Combined positive/negative purging and transplantation of peripheral blood progenitor cell autografts in breast cancer patients: a pilot study.

This trial studied the feasibility and efficiency of a novel procedure of double purging to eliminate tumor cells from leukapheresis products of stage IV breast cancer patients. After induction and mobilization therapy, 35 leukapheresis products from 16 breast cancer patients were subjected to CD34+ enrichment (i.e., positive selection) with the Isolex 300 device and subsequent immunomagnetic depletion of tumor cells (i.e., negative selection) using a cocktail of three monoclonal antibodies directed against epithelial antigens. Patients with clinical response to induction chemotherapy proceeded to tandem high-dose chemotherapy, which consisted of melphalan (140 mg/m2) followed by retransfusion of the purged graft. After hematologic recovery, patients received ifosfamide 14 g/m2, carboplatin 1.5 g/m2, and etoposide 1.5g/m2 (ICE), again followed by autografting. After positive selection, a median purity of 96.6% CD34+ cells (range 48.4-99.2%) and a recovery of 56.8% (range 25.8-92.6%) were achieved. Subsequent negative purging resulted in a median CD34+ purity of 97.2%. Overall CD34+ recovery after both purging procedures was 51.1% (range 18.5-82.4%). Tumor cells were detectable in 8 of 16 (50%) starting fractions before purging. After both purging cycles, only 1 of 16 autografts remained positive for tumor cells compared to 3 of 16 after CD34+ selection. A calculated purging efficiency of 2 to >4 log was achieved. Engraftment was rapid, reaching > or =500/microL neutrophils on day +10 after melphalan and on day +9 after ICE. A platelet count of > or =20.000/microL was reached on day +12 after melphalan and on day +11 after ICE. Thus, combining positive and negative purging is feasible, further enhances purging efficiency, and does not compromise the quality of the graft, leading to rapid engraftment after high-dose chemotherapy.

Ex vivo breast cancer cell purging by adenovirus-mediated cytosine deaminase gene transfer and short-term incubation with 5-fluorocytosine completely prevents tumor growth after transplantation.

Peripheral blood progenitor harvests of breast cancer patients are contaminated with tumor cells, suggesting a potential role for these cells in the relapse after high-dose chemotherapy. Whereas physical purging methods do not eliminate contaminating tumor cells completely, pharmacological purging, although highly efficient, is hampered by a strong nonspecific toxicity toward hematopoietic progenitor cells. Taking advantage of the high efficiency of adenovirus-mediated gene transfer to epithelial cells, we selectively loaded breast cancer cells in vitro with a cytotoxic drug by gene transfer of the prodrug-converting enzyme cytosine deaminase (AdCMV.CD) and 5-fluorocytosine (5-FC). Despite the low dose of vector administered, limited exposure to 5-FC, and transplantation only of viable tumor cells into SCID mice, all animals that received cells treated in vitro with AdCMV.CD plus 5-FC were completely free of tumor development. These data show that the selective loading of tumor cells with AdCMV.CD/5-FC might be useful for purging of autografts.

Monitoring of tumor cell purging after highly efficient immunomagnetic selection of CD34 cells from leukapheresis products in breast cancer patients: comparison of immunocytochemical tumor cell staining and reverse transcriptase-polymerase chain reaction.

We studied the efficiency of indirect tumor cell purging via enrichment of CD34+ hematopoietic progenitor cells from leukapheresis products (LP) in breast cancer patients based on immunomagnetic selection of CD34+ cells. Detection of tumor cells was made by immunocytochemical staining. In addition, we evaluated the capacity of cytokeratin 19 (CK19)- and a novel epidermal growth factor receptor (EGF-R)-specific reverse transcriptase-polymerase chain reaction (RT-PCR) for monitoring tumor cell depletion. LP from 13 breast cancer patients were analyzed. Twenty-three CD34 selection procedures were performed. A median of 1.4 x 10(10) total nucleated cells ([TNC] range, 0.88 to 3.5 x 10(10)) with a median CD34 purity of 2.5% (range, 0.4% to 6.3%) were entered into the selection procedure. Immunomagnetic CD34 enrichment resulted in a median purity of 83.3% (range, 45% to 95.4%) and a median recovery of 73.2% (range, 22% to 95%). Retransfusion of CD34-selected cells after high-dose chemotherapy resulted in a rapid and sustained hematologic recovery, reaching an absolute neutrophil count of 500/microL at day +10 and platelet count of 20,000/microL at day +11. Tumor cell depletion was quantified by immunocytochemical detection of CK19-positive cells. By this method, a median tumor cell depletion of 1.9 log (range, 0.7 to > 3 log) could be demonstrated. Immunocytochemical detection of tumor cells was more sensitive than RT-PCR, yielding positive results in 81% of LP (17 to 21) versus 58% positive LP (10 of 17). However, EGF-R-based RT-PCR was much more sensitive than CK19-based RT-PCR (10 of 17 v 1 of 17). Despite highly efficient CD34 selection, tumor cells were still detectable after CD34 enrichment using immunocytochemistry and EGF-R-specific RT-PCR. Thus, this novel EGF-R-specific RT-PCR appears to be of value as an additional method to detect contaminating breast cancer cells within LP.

Reverse transcriptase-polymerase chain reaction (RT-PCR)-controlled immunomagnetic purging of breast cancer cells using the magnetic cell separation (MACS) system: a sensitive method for monitoring purging efficiency.

