate analysis showed that Ki-67, PCNA, mitotic and PgRP indexes, stage, immunoreactivity for hormones other than insulin, diameter, and nonfunctioning type of tumor were statistically correlated to survival, Cox's regression method let only Ki-67 index emerge as an independent predictor of survival using a cutoff value of 5% in both FT and NFT.

Prohormone convertases (PC1/3 and PC2) in rat and human pancreas and islet cell tumors: subcellular immunohistochemical analysis.

Prohormone convertase 1/3 (PC1/3; also termed PC1 or PC3) and PC2 are enzymes that activate prohormones by cleaving the pairs of basic amino acids. This mechanism was initially inferred from the series of several endocrine and neuroendocrine precursor proteins, including proinsulin and proglucagon. To determine the cellular and subcellular distribution of PC1/3 and PC2 in the rat and human pancreas, immunohistochemistry was performed using polyclonal antisera against mouse PC1/3 (ST-28) and mouse PC2 (ST-29). These studies showed light and electron microscopic co-localization of insulin, PC1/3 and PC2, and the coexistence of glucagon and PC2 in the pancreatic islets. This tendency of colocalization was also depicted in one case of human insulinoma and three cases of human glucagonomas, as well as in rat insulinomas. In two cases of human insulinomas, incomplete processing of proinsulin was suggested by the absence of PC2. At the subcellular level in the rat pancreatic islet, the colocalization of PC1/3 and insulin, and that of PC2 and glucagon, were observed in the same secretory granules by immunoelectron microscopy and image analysis. These studies suggest that PC1/3 and PC2 can function with the specificities in the processing of proinsulin and proglucagon into their active forms, respectively, in the normal and neoplastic pancreatic islets.

A retrospective study of pancreatic tumors in slaughter cattle.

Sixteen primary pancreatic tumors were found in a retrospective study of bovine pancreatic lesions detected in slaughtered cattle. Eleven islet cell tumors and three pancreatic exocrine carcinomas were identified based on light microscopy and immunohistochemistry. Nine of 11 islet cell tumors were classified as malignant. Metastatic sites included iliac, mediastinal, hepatic, and mesenteric lymph nodes, peritoneum, mesentery, and liver. Six cows with multiple islet cell tumors also had pheochromocytomas. All 11 islet cell tumors had positive immunoreactivity to insulin and somatostatin. Three tumors also contained cells immunoreactive for glucagon and two tumors contained pancreatic polypeptide immunoreactive cells. Immunoreactivity of tumor cells in metastatic sites was similar to their respective primary tumors. All exocrine pancreatic carcinomas metastasized widely and were immunonegative for insulin, somatostatin, glucagon, and pancreatic polypeptide. No mixed endocrine-exocrine tumors were identified. None of the endocrine or exocrine tumors contained amyloid. Additional primary tumors of the bovine pancreas included one neurofibroma and one neurofibrosarcoma. Additional cases with lesions of the bovine pancreas included nodular hyperplasia in 15 cows, exocrine acinar atrophy and fibrosis in four cows (two of which also had pancreatic lithiasis), pancreatitis in one cow, peripancreatic fibrosis in two cows, pancreatic steatosis in one animal, and pancreatic hemorrhages in one cow.

Expression of transforming growth factors beta 1, beta 2, beta 3 in neuroendocrine tumors of the digestive system.

Neuroendocrine tumors of the digestive system are slowly growing neoplasms which often present pronounced fibrosis around tumor cells and in the peritoneal cavity. In this study, 23 midgut carcinoids and 7 endocrine pancreatic tumors were examined for the presence of TGF-beta with affinity-purified polyclonal antibodies raised against synthetic peptides coding for a specific region of latency-associated peptide sequences of TGF-beta 1, -beta 2, -beta 3, a rabbit anti serum against TGF-beta binding protein (LTBP) and a rabbit polyclonal antibody against TGF-beta type II-receptor (TGF-beta RII). Tumor cells from most tissues expressed all three isoforms of TGF-beta but LTBP was only weakly expressed. In stromal cells abundant expression of TGF-beta 2 and LTBP was found, whereas TGF-beta 1 and TGF-beta 3 were expressed only weakly. TGF beta RII immunoreactivity was observed mostly in the stromal cells. Tissue sections from 4 of these neuroendocrine tumors were also investigated by in situ hybridization. Strong signals on tumor cells were detected with TGF-beta 2 and TGF-beta 3 cRNA probes and also weakly with TGF-beta 1 and LTBP cRNA probe. Strong positive signals were observed on stromal cells with TGF-beta 2 and LTBP probe whereas only weak signals were observed on the stromal cells with TGF-beta 3 probe. Strong signals were detected on stromal cells with TGF-beta RII probe whereas no signals were observed on tumor cells. Our data suggest that TGF-beta might play an important role in the interaction of tumor and stromal cells. Thus TGF-beta might stimulate matrix production and angiogenesis of stromal cells, whereas tumor cells themselves are unaffected by the growth inhibitory activity of TGF-beta.

