Original article: Recombinant tumor necrosis factor for superficial bladder tumors

Twenty patients with histologically documented superficial bladdercancer (Ta, Tl, Tis) were treated with intravesical administrationof TNF 400–1800 micrograms. Of 18 patients with a markerlesion, 2 obtained a complete response for 8+ and 18 months.Two had a partial response and were given other intravesicaltherapies after 5 and 7 months. No or minimal systemic absorptionof TNF was observed and documented in 4 of 20 patients by pharmacokineticstudies, and no patients developed antibodies to intravesicallyadministered TNF. TNF was well tolerated in doses up to 1800micrograms. No systemic or local side effects were observed.Modest activity was attained with intravesical TNF, even inpretreated patients. TNF, superficial bladder tumors, intravesical therapy     

Systemic use of tumor necrosis factor alpha as an anticancer agent

Tumor necrosis factor-α (TNF-α) has been discussed as a potential anticancer agent for many years, however initial enthusiasm about its clinical use as a systemic agent was curbed due to significant toxicities and lack of efficacy. Combination of TNF-α with chemotherapy in the setting of hyperthermic isolated limb perfusion (ILP), has provided new insights into a potential therapeutic role of this agent. The therapeutic benefit from TNF-α in ILP is thought to be not only due to its direct anti-proliferative effect, but also due to its ability to increase penetration of the chemotherapeutic agents into the tumor tissue. New concepts for the use of TNF-α as a facilitator rather than as a direct actor are currently being explored with the goal to exploit the ability of this agent to increase drug delivery and to simultaneously reduce systemic toxicity. This review article provides a comprehensive overview on the published previous experience with systemic TNF-α. Data from 18 phase I and 10 phase II single agent as well as 18 combination therapy studies illustrate previously used treatment and dose schedules, response data as well as the most prominently observed adverse effects. Also discussed, based on recent preclinical data, is a potential future role of systemic TNF-α in combination with liposomal chemotherapy to facilitate increased drug uptake into tumors.     

Recombinant human tumor necrosis factor-alpha: evidence of an indirect mode of antitumor activity

The antitumor activity of recombinant human tumor necrosis factor (rTNF-alpha) was examined on murine tumors in mice and in cultured cells in vitro. Mice were implanted intradermally with Meth A fibrosarcoma (Meth A) on day 0. rTNF-alpha caused tumor necrosis and inhibited the tumor growth when given i.v. on day 7 or 10, but not when given on day 3. When rTNF-alpha was given i.v. in doses of 0.1-3.2 micrograms/mouse twice a week for 3 weeks beginning on day 7 or 11, the growth of solid Meth A, Colon 26 adenocarcinoma, Colon 38 carcinoma, Sarcoma-180, and M5076 reticulum cell sarcoma tumors implanted s.c. or intradermally was markedly inhibited, and the life of the mice bearing these tumors, except M5076 reticulum cell sarcoma, was prolonged. The growth of Meth A implanted i.m. was also markedly inhibited by rTNF-alpha given i.v. However, the life of mice bearing i.p. Colon 26 adenocarcinoma, MH134 hepatoma, Sarcoma-180, and Ehrlich carcinoma was not prolonged by rTNF-alpha given i.p. nine times (days 1-9) in doses up to 1.0 or 3.2 micrograms/mouse. Only in the case of mice bearing i.p. Meth A, the life was slightly prolonged by i.p. treatment with rTNF-alpha but not by i.v. treatment. In experiments against in vitro cultured cells, rTNF-alpha did not show any direct cytotoxicity against mouse tumor cells: Meth A, Colon 26 adenocarcinoma, Colon 38 carcinoma, and Sarcoma-180, but had a cytotoxic effect against L929 mouse fibroblast. The results suggest that rTNF-alpha is a unique antitumor drug with potent necrotizing activity against solid tumors in mice, and that this activity may derive from indirect mechanisms related to the growth of tumors and not to the direct cytotoxicity of the drug.     

