U.S. patent application number 10/997985 was filed with the patent office on 2005-07-14 for method for determining immune system affecting compounds.
Invention is credited to Clinchy, Birgitta, Hakansson, Annika, Hakansson, Leif.
Application Number | 20050153329 10/997985 |
Document ID | / |
Family ID | 29586115 |
Filed Date | 2005-07-14 |
United States Patent
Application |
20050153329 |
Kind Code |
A1 |
Hakansson, Leif ; et
al. |
July 14, 2005 |
Method for determining immune system affecting compounds
Abstract
The present invention relates to a method for increasing
efficacy and/or possibility of therapeutic treatment of cancer,
wherein any dys-regulatory mechanism, including inducing factor/s,
of the production of immunoregulatory substances, including one or
more cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, is therapeutically controlled to minimise
pathological production of such immunoregulatory substances, to
enhance the therapeutic control of a malignant tumour in a subject
suffering from a cancer, a method for analysing dys-regulatory
mechanism controlling substances, kit for such analysis, use of
certain compounds for preparing pharmaceutical preparations, and
pharmaceutical preparations.
Inventors: |
Hakansson, Leif;
(Vikingstad, SE) ; Hakansson, Annika; (Vikingstad,
SE) ; Clinchy, Birgitta; (Ljungsbro, SE) |
Correspondence
Address: |
YOUNG & THOMPSON
745 SOUTH 23RD STREET
2ND FLOOR
ARLINGTON
VA
22202
US
|
Family ID: |
29586115 |
Appl. No.: |
10/997985 |
Filed: |
November 29, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10997985 |
Nov 29, 2004 |
|
|
|
PCT/SE03/00869 |
May 27, 2003 |
|
|
|
60411517 |
Sep 18, 2002 |
|
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Current U.S.
Class: |
435/6.17 ;
435/7.23 |
Current CPC
Class: |
G01N 33/574 20130101;
G01N 2800/52 20130101; C07K 2317/73 20130101; C07K 16/283 20130101;
C07K 2317/76 20130101; A61K 2039/505 20130101; C07K 2317/54
20130101 |
Class at
Publication: |
435/006 ;
435/007.23 |
International
Class: |
C12Q 001/68; G01N
033/574 |
Foreign Application Data
Date |
Code |
Application Number |
May 27, 2002 |
SE |
0201563-4 |
Claims
1. Method for analysing the amount of tumour derived substances,
including receptor-bound immune complexes and proteolytic fragments
of tumour tissue substances, wherein said tumor derived substances
is a fragment of extracellular matrix, including collagen,
fibronectin, and laminin, or a fragment of blood proteins,
including albumin, immunoglobulin, and fibrinogen isolated from
tumour tissue, blood or urine from cancer patients, characterised
in that they have an activity at a molecular weight of 3 to 30 kDa,
that they have a capacity to bind to tumour or immune cell
receptors and induce the production of cytokines determined in
cultures of normal peripheral blood mononuclear cells, whereby the
amount of such dys-regulatory mechanism substances is determined by
utilising binding substances including antibodies directed to these
substances or probes complementary to their DNA and/or RNA in a
tissue sample, whereby the prognosis of a subject suffering from
cancer can be determined and/or the therapeutic efficacy of any
anti-cancer treatment can be predicted and monitored.
2. Method according to claim 1, for diagnosis of concomitant
immunity phenomena by analysing the presence of dysregulatory
factors of claim 1.
3. Method according to claim 1, wherein tissue is whole blood,
serum, plasma, lymphatic fluid, saliva, urine, faeces, ascites,
pleural effusion, pus, as well as any tissue, including
inflammatory cells.
4. Method according to claim 1, wherein any compound having the
ability of inhibiting the production, activation or activity of
enzymes generating fragments of intra-tumoural tissue are
determined.
5. Method according to claim 1, wherein any fragment or new
epitopes generated by the activity of intratumoural enzymes is
determined in any tissue from a cancer patient.
