The Relationship of Kynurenine and Neopterin Levels and Their Association with a Selection of Other Immune Markers in Chronic Myeloid Leukaemia Patients.

Among malignant diseases, chronic myeloid leukaemia (CML) is one of the best suited candidates for immunotherapy. For this purpose it is necessary to broaden the present knowledge on the immunology of this disease. As a part of such a project, the levels of kynurenine (KYN) and neopterin (NPT) were studied in 28 CML patients and in the same number of healthy subjects. At diagnosis, both KYN and NPT levels were found to be elevated in a significant portion of the patients and dependent on their leukocyte count. As in the case of KYN, increased NPT levels dropped after achieving remission. When correlating KYN and NPT levels with a selection of other markers tested, significant association was revealed only in the case of CRP and IL-6. However, there were several patients with increased KYN levels in whom NPT was not detected, and vice versa. The relapse of the disease observed in two patients was accompanied by an increased level of NPT in both cases, but by an increased level of KYN in only one of them. No significant correlation was found between KYN and NPT levels in sera taken at diagnosis. However, when the whole set of sera was taken into consideration, the association became statistically significant. Although the data obtained revealed a number of similarities between KYN and NPT production in CML patients, it also suggested a difference in the kinetics of these two biomarkers' production.

[Will vaccines appear on the scene of oncology in the near future?]. / Dockáme se protinádorových vakcín?

In parallel with the increasing knowledge of the role played by the immune system in the control oftumourgrowth, the efforts to develop anti-cancer vaccines intensify. In the present time two highly efficient prophylactic vaccines against the virus-induced cancers are in use, but a rapid progress in the development of anti-cancer therapeutic vaccines can also be seen. It is conditioned by an increasing understanding of the biology of the tumor cells and the rapid progress in the field of immunology. Nevertheless, these developments are associated with a number of difficulties, among which the immunosuppressive activities of the tumor cells and the tumor microenvironment are the most important. On the example of chronic myeloid leukemia the author proposes a strategy for the development ofa therapeutic cancer vaccine.

In vitro and in vivo effects of reovirus on HPV16-transformed mice cells.

UNLABELLED: Oncolytic viruses are examined to serve as anticancer therapeutics. It is expected that in addition to direct oncolytic effect their action will also help eliciting a solid antitumor immunity. In presented series of experiments we have employed two HPV16-transformed mouse (strain C57/B6) cell lines, TC-1 and MK16/III/ABC (MK16), and reovirus type 3, strain Dearing (RV). Both cell lines are highly susceptible to RV and produce large amounts of infectious virus in vitro while normal human are not susceptible to RV. Still, some differences were encountered. TC-1 cells produced moderately lesser amounts of infectious virus, but, paradoxically, were more efficient producers of delta1 antigen of RV and as a consequence of virus infection died more rapidly than simultaneously infected MK16 cells. Minor differences between the cell lines were observed in the percentage of cells arrested in theG2/M phase of the cell cycle and in some markers of apoptosis. When inoculating high doses (5x106) of infected cells (MOI 10 PFU/cell) into syngeneic animals their oncogenic activity was strongly suppressed, nearly completely in the case of MK16 cells and somewhat less efficiently in the case of more oncogenic TC-1 cells. Immunizing experiments in which non-oncogenic doses (106) of RV infected TC-1 cells were tested in parallel with the same doses of irradiated cells brought surprising results. When immunized animals were challenged with TC-1 cells, the irradiated cells proved to be a much better immunogen that the infected cells. However, when challenged with MK16 cells the opposite was true. It is believed that this difference was associated with the different biological properties of the cell lines tested. KEYWORDS: reovirus type 3, HPV16-transformed mouse cell lines, apoptosis, cell cycle, immunization/challenge experiments.

Isolation and properties of gene-modified mouse bcr-abl-transformed cells expressing various immunostimulatory factors.