High efficiency presentation of TNP-conjugated islet antigen to islet-specific T cells by a hybrid B cell line expressing TNP-specific surface Ig.

There is compelling evidence from animal models that type I diabetes is a consequence of T cell-mediated destruction of islet beta-cells. The recent isolation of islet-specific T cell clones from nonobese diabetic mice provides a means of identification of the Ag on islet cells that are responsible for stimulation of autoreactive T cells. We describe an APC line constructed by fusion of spleen B cells obtained from nonobese diabetic mice to a B lymphoma that was transfected with the H and L chains of an IgM specific to the hapten TNP. Using this hybrid APC we have observed a dramatic increase in the efficiency of presentation of TNP-conjugated islet cell protein preparations compared to that seen with conventional APC. Our results illustrate the potential use of this APC line for isolation and characterization of islet Ag relevant to the T cell response.

Immunohistochemical characterization of an amphicrine mucinous islet-cell carcinoma of the pancreas. Case report.

Immunohistochemical characteristics of a mucinous islet-cell carcinoma of the pancreas are described. The tumour presented with jaundice in a 59-year-old male. It consisted of polygonal atypical cells forming a reticular pattern, and invaded the common bile duct. In DNA flow cytometry, the tumour cells showed a clear-cut aneuploid peak. Intercellular mucin was abundant. A panel of antisera and monoclonal markers was applied in the immunohistochemical analysis. In addition to general epithelial and endocrine markers, the tumour cells showed a focal positive immunoreaction with anti-glucagon, anti-insulin, anti-vasoactive intestinal polypeptide, anti-pancreatic secretory trypsin inhibitor and anti-phospholipase A2 antigen. At the ultrastructural level, mucous and neuroendocrine granules were demonstrated in the same tumour cells.

A study of biological behavior based on the expression of a proliferating antigen in neuroendocrine tumors of the digestive system.

The expression of a proliferating antigen by Ki-67 immunohistochemistry was evaluated in 32 gastrointestinal carcinoids and in 5 pancreatic islet cell tumors. In the tissue sections the number of labelled nuclei was calculated per tumor area. The tumors were classified as low proliferating (less than 0.3 labelled cells/mm2), medium proliferating (0.3-1 labelled cells/mm2), and high proliferating (greater than 1 labelled cell/mm2). In 26 tumors obtained from patients receiving antitumor therapy (alpha-interferon) the proliferative activity was decreased. In treated midgut carcinoids the proliferative activity in metastatic tissue was significantly reduced (p less than 0.05). Though not statistically significant, primary midgut carcinoids collected from untreated patients displayed a lower proliferative activity than liver metastases. A survival analysis revealed that patients with tumors displaying low proliferative activity had a better survival than those with high proliferative activity (p less than 0.05). Single cell cytofluorometric DNA analyses showed regular diploid stem cell lines in the majority of tumors from untreated patients (9/11 cases). No correlation was found between the calculated proliferative activity and the DNA profile. The obtained results indicate that the expression of a proliferation antigen by Ki-67 immunohistochemistry can be used to evaluate the biological behavior of neuroendocrine tumors of the digestive system and predict survival.

Effects of high in vivo levels of vasoactive intestinal polypeptide on function of circulating lymphocytes in humans.

