Desensitization protocol using bortezomib for highly sensitized patients awaiting heart or lung transplants.

The use of bortezomib in combination with other desensitization therapies like plasmapheresis, IVIG, and rituximab has allowed the decrease of antibody levels during treatment in some patients. However, all patients described here have experienced rebound effects to the same or higher levels than the ones before therapy was started. Unfortunately, no donors became available to some of these patients when their antibodies were at lower levels. Three out of the four patients presented had adverse reactions to bortezomib which include nausea, vomiting, diarrhea, myalgias and severe neuropathy. In one patient (pre-heart transplant patient #1) we noticed that some clones were selectively more susceptible to the treatment with bortezomib than others. We will continue antibody monitoring in this patient and hopefully the possibility is there, even though the overall PRA is not reduced, that certain clones will be affected and no longer produced antibody allowing these patients a wider selection of acceptable donors.

Management of the sensitized cardiac recipient: the use of plasmapheresis and intravenous immunoglobulin.

Previously, we reported that the combination of plasmapheresis (PP) and intravenous immunoglobulin (IVIg) allow sensitized patients to undergo orthotopic heart transplantation (OHT), even across a positive crossmatch. In the current study, the effect of that combination, PP+IVIg, on survival of a larger group of such recipients is investigated. The latter group (I) consisted of 35 sensitized patients who received PP+IVIG together with standard immunosuppressive drugs. Rejection was seen in 11 patients, findings strongly suggestive of a vascular (humoral) being identified in five of those cases. Four deaths occurred, two of them in the immediate post-operative period, one after almost six months, and one after almost two yr post-OHT. Follow-up range 4.5 months to 7.8 yr post-OHT (average=1.1 yr). Patient survival was analyzed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given standard immunosuppressive drugs only (N=276) showed enhanced survival of group I (p=0.0414 by log-rank test). We conclude that the combination of PP and IVIG (i) is associated with declines in T- and B-percent-reactive antibody and in crossmatch positivity, and (ii) is very useful in the management of the sensitized cardiac patient undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch.

Detection of retroviral superantigen and products of the envelope gene from endogenous mouse mammary tumor virus in B cells from BALB/c mice.

Minor lymphocyte-stimulating antigens and other superantigens have been shown to be encoded by the 3' long terminal repeat (LTR) open reading frame (ORF) of the endogenous and exogenous mammary tumor viruses. We have previously reported the presence of an antigen(s) related to mouse mammary tumor virus (MMTV) env products in splenic B cells of BALB/c mice. By Western blots an MMTV-related molecule of 68 kDa was detected in splenic preparations of B lymphocytes, but not in T cells. Antibodies against the MMTV envelope proteins gp52 and gp36, obtained by elution after binding to nitrocellulose in the presence of purified MMTV, reacted in Western blots with a 68-kDa protein present in B cells, indicating that this molecule is related to both MMTV envelope proteins. Using antibody against the MMTV 3' LTR ORF coding sequence, 10-15% of splenic B cells reacted by immunoperoxidase staining with this reagent, while no such staining was observed in splenic T cell preparations. Furthermore, in preparations of splenic B cells, but not T cells, two bands of 68 and 33 kDa, respectively, were detected by Western blots using the anti-ORF. These results demonstrate that the superantigen protein is present in B cells of BALB/c mice in two distinct forms, i.e., as a 68-kDa molecule, possibly associated with products of the env gene, and as a 33-kDa form.

Soluble and membrane-bound TNF-alpha are involved in the cytotoxic activity of B cells from tumor-bearing mice against tumor targets.

Splenic B cells from BALB/c mice bearing mammary adenocarcinomas are capable of performing Ab-dependent cellular cytotoxicity. Effector-target conjugation after 18 h results in minimal cytoplasmic damage, whereas extensive nuclear disintegration is observed. To determine whether splenic B cells from tumor-bearing mice can effect direct cytotoxicity against tumor cells, L929 and WEHI 164 cells were used as targets. B lymphocytes from tumor-bearing mice, but not from normal animals, were capable of lysing these two types of tumor cells. However, only a low level of cytotoxicity could be detected when the nontumorigenic 3T3 cells were used as targets. To elucidate the mechanism of cytotoxicity of these killer B cells, RNase protection assays were performed using perforin, granzyme A, TNF-alpha, and lymphotoxin probes. No perforin, granzyme A, or lymphotoxin RNA could be detected in purified preparations of B cells from normal and tumor-bearing mice. B cells from normal mice did not have TNF-alpha RNA. In contrast, B cells from tumor bearers expressed TNF-alpha RNA. TNF-alpha could be detected in supernatants from both unstimulated and stimulated tumor bearers' splenic B cells, as measured by ELISA, and its lytic activity was neutralized by anti-TNF-alpha Ab. Western blots revealed the presence of TNF-alpha on the surface of the killer B cells. Paraformaldehyde-fixed B cells from tumor-bearing mice but not from normal animals were able to lyse TNF-alpha-sensitive tumor targets. This cytotoxicity was neutralized by anti-TNF-alpha Ab. These results suggest that TNF-alpha in soluble and membrane-bound forms may be involved in the mechanism of cytotoxicity exerted by B cells from tumor-bearing mice.

Role of tumor-derived cytokines on the immune system of mice bearing a mammary adenocarcinoma. II. Down-regulation of macrophage-mediated cytotoxicity by tumor-derived granulocyte-macrophage colony-stimulating factor.

