原发性肝癌的免疫状态及其过继免疫治疗

1993年3月～1995年12月，20例无手术切除指征的肝癌患者接受rIL－2／LAK过继免疫治疗，其中6例（30％）获部分缓解。16例肝癌患者于治疗前后行免疫功能测定，结果显示：1）原发性肝癌病人外周T细胞亚群及NK活性是明显抑制状态（P＜0．001）；2）患者经过过继免疫治疗后，T细胞工群及NK细胞活性明显改善。上述结果表明原发性肝癌病人是明显免疫抑制状态，采用rIL－2／LAK区域过继免疫治疗有效。     

Local administration of autologous lymphokine-activated killer cells and recombinant interleukin 2 to patients with malignant brain tumors

Lymphokine-activated killer cells (LAK cells) were induced from lymphocytes from patients with malignant glioma by using interleukin 2 (IL-2), and their killing activity was examined. Their LAK activity against Daudi cells was 66.2 +/- 13.1% and 48.7 +/- 12.7% against self glioma cells, 54.4 +/- 10.1% against K562 cells, 43.1 +/- 7.9% against Raji cells, and 33.5 +/- 16.2% against allogeneic glioma cells. The phenotype of these LAK cells was Leu 1 (++), 2a (+/-), 3a (++), 7 (+), and 11 (++). The phenotype of precursor LAK cells, on the other hand, was Leu 1 (-), 2a (-), 3a (+), 7 (-), and 11 (++). Other activated killer cells, including LAK cells, phytohemagglutinin-activated killer cells, autoactivated killer cells, and their precursor LAK cells, were studied serologically in order to identify their phenotypic characteristics. From these data, the LAK cell populations were considered to be polyclonal. Using these LAK cells plus IL-2, local adoptive immunotherapy was undertaken in 23 patients with recurrent malignant glioma. We injected, that is, autologous LAK cells plus IL-2 directly into the cavities of the brain tumors; 1.2 to 324 x 10(8) LAK cells per ml and 0.8 to 5.4 x 10(3) units of IL-2 were directly injected into the brain tumor by using an Ommaya reservoir. Definite tumor regression, improvement of some clinical symptoms, and continuous remission over 6 mo or more were observed in six, nine, and three patients, respectively. There were no marked side effects, except for slight fever and chill, in eight and three patients, respectively. These results suggested the possibility of induction of a sufficient number of LAK cells from the lymphocytes of the patients with recurrent malignant glioma, indicating that local adoptive immunotherapy by direct injections of LAK cells and IL-2 into the brain tumor will prove to be an effective means of immunotherapy. Additional follow-up of the patients will be required before its therapeutic value can be established.     

Lymphokine-activated killer (LAK) cells. Analysis of factors relevant to the immunotherapy of human cancer

Lymphokine-activated killer (LAK) cells can be generated by incubating fresh peripheral blood lymphocytes (PBL) in Interleukin-2 (IL-2). LAK cells kill fresh autologous and allogeneic human tumor cells in vitro. This study analyzes aspects of LAK cells that make them a promising candidate for the adoptive immunotherapy of human cancer. LAK cells can be generated from PBL of normal individuals and tumor-bearing patients. Pure, recombinant IL-2 generates LAK cells capable of killing a wide variety of tumors including sarcomas and cancers of the colon, pancreas, adrenal gland, and esophagus. Thirty-six of 41 (88%) fresh, noncultured, human tumor cell suspensions prepared from surgical specimens were lysed by LAK cells in a standard 4-hour chromium-release assay. Normal PBL were not killed. LAK cells can be expanded in vitro for periods longer than 2 months, potentially more than 10(20)-fold, while maintaining lytic ability. These results and the demonstrated efficacy of LAK cells in the therapy of murine tumors make LAK cells a candidate for clinical use in the adoptive immunotherapy of human cancer.     