To examine the possible in vivo significance of the immunomodulatory effects of vasoactive intestinal polypeptide described in vitro, several parameters of peripheral blood lymphocyte function were studied in a patient with a pancreatic endocrine tumor and high circulating levels of vasoactive intestinal polypeptide. There was no imbalance of the circulating lymphocyte subpopulations, and the in vitro responses of the patient's lymphocytes to mitogens were normal. However, there was an increased number (32%) of peripheral lymphocytes expressing interleukin 2 receptor. Serum immunoglobulin M levels were higher than in controls, and the patient's lymphocytes exhibited a spontaneous in vitro immunoglobulin M production higher than normal. Comparable increases in both interleukin 2 receptor expression and immunoglobulin M production were induced in vitro in normal peripheral lymphocyte cultures by the addition of vasoactive intestinal polypeptide concentrations similar to that detected in the patient's plasma. These findings indicate that a modulatory effect of vasoactive intestinal polypeptide on lymphocyte activation and immunoglobulin synthesis may be operating in vivo. They also suggest that vasoactive intestinal polypeptide does not mediate major defects in peripheral blood lymphocyte function in vivo.

Heterogeneity of islet cell autoantibodies in terms of insulin release from rat islets and insulinoma cells.

The clinical significance of cytoplasmic islet cell autoantibodies (ICA) has been studied since their discovery by Bottazzo et al. in 1974. Some ICAs destroy pancreatic B cells in the presence of complement, whereas others take no part in this destruction. This suggests that islet function varies with the amount of ICA produced. In the present investigation we report the heterogeneity of monoclonal islet cell antibodies produced by one of us in terms of insulin release from isolated rat islets as well as from rat insulinoma cells (RINr).

Autoimmune reactions in a patient with malignant insulinoma treated by multiple low dose streptozotocin.

A 66-year-old female patient with a malignant insulinoma was treated with streptozotocin (STZ; Zanosar) in 5 cycles every 4 weeks as 5 day courses with an intravenous dosage of 850 mg per day. Under this treatment hypoglycemic episodes decreased continuously in number as well as severity and - after a delay of 12 months after the last treatment - an overt diabetes mellitus appeared. Plasma insulin concentrations dropped immediately after starting of STZ therapy. On the other hand, islet cell surface antibodies and their complement-dependent cytotoxicity increased continuously, being at their highest 6 months after termination of STZ treatment. Thus, STZ is able to induce a specific immune response against islet cells with a progressive damage of malignant insulin producing cells.

Flow-cytometric detection of human anti-rat insulinoma antibodies in relation to anti-human islet cell and anti-insulin antibodies. Recognition of distinct antigens by antibodies in early type I diabetes.

Flow cytometry was recently introduced for the detection of antibodies in human serum to a cultured insulin-secreting rat insulinoma cell line (RINm5F) to investigate humoral immune reactivity in newly diagnosed type I (insulin-dependent) diabetic patients. Fifty-three patients were observed for 6-20 mo after clinical onset of diabetes with a reported duration of symptoms of less than 6 wk. Human anti-RINm5F antibodies were detected in 28%, human anti-islet cell antibodies in 62%, and anti-insulin autoantibodies in 36% of patients before initiation of insulin therapy. Occurrence of human anti-RINm5F antibodies at this stage was correlated with human anti-insulin autoantibodies rather than with the formation of anti-islet cell antibodies. Incidence of anti-RINm5F antibodies in individuals with duration of diabetes greater than 6 wk was 38%, whereas human anti-islet cell antibodies and anti-insulin antibodies became detectable in 72 and 61% of the patients, respectively. These findings are in line with previous reports of immunoprecipitation by human diabetic serums of a 64,000-Mr antigenic structure in freshly prepared rat islet cells. The results suggest a reactivity of distinct classes of antibodies in serums of patients with type I diabetes to disparate antigens on human islet cells and cloned rat insulinoma cells and, moreover, reactivity to insulin as the secreted product. Further characterization of the reacting RINm5F antigens and prospective studies in subjects at risk for diabetes are required to validate the application of RIN cells to the investigation of immune mechanisms involved in the pathogenesis of human type I diabetes.

Tissue expression of the tumour associated antigen CA242 in benign and malignant pancreatic lesions. A comparison with CA 50 and CA 19-9.