UNLABELLED: B210 cells are murine (BALB/c) cells transformed by bcr-abl fusion gene. After intravenous administration they are capable of inducing leukaemia-like disease in syngeneic mice. From these cells a thymidine-kinase less subline was derived. It was significantly less pathogenic than the parental cells. However, a highly pathogenic clone denoted B210cTK-/cl-2 was isolated from its population. As determined by Western blotting, these cells produced more p210 protein than the parental B210 cells. To successfully transfect these cells a modified electroporation method was introduced. Bicistronic plasmids carrying gene for herpes simplex thymidine kinase (HSV TK) and the gene for either granulocyte-monocyte colony stimulation factor (GM-CSF), interleukin-2 (IL-2) or interleukin 12 (IL-12) were used for the transfection experiments. Gradually, cell lines producing these cytokines were isolated in media supplemented with hypoxantin, aminopterin and thymidine (HAT). All of them were highly sensitive to ganciclovir in vitro confirming that the cells produced HSV TK. The genetic modification of B210cTK-/cl-2 was associated neither with the alteration of p210 bcr-abl production nor with any changes in expression of MHC class I molecules. From populations of each of the three lines several cell clones were isolated and tested for the production of the respective cytokines. The original uncloned population and several clones differing in the cytokine production were administered intravenously into mice. All animals survived without symptoms of the disease suggesting that the gene-modification was associated with the loss of pathogenicity. KEYWORDS: CML, Bcr-Abl, HSV TK, cytokines, gene-modified tumour cells, pathogenicity.

Immunological profiles of patients with chronic myeloid leukaemia. I. State before the start of treatment.

In view of the increasing interest in the immunotherapy of CML it seems highly desirable to broaden the present knowledge on the immune reactivity of CML patients. A group of 24 patients and 24 healthy controls were studied for the total of 15 immunological parameters, including the prevalence of antibodies against human herpesviruses and papillomaviruses. To clearly discriminate between changes associated with the disease and those induced by the therapy, all patients were enrolled prior to the start of any anti-leukaemic therapy. Statistically significant differences between patients and controls were found in the levels of IgA, C4 component of complement, CRP and IL-6, the production of Th1 cytokines in stimulated CD3 cells and the E. coli stimulatory index. The analysis of the interrelationship between the results obtained in the individual patients presented some unexpected findings, such as the lack of correlation between the CRP and IL-6 levels. It will be the purpose of a follow-up to determine whether and how the immune status of the patients prior to the treatment correlates with their response to therapy and how the individual immunological profiles change in the course of the disease. These observations will be utilized in the future immunotherapeutic studies to constitute the vaccine- and placebo-treated groups.

[Cervical cancer uteri: from the etiology to prophylactic vaccine]. / Karcinom delozního cípku: od poznání etiologie k profylaktické vakcíne.

The authors briefly summarize the history of the research on the cervical cancer (CC) which has resulted in the recognition of human papillomaviruses (HPV) as the key etiological factors in CC. They describe the HPV properties and the process leading to the development of prophylactic vaccines directed against HPV genotypes most frequently responsible for the development of CC. They summarize the results of the recent studies with these vaccines and strongly recommend their introduction. At the same time they stress that the vaccination programs must not disturb the present system of preventive gynecological check-ups. These will remain the most efficient weapon in the war against CC for at least two decades.

Characteristics of two mouse bcr-abl-transformed cell lines. II. Pathological lesions induced in mice.

Groups of six BALB/c mice each were intravenously inoculated with lethal doses of Ba-P210 (B210) or 12B1 cells and examined by autopsy, histology, special staining methods, enzyme histochemistry and immunohistochemistry. Clinical symptoms related to neoplasia consisted of a poor nutritional state, anaemia, mild to moderate dehydration and apathy. Paresis was apparent in three mice inoculated with 12B1 cells. Necropsy revealed splenomegaly in all animals. Sporadic haemorrhages in the lungs and enlargement of some lymph nodes were seen in some of the animals. Histological examination showed neoplastic cells in the spleen, in the bone marrow of the sternum, in the lung interstitium and in sinusoids of the liver in all mice. In six of nine brains examined, mild to moderate infiltration by neoplastic cells was observed. In all but two mice mild infiltration of the kidneys was found. The enlargement of lymph nodes was caused by an accumulation of neoplastic cells. The paresis was due to neoplastic infiltration of the vertebra, epidural space and spinal roots. Staining with Sudan black revealed cytoplasmic granules in neoplastic cells; however, the peroxidase reaction was negative. Numerous neoplastic cells disseminated in the red pulp of the spleen were reactive with CD3, CD79beta, CD11b and with neutrophil antibodies. We classified the disease induced by both of the cell lines as acute myeloid undifferentiated leukaemia (AML MO).