6. Method according to claim 3, wherein the activity of any
compound having the ability of inhibiting the production,
activation or activity of enzymes generating fragments is monitored
by determining these fragments or new epitopes exposed by the
enzymatic activity in any tissue from a cancer patient.
7. Method according to claim 6, wherein the inhibiting compound is
a matrix metalloproteinase inhibitor.
8. Method according to claim 1, wherein any compound blocking
production or biological activity of a factor inducing pathological
production of any dys-regulatory mechanism of immunoregulatory
substances, including one or more cytokines, including IL-1.beta.,
IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha., and others including
enzymes, production, is determined.
9. Method according to claim 1, wherein the amount of any inducing
factor or mRNA thereof inducing the production of immunoregulatory
substances, including one or more cytokines including IL-1.beta.,
IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha. and others, found in
tissue, is determined by determining the production of
immunoregulatory substances, including cytokines, including IL-1Ra,
IL-6, IL-1.beta. and/or TNF-.alpha. and others produced by PBMC
after exposure to these factors.
10. Method according to claim 1, wherein samples are obtained in a
way, including tubes and syringes, not binding or inactivating
immunoregulatory substances, including inducing factors.
11. Method according to claim 1, wherein the amount of any inducing
factor inducing the production of immunoregulatory substances,
including one or more cytokines including IL-1.beta., IL-1Ra, IL-6,
IL-10, IL-17, TNF-.alpha., and others, is determined directly.
12. Method according to claim 1, wherein the amount of any urine
present inducing factor inducing the production of immunoregulatory
substances, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, is determined by using an urine dip stick
containing binding substance/s binding said inducing factor and/or
colour developing reagents to said inducing factor.
13. Method according to claim 1, wherein the amount of cell bound
immune complexes, CBIC, is determined.
14. Method according to claim 1, wherein peripheral blood
mononuclear cells PBMC being positive for any immunoglobulin
staining are determined.
15. Method according to claim 1, wherein IL-1Ra is determined.
16. Method according to claim 1, wherein down-regulation of CD28 on
CD4+ and/or CD8+ lymphocytes is determined.
17. Method according to claim 1, wherein down-regulation of CD80
and/or CD86 is determined.
18. Method according to claim 1, wherein determination of any other
modulation of other immunoregulatory substances is made.
19. Method according to claim 18, wherein the assay utilises any
tissue and the determinations are made using any
immuno-cyto-histochemical method, as electrophoresis,
chromatography, any immunoassay including, ELISA, Elispot, RIA and
others any blotting technique, including Western blotting, Southern
blotting and others, any bioassay, any tissue culture technique,
RT-PCR, flow cytometry, cytometric bead array, DNA microarray
and/or proteomics.
20. Method according to claim 1, wherein dys-regulatory mechanism
substances in tissue from cancer patients, which substances
suppress the immune mediated systemic protection resulting in
establishment of micrometastases, are identified.
21. Method according to claim 1 for diagnosing of presence/absence
of cancer by identifying pathological immunoregulatory substances
in cancer and diagnosis of cancer related/tumour derived tissue
factor of importance for a cancer patient's performance status,
immune mediated anti-tumour reactivity, systemic protection of
metastatic disease of a patient suffering from cancer and response
to treatment including immuno-, chemo-, bio- and radiotherapy.
22. Method according to claim 21, wherein said factor is present in
tumour tissue and body fluids.
23. Method according to claim 21, wherein said factor has the
ability of inducing cytokines or other immunoregulatory
substances.
24. Method according to claim 21, wherein said factor directly or
indirectly has the ability of inducing production of proteolytic
enzymes by tumour cells or inflammatory cells.
