Allogeneic gene-modified tumour cells in metastatic kidney cancer. Report II.

In a limited study, comprising only ten patients, we have previously reported that allogeneic irradiated RCC-cell-line cells, engineered to produce IL-2 (ACHN-IL-2), admixed with autologous metastatic formalin-treated tumour cells were used to vaccinate MRCC patients in progression of disease and also receiving IL-2 immunotherapy. The cells, admixed to autologous TC, were administered subcutaneously. We now report an extended study on thirty patients and one hundred thirty-one controls. Patients received 4-20 injections (mean 10 +/- 4), containing an average of 92 x 10(6) +/- 45 x 10(6) ACHN-IL-2 transfected cells (a minimum of 25 x 10(6), and a maximum of 200 x 10(6)). Autologous TC, admixed to allogeneic, were also administered by 4-16 s.c. injections (mean 7 +/- 3), i.e. a total of 12 x 10(6)-160 x 10(6) cells. Vaccination was administered during 73-1451 (307 +/- 316) days, and the follow-up continued for 1122 +/- 1240 days (106-5137). Throughout this period, the patients continued receiving the previously set immunotherapy treatment. No adverse side effects related to the treatment were noticed. One complete and four partial tumour responses were observed, as well as nine cases of stable disease. Thirteen patients died in the treated group (43%) and 63 (44%) in the control group. Responding patients resumed progression in 4-11 months and died 18 and 36 months after beginning the vaccine therapy. The Gehan Wilcoxon's test showed a significantly (P < 0.01) better survival in the vaccinated patients compared to that of the controls. Thus, we confirm, in an increased number of patients and an extensive follow-up, that our vaccination protocol is safe, devoid of adverse side effects, and promising.

Allogeneic gene-modified tumour cells in metastatic kidney cancer. Preliminary report.

An allogeneic irradiated RCC cell line, engineered to produce IL-2 (ACHN-IL-2), admixed with autologous metastatic formalin-treated tumour cells, was used to vaccinate ten MRCC patients in progression of disease in spite of IL-2 immunotherapy. The cells were administered subcutaneously and/or intra-tumourally. Sixty-four MRCC patients in progressive disease, not treated by vaccination but receiving similar IL-2 immunotherapy, were considered as the control group. Patients received 4-16 injections (mean 9 +/- 4), containing an average of 10.6 x 10(7) +/- 7.7 x 10(7) ACHN-IL-2-transfected cells (a minimum of 4 x 10(7), and a maximum of 31 x 10(7)). Four patients also received intra-tumour injections. Vaccination was administered during 30-418 days, and the follow-up continued for 649 +/- 353 days (190-1342). Throughout this period, the patients continued receiving the previously set immunotherapy treatment. No adverse side effects related to the treatment were observed. One complete and one partial tumour response were observed, as well as two stable and one no-relapse disease. All but one patient died. Responding patients resumed progression in 4-11 months and died 18 and 36 months after beginning the vaccine therapy. In spite of the small number of treated patients, Wilcoxon's test showed a significant (P < 0.05) improvement of the survival in the vaccinated group compared to that of the control. The described vaccination protocol seems safe, devoid of adverse side effects and promising. It warrants further investigation.

Immunotherapy of metastatic kidney cancer.

From April 1986 to September 2000, 122 MRCC patients were treated by monthly intralymphatic injections (containing a mean of 573 IL-2 U and 26 x 10(6) LAK cells) and i.m. administration of IFN and TF; 71 patients also received a 3-day cycle of monthly IL-2 inhalations with a mean of 998 daily U. MRCC cases not treated by immunotherapy (n = 89) represent our historical controls. Adverse clinical side effects related to treatment were negligible. CR (n = 11) and PR (n = 13) were noticed in 24/122 patients. Of 24 responding patients, 17 resumed progression, whereas 7 remain in remission 11-69 months later. The overall median survival of treated patients (28 months) was 3.5-fold higher than the median survival of historical controls (7.5 months), and a Kaplan-Meier curve showed 25% survival 11 years after the beginning of immunotherapy. Apparently, the addition of IL-2 by inhalation improved survival. The present immunotherapy protocol appears to be efficacious, safe, devoid of adverse side effects, far less costly than others and able to offer a good quality of life to MRCC patients; if confirmed in a multicenter trial, it could set the basis for developing low-dose immunomodulatory treatments.

["Unknown" ectopic ureteral opening. Experience with 8 clinical cases]. / Sbocchi ureterali ectopici "misconosciuti". Esperienza su otto casi clinici.