Use of polyclonal rabbit antibodies for detection of the bcr-abl fusion zone in cells transfected with experimental bcr-abl DNA vaccines.

Rabbits were immunized with peptides covering the fusion zone of the chimeric bcr-abl protein in order to prepare antibodies capable of detecting the expression of a selected portion of this fusion zone, by a variety of experimental genetic vaccines. Three peptides of different size covering the b3a2 fusion zone, either unmodified or modified by the omission of alanine at the N-terminal of the a2 section of the fusion zone, and one peptide covering the unmodified b2a2 fusion zone were used. All were capable of eliciting antibodies reactive with the respective immunizing peptides. Their cross-reactivities, especially the results of cross-absorption experiments, strongly suggested that the serum of the rabbit immunized with an octadekapeptide mimicking the b3a2 fusion zone contained antibodies against a novel antigenic determinant created by the chimeric protein, and also against an epitope present in the adjacent a2 section but no antibody reactive with the adjacent b3 region. In Western blotting, these antibodies were capable of detecting the p210bcr-abl or a portion of it (a 25 amino acid-long sequence covering the b3a2 fusion zone) in lysates of 293T cells transfected with plasmids that carried either the full cDNA of the bcr-abl gene or a fragment thereof fused with either the HSP70 gene or certain other genes.

[Promise of immunotherapy of the chronic myeloid leukaemia]. / Moznosti imunoterapie chronické myeloidní leukémie.

Because of the presence of unique antigens, chronic myeloid leukaemia (CML) represents an appealing target for immunotherapy. The progress achieved in the fields of gene therapy, tumour immunology and vaccinology offers a wide spectrum of methods that could be utilized for the development of therapeutic vaccines against CML. Experience obtained in several clinical studies with peptide-based vaccines have made it clear that it is possible to induce specific immune reactivity; however, its clinical efficacy has been low if any. Studies in mouse systems, which are under way, should be helpful in defining the optimal strategy for immunizing human subjects against bcr-abl positive cells. The author adduces some advantages, but also the limitations, of animal models for this purpose. He also comments on the possibility that the bcr-abl-based therapeutic vaccines might be found ineffective and proposes procedures how to deal with the problem.

Characteristic of two mouse bcr-abl-transformed cell lines: I. General properties of the cells.

In an effort to develop an experimental system suitable for immunological studies in which Bcr-Abl-positive cells are to be used as antigens, we examined the properties of two mouse (Balb/c) established cell lines that express the Bcr-Abl protein and are oncogenic for syngeneic animals. Under standard conditions the two cell lines, viz. Ba-p210 (B210) and 12B1, expressed comparable amounts of the Bcr-Abl protein. However, they differed in a number of characteristics. From the morphological point of view, B210 cells were the more homogeneous, being mainly represented by leukaemic blastic cells with a large number of AgNORs as markers indicating a high proliferative activity. 12B1 cells were more polymorphic and giant cells were detected within their populations. Many 12B1 cells exhibited nuclear segmentation and "band-like" structures. Markers of proliferation were less frequent in 12B1 and the tendency for aging was more pronounced in these cells. The 12B1 cells were slightly more sensitive to imatinib mesylate than B210 cells. In B210 cells, the expression of MHC class I was downregulated, which was not the case with 12B1 cells. Both cell lines induced leukaemia-like disease in mice after intravenous application but, as compared with B210, 12B1 cells were about 100 times more oncogenic and the disease they induced was more aggressive. Moreover, 12B1, but not B210, induced tumours after subcutaneous or intraperitoneal inoculation.

[Problems of causality in medicine: The case of viruses and tumors--Part 2. Viruses and human malignant tumors]. / K problému kauzality v medicíne. Prípad viru a nádoru--Cást 2. Viry a lidské zhoubné nádory.

A special case in contemporary etiological studies is definition of the role of viruses in the pathogenesis of human cancer. Virus-associated cancer develops only in a small minority of infected subjects, which implies that, if the virus does play a role in the pathogenesis of the malignancy, other factors must be also involved. The author summarises the general properties of human tumour viruses, reviews the development of causal thinking in microbiology and proposes guidelines that might help to determine the role of viruses in human cancer.

[To the problems of causality in medicine: the case of viruses and tumors--I. General principles of causal studies in medicine]. / K problému kauzality v medicíne. Prípad viru a nádoru--cást 1. Obecné zásady kauzálních studií v medicíne.