Locoregional adoptive immunotherapy using LAK cells and IL-2 against liver metastases from digestive tract cancer

We investigated the clinical efficacy of locoregional and systemic adoptive immunotherapy (AIT) with or without interleukin-2 (IL-2) against solid metastatic lesions from digestive tract cancer. Eighteen patients, who were treated with more than 10(10) lymphokine-activated killer (LAK) cells, were enrolled in this study. Seven of the 18 patients received hepatic arterial infusion (HAI) of LAK cells with or without IL-2 against metastatic liver tumors (locoregional therapy group). The remaining 11 patients received systemic transfer of LAK cells with IL-2 against metastatic lesions located in organs other than the liver (systemic therapy group). Three of 7 locoregional therapy group patients showed clinically significant tumor regressions that were evaluated as being equivalent to partial response (PR). Two of the 11 systemic therapy group patients showed significant tumor regressions, but this response rate was much lower than that of the locoregional therapy group. The 2 effective cases in the systemic therapy group were esophageal cancer patients. Locoregional AIT with or without IL-2 against liver metastases from digestive tract cancer could be an effective therapeutic modality in some patients who are refractory to conventional therapies (e.g., chemotherapy and radiotherapy). It is necessary to find a new way to augment the anti-tumor effect of this therapy in combination with prior or concomitant chemotherapy.     

Adoptive immunotherapy using lymphokine-activated killer (LAK) cells and interleukin-2 for recurrent malignant primary brain tumors

Summary Ten patients with recurrent malignant primary brain neoplasms were treated with adoptive immunotherapy using lymphokine-activated killer (LAK) cells and interleukin-2 (IL-2). Nine patients had supratentorial glioma and they received multiple intratumoral instillations of LAK cells through reservoir-catheter system or burrhole. The other patients with disseminated subarachnoid metastases from posterior fossa medulloblastoma received immunotherapy via lumbar subarachnoid route. A partial and transient clinical response was observed in two patients following the therapy, and a cystic transformation of the essentially solid tumor was noted on the CT scans of these two patients. No significant clinical or radiological response to the treatment was observed in the remaining 8 patients. The results of this preliminary study reveal limitations of the regional intratumoral adoptive immunotherapy using currently available techniques and provide sufficient evidence of its effectiveness to warrant further investigations.     

CIK细胞体内外抗肝癌细胞作用

目的：研究肝癌患者CIK（cytokine-induced killer) 细胞的体外杀伤自体肝癌原代细胞的细胞毒活性以及正常人CIK细胞在裸鼠体内的抗肿瘤作用。方法：分别分离获得肝癌患者和下人的外周血单个核细胞（PBMC）,加入细胞因子,体外诱导成CIK细胞,用流式细胞仪对细胞作动态表型分析,并与正常人的CIK细胞作对比。用^51Cr释放法,测定肝癌患者的CIK细胞体外杀伤自体肿瘤细胞的细胞毒性活性。在Balb/c裸鼠皮下接种肝癌细胞BEL－7402,观察CIK细胞对荷瘤鼠的抑瘤作用,并与LAK、PBMC细胞相对比。结果：肝癌患者的CIK细胞体外增殖力强,至培养28天时达到最大增值倍数300多,表型分析结果表明,CD^3 CD56^ 双阳性细胞得到了大量的扩增,其含量由原来的0．23％上升到第21天的17．8％。体外实验表明,肝癌患者的CIK细胞杀伤自体原代肝癌细胞的细胞毒性活性明显高于自体的PBMC细胞。裸鼠体内实验表明,肝癌患者的CIK细胞能够显著抑制肿瘤的生长,其抑瘤率可达84．7％,高于LAK细胞的52．8％及PBMC的37．1％（P＜0．05和P＜0．01）。结论：CIK细胞具有较强的体内外抗肝癌细胞活性,有可能应用于临床上肝癌的过继性免疫治疗。     

LAK cells and cancer

The effectiveness of LAK cells (lymphokine-activated killer cells) on malignant tumors in vivo and in vitro was discussed. LAK cells induced from lymphocytes by interleukin-2 (IL-2) were able to kill target malignant cells in a nonspecific manner. Combination of IL-2 enhanced LAK activity. Adoptive immunotherapy with LAK cells and IL-2 carried out in the USA has produced effective results in several cases; complete regression of skin metastases of malignant melanoma and partial regression of other malignancies. However, high doses of IL-2 mediated a toxic side effect, capillary permeability leak syndrome. Our studies have revealed that LAK cells after one to two weeks incubation do not require such a high concentration of IL-2, and that adoptive immunotherapy using such, LAK cells and IL-2 can be carried out safely.     