Recombinant single-chain antibody fusion construct targeting human melanoma cells and containing tumor necrosis factor

Fusion constructs targeting tumor cells have significant potential applications against both solid tumors and hematologic malignancies. We developed a fusion construct of tumor necrosis factor (TNF) and a single-chain antibody (scFvMEL) recognizing the gp240 antigen on human melanoma cells. The scFvMEL/TNF construct, like TNF itself, was found to exist in solution primarily as a trimer of 45 kDa monomers (trimeric molecular weight = 135 kDa). The fusion construct bound specifically to gp240 antigen-positive but not to antigen-negative cells. The TNF component of the construct was biologically active (specific activity = 1 x 10(7) U/mg) compared with free TNF (specific activity = 2.6 x 10(7) U/mg) and was more cytotoxic to antigen-positive A375-M melanoma cells (IC(50) = 100 pM) than TNF alone (IC(50) = 1,000 pM) and, additionally, was active against AAB-527 melanoma cells (IC(50) = 20 nM) resistant to TNF itself (IC(50) > 1,000 nM). The augmented cytotoxicity was mediated by antibody-specific binding to the cell surface. Both A375-M and AAB-527 cells were shown to express TNFR1 and TNFR2 on the cell surface. The TNF moiety of the fusion construct was efficiently delivered into cells in time-dependent increase in cytosol as assessed by immunofluorescent staining of human melanoma cells. Radiolabeled scFvMEL/TNF localized effectively in human melanoma xenografts in nude (nu/nu) mice with a tumor:blood ratio of approximately 8 at 72 hr after administration. Our studies suggest that because of its unique biologic activity and low antigenic potential, scFvMEL/TNF makes an excellent cytotoxic protein for potential clinical treatment of human melanoma.     

Inhibition of nuclear factor kappaB induces apoptosis following treatment with tumor necrosis factor alpha and an antioxidant in human prostate cancer cells

Transforming growth factor beta-1 (TGFbeta-1) and tumor necrosis factor alpha (TNF-alpha), an activator of nuclear factor kappa B (NF-kappaB), modulate apoptosis and/or cell growth. This study was designed to investigate the activity of NF-kappaB and its regulation of inhibitor of apoptosis gene (c-IAP2) in two human prostate cancer cell lines, DU-145 (which is androgen unresponsive) and ALVA-101 (which is moderately androgen responsive). These cells were treated with and without various concentrations of a strong antioxidant, pyrrolidinedithiocarbamate (PDTC), and TNF-alpha at various time intervals. Following treatments, cell growth and apoptosis were determined by ELISA techniques. NF-kappaB activity was determined by electrophoretic mobility shift assay (EMSA), and c-IAP2 mRNA production was determined with Northern blot analysis. PDTC treatment significantly reduced cell growth up to 80% in both DU-145 and ALVA-101 cells. TNF-alpha and lower but not higher doses of PDTC combined demonstrated an additive inhibition of cell growth in both cell lines. Active NF-kappaB and c-IAP2 was blocked significantly following PDTC treatments, whereas treatments with TNF-alpha alone showed increased NF-kappaB activity and c-IAP2. However, when both PDTC and TNF-alpha were combined, nuclear presence of NF-kappaB and c-IAP2 were reduced significantly (P < 0.05) to levels observed with PDTC alone. In conclusion, the antioxidant, PDTC, appears to initiate apoptosis by blocking cytoplasmic NF-kappaB translocation to the nucleus where it normally activates the production of apoptosis-inhibitory proteins like c-IAP2. Both TNF-alpha and PDTC alone cause apoptosis and reduce cell growth, but their combined effects are additive in reducing cell growth of DU-145 and ALVA-101 human prostate cancer cells.     

