抗原致敏树突状细胞诱导CIK对肺癌细胞杀伤作用的研究

[目的]研究肿瘤抗原致敏的树突状细胞（DC）诱导淋巴因子激活的杀伤细胞（LAK）和细胞因子诱导的杀伤细胞（CIK）对肺癌细胞株A549和肺腺癌原代细胞的杀伤作用。[方法]取健康人外周血单个核细胞,常规诱导出DC、CIK、LAK细胞。用肺癌A549细胞提取的肿瘤抗原冲击DC,倒置显微镜下观察DC形态。流式细胞仪检测DC经抗原冲击和未经抗原冲击后其表型变化。LDH释放法测定杀伤活性。[结果]DC经肿瘤抗原冲击后在镜下呈典型成熟形态,其表面分子CD40、CD80、CD86和HLA-DR的表达明显较未经肿瘤抗原冲击的DC高。DC＋CIK细胞对A549和肺腺癌原代细胞的杀伤活性高于CIK细胞、LAK细胞和DC＋LAK细胞（P〈0.05）,随着效靶比的升高,其杀伤效应随之增强（P〈0.05）。[结论]肿瘤抗原致敏的DC可诱导特异性CIK细胞,DC＋CIK细胞对A549和肺腺癌原代细胞的杀伤作用明显高于DC＋LAK、CIK、LAK细胞。     

抗原致敏DC诱导CIK细胞对肺腺癌细胞的杀伤作用

[目的]研究肿瘤抗原致敏的树突状细胞（DC）诱导淋巴因子激活的杀伤细胞（LAK）和细胞因子诱导的杀伤细胞（CIK）对肺腺癌原代细胞的杀伤作用，并与单独LAK、CIK细胞的杀伤效果进行比较。[方法]取健康人外周血单个核细胞（PBMNC），常规诱导出DC、CIK、LAK细胞；用肺癌A549细胞提取的肿瘤抗原冲击DC，倒置显微镜下观察DC形态，流式细胞仪检测DC经抗原冲击和未经抗原冲击后其表型变化；把CIK细胞、DC-CIK细胞、LAK细胞和DC-LAK细胞作为效应细胞，肺腺癌原代细胞作为靶细胞，共分为4组，在10：1、20：1、50：1的效靶比时，进行杀伤试验，使用LDH释放法测定杀伤活性。[结果]DC经肿瘤抗原冲击后在镜下呈典型成熟形态；流式细胞仪检测DC经肿瘤抗原冲击和未经肿瘤抗原冲击其表面分子CD40、CD80、CD86和HLA-DR的表达，前者明显高于后者，两者有显著性差异（P〈0．01）；DC—CIK细胞对肺腺癌原代细胞的杀伤活性高于DC—LAK细胞、CIK细胞和LAK细胞（P〈0．05），随着效靶比的升高，DC-CIK细胞对肺癌细胞的杀伤效应随之增强（P〈0．05）。[结论]肿瘤抗原致敏的DC可诱导特异性CIK细胞，DC-CIK细胞对肺腺癌原代细胞的杀伤作用明显高于DC—LAK、CIK、LAK细胞。     

抗原致敏DC联合CIK细胞对肺癌细胞杀伤作用的研究

[ 目的]研究肿瘤抗原致敏的树突状细胞（DC）联合细胞因子诱导的杀伤细胞（CIK）对肺腺癌原代细胞的杀伤作用，及肺癌细胞杀伤作用中细胞因子水平。[方法]取健康人外周血单个核细胞（PBMNC），常规诱导出DC、CIK、LAK细胞；用肺癌A549细胞提取的肿瘤抗原冲击DC，倒置显微镜下观察DC形态，流式细胞仪检测DC经抗原冲击和未经抗原冲击后其表型变化：把CIK细胞、DC-CIK细胞、LAK细胞和DC-LAK细胞作为效应细胞，肺腺癌原代细胞作为靶细胞，共分为4组，在10：1、20：1、50：1的效靶比时，进行杀伤试验，使用LDH释放法测定杀伤活性；ELISA法检测杀伤试验中细胞因子IL-2、IL-12、IFN-γ的分泌水平。[结果]DC经肿瘤抗原冲击后在镜下呈典型成熟形态；DC—CIK细胞对肺腺癌原代细胞的杀伤活性高于CIK细胞、LAK细胞和DC—LAK细胞（P〈0．05），随着效靶比的升高，DC—CIK细胞对肺癌细胞的杀伤效应随之增强（P〈0．05）；细胞杀伤试验中DC—CIK细胞组中IFN-γ、IL-12的分泌量明显高于其它3组（P〈0．05）：而IL2的分泌量以DC-LAK细胞组为最高，DC—LAK和LAK细胞组明显高于其他2组（P〈0．05）。[结论]肿瘤抗原致敏的DC可诱导特异性CIK细胞，显著提高CIK细胞对肺腺癌原代细胞的杀伤作用，其杀伤作用可能与IFN-γ、IL12的分泌量有关。     

