Treatment of recurrent malignant glioma by repeated intracerebral injections of human recombinant interleukin-2 alone or in combination with systemic interferon-alpha. Results of a phase I clinical trial.

Nine patients with a recurrent malignant glioma were treated with repeated intracavitary or intracerebroventricular injections of human recombinant interleukin-2 (rIL-2) alone or in combination with systemic interferon-alpha (IFN-alpha). Five patients received only rIL-2 and four were treated with rIL-2 plus subcutaneous injections of IFN-alpha. Therapy was administered on a Monday, Wednesday, Friday schedule for up to 10 weeks, beginning with a dose of 10,000 IU rIL-2/injection. Doses were escalated every two weeks until some toxicity was apparent. The maximum amount of rIL-2 any one patient in this group received was 580,000 IU. Patients on combination immunotherapy were held at an rIL-2 dosage of 10,000 IU while IFN-alpha, which began at 3 million IU, was escalated every other week up to 18 million IU/dose. They were then held at that IFN-alpha dosage and rIL-2 was increased to 50,000 IU. The total amount of rIL-2 and IFN-alpha any one in this group received was 510,000 IU and 417 million IU, respectively. Repeated injections of 10,000 IU rIL-2 were well-tolerated by all nine patients and no change in their functional status was seen. At doses at 50,000 IU rIL-2, increased edema around the tumor cavity was observed by MRI/CT scand in 3/5 patients and clinical side-effects in the form of somnolence and headache along with some morbidity specifically associated with tumor location were also seen. Patients receiving rIL-2+ IFN-alpha showed progressive fatigue, muscle weakness, and occasionally nausea. Two of these patients showed increased peritumoral edema on MRI/CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

Corticosteroids inhibit the generation of lymphokine-activated killer activity in vitro.

In phase-I clinical trials of adoptive immunotherapy using lymphokine-activated killer (LAK) cells plus recombinant interleukin-2 (rIL-2) (Cetus) for the treatment of malignant glioma, we observed that blood mononuclear cells (MNC) from patients dependent on dexamethasone for management of cerebral edema produced substantially less LAK activity as compared to MNC of normal blood donors or glioma patients not receiving steroid therapy. Therefore, we examined the in vitro effects, brought about by therapeutically attainable concentrations of various corticosteroids, on the proliferative response, production of gamma interferon (IFN-gamma), and induction of LAK activity from blood MNC of normal donors. Incubation in media containing rIL-2 (1000 U/ml) with either dexamethasone, hydrocortisone, methylprednisolone, or prednisolone profoundly affected all of these parameters. First, while 0.01 micrograms/ml of either dexamethasone or hydrocortisone caused a slight enhancement of the mitogenic response of lymphocytes to phytohemagglutinin, a dose-dependent decline occurred as concentrations increased to 10 micrograms/ml. The addition of prednisolone and methylprednisolone elicited a dose-dependent inhibition of lymphocyte proliferation over the entire concentration range tested. At 0.1 microgram/ml or higher, dexamethasone, hydrocortisone, methylprednisolone and prednisolone significantly (P less than 0.02) inhibited the production of IFN-gamma: respectively 18.9%, 4.4%, 2.2%, and 12.3% of the IFN-gamma produced by MNC in the absence of steroids. All four corticosteroids inhibited the induction of LAK activity. Compared to MNC that had been incubated with 1000 U/ml rIL-2 alone, MNC cultured with rIL-2 and 10 micrograms/ml either dexamethasone or prednisolone demonstrated significantly lower cytotoxicity (P less than 0.05) for the natural-killer-cell-resistant cell line, Daudi. Culturing MNC with hydrocortisone had a more dramatic result, causing a significant decline (P less than 0.01) in lytic activity at both 1.0 micrograms/ml and 10 micrograms/ml, while incubation with methylprednisolone produced a significant drop (P less than 0.02) in LAK-mediated cytotoxicity at 0.1 micrograms/ml as well as 1.0 micrograms/ml and 10 micrograms/ml. When cytotoxicity was expressed as lytic units per million effectors, a dose-response decline in lytic activity was once again apparent, with hydrocortisone, methylprednisolone and prednisolone showing significant inhibition (P less than 0.05) at both 1.0 micrograms/ml and 10 micrograms/ml and dexamethasone at 10 micrograms/ml (P less than 0.01). These results indicate that corticosteroids commonly used in the management of cere