25. The use of at least one regulatory mechanism controlling factor
of at least tumour derived substances, including receptor-bound
immune complexes and proteolytic fragments of tumour tissue
substances, wherein said tumor derived substances is a fragment of
extracellular matrix, including collagen, fibronectin, and laminin,
or a fragment of blood proteins, including albumin, immunoglobulin,
and fibrinogen isolated from tumour tissue, blood or urine from
cancer patients, characterised in that they have an ctivity at a
molecular weight of 3 to 30 kDa, that they have a capacity to bind
to tumour or immune cell receptors and induce the production of
cytokines determined in cultures of normal peripheral blood
mononuclear cells, for the production of a pharmaceutical
preparation to be used for therapeutic control and for minimisation
of pathological production of immunosuppresive immunoregulatory
substances, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
and/or TNF-.alpha., and others, including enzymes or to stimulate
production of immunosupportive immunoregulatory substances in a
patient suffering from a cancer and to enhance the efficacy and/or
possibility of therapeutic treatment of cancer or modulation of
dys-regulatory factors to enhance performance status.
26. Use according to claim 25, wherein a FcR modulating agent is
used in the manufacture of a pharmaceutical preparation for
controlling immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, and/or
TNF-.alpha., and others, production in a patient suffering from
cancer by therapeutically modulating FcR activity, such as blocking
FcR/Fc.gamma.R activity or cross-linking FcR/Fc.gamma.R
activity.
27. Use according to claim 25, wherein at least one immunoglobulin,
FcR antibodies or fragments of antibodies or synthetic constructs
including peptides directed to FcR is used in the manufacture of a
pharmaceutical preparation for blocking or cross-linking FcR
cross-linking.
28. Use according to claim 26, wherein an agent modulating
Fc.gamma.R I, Fc.gamma.R II and/or Fc.gamma.R III used to stimulate
IL-2 stimulation of clonal expansion of lymphocytes is used in the
manufacture of a pharmaceutical preparation.
29. Use according to claim 26, wherein at least one FcR-modulating
soluble receptor, fragment, peptide or synthetic construct directed
to the Fc-part of immunoglobulins is used in the manufacture of a
pharmaceutical preparation.
30. Use according to claim 26, wherein at least one FcR-modulating
enzyme inhibitor is used in the manufacture of a pharmaceutical
preparation.
31. Use according to claim 26, wherein at least one FcR-inhibiting
matrix metalloproteinase inhibitor is used in the manufacture of a
pharmaceutical preparation.
32. Use according to claim 25, wherein any compound including any
enzymes, blocking production or biological activity of any factor
inducing pathological production of one or more cytokines is used
in the manufacture of a pharmaceutical preparation for blocking a
factor inducing pathological production of such cytokines.
33. Use according to claim 25, wherein a compound having the
ability of inhibiting the activation and/or activity of enzymes
generating immunomodulatory fragments is used in the manufacture of
a pharmaceutical preparation for inhibiting the activation or
activity of enzymes generating immunomodulatory fragments.
34. Use according to claim 25, wherein antibodies directed to
enzymes generating immuno-modulatory fragments are used in the
manufacture of a pharmaceutical preparation.
35. Use according to claim 25, wherein at least one monoclonal
antibody, anti-integrin antibody, peptide and/or synthetic
construct thereol is used inl tile manufacture of a pharmaceutical
preparation.
36. A pharmaceutical composition comprising a regulatory mechanism
controlling factor tumour derived substances, including
receptor-bound immune complexes and proteolytic fragments of tumour
tissue substances, wherein said tumor derived substances is a
fragment of extracellular matrix, including collagen, fibronectin,
and laminin, or a fragment of blood proteins, including albumin,
immunoglobulin, and fibrinogen isolated from tumour tissue, blood
or urine from cancer patients, characterised in that they have
an-ctivity at a molecular weight of 3 to 30 kDa, that they have a
capacity to bind to tumour or immune cell receptors and induce the
production of cytokines determined in cultures of normal peripheral
blood mononuclear cells or cell lines, to be used for
therapeutically control and minimise pathological production of
immunosuppresive immunoregulatory substances including one or more
cytokine, or to stimulate production of an immunosupportive
immunoregulatory substance in a patient suffering from a cancer to
enhance the efficacy and/or possibility of therapeutic treatment of
cancer, optionally in combination with therapeutically inert
additive to enhance performance status.