CB6F1小鼠树突状细胞诱导细胞毒性T淋巴细胞的杀伤作用

[目的]探讨CB6F1小鼠脾树突状细胞(DC)的培养及其诱导针对小鼠路易斯肺癌(LLC)的细胞毒性T淋巴细胞(CTL)对肿瘤的杀伤效应.[方法]应用CB6F1小鼠脾细胞在GM-CSF、IL-4等细胞因子作用下培养出DC,反复冻融法制备LLC抗原致敏DC,与淋巴细胞及IL-2混合培养诱导出肿瘤特异性CTL,利用乳酸脱氢酶法检测CTL的杀伤活性.[结果]用GM-CSF、IL4联合培养小鼠脾细胞第4d,可见细胞形态发生改变,培养第8d,可见典型的刺突样DC,通过流式细胞术检测了DC表型高表达CD80占76.5％,CD86占60.0％,MHCⅡ占67.4％,CD11C占80.6％.[结论]应用GM-CSF、IL-4、LPS等细胞因子培养CB6F1小鼠脾细胞经过肿瘤抗原冲击,可以培养出成熟DC,并且DC可以诱导出具有杀伤活性的肿瘤特异性CTL.     

宫颈癌患者外周血树突状细胞抗宫颈癌免疫反应

[目的]研究自宫颈癌患者外周血分离、培养而来的树突状细胞体外对宫颈癌Hela细胞的抑制作用.[方法]应用细胞因子诱导培养从宫颈癌患者外周血分离的单核细胞,获得成熟DC.宫颈癌组织来源抗原致敏DC,激活T细胞增殖分化为细胞毒性T淋巴细胞(CTL).MTT法检测比较负载抗原DC与未负载抗原DC诱导的CTL对Hela细胞和SKOV3细胞不同的杀伤效应.[结果]宫颈癌细胞抗原致敏的DC,激活肿瘤抗原特异性CTL,对宫颈癌Hela细胞产生高效而特异的杀伤作用(56.410%),对卵巢癌SKOV3细胞仅有一定的杀伤作用(24.901%);而未致敏DC激活的CTL对以上两种肿瘤细胞只有很低的杀伤作用,分别为10.256%和20.151%.单纯肿瘤抗原刺激下的T细胞,对Hela和SKOV3细胞产生非特异性杀伤作用,其效率仅为1.865%及15.613%.[结论]宫颈癌患者外周血DC在体外能诱导高效而特异的抗宫颈癌细胞免疫反应,提示肿瘤抗原激活的DC作为疫苗在宫颈癌的免疫治疗中具有重要意义.     