The authors after studying eight different cases of ectopic ureters, try to illustrate the most important points of the diagnostic course in this pathology. In fact, in this field of studies, it is not easy, every time, to define diagnosis by the usual ways of investigation, so the authors describe just those cases which were missed by past clinical evaluations. They want to demonstrate by their experience of work, that it is possible to avoid a wrong diagnosis by an accurate evaluation of the clinical phenomenology, but most of all by a good research and right interpretation of the clinical and radiologic signs, direct and not, of this pathology.

Adenosine decreases aspartate and glutamate release from rat hippocampal slices.

The effect of adenosine and related compounds on the release of endogenous aspartate and glutamate from isolated, superfused rat hippocampal slices was studied at rest and during electrical stimulation of the stratum radiatum in the CA3/CA2 region, using a sensitive mass-spectrometric technique. Evoked extracellular potentials were recorded from the CA1 region. Adenosine, at 3 X 10(-4) M concentration, inhibited the stimulation-evoked potentials and prevented the stimulation-induced release of aspartate and glutamate. Similarly, 1-phenylisopropyladenosine (10(-6) M) and cyclohexyladenosine (10(-6) M) depressed both electrical and neurochemical responses to stimulation of the stratum radiatum. 8-Phenyltheophylline (5 X 10(-6) M) increased the release of aspartate and glutamate and antagonized the cyclohexyladenosine-induced inhibition of amino acid release. Our results support the hypothesis that adenosine modulates the electrophysiological responses to stimulation of stratum radiatum through a reduction of the release of the excitatory amino acids aspartate and glutamate.

Lesions of cholinergic forebrain nuclei: changes in avoidance behavior and scopolamine actions.

The acquisition of active (shuttle-box) and passive avoidance conditioned responses and the effects of scopolamine on acetylcholine (ACh) output in freely moving rats and on conditioned responses were investigated 20 days after placing a unilateral lesion in the magnocellular forebrain nuclei (MFN). In the lesioned rats spontaneous ACh output from the cerebral cortex ipsilateral to the lesion was slightly decreased, while on the other hand the increase in ACh output elicited by scopolamine was strongly reduced. Sham operated rats always performed more active avoidance responses than MFN lesioned rats in the daily training shuttle-box sessions, and the facilitating effect of scopolamine (1 mg/kg IP) on the shuttle-box performance was suppressed. However the lesion did not disrupt the shuttle-box performance whenever training had taken place before the lesion. In the lesioned rats retested 30 min after the training trial, an impairment of the passive avoidance response was found. The effect of the lesion was potentiated by scopolamine. The results show therefore that MFN lesions impair the cortical cholinergic mechanisms, whose activity seems to play an important role in cognitive functions.

Effect of magnocellular forebrain nuclei lesions on acetylcholine output from the cerebral cortex, electrocorticogram and behaviour.

ACh output from the cerebral cortex, electrocortical activity, spontaneous alternation and the acquisition of a conditioned avoidance response have been investigated in rats 20 days after the placement of a unilateral lesion of the magnocellular forebrain nuclei (MFN). ACh output from the hemisphere ipsilateral to the lesion was 40% lower than in sham operated rats. Electrocortical activity quantified with a frequency analyzer supplemented by a period and power spectrum analysis showed a marked asymmetry between the two hemispheres of the lesioned rats. The total electrical activity was strongly reduced over the lesioned hemisphere. The reduction involved all frequencies but was more evident in the high frequencies. In the lesioned rats spontaneous alternation was not impaired and spontaneous motility was enhanced while the acquisition of a conditioned active avoidance in a two-way shuttle box was significantly hampered. The possibility is envisaged that the destruction of cholinergic fibres impinging upon the cerebral cortex may decrease cortical activation and impair the selective awareness necessary for information acquisition and exclusion of irrelevant output.

Changes in high affinity choline uptake in rat cortex following lesions of the magnocellular forebrain nuclei.

High affinity choline uptake (HACU) and choline acetyltransferase (CAT) were measured in the cerebral cortex of rats 4 and 20 days after placing electrolytic lesions in the magnocellular forebrain nuclei (MFN) or in the pallidum. Four days after MFN lesion a 40-50% decrease in ipsilateral cortical HACU was found and a slightly smaller decrease was found 4 days after the pallidum lesion. Twenty days after the lesion, HACU activity returned to control values in the ipsilateral parietal cortex, its decrease was smaller than 4 days postlesion in the ipsilateral frontal cortex and a significant increase was found in the contralateral cortex. CAT activity showed a 40% decrease in the frontal, parietal and occipital ipsilateral cortex 4 days after MFN lesion. The same decrease was found 20 days postlesion. However, at this time a significant increase in CAT activity was detected in the contralateral cortex. The ipsilateral recovery of HACU activity 20 days after the lesions and the contralateral increase in HACU and CAT activity demonstrate the remarkable and widespread functional adjustment associated with discrete brain lesions. The existence of a large cholinergic pathway projecting to the neocortex from the basal forebrain region is also confirmed.