Intralesional infusion of lymphokine-activated killer (LAK) cells and recombinant interleukin-2 (rIL-2) for the treatment of patients with malignant brain tumor.

Twenty patients with supratentorial, intracerebral lesions defined by computed tomographic scan or magnetic resonance imaging were treated by surgery and adoptive immunotherapy with lymphokine-activated killer (LAK) cells and recombinant Interleukin-2 (rIL-2, Cetus). Seventeen patients had glioblastoma, two had high-grade oligodendroglioma, and one patient had two metastatic sarcoma lesions. LAK cells were produced from blood mononuclear cells (MNC) obtained by 2 to 3 leukapheresis procedures and cultured (2.5 x 10(6) MNC/ml) 3 to 5 days with 1000 units rIL-2/ml. Although LAK cells could be produced from MNC of all patients, those taking steroids or with a low Karnofsky functional status generated, on average, suboptimal LAK cell activity. Age, sex, and serum anticonvulsant levels do not seem to influence a patient's ability to produce LAK cells in vitro. For therapy, cultured MNC (1-15 x 10(9] containing LAK cells were suspended in saline containing 10(6) units rIL-2 and injected into tissue surrounding the tumor cavity during craniotomy. For 3 days after their operations, patients received 10(6) units rIL-2 into the tumor cavity through an Ommaya reservoir. The treatment protocol was tolerated well by all patients, although they all experienced some degree of headache, fever, or lethargy that cleared within a few days of the last rIL-2 injection. When computed tomographic (CT) scans were obtained soon after treatment, areas of low density suggested a greater-than-normal extent of edema around the operative site. At the present time, CT scans indicate that the tumors of seven patients have recurred with an average disease-free interval of 25 +/- 6 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adoptive immunotherapy for recurrent glioblastoma multiforme using lymphokine activated killer cells and recombinant interleukin-2.

Thirteen patients with recurrent glioblastoma were treated with adoptively transferred autologous lymphokine activated killer (LAK) cells and recombinant interleukin-2 (rIL-2). Patients' blood mononuclear cells (MNC) obtained by leukapheresis were cultured at 2.5 million MNC per ml for 3 to 5 days in media containing 1000 U rIL-2/ml. After incubation, the nonadherent MNC from all cultures (0.5-5 X 10(9] were combined and concentrated for infusion in 5 to 10 ml saline containing 10(6) U rIL-2. Nine patients received one injection of LAK cells and rIL-2 into the brain tissue immediately surrounding the tumor cavity during craniotomy for subtotal tumor removal (Group 1). On each of the 3 days after surgery, patients received boosters of 10(6) U rIL-2 delivered into the tumor cavity through a skin flap or via an Ommaya reservoir. Approximately 1 to 2 weeks after this series of injections, these patients were treated with a second cycle of LAK cells and rIL-2 injected into the tumor cavity using the reservoir. Four patients received both adoptive immunotherapy cycles by intracavitary injection (Group 2). In this relatively small patient pool, neither age, sex, Karnofsky score, treatment history, nor anticonvulsant and steroid dosage appeared to influence a patient's ability to make LAK cells. The therapy, itself, was well-tolerated by all patients although they all displayed symptoms of aseptic meningitis and increased intracranial pressure, i.e., headache, fever, malaise on the days of LAK cell and/or rIL-2 infusion. The therapy did not appear to have a significant impact on patient survival (mean, 30 weeks) especially for those patients with a high postsurgical tumor burden. As the therapy is safe, the authors believe its efficacy can best be tested in patients with a newly diagnosed or recurrent glioblastoma which lies in an area where a near-total resection is possible.