Interleukin-2 enhances biopterins and catecholamines production during adoptive immunotherapy for various cancers

Biopterins production during three different protocols for adoptive immunotherapy for human cancer was investigated. Adoptive immunotherapy treatment with interleukin-2 (IL-2) was carried out for 13 patients with malignant melanoma; eight with metastatic renal cell carcinoma; and three with metastatic colon cancer. The authors estimated total biopterins in plasma and lymphokine (IL-2)-activated killer cells (LAK) from these patients before and during various treatment phases to determine if increased biopterins production reflects leukocyte activation by IL-2 or antitumor activity. They noted an increased synthesis of total "biopterins," i.e., biopterin; 7,8-dehydrobiopterin; and L-neopterin in LAK cells and plasma which correlated with IL-2 exposure. Mean plasma biopterins were normal (1.2 +/- 0.5 ng/ml) before therapy; in contrast, biopterins increased significantly to 3.4 +/- 1.9 ng/ml and 3.9 +/- 1.9 ng/ml during IL-2 and IL-2 + LAK treatment each, respectively. Similar biopterin elevations were noted irrespective of the different adoptive immunotherapy protocols used. Elevated biopterins decreased to normal levels (1.2 +/- 0.7 ng/ml) when IL-2 treatment was omitted. Tumor regression with adoptive immunotherapy did not correlate with increased plasma biopterins. Increased biopterins production was also associated with increase in plasma catecholamine after IL-2 treatment during adoptive immunotherapy. Conceivably increased biopterins, induced by IL-2 activation of a leukocyte population, is a cell-mediated consequence not necessarily serving as a signal for the antitumor effect associated with adoptive immunotherapy.     

A phase II study of interleukin-2 and lymphokine-activated killer cells in patients with metastatic malignant melanoma

Thirty-six patients with metastatic melanoma were entered into a study of the therapeutic efficacy of adoptive immunotherapy with high-dose interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells. Thirty-two patients who received all components of the therapy are evaluable for response, and all patients are evaluable for toxicity. Sites of disease included lung, liver, subcutaneous nodules, and intra-abdominal metastases. One complete response (CR) and five partial responses (PRs) resulted from treatment (19% response rate). The median response duration was 5 months, with the durable CR continuing at 31+ months and one durable PR continuing for 13 months. Sites of response included lung, liver, subcutaneous nodules, and lymph nodes. Response, response duration, or site of response did not correlate with the total dose of IL-2 administered, rebound lymphocytosis, or the number of LAK cells infused. Toxicity included hypotension, fluid retention with a "capillary leak syndrome" in most patients, and transient multiorgan dysfunction that resolved promptly after the completion of therapy. Adverse cardiac events occurred in 16% of patients, with one myocardial infarction leading to a death. This study confirms the activity of the initial IL-2/LAK cell regimen in metastatic melanoma reported by Rosenberg et al, supporting the concept of adoptive immunotherapy as an important new treatment approach for this disease.     

The possible role of sorafenib as a part of the multimodal treatment for hepatocellular carcinoma

The role of sorafenib is unclear in multimodal treatment for hepatocellular carcinoma (HCC). We analyzed patients who underwent multimodal treatment including surgical operation for advanced HCC after administration of sorafenib. A 79- year-old man underwent extended right hepatectomy for Stage III huge HCC. Three years later, multiple recurrences observed in the liver, and an extrahepatic tumor was diagnosed. Peritoneal seeding was suspected, thus we decided to start a sorafenib administration. After 11 months, new intrahepatic lesions were detected, but extrahepatic tumor was unchanged. We considered the extrahepatic tumor was solitary and resectable, and new lesions in the liver were still treatable, then we attempted a surgical treatment with partial hepatectomy and ablation therapy. The tumor was successfully resected, and residual viable tumors were treated by radiofrequency ablation. The patient remains alive without recurrence at 7 months. We could perform a surgical treatment for another 2 patients with sorafenib treatment. These results suggested that there are cases of advance HCC in which multimodality treatment including surgical treatment can be achieved after sorafenib administration.     