胃肿瘤抗原致敏的脐血 DC 联合 CIK 对胃癌细胞株 SGC-7901杀伤活性的研究

目的：探讨体外胃肿瘤抗原致敏脐血 DC 联合细胞因子诱导的杀伤细胞（CIK）对胃癌细胞株 SGC-7901的杀伤作用。方法分离脐血单个核细胞培养 DC 细胞和 CIK 细胞。流式细胞仪检测成熟 DC 细胞表面抗原 CD83、CD86、CD11c 及 CIK 细胞表面抗原 CD3、CD56、CD4、CD8、CD16表达。致敏 DC-CIK、非致敏 DC-CIK、CIK 作为效应细胞,SGC-7901作为靶细胞,利用乳酸脱氢酶（LDH）释放法检测致敏 DC-CIK、脐血 DC-CIK、CIK 分别在效靶比10：1、20：1、40：1时对胃癌细胞的杀伤活性。结果成熟脐血 DC 表面抗原 CD83＋ CD86＋、CD11c ＋ CD83＋、CD86＋ CD11c ＋表达率分别为（75.4±2.1）％、（79.3±1.4）％、（80.2±2.6）％。致敏脐血 DC 表面表达率分别为（77.7±1.5）％、（82.6±1.9）％、（76.9±2.6）％,二者差异无统计学意义（t ＝1.526,P ﹥0.05;t ＝0.958,P ﹥0.05;t ＝1.049,P ﹥0.05）。成熟 CIK 中 CD4＋细胞占（22.8±1.3）％,CD8＋细胞占（77.3±1.8）％,CD3＋ CD56＋ CD16＋细胞占（24.5±2.1）％。致敏 DC-CIK、DC-CIK、CIK 都对胃癌细胞有杀伤作用,致敏 DC-CIK 在效靶比为10：1、20：1、40：1时杀瘤活性分别为（37.68±1.49）％、（41.67±0.90）％、（42.71±0.98）％,在效靶比为40：1时杀瘤活性最强,DC-CIK 组分别为（36.77±0.46）％、（38.94±0.95）％、（41.15±0.89）％,CIK组分别为（34.74±1.01）％、（37.76±0.43）％、（39.65±0.79）％,三组间差异有统计学意义（F ＝5.92, P ﹤0.05;F ＝19.13,P ﹤0.05;F ＝8.88,P ﹤0.05）。结论胃肿瘤抗原致敏脐血 DC 可明显增强 DC-CIK的杀瘤活性,致敏脐血 DC-CIK 在效靶比为40：1时杀瘤活性最强。     

肝癌细胞对重组人HSP70联合肝癌组织冻融抗原修饰树突状细胞的免疫应答

目的:研究重组人热休克蛋白70(rhHSP70)联合肝癌组织冻融抗原修饰的树突状细胞(dendritic cell,DC)诱导对肝癌细胞的免疫杀伤效应.方法:外周血单个核细胞经粒-巨噬细胞集落刺激因子(GM-CSF)、白细胞介素4 (IL-4)诱导生成DC,负载冻融抗原的同时加入rhHSP70,不同分组致敏的DC激活淋巴细胞生成肿瘤抗原特异性细胞毒性T淋巴细胞(cytotoxic T cells,CTL),四甲基偶氮唑蓝(MTT)法及3H-TdR法检测DC刺激淋巴细胞增殖能力, MTT法检测CTL对肝癌细胞的体外杀伤活性,酶联免疫吸附试验(ELISA)测定细胞因子的分泌,流式细胞术(FCM)检测DC表型变化.结果:冻融抗原致敏的DC可明显促进淋巴细胞增殖,能有效呈递肝癌冻融抗原,诱导产生抗原特异性CTL,联合rhHSP70能进一步增强CTL对肝癌细胞的杀伤作用.结论:肝癌冻融抗原联合rhHSP70修饰的DC诱导CTL对肝癌细胞能产生高效杀伤作用.     

脐血来源树突状细胞体外诱导抗卵巢癌免疫特异性

[目的]研究脐血来源树突状细胞(DC)体外诱导特异性抗卵巢癌细胞的免疫效应.[方法]①从脐血中分离单个核细胞(MNCs)后,获得单核细胞(Mo).粒单集落刺激因子(GM-CSF)和白介素4(IL-4)诱导分化,培养7天后应用流式细胞仪进行细胞表型分析.②诱导单核细胞分化的第3天加入人卵巢癌细胞株3AO的冻融抗原,共培养4天后获得负载肿瘤抗原的成熟DC;将致敏DC与从脐血中分离的同种异体T淋巴细胞共培养3天,获得细胞毒T淋巴细胞(CTL);四甲基偶氮唑蓝(MTT)法检测CTL及上清对人卵巢癌细胞株3AO、人胚肾细胞株293T(对照细胞)、人肝癌细胞株HCCC-9810的细胞毒作用.[结果]①脐血来源单核细胞(Mo)在GM-CSF和IL-4作用下,7天后可分化生成成熟的DC,高表达DC特异性抗原CDla、CD80(B7-1)、CD86(B7-2)、HLA-DR、CD83.②DC可负载并递呈肿瘤抗原,激活同种异体T淋巴细胞,诱导肿瘤特异性CTL产生.不同浓度CTL及上清对卵巢癌细胞3AO有特异性杀伤、抑制作用(P＜0.05).[结论]脐血中单核细胞可体外分化扩增为成熟的功能性DC,并诱导出特异性杀伤卵巢癌细胞的免疫效应.     