Clarification of the aetiology of chronic human diseases such as atherosclerosis or cancer is one of the dominant topics in the contemporary medical research. It is believed that identification of the causal factors will enable more efficient prevention and diagnosis of these diseases and, in some instances, also permit more effective therapy. The task is difficult because of the multistep and multifactorial origin of these diseases. In this paper the author attempts to review the present methodological approaches to aetiological studies of chronic diseases and discusses the role of criteria for identifying causal relationships.

Immunogenicity of dendritic cell-based HPV16 E6/E7 peptide vaccines: CTL activation and protective effects.

We have investigated the capacity of cellular vaccines based on dendritic cells loaded with human HPV16 E6/E7 oncoprotein-derived peptides to induce immune responses in vitro and to elicit protective immunity in a murine experimental model mimicking human HPV16-associated carcinomas. Dendritic cells loaded with the HPV16 E6/E7 peptides exhibiting CTL or Th epitopes (E6(41-50), E6(81-90), E6(98-107), E6(130-137), E7(49-57), and E7(44-62)) were able to stimulate in vitro DNA synthesis in syngeneic H-2b spleen cells. The priming capacity of peptide-loaded BMDC and peptide-loaded dendritic cell lines DC2.4 and JAWS II was compared. It has been found that both peptide-loaded BMDC and established dendritic cell lines can activate the syngeneic responder cells, but the priming capacity of BMDC was substantially higher. In the second set of experiments, we have examined the cytolytic activity of syngeneic spleen cells after repeated activation in vitro with BMDC loaded with HPV16 synthetic peptides containing CTL epitopes. Significant cytotoxic responses against HPV16 E6/E7 antigen-expressing TC-1 targets have been found after repeated in vitro activation with all peptides containing the CTL epitopes. In contrast, peptide E7(44-62) harbouring both Th and CTL epitopes induced significant cytotoxic responses already after single in vitro activation. This cytotoxic effect could be enhanced with admixture of the E7(49-57) peptide. Experiments with MHC class I proficient (TC-1, MK16-IFNgamma) and deficient (MK16) target cells revealed that the dendritic cells loaded with the E6/E7 HPV16 peptides activated CTLs in vitro, but not the other cytolytic effector mechanisms. The effectiveness of the peptide-loaded BMDC-based cellular vaccines was also investigated in vivo. C57BL/6 (H-2b) mice were immunized with various peptide-loaded BMDC and subsequently challenged with TC-1 cells. The strongest protective effect was achieved with the BMDC loaded with the peptide E7(44-62) harbouring both CTL and Th epitopes. Mice immunized with the E7(44-62) peptide remained tumour-free after s.c. transplantation of the TC-1 cells and exhibited long-lasting protective immunity, whereas the mice immunized with E6(81-90) and E7(49-57) peptides did not remain tumour-free and exhibited only partial inhibition of tumour growth detectable as depression of the tumour growth curves.

[Gene therapy in the Czech Republic]. / Genová terapie v Ceské republice.

Gene therapy represents one of the most promising applications of molecular biology and genetic engineering in medicine. At present its introduction meets series of problems which are of technical, methodological and ethical nature. Although the research in the field of gene therapy in the Czech Republic is on a good level, there is little hope that its achievements will be tested in clinical trials in the near future. In the Czech Republic a law enabling the use of preparations based on the newest biotechnologies in human medicine is missing. Similarly, a production unit capable of preparing the new gene-based drugs according to the Good Manufactory Praxis is not available and the State Institute for Control of Drugs has not any working group fully qualified for their control. The paper proposes actions aimed at solving the present unfavourable situation. The fact that the interest of clinicians in gene therapy is rapidly growing, and that there are signs of increasing interest of public in its achievements, gives good prospects for the introduction of gene therapy into medical praxis in this country in the not very distant future.

[Gene therapy of the graft versus host reaction]. / Genová terapie reakce stepu proti hostiteli.