Morphology of taste buds on the gill arches of the mullet Mugil cephalus, and the killifish Fundulus heteroclitus.

The morphology of taste buds on the gill arches of two euryhaline teleosts, the mullet Mugil cephalus, and the killifish Fundulus heteroclitus, were investigated using light microscopic and scanning and transmission electron microscopic techniques. On the mullet gill arches, taste buds were limited to the pharyngeal surfaces of the smooth-surfaced gill rakers. On the killifish gill arches, taste buds were located on the pharyngeal surfaces of all gill rakers and on the gill arch itself at the bases of the gill rakers. Despite dramatic differences in gill-raker structure between these two species, the taste buds themselves were similar ultrastructurally and closely resembled those described in other fishes. Cells within the taste buds included spindle-shaped dark and light cells and basal cells. Ultrastructural features of both the light and dark cells could support either receptor or transport functions. Tufts of microvilli, including one thick microvillus per light cell and numerous thin microvilli per dark cell, protruded at the apex of each taste bud between the ridged surface epithelial cells. Light cells contained numerous tubular membrane elements some of which appeared to open onto the apical surface of the taste bud. Dark cells contained numerous microtubules and apical, electron-lucent vesicles possibly involved in transport.

The cerebral ventricles of the dog. I. Ultrastructural features of supraependymal cells during the inflammatory response.

The present investigation examined the ependymal linings of the cerebral ventricles of the dog following a single intracisternal injection of the viable antigen, bacillus Calmette-Guerin (BCG). One or 3 days following the injection of BCG, animals were perfused with buffered aldehydes. Portions of the linings of the lateral, third and fourth cerebral ventricles were removed and routinely prepared for scanning and transmission electron microscopy. Following BCG injection, a tremendous increase in the number of supraependymal cells is apparent throughout the entire cerebral ventricular system. Especially high concentrations of cells were observed on the ependyma overlying the following regions; the caudate nucleus, in the lateral ventricles; the interthalamic adhesion, lateral walls and floor of the third ventricle; lateral margin of the floor, lateral apertures and median sulcus of the fourth ventricle. The supraependymal cell population of infected animals was composed of macrophages, B lymphocytes, neutrophils, and lymphoblasts. Macrophages were found in highest concentration within these supraependymal cell populations. Furthermore, large aggregates of macrophages were observed on the ependyma overlying the interthalamic adhesion of the third ventricle and median sulcus of the fourth ventricle. It was suggested that these clusters may represent the early development of epithelioid granulomas.

The cerebral ventricles of the dog. II. Evidence of a hematogenous origin of supraependymal cells during the inflammatory response.

The present investigation examined the ependymal linings of the choroid plexus and cerebral ventricles of the dog following a single intracisternal injection of viable, bacillus Calmette-Guerin (BCG). One or 3 days following the injection of BCG, animals were perfused with buffered aldehydes. The choroid plexus of each cerebral ventricle as well as samples of the ependyma from the caudate nucleus, interthalamic adhesion, and median sulcus were removed and prepared for transmission electron microscopy. Following injection of BCG, leukocytic cells are found in association with the following structures and areas of the subependyma and choroid plexus: the endothelium of small blood vessels and capillaries; the walls of small blood vessels; the subependymal neuropil; the choroid plexus stroma; the single layer of ependyma bordering the luminal surfaces of the choroid plexi and ventricles; and the free, luminal surfaces of the choroid plexus and ventricular ependyma. The population of leukocytic cells included monocytes, macrophages, neutrophils, lymphoblasts, and plasma cells. The results of the present study suggest that the supraependymal leukocyte population of infected animals reaches the cerebral ventricular linings by migrating from the choroidal and subependymal vasculature.