The expression of a novel tumour associated antigen CA 242, defined by the monoclonal antibody C 242, was studied by immunoperoxidase staining in formalin-fixed, paraffin-embedded tissue sections from normal pancreata, pancreata with pancreatitis and benign and malignant pancreatic neoplasms. The antigenic determinant of the C 242 antibody is a sialylated carbohydrate structure, related but chemically different from tumour marker antigens CA 19-9 and CA 50. Thirty-eight of 41 (93%) well to moderately differentiated ductal adenocarcinomas of the pancreas and all cystadenocarcinomas were positive for CA 242. The staining was most intense in the apical border of the cells, and in the intraluminal mucus. Only two out of seven poorly differentiated adenocarcinomas stained, and the number of positive cells was smaller than in well differentiated carcinomas. Only occasional cells were stained in one out of five anaplastic carcinomas. Part of large ducts were positive in 91% (21/23) specimens of chronic pancreatitis. In acute pancreatitis small terminal ducts, centro-acinar cells and some large ducts stained for CA 242. In normal pancreas only a few small terminal ducts were CA 242 positive. Carcinomas always stained more strongly for CA 242 than normal pancreatic tissue adjacent to the carcinoma. The results of CA 242 are compared with those of tumour marker antigens CA 50 and CA 19-9. Serum CA 242 levels were determined in 23 of the patients with pancreatic cancer using a fluoroimmunoassay. Fifteen (65%) patients had an elevated value. There was no clear-cut correlation between the serum levels and the immunohistochemical expression of the CA 242 antigen. The expression of CA 242 in pancreatic tissue resembles that of CA 50 and is similar to CA 19-9. The antigen is expressed in serum of many patients with pancreatic cancer and, therefore, is a potential candidate for a serum tumour marker.

Studies on the chemical and immunological destruction of insulin-secreting islet cell tumours.

Chemical and immunological destruction of insulin-secreting islet cell tumours were evaluated in vivo and in vitro using the transplantable radiation-induced NEDH rat insulinoma and the derived clonal RINm5F cell line. Administration of a large amount of polyclonal insulin antibody did not affect the development of hypoglycaemia, tumour weights or the survival of insulinoma-bearing rats. Streptozotocin (100 mg/kg body weight) evoked a rapid and sustained decrease of insulin concentrations, accompanied by tumour regression and elevation of plasma glucose. Administration of alloxan (200 mg/kg) was without effect. In vitro, streptozotocin and alloxan exerted approximately equipotent time-dependent and concentration-dependent cytotoxic effects on cultured insulinoma cells as established by cell staining with trypan blue. The cytotoxic actions of both drugs were decreased by agents believed to scavenge free radicals or to act as inhibitors of poly(ADP-ribose)synthetase. Exposure of clonal RINm5F cells to the nitrosocompounds, N-methyl-N'-nitro-N-nitrosoguanidine and N-nitroso-N-methylurea, resulted in a particularly marked reduction in cell viability compared with streptozotocin.

Monoclonal antibodies as probes to the differentiated exocrine pancreas react to monoclonal islet tumor tissue.

Pancreatic exocrine and ductal reacting monoclonal antibodies were derived from a mouse immunized with fixed pluripotent rat islet tumor cells (MSL) and boosted in vitro with fixed and concentrated tumor cell culture supernatant. Antibodies were obtained against duct cells, intercalated ducts, acinar cells and zymogen granules as well as against parietal cells. Unexpectedly, no monoclonal antibodies were directed against the endocrine pancreas, whereas six out of seven exocrine reacting antibodies stained total or subpopulations of cells in sections of monoclonal hypoglycemic MSL-tumors. These data may support the hypothesis of a common endodermal origin of the exocrine and endocrine pancreas.

Could bovine serum albumin be the initiating antigen ultimately responsible for the development of insulin dependent diabetes mellitus?

Western blotting of either a cloned rat beta-islet tumour cell extract or isolated BB rat islets with rat anti-bovine serum albumin antiserum revealed a cross-reacting protein (Mr = 69,000). A protein of similar molecular size was observed by fluorography in proteins immunoprecipitated from islet cells labelled with (35S)-methionine using anti-bovine serum albumin antiserum. In comparing the primary structure of the beta subunits of the proteins Ia, DQ and DR a region of homology with bovine serum albumin became evident. Analysis of the amino-acid homology in relation to the DR/DQ allotypes found in the human population gave a strong correlation between the combined DR and DQ homology score with bovine serum albumin and the incidence of insulin dependent diabetes mellitus.