A modified reverse transcriptase-polymerase chain reaction (RT-PCR) technique was established with the aim of monitoring the tumor cell contamination in peripheral blood stem cells harvested from breast cancer patients. In an experimental approach, single cell suspensions of different breast cancer cell lines were mixed to normal peripheral blood mononuclear cells in order to 1) determine the sensitivity of tumor cell detection within PBMC and 2) compare polymerase chain reaction in its capacity of monitoring the efficiency of immunomagnetic purging using the magnetic cell separation (MACS) system to immunocytochemical staining. Several target sequences were assessed for their indicative potential and specificity allowing the detection of breast cancer cells by RT-PCR. Among the sequences evaluated, epithelial growth factor receptor (EGF-R) mRNA and Cytokeratin 19 mRNA were shown to be highly specific and sensitive markers for the detection of breast cancer cells within normal peripheral blood mononuclear cells and for the evaluation of the efficiency in immunomagnetic purging. In addition, we were able to show that the MACS is a potent and efficient tool for the selection of tumor cells from peripheral blood mononuclear cells, thus establishing its value for clinical scale immunomagnetic purging.

Generation of lymphokine-activated killer cells in long-term cultures.

The induction of lymphokine-activated killer (LAK) cells with low levels of interleukin-2 (IL-2) was studied in long-term cultures with regard to the relationship between cytotoxicity and proliferation. Proliferation of LAK cells reduced their cytolytic activity, which was restored when proliferation stagnated. In order to explain this phenomenon, a competition between receptors of intermediate and high affinity for IL-2 is suggested. Whereas the former type of receptor mediates cytotoxicity, the second one seems to be responsible exclusively for proliferation of LAK cells.

Dipeptidyl peptidase IV in human T lymphocytes. Impaired induction of interleukin 2 and gamma interferon due to specific inhibition of dipeptidyl peptidase IV.

Specific inhibitors of the membrane-bound dipeptidyl peptidase IV (DP IV) and polyclonal antibodies against this enzyme were used to investigate the relationships between DP IV activity and the production and action of T cell-derived lymphokines. Production of interleukin 2 (IL-2) and gamma interferon by mitogen plus phorbol ester-stimulated mononuclear cells from human blood was found to be reduced in the presence of N-Ala-Pro-O-(nitrobenzoyl-)-hydroxylamine, epsilon-(4'-nitro) benzoxycarbonyl-Lys-Pro, and anti-(DP IV) immunoglobulin in a dose-dependent manner. Moreover, the proliferative response of mitogen-stimulated mononuclear cells to IL-2 is impaired in the presence of DP IV inhibitors. Therefore it is suggested that the membrane peptidase DP IV is involved in the induction and activation of cytokines controlling lymphocyte proliferation.

[The induction of lymphokine-activated killer cells: increased cytotoxicity via long-term cultivation]. / Induktion von Lymphokin-aktivierten Killerzellen: Erhöhte Zytotoxizität durch Langzeitkultur.

A long-time culture regime is tested for the production of lymphokine-activated killer cells from human lymphocytes, which combines the advantage of cell expansion with an increased cytotoxicity. The concentrations of IL-2 used are relatively low.

Age-related changes of DNA winding and repair in human peripheral lymphocytes.

Superhelical density and incision capacity for UV light-induced damage have been studied in nuclear DNA of human peripheral lymphocytes as a function of donor age. With advancing age between 20 and 90 years the content of negative superhelical turns increases, whereas the ability to incise UV lesions is impaired. These data may be suggestive of an immature lymphoid cell state arising in aging.

Correlation between the phenotype and the functional capacity of activated T cells in patients with active systemic lupus erythematosus.

Activated T cells in the peripheral blood of patients with systemic lupus erythematosus (SLE) were determined using monoclonal antibodies against activation antigens. Elevated percentages of HLA-DR+ T cells were found in association with active disease. In contrast, we observed an increase in IL-2 receptor-bearing T cells in only six out of 16 patients with active disease. In vitro assays, like spontaneous proliferation, response to IL-2, production of IL-2, and immunoglobulin synthesis have shown that the different patterns of activation antigens are related to different functional stages of T-cell activation. The possible therapeutic consequences are discussed.

Simple preparative two-step purification of interleukin-2 from culture medium of lectin stimulated normal human lymphocytes.

A procedure has been developed for the rapid purification of human IL-2 using reversed-phase liquid chromatography on LiChroprep RP-8 and Separon SGX C-18. The resulting IL-2 has a specific activity of 1 X 10(7) U/mg protein and reveals in SDS-PAGE 2 molecular weight forms (approximately 14 kDa and approximately 16 kDa) under reducing and non-reducing conditions. Both forms are biologically active. In 2-dimensional electrophoresis purified IL-2 shows a complex pattern of protein spots located in the IL-2 region which may be due to differences in glycosylation.

Winding anomalies in nuclear DNA from malignant cells. I. Experimental evidence.

The superhelical properties of nuclear DNA from malignant cells of human origin (leukemic cell lines Reh and D-562, mesothelioma cell line, and peripheral blood monocytes from acute monocytic leukemia) were investigated in neutral sucrose gradients with ethidium bromide. As compared with the universal superhelical density of nuclear DNA from normal cells, the DNA released from malignant cells showed a substantially higher negative superhelix content, equivalent to an increased deficiency in right-handed DNA duplex turns. In regard to analogous results obtained from other malignant cell systems, the extremely underwound structural state of nuclear DNA appears to be a feature common to malignant cells.