抗原致敏DC联合CIK在原发性肝癌治疗中的应用

目的:探讨负载自身肝癌裂解物的树突状细胞(DC)与细胞因子诱导杀伤细胞(CIK)共培养对CIK体外杀伤活性的影响,并观察抗原致敏DC(Ag-DC)联合CIK治疗原发性肝癌后患者的免疫状态、临床疗效及毒副反应.方法:选择24例原发性肝癌患者,分离外周血单个核细胞,其中贴壁细胞经GM-CSF和IL-4诱导产生DC,并负载自体肿瘤裂解物;悬浮细胞经IFN-γ、IL-2、抗CD3单抗、IL-1α体外诱导产生CIK.将Ag-Dc与CIK共培养,观察CIK在体外对肝癌细胞株SMMC-7721的杀伤活性;24例患者接受Ag-DC+CIK的过继免疫治疗,观察疗效.结果:1)Ag-DC与CIK共培养后,CIK体外肿瘤杀伤活性明显提高;2)Ag-Dc联合C1K治疗原发性肝癌可明显改善患者细胞免疫功能,提高临床疗效;3)除一过性发热、畏寒外未见其它不良反应.结论:负载自体肿瘤细胞裂解物的DC疫苗联合CIK可作为原发性肝癌常规治疗的有效辅助手段.     

递呈乳腺癌细胞MCF-7肿瘤抗原的树突状细胞对T细胞的激活

目的：在体外利用细胞因子的诱导获取树突状细胞（DC），并观察递呈肿瘤抗原后的成熟DC对T细胞的激活作用。方法：健康人外周血单个核细胞（PBMC）在体外用细胞因子诱导获取DC，并经乳腺癌细胞MCF-7肿瘤细胞裂解物体外冲击，再以1：5的比例将致敏DC与T细胞共同孵育5d并共同作为效应细胞，通过FACS分析T细胞激活前后的表型变化以及MTT试验观察体外特异性肿瘤杀伤效果。结果：DC在细胞因子的诱导下7d后，形态学表现为伸出许多伪足样突起，在摄取抗原后可见内吞样小泡。FACS检测呈现成熟DC的标志，CD40、CD83、CD80、CD86和HL-DR等高表达。另外，未经成熟DC激活的T淋巴细胞以辅助性T细胞（Th）为主，CD4^＋ 52．1％，CD8^＋ 仅22．1％；而经成熟DC激活的T淋巴细胞以杀伤性T细胞（Tc）为主，CD4^＋ 32．6％，CD8^＋ 64．2％。同时，MTT试验证实经递呈MCF-7肿瘤抗原的DC激活了细胞毒性T淋巴细胞（CTL），并对MCF-7具有特异性肿瘤杀伤作用。结论：体外递呈肿瘤抗原MCF-7的成熟DC对T细胞具有激活作用，并产生肿瘤特异性CTL。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Concomitant radiotherapy with chemotherapy in patients with glioblastoma

Glioblastomas are the most frequent and the most aggressive primary brain tumors in adults. Therapeutic strategy is challenging because of radioresistance and chemoresistance explaining the poor prognosis (median survival of 12 months). Standard therapy consisted until recently of surgery and postoperative radiotherapy while the impact of chemotherapy (investigated as adjuvant, neo adjuvant therapy or concomitant with irradiation) was a matter of debate. However a recent phase III study has concluded to the benefit of adjuvant temozolomide administered during and after radiotherapy. This strategy is yet to become a standard.