胃癌细胞肿瘤坏死因子受体的研究

目的　探讨人胃癌细胞肿瘤坏死因子受体 ( TNFR)的数目与胃癌细胞分化程度以及与肿瘤坏死因子突变体 ( TNF- m)细胞毒效应之间的关系。方法　以12 5I- TNF- m为配体 ,用放射配体结合分析法 ,检测了高、中、低不同分化程度的体外培养胃癌细胞 ( MKN2 8、SGC790 1、MKN4 5)的 TNFR,同时用 MTT比色法研究了 TNF- m对三株胃癌细胞的细胞毒效应。结果　三株胃癌细胞 TNFR数目分别为每细胞 9.8× 10 -12 nmol、5.6× 10 -12 nmol、3.2× 10 -12 nmol,三者之间比较 ,TNFR数目差异有显著性 ( P<0 .0 5)。解离常数基本一致 ,同一温度时三株胃癌细胞 TNF- m的内化率几乎相等 ,且呈温度依赖关系。TNFR的半衰期大约为 90分钟 ,胞膜与胞浆 TNFR数目之比约为 1∶ 2 ,TNF- m对三株胃癌细胞的最大杀伤率分别为 86%、60 %、34 % ,差异有显著性 ( P<0 .0 5) ,且 39℃时的杀伤率高于37℃时的杀伤率。结论　胃癌细胞表面 TNFR数目与胃癌分化程度相关。 TNF- m的细胞毒效应与TNF数目及 TNF- m的内化量有关。     

重组改构人肿瘤坏死因子姑息治疗晚期肿瘤伴随恶性胸腔积液的临床观察

目的：回顾性分析重组改构人肿瘤坏死因子（rmhTNF）在晚期肿瘤伴恶性胸腔积液患者姑息治疗中的效果。方法将25例晚期肿瘤伴发恶性胸腔积液的患者最大限度地引流胸腔积液,然后给予rmhTNF 300万IU,每3天一次,连续4次,观察疗效和不良反应。结果治疗后4例患者由于已经进入肿瘤终末期,于4周内死亡。在治疗4周内有76.2%（16/21）的患者未复发;对于曾经使用其他方法治疗过的15例患者,有73.3%（11/15）未复发。25例患者共给药83次,其中发热发生率10.8%（9/83）,流感样症状发生率1.2%（1/83）,总发生率为12.0%（10/83）。所有的不良反应是完全可逆的,对症治疗即可消失。结论胸腔内灌注rmhTNF治疗恶性胸腔积液是一种不良反应相对较少,疗效确切的方法,在其他方法失败的情况下也有效,适用于身体状况较差进行姑息治疗的患者。     

Recombinant human tumor necrosis factor administered as a five-day continuous infusion in cancer patients: phase I toxicity and effects on lipid metabolism

Recombinant human tumor necrosis factor (rH-TNF) is a cytotoxic monokine with pleiotropic effects. A phase I trial of rH-TNF was initiated using a five-day continuous intravenous (IV) infusion repeated every 28 days. Thirty-eight courses of therapy were administered to 19 patients. The starting dose was 5 X 10(4) U/m2/d, with escalations to 1.0 X 10(5), 2.0 X 10(5), 2.4 X 10(5), and 3.0 X 10(5) U/m2/d. Systemic side effects, including fever, chills, hypotension, fatigue, anorexia, and headaches, were mild and self-limiting. At the maximum tolerated dose of 3.0 X 10(5) U/m2/d, dose-limiting hematologic toxicity was manifested by transient thrombocytopenia and leukopenia. Elevated bilirubin levels were also seen at the higher dose levels. Lipoprotein analysis demonstrated that the five-day treatment with rH-TNF was associated with decreases in high-density lipoproteins, as well as increases in triglycerides and very-low-density lipoproteins. Pharmacokinetic studies using an enzyme-linked immunosorbent assay (ELISA) test indicated plasma rH-TNF levels less than 0.2 U/mL. The recommended phase II dose of rH-TNF administered as a five-day continuous infusion is 2.4 X 10(5) U/m2/d.     

Antitumor effect of tumor necrosis factor against various primarily cultured human cancer cells

The antitumor activity of tumor necrosis factor (TNF) against various primarily cultured human cancer cells (32 cases) was investigated by the 51Cr cytotoxic release assay and the tumor stem cell assay. Over 50% sensitivity (the ratio to the cytotoxicity in L929 cells) was noted in 4 of 14 cases of gastric cancer (28.6%), 7 of 9 cases of leukemic cells (77.8%), and 1 case each of pancreatic carcinoma and ovarian cancer. Scarcely any sensitivity, however, was observed in 1 case of acute promyelocytic leukemia or in some of the gastric cancer cases. No correlation was observed between the histological type of the cancer and TNF sensitivity. The above results seem to confirm that TNF has significant antitumor activity against human cancer cells.     