37. Pharmaceutical composition according to claim 36, wherein a FcR
modulating agent is present in a pharmaceutical preparation for
controlling immunoregulatory substances, including one or more
cytokine production in a patient suffering from cancer by
therapeutically modulating FcR activity.
38. Pharmaceutical composition according to claim 37, wherein a FcR
modulating agent is used in tihe manufacture of a pharmaceutical
preparation for controlling immunoregulatory substances, including
one or more cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10,
IL-17, TNF-.alpha., and others, including enzymes, production in a
patient suffering from cancer is modulated by therapeutically
blocking FcR/Fc.gamma.R activity.
39. Pharmaceutical composition according to claim 37, wherein at
least one immunoglobulin, FcR antibodies or fragments of antibodies
or synthetic constructs including peptides directed to FcR is used
in the manufacture of a pharmaceutical preparation for blocking or
cross-linking FcR activity.
40. Pharmaceutical composition according to claim 39, wherein an
agent modulating Fc.gamma.R I, Fc.gamma.R II and/or Fc.gamma.R III
is present to stimulate IL-2 stimulation of clonal expansion of
lymphocytes.
41. Pharmaceutical composition according to claim 39, wherein
anti-Fc.gamma.R I antibodies is present in a pharmaceutical
preparation for blocking of Fc.gamma.R.
42. Pharmaceutical composition according to claim 39, wherein any
compound blocking production or biological activity of any factor
inducing pathological production of one or more cytokines is used
in the manufacture of a pharmaceutical preparation for blocking a
factor inducing pathological production of such cytokines.
43. Pharmaceutical composition according to claim 36, wherein a
compound having the ability of inhibiting the production,
activation of enzymes generating immunomodulatory fragments is
present in the pharmaceutical preparation for inhibiting the
activation of enzymes generating immunomodulatory fragments.
44. Pharmaceutical composition according to claim 36, wherein a
compound blocking a factor inducing pathological production of
immunoregulatory substances, including one or more cytokine
production is present in the pharmaceutical preparation for
blocking a factor inducing pathological production of such
immunoregulatory substances.
45. Pharmaceutical composition according to claim 36, wherein
antibodies directed to enzymes generating immuno-modulatory
fragments are present.
46. Pharmaceutical composition according to claim 36, wherein at
least one monoclonal antibody, anti-integrin antibody, peptide
and/or synthetic construct thereof, is used.
47. Cancer related/tumour derived tissue factor of importance for a
cancer patient's performance status, immune mediated anti-tumour
reactivity, systemic protection of metastatic disease of a patient
suffering from cancer and response to treatment including immuno-,
chemo-, bio- and radiotherapy.
48. Factor according to claim 47, wherein said factor is present in
tumour tissue and body fluids.
49. Factor according to claim 47, wherein said factor has the
ability of inducing cytokines or other immunoregulatory
substances.
50. Factor accordinrg to claim 47, wherein said factor directly or
indirectly has the ability of inducing production of proteolytic
enzymes by tumour cells or inflammatory cells.
51. Factor according to claim 47, wherein said factor is a fragment
of extra cellular matrix, including collagen, fibronectin and
laminin.
52. Factor according to claim 47, wherein said factor is a fragment
of at least one serum protein.
53. Factor according to claim 52, wherein said factor is a fragment
of serum albumin.
54. Factor according to claim 47, wherein said factor is a fragment
of at least one immunoglobulin.
55. Factor according to claim 47, wherein said factor is a fragment
of fibrinogen.