Antimetastasis effect of lymphokine-activated killer (LAK) cells on fibrosarcoma in WKA rats

Treating WKA rats with fibrosarcoma with LAK cells, antimetastasis effect was studied. The results indicated that splenocytes incubated by IL-2 could produce lytic activity to WKA rats with fibrosarcoma in vitro. Passive infusion of LAK cells lead to a marked reduction in the number of metastatic nodules in the lung. After intravenous injection of LAK cells, cancer cells in the lung speedily disappeared. LAK cell administration for 3 times gave better result than once only (P less than 0.01). In this paper, the possibility of LAK cells used as an adoptive immunotherapy for human neoplasms is briefly discussed.     

A new approach to generating antitumor effectors for adoptive immunotherapy using human adherent lymphokine-activated killer cells

Lymphocytes from human peripheral blood incubated with interleukin-2 (IL2) develop lymphokine-activated killer (LAK) activity with the ability to kill a wide variety of tumor cells in a non-major histocompatibility complex-restricted manner. Adoptive immunotherapy with LAK cells and IL2 has been reported to lead to a regression of solid tumors in some patients with advanced malignancies. Aiming to improve the effectiveness of clinical adoptive immunotherapy, we developed a procedure for selective enrichment from human blood mononuclear cells (MNC) of IL2-activated antitumor effector cells. These cells, termed adherent LAK (A-LAK) cells because of their characteristic property of adherence to plastic, demonstrated both higher proliferative potential and greater antitumor cytotoxicity than unseparated MNC. Human A-LAK cells represented only 1 to 4% of IL2-activated MNC at 24 h but expanded from 130- to 1100-fold in 20 days. They comprised a population highly enriched in CD3-Leu19+ effector cells with antitumor activity against fresh human solid tumor cells and established cell lines. A-LAK cells retained antitumor activity for up to 14 days when cultured in the presence of IL2. They also mediated antibody-dependent cytotoxicity. Large-scale generation of A-LAK cells from the blood of patients with cancer proved feasible and should yield populations that are effective in vivo at lower doses than those required with unseparated LAK cells. This offers the potential for improving the antitumor effects, reducing the toxicity, and facilitating the administration of adoptive immunotherapy in humans. A Phase I/II clinical trial utilizing A-LAK cells and IL2 in patients with melanoma and renal cell carcinoma is now in progress.     

Local adoptive immunotherapy using lymphokine-activated killer cells and interleukin-2 against malignant pleural mesothelioma: report of two cases.

Malignant pleural mesothelioma is refractory to conventional therapy. We tried local adoptive immunotherapy using lymphokine-activated killer (LAK) cells and interleukin-2 (IL-2) to control malignant pleural effusion due to mesothelioma in two patients: Case 1 was that of a 69-year-old man, and Case 2 that of a 49-year-old woman with complicating chronic idiopathic thrombocytopenic purpura. A systemic survey revealed no sign of metastasis in either case. Intrapleural instillations of 6.7 x 10(9) autologous LAK cells in Case 1, or 11.3 x 10(9) allogeneic LAK cells in Case 2, with daily injections of IL-2 resulted in reductions of the pleural effusions in each case and in a decline in the level of hyaluronic acid in the effusion, in Case 1. The instillations of autologous and allogeneic LAK cells were well tolerated. The results suggest that local adoptive immunotherapy could be useful in the treatment of malignant effusion due to mesothelioma.     

In vivo and in vitro effect of adoptive immunotherapy of experimental murine brain tumors using lymphokine-activated killer cells

Adoptive immunotherapy for the experimental murine brain tumor was investigated by using lymphokine-activated killer (LAK) cells both in vitro and in vivo. Supernatants of 48-h culture medium of spleen cells from Wistar rats in the presence of concanavalin A were used as interleukin 2 (IL-2). LAK cells were generated by cocultivation of spleen cells from Fischer rats with IL-2 with the peak reactivity on Day 2 or 3 of culture. Lytic activity was observed against not only syngenic tumor cells but also allogenic and xenogenic tumor cells, while no lytic activity was observed against normal brain cells. The cell depletion test, dye exclusion test, and immunofluorescence method using monoclonal antibodies revealed that LAK cells partially belonged to the population of the activated T-cell group, but the precursor cells did not react with any monoclonal antibodies used. On the basis of these results in vivo study was performed. LAK cells and immune spleen cells were adoptively transferred to the rats i.v. or intratumorally (i.t.) on the seventh day after the inoculation of T9, a gliosarcoma induced by methylcholanthrene from Fischer rats, into the right basal ganglia. Then the survival rate and necrotic foci were compared between the groups treated with those cells and the control. The survival rate of the groups treated with LAK cells was significantly higher than that of the control (administered i.v.; P less than 0.01, administered i.t.; P less than 0.05). But the treatment with immune spleen cells was not effective. The incidence and area of necrotic foci in the tumors treated with LAK cells were greater than those of the others. Microautoradiography was also performed using [3H]thymidine-labeled LAK cells, which were administered i.v. to the models on the 14th day after the inoculation of T9. It was revealed that LAK cells accumulated in the lung shortly after the administration and then in the liver and spleen, especially in the white pulp. IL-2 inhibitor activity of the sera from the tumor-bearing rats was greater than that of normal rats (P less than 0.001), but it was depressed markedly by cyclophosphamide (P less than 0.01). The adoptive transfer of LAK cells may be one of the effective treatments of malignant brain tumor. The nature of IL-2 inhibitors is necessary to be clarified for more effective immunotherapy.     