Clinical pharmacology of recombinant human tumor necrosis factor in patients with advanced cancer

Twenty-six patients with advanced cancer refractory to standard therapy were treated with recombinant human tumor necrosis factor (rTNF) in a study aimed at determining the toxicity and tolerance of rTNF and at seeking evidence of antitumor activity. The study design involved two treatments per week for 4 weeks with alternating subcutaneous and intravenous (IV) administration, and weekly dose escalation through four levels in each patient. The dose range was 1 to 200 micrograms/m2 for IV bolus injection, and 5 to 250 micrograms/m2 for subcutaneous injection. Thirteen patients completed the full course. Early discontinuation of treatment was related to rTNF toxicity in seven cases. The major side effects were rigors, fever, headache, fatigue, and hypotension. Acute changes in granulocyte, lymphocyte, and monocyte counts, changes in serum zinc levels and plasma cortisol levels consistent with an acute phase response, and inflammation at the site of subcutaneous injection were also seen. At doses of 125 to 250 micrograms/m2, inflammation at the subcutaneous injection site was unacceptably severe. Minor changes were seen in hemostatic parameters. Hypotension was corrected by fluid administration and did not require treatment with vasopressors. Initial serum concentrations of rTNF were measured at five minutes after IV administration and were found to range from 2.5 ng/mL after a dose of 35 micrograms/m2 to 80 ng/mL after a dose of 200 micrograms/m2. The half-life of rTNF in the blood was 20 minutes. A decrease in lymph node size was observed in a patient with B cell lymphoma.     

Induction of synthesis of tumor necrosis factor in human and murine cell lines by exogenous recombinant human tumor necrosis factor

Treatment of sensitive human myosarcoma cells (KYM-S) with exogenous tumor necrosis factor (r-TNF) resulted in the production of TNF by the cells. The newly synthesized cellular TNF was identified immunologically on Western blots and as a single 1.8-kilobase band on Northern blots. TNF synthesis began within 2 h of administration of the exogenous TNF in a dose-dependent manner. r-TNF also induced TNF synthesis in mouse tumorigenic fibroblasts (L-M). Resistant sublines of these cells as well as TNF nonsensitive human diploid fibroblasts possessed TNF mRNA without pretreatment, indicating an inverse correlation between levels of TNF expressed and sensitivity to the cytotoxic effects of exogenous TNF. It is conceivable that the newly synthesized cellular TNF functions in some protective manner to block cytolytic effects of exogenous TNF.     

rmh-TNF协同顺铂抗小鼠Lewis肺癌血管生成的作用

目的：观察重组改构人肿瘤坏死因子（recombinant mutant human tumor necrosis factor，rmh-TNF）协同顺铂（cisplatin，又称DDP）抗小鼠Lewis肺癌血管生成的作用。方法：建立C57BL／6小鼠Lewis肺癌模型，随机分为4个治疗组：生理盐水对照组、rmh-TNF（150万U／kg）组、DDP（6．15mg／kg）组、联合用药组（DDP＋rmh—TNF）。接种肿瘤细胞后12d开始瘤内注射药物3d，RT-PCR法测定瘤组织中HIF—1α的表达，免疫组化法检测肿瘤组织血管内皮生长因子（vascular endothelial growth factor，VEGF）、激酶结构域受体（kinase domain region receptor，KDR）、微血管密度（microvascular density receptor，MVD）的表达，流式细胞术测定基质金属蛋白酶2（matrix metallopmteinase-2，MMP-2）的表达。结果：对照组、rmh-TNF组、DDP组和联合用药组小鼠肿瘤组织中的MVD数分别为（24．76&#177;1．28）、（18．95&#177;1．22）、（19．53&#177;1．15）、（10．43&#177;1．05），两单药组的MVD数明显低于对照组（P〈0．05）；联合用药组低于两单药组（P〈0．05）。HIF-1αmRNA相对表达水平分别为（0．171&#177;0．004）、（0．138&#177;0．006）、（0．134&#177;0．006）、（0．095&#177;0．006），两单药组较对照组明显下降（P〈0．05），联合用药组明显低于两单药组（P〈0．05）。肿瘤组织中MMP-2蛋白的荧光指数FI值依次为（1．000&#177;0．000）、（0．875&#177;0．020）、（0．848&#177;0．127）、（0．545&#177;0．107），单药组的MMP-2蛋白的（FI）值较对照组明显下降（P〈0．05），联合用药组明显低于两单药组（P〈0．05）。单药组VEGF、KDR表达均明显低于对照组（P〈0．05），联合用药组的表达均低于各单药组（P〈0．05）。结论：rmh—TNF能够增强DDP抗小鼠Lewis肺癌血管生成的作用。     