Graft-versus-host-disease (GVHD) is a frequent and dangerous complication of allogenic transplantations of bone marrow. Gene therapy offers a way to deal with the problem. It is based on the introduction of suicide genes (SG) into the donor's T lymphocytes, which are responsible for the development of GVHD. If it develops, the presence of SG in the effector cells gives an opportunity to get rid of them, because their products are capable of changing otherwise innocuous substances into highly cytotoxic metabolites. For the transduction of SG retrovirus-based vectors are used. The authors tried to employ for this purpose recombinant adeno-associated viruses (rAAV). The attempt was unsuccessful. When using rAAV as vectors, the efficacy of transduction was very low. Further experiments indicated that this failure was due to the absence of receptor for AAV in T lymphocytes. It seems clear that until the surface of rAAV is modified to facilitate their penetration into T cells, they cannot replace retroviruses for transfer of SG into this cell type.

Prospective study on cervical neoplasia: presence of HPV DNA in cytological smears precedes the development of cervical neoplastic lesions.

OBJECTIVES: The principal aim of the study was to verify whether HPV infection in healthy women, as determined by HPV DNA detection, was associated with an increased risk of development of cervical lesions. METHODS: Cervical smears collected at enrolment into the prospective study conducted in Prague during 1975-83 were tested for the presence of HPV DNA by means of a polymerase chain reaction (PCR) using the general GP5/6 primers and a mixture of primers specific for the E6 gene. 120 smears from patients in whom cervical neoplasia had been detected in the course of the prospective study and 208 smears from control women who had remained healthy throughout the observation period were analysed. Patients and controls were matched by age, number of sexual partners, age at first intercourse, and smoking habit. Patients were divided into three groups, A, B, and C, according to their cytological, colposcopic, and histological findings at enrolment. Group A consisted of 67 women found ill at enrolment, group B of 26 women with slightly suspicious findings, while group C comprised 27 women with normal findings at enrolment. In addition, sera taken at enrolment from these patients and controls were tested for the presence of antibodies reactive with virus-like particles (VLPs) of HPV 16, 18, and 33. RESULTS: For the whole cohort, there was a statistically highly significant difference in the presence of HPV DNA between patients and controls. Furthermore, the difference in the presence of HPV DNA between patients and controls was highly significant not only in those who had been found ill at enrolment (group A) but, most importantly, also in women who had developed the disease in the course of the follow up (groups B and C). Women positive for HPV DNA possessed HPV antibodies to VLP16, 18 and 33 significantly more often than those who were free of HPV DNA. CONCLUSION: This indicated that healthy women who were positive for HPV DNA at enrolment were at an increased risk of developing cervical neoplasia (OR = 18.5; CI 5.9 to 57.6).

Prophylactic, therapeutic and anti-metastatic effects of BMDC and DC lines in mice carrying HPV 16-associated tumours.

Oncogenic, moderately immunogenic MK16/1/IIIABC (MK16) cells were previously established by co-transfection of HPV 16 E6/E7 and activated H-ras oncogene DNA into C57BL/6 kidney cells. Subcutaneous transplantation of the MK16 cells produced progressively growing neoplasms which metastasized spontaneously to lungs. In this communication we report that prophylactic administration of bone marrow-derived dendritic cells (BMDC) as well as dendritic cell (DC) lines DC2.4 and JAWS II at the site of subsequent MK16 tumour transplants inhibited tumour growth and reduced the number of lung metastases. Similarly, in therapeutic experiments, administration of BMDC and DC lines at the site of the growing MK16 tumours or at the site of MK16 tumour residua after surgery inhibited tumour growth. Both BMDC-based vaccines and vaccines based on DC lines had also an antimetastatic effect. These results indicate that the DC line-based vaccines, which represent a standard, well-characterized and more homogeneous material, technically easier to prepare than the fresh BMDC-based vaccines, can be utilized for therapy of surgical minimal residual disease in HPV 16-associated neoplasms and are prospective for relevant clinical trials.

Local IFN-gamma therapy of HPV16-associated tumours.