56. Method for increasing efficacy and/or possibility of
therapeutic treatment of cancer, wherein, tumour derived
substances, including receptor-bound immune complexes and
proteolytic fragments of tumour tissue substances, wherein said
tumor derived substances is a fragment of extracellular matrix,
including collagen, fibronectin, and laminin, or a fragment of
blood proteins, including albumin, immunoglobulin, and fibrinogen
isolated from tumour tissue, blood or urine from cancer patients,
characterised in that they have an activity at a molecular weight
of 3 to 30 kDa, that they have a capacity to bind to tumour or
immune cell receptors and induce the production of cytokines
determined in cultures of normal peripiheral blood mononuclear
cells or cell lines, whereby the amount of such dys-regulatory
mechanism substances is therapeutically controlled to minimise
pathological production or biological activity of such
immunoregulatory substances being immunosuppresive, or to stimulate
the production of such immunoregulatory substances being
immunosupportive to enhance the performance status of the patient
and/or to enhance the therapeutic control of a malignant tumour in
a subject suffering from a cancer.
57. Method according to claim 56, wherein the cytokines IL-1.beta.,
IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha., and others, are
therapeutically controlled.
58. Method according to claim 56, wherein any dys-regulatory
mechanism of immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha. and others, production in a patient suffering from
cancer is modulated by therapeutically treating the patient to
provide a FcR modulation by administering a therapeutically
effective amount of a FcR modulating agent, such as a
FcR/Fc.gamma.R blocking agent or a FcR/Fc.gamma.R cross-linking
agent.
59. Method according to claims claim 58, wherein blocking or
cross-linking of FcR is carried out using a therapeutically active
amount of at least one immunoglobulin, FcR antibodies or fragments
of antibodies or synthetic constructs including peptides directed
to FcR.
60. Method according to claim 56, wherein a compound having the
ability of inhibiting the production, activation or activity of
enzymes generating immunomodulatory fragments is administered in a
therapeutically effective amount.
61. Method according to claim 60, wherein the inhibiting compound
is a monoclonal antibody, an anti-integrin antibody, peptides
and/or synthetic constructs.
62. Method according to claim 58, wherein the modulating substance
is an enzyme inhibitor.
63. Method according to one or more of the preceding claims claim
58, wherein the inhibiting compound is a matrix metalloproteinase
inhibitor.
64. Method according to claim 57, wherein any compound blocking the
factor inducing IL-6 production is administered in a
therapeutically effective amount.
65. Method according to claim 57, wherein any compound blocking the
factor inducing IL-1.beta. production is administered in a
therapeutically effective amount.
66. Method according to claim 57, wherein any compound blocking the
factor inducing IL-10 production is administered in a
therapeutically effective amount.
67. Method according to claim 57, wherein any compound blocking the
factor inducing TNF-.alpha. production is administered in a
therapeutically effective amount.
68. Method according to claim 57, wherein any compound blocking the
factor inducing IL-1Ra production is administered in a
therapeutically effective amount.
69. Method according to claim 57, wherein monoclonal antibodies
directed to enzymes generating immuno-modulatory fragments are
administered in a therapeutically effective amount.
70. Method according to claim 57, wherein at least one
anti-integrin antibody, peptide or construct is administered in a
therapeutically effective amount.
71. Method according to claim 56, for treating cancer by
administering a therapeutically active amount of compound to a
person suffering from a cancer, which compound inhibits the
production and/or biological activity of at least one factor of
importance for the performance status of a patient suffering from
cancer, immune mediated anti-tumour reactivity of a patient
suffering from cancer, systemic protection of metastatic disease of
a patient suffering from cancer and response to treatment including
immuno-, chemo-, bio- and radiotherapy of a patient suffering from
cancer.
72. Method according to claim 71, wherein the fragment to be
inhibited is extra cellular matrix derived fragment matrix,
including fragments of collagen, fibronectin and laminin.
73. Method according to claim 71, wherein the fragment to be
inhibited is a serum protein fragment.
74. Method according to claim 73, wherein the fragment to be
inhibited is a serum albumin derived fragment.