肿瘤坏死因子相关的凋亡诱导配体对胰腺癌细胞抗肿瘤作用的研究

Objective To investigate the antitumor effect of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)gene transfection mediated by adenovirus into human pancreatic carcinoma cell line Panc-1, and the mechanisms involved in this effect. Methods TRAIL gene was transfected into pancreatic cancer cell line Panc-1 by an adenovirus vector (Ad-TRAIL).Level of TRAIL mRNA expression was determined using RT-PCR, and TRAIL protein synthesis was evaluated with Western blot. Cell-growth activities were determined by MTT assay. The bystander effect was observed by co-culturing the Panc-1cells with the transfected TRAIL gene at different ratios. Apoptosis in pancreatic cancer cells was detected by flow cytometry.Procaspase-8 and procaspase-3 were determined by Western blot. Results The stable overexpression of TRAIL was detected in Panc-1 cells transfected by Ad-TRAIL. Ad-TRAIL significantly inhibited of cell viability of Panc-1 cells. Furthermore,co-culture of cancer cells transfected with TRAIL with that nontransfected resulted in the cell death of both cells by bystander effect. Moreover, the percentage of apoptotic cells was significantly higher in the Ad-TRAIL-treatment group compared to the control groups (P ＜ 0.01). And there was a diminished amount of procaspase-8 and procaspase-3 after infection with Ad-TRAIL. Conclusion The overexpression of TRAIL gene in Panc-1 cells by Ad-TRAIL exerts its antitumor effects, and themechanisms involved in this effect may be proapoptosis and bystander effect.     

Antitumor effect of the tumor necrosis factor against various types of human cancer cells

The antitumor activity of tumor necrosis factor (TNA) against various human cancer cells (32 cases) was investigated by 51Cr cytotoxic release assay and tumor stem cell assay. Over 50% sensitivity (the ratio of cytotoxicity for L929 cells) was shown by 4 of 14 cases of gastric cancer (28.6%), 7 of 9 cases of leukemic cells (77.8%), and 1 case each of pancreatic carcinoma and ovarian cancer. However, scarcely any sensitivity was shown by APL, a portion of the gastric cancer cells, normal lymphocytes or colony-forming cells tested. No correspondence was observed between the histological type of the cancer and TNF sensitivity. The above results seem to confirm the significant antitumor activity of TNF against human cancer cells.     

Hyperthermia enhances tumor necrosis factor alpha-induced apoptosis of a human gastric cancer cell line

We have investigated the effects of hyperthermia on the apoptosis induced by tumor necrosis factor alpha (TNF-alpha). Confluent monolayers of human gastric cancer cell line MKN45 were either treated or untreated with hyperthermia for 1 h. The cells were subsequently stimulated with TNF-alpha. A 24-h incubation with TNF-alpha did not affect cell viabilities; however, pretreatment with hyperthermia significantly enhanced the level of apoptosis induced by TNF-alpha. Pretreating MKN45 cells with hyperthermia (42.0 degrees C) significantly inhibited the TNF-alpha-induced increase in the binding activity of NF-kappaB to DNA. This study suggests that hyperthermia can inhibit the TNF-alpha-induced NF-kappaB activation and that hyperthermia renders human gastric cancer cells susceptible to the TNF-alpha-induced apoptosis, possibly via inhibition of the NF-kappaB pathway.     