Treatment of hepatocellular carcinoma utilizing lymphokine-activated killer cells and interleukin-2

This paper is a report on adoptive immunotherapy involving consecutive injections of recombinant interleukin-2 and lymphokine-activated killer (LAK) cells in the treatment of hepatocellular carcinoma. Peripheral blood lymphocytes, obtained by leukopheresis, acted as the activated killer cells with a co culture of recombinant interleukin-2 in the culture system. After 4 days, the activated killer cells were returned into the patients' bodies intra-arterially and intravenously. No complete remissions or partial remissions have resulted, although five of the seven patients showed a significant decrease in their serum -fetoprotein levels after treatment. In addition, one case showed a patent portal truncus while another indicated the appearance of central necrosis on the computerized tomograph scan. Although the period of observation was short, there were no recurrences after the combination therapy of tumor resection and LAK adoptive immunotherapy. It might be difficult to treat hepatocellular carcinoma with adoptive immunotherapy alone, but there is some possibility of conducting therapy for hepatocellular carcinoma after removing the majority of the tumor cells by surgical resection and transcatheter arterial embolization therapy. This conclusion indicates, at least theoretically, that adoptive immunotherapy will be suitable in the treatment of hepatocellular carcinoma as one of the combination therapies with the two major forms of treatment mentioned above.     

Combination of adoptive immunotherapy and chemotherapy against advanced cancer with peritoneal dissemination

In a case of advanced gastric cancer with bilateral Krukenberg's tumors and peritonitis carcinomatosa, total gastrectomy, splenectomy and bilateral oophorectomy was performed. Since progressive peritoneal dissemination was recognized, 150 mg of CDDP and 10 mg of MMC which were proved to be effective by chemosensitivity test of anticancer drugs were administered intraperitoneally. After one month, ascites increased. So LAK cells and TIL were transferred intraperitoneally 6 times. With this treatment ascitic collection remarkably decreased, the performance status improved and serum level of IAP and CA125 normalized. Thus, it is clarified that the combination of adoptive immunotherapy and chemotherapy possesses therapeutic efficacy against advanced gastric cancer with peritonitis carcinomatosa.     

Regional administration of lymphokine-activated killer cells can be superior to intravenous application.

A patient with liver metastases of human lymphocyte antigen (HLA) class II-negative malignant melanoma was treated with several cycles of adoptive immunotherapy with interleukin-2 and lymphokine-activated killer (LAK) cells. The authors evaluated the efficacy of regional transfer of LAK cells versus systemic intravenous administration. Initially, the patient was treated according to a regional treatment protocol, consisting of perfusion of the spleen with interleukin-2 and transfer of LAK cells into the portal vein; a partial remission was observed. Because of technical problems, interleukin-2 and LAK cells were administered intravenously in a second treatment cycle. This systemic treatment course resulted only in a minor mixed response of the hepatic metastases. A third treatment course was administered with the use of intravenous interleukin-2 infusion and arterial perfusion of the liver with LAK cells. The patient had separate hepatic arteries to both lobes of the liver as an anatomic variation. Because most of the tumor mass was present in the right lobe of the liver, a third of the LAK cells were injected into the right hepatic artery and the remaining cells were administered intravenously. The lesions in the right lobe of the liver regressed, but disease progression occurred in the left lobe. A fourth treatment cycle, consisting of intravenous infusion of interleukin-2 and arterial perfusion of both lobes of the liver with LAK cells, resulted in a complete response of all hepatic lesions, which has lasted 18 months to date. Because, in this patient, tumor regression was observed only in anatomic areas of the liver, which were perfused with LAK cells, it is suggested that the regional administration of LAK cells was essential for successful treatment.     