75. Method according to claim 71, wherein the fragment to be
inhibited is an immunoglobulin derived fragment.
76. Method according to claim 71, wherein the fragment to be
inhibited is a fibrinogen derived fragment.
77. Method according to claim 71, wherein a matrix metalloprotease
inhibitor having the ability of inhibiting the proteolytic effect
of matrix metalloproteases in forming a tissue factor of
cancer.
78. Method according to claim 77, wherein the inhibitor has the
ability of inhibiting the proteolytic effect of one or more of the
matrix metalloproteases, including the group of MMP-1, MMP -2, MMP
-3, MMP-7, MMP-13.
Description
TECHNICAL FIELD
[0001] The present invention relates to method for treating cancer,
method for determining immunoregulatory substances, kit for
carrying out said determination, use of certain compounds for
preparation of pharmaceutical compositions, as well as
pharmaceutical compositions.
BACKGROUND OF THE INVENTION
[0002] Evidence of the occurrence of immunogenic tumours among a
majority of different types of human cancers is increasing, e.g.,
specific cytotoxic T-lymphocytes, CTLs, are found in the blood of
cancer patients, antibodies against tumour associated antigens have
been identified, inflammatory cells are infiltrating the tumours,
there is often a correlation between these cells and prognosis or
response to immunotherapy and an immune mediated anti-tumour
reactivity has been demonstrated after therapy.
[0003] The function of immune cells in cancer patients is, however,
often impaired. Generally this is more pronounced in tumour
infiltrating mononuclear cells (Vose et al., 1977), TIMC, than in
cells obtained from peripheral blood. It has for example repeatedly
been demonstrated that the proliferative response to mitogens, such
as phytohemagglutinin (PHA) or concanavalin A (ConA), is inhibited,
natural killer cell (NK-cell) activity and cytotoxic activity of
CTLs are reduced as is the maturation and function of dendritic
cells and the immune balance seems to be directed to a T-helper 2
situation (Pawelec et al. 2000).
[0004] Immunosuppression of TIMC can, however, at least to some
extent be overcome, either by washing, preincubation before
stimulation, or culturing in interleukin-2. Amazingly, the
down-regulation of the immune system, which relates to cancer, does
not result in a seriously increased incidence of infectious
diseases in these patients.
[0005] The demonstration of concomitant immunity shows the
existence of regional immunosuppression in the absence of systemic
suppression, indicating a regional--systemic gradient of
immunosuppression (North, 1985). Systemic immunosuppression can
thus be regarded as a systemic dissemination, or "spill-over" of
intra-tumoural suppression.
[0006] Extracts or supernatants from tumours are often
immunosuppressive (Sulitzeanu, 1993). Several factors have been
suggested to mediate this suppression, e.g., TGF-.beta., PGE.sub.2,
IL-10, IL-4 and others, either being produced by the tumour cells
as such or by tumour-infiltrating lymphocytes (TIL) or tumour
associated macrophages (TAM) (e.g. Menetrier-Caux et al., 1999;
Heimdal et al., 2000; Heimdal et al., 2001). However, no
fundamental mechanism has been identified so far (Mocellin,
2001).
[0007] The immunosuppression of cancer patients described above
often involves an ongoing systemic, chronic inflammation with an
increased production of cytokines, in particular IL-6 and
TNF-.alpha. seems to be important mediators in this process. This
results in a paraneoplastic syndrome with a poor performance
status--impaired general condition, which is characterized by
anorexia, fatigue, subfebrility and distortion of various
biochemical laboratory parameters, e.g., low haemoglobin
concentration, high numbers of platelets, increased numbers of
blood monocytes, increased concentration of acute phase reactants,
increased c-reactive protein (CRP) and erythrocyte sedimentation
rate (ESR) and other factors (Barton , 2001; Blay et al., 1992;
Blay et al., 1997; Gadducci et al., 2001; Walther et al., 1998).