We have examined whether peritumoral administration of IFN-gamma can inhibit growth of HPV16-associated, MHC class I- tumour MK16/1/IIIABC (MK16) transplanted in syngeneic mice. It has been found that peritumoral administration of recombinant IFN-gamma performed on days 0-11 after tumour challenge inhibited growth of MK16 s.c. tumour transplants. If the therapy with IFN-gamma was started when the tumours had already reached a palpable size, the IFN-gamma administration was without any effect. To investigate the antitumour effects of IFN-gamma in a clinically more relevant setting, surgical minimal residual tumour disease was utilized. Subcutaneously growing MK16 carcinomas, 8-12 mm in diameter, were removed and the operated mice were injected with IFN-gamma on days 3-14 after the operation at the site of surgery. Treatment with IFN-gamma resulted in a moderate, reproducible, but statistically insignificant inhibition of tumour recurrences. In the next experiments we have addressed the question whether the tumour-inhibitory effect of IFN-gamma was due to the upregulation of MHC class I molecule expression on MK16 tumour cells. IFN-gamma-treated and control mice were sacrificed, their tumours were explanted, and the expression of MHC class I molecules on the MK16 tumour cells was examined. As presumed, the MHC class I expression on the cells of IFN-gamma-treated tumours, as well as on their lung metastases, was upregulated. However, an unexpected moderate upregulation of the MHC class I expression was also observed on MK16 tumours from the control, exogenous IFN-gamma-uninjected mice. Cytofluorometric analysis of the in vivo transplanted MK16 tumours from both groups has excluded that the increased percentage of the MHC class I molecules on the tumour cell populations could be due to the infiltration of the tumours with MHC class I+ leukocytes, since no expression of MHC class II, CD11b, CD80/CD86, and CD11c molecules in the MK16 cell population was observed.

Adjuvant cytokine treatment of minimal residual disease after surgical therapy in mice carrying HPV16-associated tumours: cytolytic activity of spleen cells from tumour regressors.

It has been found previously that IL-2, IFNgamma and GM-CSF were capable of reducing the recurrence rate of HPV 16-associated tumours in mice with SMRTD. We were interested whether the therapeutic effect of the surgery and adjuvant cytokine treatment was accompanied by cytolytic activity of spleen cells and whether the activity of the spleen cells was different in mice that had rejected tumour residua after surgery and adjuvant therapy with cytokines (tumour regressors) as compared to those that had not rejected the tumour residua (tumour progressors). We have examined the cytolytic activity of spleen cells from MHC class I+ TC-1 tumour regressors and progressors after treatment of TC-1 SMRTD with GM-CSF, and the activity of spleen cells from MHC class I- MK16 tumour regressors and progressors after treatment of MK16 SMRTD with IL-2 and IFNgamma. It has been found that irrespective of the tumour type and adjuvant treatment, the spleen cells from tumour regressors after surgery were regularly more cytolytic when allowed to react with target cells from HPV 16-associated tumours than the spleen cells from tumour progressors. No substantial differences between the cytolytic activity of spleen cells from the operated-only and operated plus cytokine (GM-CSF, IL-2, IFNgamma) adjuvant treated groups were observed. The cytolytic activity of spleen cells from mice with SMRTD allowed to react with MHC class I+ , MHC class I-, NK-sensitive and NK-resistant targets is compatible with the interpretation that in the mice with MHC class I+ TC-1 tumours, primarily cytotoxic T lymphocytes (CTL) were efficient, whereas in the mice with MHC class I- MK16 tumours, both NK and non-lymphocytic effector cells were involved.

MHC class I+ and class I- HPV16-associated tumours expressing the E7 oncoprotein do not cross-react in immunization/challenge experiments.

It has been demonstrated repeatedly that a high proportion of tumours derived from MHC class I+ precursors are MHC class I-. Since a major task in immunotherapy strategies for treatment of malignancies is to develop polyvalent tumour vaccines efficient against a broad spectrum of tumours, we have examined whether MHC class I+ cell-based tumour vaccines can cross-protect against homologous MHC class I- tumour challenge and vice versa. For these purposes, we have used two oncogenic cell lines induced independently by co-transfection of murine H-2b cells with E61E7 HPV16 and activated Ha-ras oncogenes, the tumours TC-1 (MHC class I+, HPV16 E7+) and E7+). Surprisingly, it was found that these two tumours do not cross-react, although both of them contain the crucial HPV16-coded tumour rejection antigen E7. Preimmunization with the MHC class I+ tumour did not protect against a subsequent challenge with the MHC class I- tumour and vice versa; however, immunization with the TC-1 tumour could protect syngeneic mice against the TC-1 tumour challenge and, similarly, immunization with the MK16/1/IIIABC tumour could protect mice against the MK16/1/IIIABC tumour challenge. If this finding can also be confirmed as a more general phenomenon with other MHC class I+ and class 1- tumours, it could have serious implications for design of immunotherapeutic vaccines and protocols.