Peritoneal elicited macrophages (PEM) from mammary tumor-bearing mice have a decreased capacity to become cytotoxic against syngeneic, allogeneic, and xenogeneic target cells upon in vitro stimulation with LPS, as compared with PEM of normal mice. A regulatory mechanism other than PG release is suggested because the addition of both indomethacin and LPS to macrophage cultures from tumor-bearing mice caused no changes in their cytotoxic capability. Because tumor products have been implicated in the down-regulation of immune responses, we investigated whether pretreatment with supernatants from the tumor cell line DA-3, derived from the in vivo mammary adenocarcinoma D1-DMBA-3, affects the cytolytic capacity of macrophages. This treatment inhibits, in a dose-dependent fashion, the ability of stimulated normal PEM to kill target cells. Partial purification of DA-3 cell line supernatant showed that most of the inhibitory activity was exerted by factors with a molecular mass greater than 10 kDa and less than 30 kDa. However, slight inhibition could also be observed with fractions containing molecules less than 10 kDa. The data suggest that more than one factor released by the mammary tumor cells may be involved in the down-regulation of macrophage-mediated cytotoxicity. Because the DA-3 cells constitutively produce granulocyte-macrophage CSF (GM-CSF), which has a molecular mass of 27 kDa, we pretreated PEM from normal mice in vitro with rGM-CSF for 24 h. This resulted in a dose-dependent decrease in their capacity to kill tumor target cells upon LPS stimulation. Furthermore, PEM from normal mice injected with rGM-CSF for 25 days displayed a profound decrease in their cytolytic ability against DA-3 targets upon in vitro stimulation with increasing amounts of LPS. The pretreatment of PEM from normal mice with a combination of DA-3 cell supernatants and specific anti-GM-CSF partially neutralized the inhibitory effect of the DA-3 supernatant on macrophage tumoricidal capability. These results indicate that tumor-derived GM-CSF is an important factor involved in the decreased macrophage cytotoxicity during mammary adenocarcinoma progression.

Friend leukemia complex infection of mice as an experimental model for AIDS studies.

It is now clear that AIDS results from a complex pathogenesis where virus-induced cytopathology represents only one of the contributing factors, while the others remain elusive. For this and other reasons there is much interest in the mechanisms whereby other classically immunodepressive noncytocidal retroviruses, such as viruses of the murine Friend leukemia complex (FLC), affect the immune system. FLC-induced immunosuppression has already provided important leads to the understanding of the mechanisms whereby retroviruses immunosuppress their hosts. It is expected that further investigation of the model will prove useful in several areas of AIDS research, including the development of efficacious drug therapies.

Interleukins 1 and 2 production and responsiveness in the early stages of retroviral infections of mice.

Infection of BALB/c mice with the Friend leukemia complex (FLC) or its helper F-MuLV produced no major changes of IL 1 production and responsiveness but caused profound derangements of IL 2 homeostasis. IL 2 production by spleen cells was severely decreased from the early stages postinfection (pi). By Day 8 the effects of the two viral preparations were similar. Reminiscent of the kinetics of immunosuppression produced by the two viruses, subsequently the effects diverged: in the case of FLC, IL 2 accumulation became progressively lower, while F-MuLV-infected spleen cells produced approximately half the normal levels of IL 2 irrespective of time pi. At Day 8 pi unstimulated spleen cells absorbed enhanced amounts of IL 2, but failed to proliferate in response to it. Unfractionated and adherent spleen cells from infected mice (but not cell-free virus or culture fluids) inhibited the proliferative response of CTLL-2 cells to IL 2, suggesting a "suppressor" function for infected macrophages. Exogenous IL 2 failed to bring in vitro antigen or mitogen responsiveness of infected spleen cells to the levels seen with control cells and did not affect FLC-induced leukemogenesis in vivo.

Altered interleukin production during Friend leukemia virus infection.

Spleen cells from BALB/c mice, infected 14 to 28 days earlier with Friend leukemia virus (FLV), were shown to be inhibited in their ability to produce interleukin 2 (IL-2) when stimulated with mitogen. Likewise, these spleen cell populations failed to respond following mitogenic stimulation or exogenous addition of recombinant IL-2. By contrast, the FLV-infected spleen cell populations produced normal levels of interleukin 1 (IL-1) and thymocytes from FLV-infected mice responded normally to addition of exogenous IL-1. This suggests that FLV infection selectively affects the ability of spleen cells to produce cytokines. Spleen cell populations enriched for T lymphocytes and depleted of tumor cells by density gradient centrifugation in Ficoll were unable to produce IL-2. This indicates that the failure to detect IL-2 in cells from FLV-infected mice was not due to a dilution of T lymphocytes by tumor cells but was a functional inability to produce IL-2. Furthermore, enriched T lymphocytes from FLV-infected mice failed to respond blastogenically to exogenous IL-2. Additional studies indicate that tumor cells, but not macrophages or T lymphocytes from FLV-infected spleens, suppressed the blastogenic response to mitogens and IL-2 production by normal splenic T lymphocytes.

Tetrahydrocannabinol-induced suppression of macrophage spreading and phagocytic activity in vitro.

The effects of tetrahydrocannabinol (THC) on several parameters of macrophage function in vitro were assessed. Delta 9 THC added to cultures of normal mouse peritoneal cells in vitro affected the ability of the cells to spread on glass surfaces and also had some effect on their ability to phagocytize yeast. These effects were dose related. A concentration of 20 micrograms of THC almost completely inhibited macrophage spreading, but it also decreased viability and the total number of these cells. Doses of 10 or 5 micrograms of THC also inhibited spreading but had little effect on cell viability or number. A dose of 1.0 microgram of THC had some inhibitory effect on spreading and the lowest dose affecting spreading appeared to be about 0.05 micrograms per culture. Higher doses of THC were necessary to inhibit phagocytosis of yeast particles as determined by direct microscopic examination or use of radiolabeled yeast as the test particles. These results indicate that several readily measured functions of macrophages may be suppressed by THC.