This condition is correlated to the tumour burden of the patient,
being worse in more advanced disease. In the clinical situation,
attempts are often made to ameliorate the poor general condition of
these patients by corticosteroid treatment.
[0008] Chronic inflammatory reactions in cancer patients often
result in a poor response to the immunotherapy (Blay et al. 1992;
Deehan et al., 1994; Lissoni et al., 1999; Tartour et al., 1996).
There are some animal and human reports on the importance of the
immune status of tumour bearers for response to cytotoxic
treatment/chemotherapy or radiotherapy. (Goldin et al., 1980; Milas
et al., 2001)
[0009] Immunostimulatory treatment of the dysregulated immune
system of cancer patients might be counter-productive. If the
immune system in cancer is directed to down-regulation of the
chronic inflammatory reaction there is a risk that further
therapeutic immunostimulation will enhance the immunosuppression
and thereby further down-regulate the immune reactivity against the
tumour cells. The strategy should therefore be to eliminate
mediators of immunosuppression before the immune system is
stimulated.
[0010] In developing immunotherapeutic strategies in cancer several
critical steps, of major importance for initiation and maintenance
of immune mediated anti-tumour reactivity, have to be
considered.
[0011] For initiation of an immune response the tumour has to be
recognised as non-self. The initial induction of an immune response
to tumour associated antigens takes place at an early stage of the
malignant disease while the tumour burden is still reasonably small
and tumour related immunosuppressive mechanisms are not yet
activated. In this situation the immune reactivity to the tumour is
beneficial and control the malignant growth for some time.
[0012] In order to get an immune response a proper interaction
between antigen presenting cells (APCs) and lymphocytes has to take
place with a well-orchestrated production of cytokines and
expression/interaction of co-stimulatory molecules.
[0013] In cancer patients with macroscopic, progressive tumour a
different situation prevails. The anti-tumour immune reactivity has
been suppressed. In a small subset of patients the
immunostimulatory therapeutic strategies, which are available,
e.g., interferons, interleukins, vaccination, can overcome this
immunosuppression, which results in objective tumour regression in
only about 10-15 percent of the patients and short-lasting minor
regressions in some more. The poor efficacy of such treatment
strategy depends on the occurrence of non-immunogenic tumours,
serious immunosuppression (which can not be overcome by current
therapeutic methods) and down-regulation of the immune reactivity
during immunotherapy. Tumour related suppressor substances might
interfere with these mechanisms during development of
immunosuppression. Immune mediated anti-tumour reactivity also
seems to be down regulated via interaction with FcR, in particular
Fc.gamma.R.
[0014] Tumour related immunosuppression takes place at four levels:
Activation, recruitment of effector cells to the tumour, migration
of these cells from stromal areas close to the tumour cells and
cytotoxic activity.
[0015] Mechanisms by which malignant tumours can down-regulate the
immune system are
[0016] tumour derived non-immunogenic substances with suppressor
activity;
[0017] well-characterized immunomodulating substances, cytokines,
e.g., transforming growth factor beta (TGF-.beta.), IL-10, as well
as PGE.sub.2,
[0018] tumour associated antigen (TAA) resulting in antigenic
overload, production of antibody and immunocomplex (IC);
[0019] serum blocking factors, which are probably related to immune
complexes, cross-linking Fc receptor (Fc.gamma.R);
[0020] proteolytic fragments from tumour substances, e.g.,
extracellular matrix (ECM);
[0021] T-helper 1/T helper 2 (Th1/Th2) balance
[0022] Stimulation of the inhibited immune reactivity to the tumour
can be achieved using several therapeutic strategies. However,
several function parameters are down-regulated during the
treatment, particularly in tumour areas with the most pronounced
regressive changes.
[0023] It would thus be of great importance in the treatment of
cancer patients to identify the mechanisms by which the immune
system is dys-regulated and to develop proper diagnostic tests of
this condition. The ultimate goal is then, based on these tests to
find measures to treat, eliminate the immunosuppression, and
thereby improve the general condition of cancer patients and
increase the therapeutic efficacy in cancer.