Recombinant human tumor necrosis factor-alpha: thrombus formation is a cause of anti-tumor activity

In a previous study we showed that recombinant human tumor necrosis factor-alpha (rTNF-alpha) has no cytolytic effect on Meth A fibrosarcoma cells in vitro but that it has a strong anti-tumor activity in vivo. In the present work, we define the in vivo mode of action of rTNF-alpha on solid-form Meth A fibrosarcoma implanted intradermally (i.d.) in mice. rTNF-alpha exhibited strong anti-tumor activity when given intravenously (i.v.) 7 or 10 days after tumor implantation, but not when given 3 days after implantation. Light and electron microscopy showed that rTNF-alpha impaired microcirculation by producing fibrin-like substances in newly formed microcapillaries in 7-day-old tumor tissue. An anti-coagulant, dicoumarol, abrogated the effect of rTNF-alpha. Injection of carbon particles showed that the development of capillaries in 7-day-old tumors was more extensive than in 3-day-old tumors, and suggested that the anti-tumor activity of rTNF-alpha depends upon a fully developed fine network of induced capillaries in the tumor. Electron microscopy showed that rTNF-alpha increases the number of primary and secondary lysosomes in the cytoplasm of 7-day-old tumor cells. The results suggest that rTNF-alpha selectively stems the blood flow in newly formed microcapillaries, eventually leading to autolysis of the tumor cells.     

Phase I study of recombinant human tumor necrosis factor

Summary A phase I clinical and pharmacokinetic study of recombinant human tumor necrosis factor (rH-TNF) was conducted in a single dose schedule in 33 patients with advanced cancer. rH-TNF was given by i.v. infusion over 30 min with a starting dose of 1x10⁵ units/m². The dose was escalated up to 16x10⁵ units/m² according to the modified Fibonacci scheme. Toxic effects were similar but not identical to those reported with interferons and interleukin-2, and included fever, rigors, nausea and vomiting and anorexia in a non-dose-dependent manner, and hypotension, leukocytosis, thrombocytopenia and transient elevation of transaminases (SGOT and SGPT) in an approximately dose-dependent manner. DIC syndrome was observed in one patient who had received 16x10⁵ units/m². The dose-limiting toxicities were hypotension, thrombocytopenia and hepatotoxicity, and the maximum tolerated dose in a single i.v. infusion of rH-TNF appeared to be 12x10⁵ units/m² when thrombocytopenia and elevation of SGOT and SGPT were taken as the dose-limiting toxicities. However, if hypotension was included, the maximum safely tolerated dose appeared to be 5x10⁵ units/m².     

Impaired production of tumor necrosis factor in breast cancer

Spontaneous and lipopolysaccharide (LPS)-induced production of tumor necrosis factor (TNF) by peripheral blood macrophages was investigated in breast cancer. Whereas spontaneous TNF production by macrophages derived from patients with breast cancer was comparable with the one found in healthy controls (P greater than 0.1), LPS-stimulated macrophages derived from patients in the disease-free interval as well as with metastatic breast cancer were found to produce significantly lower amounts of TNF, as compared with macrophages derived from healthy control individuals (P less than 0.0005). However, the production of TNF did not significantly differ between the two patient populations (P greater than 0.05). The impairment of LPS-induced TNF production did not depend upon such characteristics of the primary tumor as size, axillary lymph node and estrogen receptor status, or upon the fact of administration of adjuvant chemotherapy and, in patients with metastatic disease, hormone treatment. To further investigate cytokine production by macrophages, spontaneous and LPS-induced interleukin-1 (IL-1) production was investigated also. However, no difference was found between patients and controls concerning IL-1 generation. The authors thus conclude that LPS-induced TNF production was impaired in breast cancer independent of the presence of detectable metastatic disease, whereas IL-1 production remained unimpaired.