Enhancing effect of pokeweed mitogen on the proliferation and the cytotoxicity of lymphokine-activated killer cells.

In order to obtain more potent lymphokine-activated killer (LAK) cells for use in adoptive immunotherapy, pokeweed mitogen (PWM) was added to the culture medium for the initial 24-48 h of culturing. The proliferation rate of PWM-stimulated LAK cells reached about 1000-fold after 3-week culture. This rate was nearly the same as that of LAK cells stimulated by 10 ng/ml of OKT3, the mouse anti-CD3 monoclonal antibody. However, the cytotoxicity of PWM-stimulated LAK cells was significantly more potent than that of OKT3-stimulated LAK cells. Phenotypic analysis revealed that PWM-stimulated LAK cells were CD3+CD56(+)-dominant while OKT3-stimulated LAK cells were CD3+CD56(-)-dominant. About half of CD3+CD56+ PWM-stimulated LAK cells was CD8+. These results suggest that more efficient adoptive immunotherapy is possible by using high-dose PWM-stimulated LAK cells with more potent cytotoxicity. Interleukin-1 beta and tumor necrosis factor alpha were significantly increased in the culture media after 24-h incubation with 1 micrograms/ml of PWM. Secretion of interferon-gamma was not enhanced by this concentration of PWM within 24 h. Therefore, PWM is considered to activate monocytes or macrophages to produce these cytokines in advance, influencing the proliferation and the cytotoxicity of LAK cells.     

原发性肝细胞肝癌PD-L1蛋白表达及在免疫治疗中的意义

目的探讨程序性死亡配体PD-L1蛋白在原发性肝细胞癌(HCC)中的表达、病理特征及其在免疫治疗中的意义。方法采用免疫组织化学方法,对95例原发性肝细胞肝癌进行PD-L1(22C3)标记,观察肿瘤细胞的PD-L1蛋白表达情况、观察分析其病理特征。结果HCC的肿瘤细胞PD-L1检测PD-L1蛋白表达:cutoff值,TPS≥1%表达为阳性,有7例,其中T≥50%,为强阳性有2例;cutoff值,T<1%或无肿瘤细胞表达,为阴性,有86例。结论PD-L1蛋白在HCC中有一定意义数量的表达,与肿瘤分化程度无明显相关性。免疫治疗近年在HCC肿瘤研究受到了较多的关注,其中靶向PD1/PD-L1抗癌免疫疗法的一些研究结果给晚期HCC患者带来新的希望。PD-L1的检测,将可能为更多HCC患者免疫治疗带来益处,具有一定的临床意义。     

Effect of lymphokine-activated killer cell fraction on the development of human hematopoietic progenitor cells

Lymphokine-activated killer (LAK) cells from cultures of human peripheral blood mononuclear cells with recombinant interleukin-2 (rIL-2) have been clinically used in adoptive immunotherapy for cancer patients. To study their influence on human hematopoiesis, the LAK cell fraction was cocultured with marrow nonphagocytic cells from normal subjects in an assay system of hematopoietic progenitors. The fraction suppressed colony growth from relatively mature erythroid progenitors in a dose-dependent manner. Although unactivated cells, which were produced without IL-2, augmented the growth of early erythroid progenitors, the LAK cell fraction did not. This fraction suppressed colony growth from mature granulocyte-macrophage progenitors (day 7 CFU-GM) especially with an 18-h preincubation prior to coculture. It also suppressed both immature granulocyte-macrophage progenitors (day 14 CFU-GM) and multipotential hematopoietic progenitors. The suppressive effects were observed on colony growth from autologous marrow cells as well as allogeneic marrow cells. The suppression of day 7 CFU-GM colony growth by supernatants due to preincubation with marrow cells and the LAK cell fraction suggested that the humoral factor contributes to the suppression by the LAK cell fraction. These data suggest that the LAK cell fraction suppresses the development of human hematopoietic progenitor cells.