SUMMARY OF THE PRESENT INVENTION
[0024] It has been found that efficacy and possibility of
therapeutic treatment of cancer can be increased, whereby any
dysregulatory mechanism of the production of immunoregulatory
substances, is therapeutically controlled to minimise pathological
production of such immunoregulatory substances, to enhance the
therapeutic control of a malignant tumour in a subject suffering
from a cancer and the chronic inflammatory reaction in cancer
patients which latter reaction plays an important role in cancer
therapy.
[0025] The object of the present invention is thus to obtain a
method for increasing the possibility of treating cancer, a method
for determining factor(-s) related to prognosis and allowing
prediction and monitoring therapy of cancer, and a kit for
determining such factor(-s), use of substances to prepare
pharmaceutical compositions, as well as pharmaceutical
compositions.
DESCRIPTION OF THE PRESENT INVENTION
[0026] It has now surprisingly been found a method for increasing
efficacy is and possibility of therapeutic treatment of cancer,
wherein any regulatory mechanism, including inducing factor/s, of
the production of immunoregulatory substances, including
IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha., and others, is
therapeutically controlled to minimise pathological production of
such immunosuppressive immunoregulatory substances or to stimulate
the production of immunosupportive immunoregulatory substances to
enhance the performance status of a patient and/or to enhance the
therapeutic control of a malignant tumour in a subject suffering
from a cancer.
[0027] According to a preferred embodiment any dysregulatory
mechanism of immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha. and others, production in a patient suffering from
cancer is modulated by therapeutically treating the patient to
provide a FcR modulation by administering a therapeutically
effective amount of a FcR modulating agent.
[0028] According to another preferred embodiment any dysregulatory
mechanism of immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, production in a patient suffering from
cancer is modulated by therapeutically treating the patient to
provide a FcR/Fc.gamma.R modulation by administering a
therapeutically effective amount of a FcR/Fc.gamma.R blocking
agent.
[0029] According to another preferred embodiment any dysregulatory
mechanism of immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, production in a patient suffering from
cancer is modulated by therapeutically treating the patient to
provide a FcR/Fc.gamma.R modulation by administering a
therapeutically effective amount of a FcR/Fc.gamma.R cross-linking
agent.
[0030] According to another preferred embodiment blocking or
cross-linking of FcR is carried out using a therapeutically active
amount of at least one immunoglobulin, FcR antibodies or fragments
of antibodies or synthetic constructs including peptides directed
to FcR.
[0031] According to another preferred embodiment at least one
FcR-modulating substance minimising production of interleukin-1
receptor antagonist is administered in a therapeutically effective
amount.
[0032] According to another preferred embodiment wherein the
modulation is carried out by blocking FcR by administering F(ab),
or F(ab')2-fragments.
[0033] According to another preferred embodiment the modulating
substance is a soluble receptor, fragment, peptide or synthetic
construct directed to the Fc-part of immunoglobulins.
[0034] According to another preferred embodiment Fc.gamma.R I,
Fc.gamma.R II and/or Fc.gamma.R III is modulated to stimulate IL-2
stimulation of clonal expansion of lymphocytes.
[0035] According to another preferred embodiment any compound
blocking the production or biological activity of a factor inducing
pathological production of any dysregulatory mechanism of
immunoregulatory substances, including one or more cytokines,
including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha., and
others, production, is administered in a therapeutically effective
amount.
[0036] According to another preferred embodiment the blocking
compound is a receptor blocking compound.
[0037] According to another preferred embodiment the blocking
compound is a monoclonal antibody, fragments thereof, peptides or
synthetic constructs.
[0038] According to another preferred embodiment a compound having
the ability of inhibiting the activation or activity of enzymes
generating immunomodulatory fragments is administered in a
therapeutically effective amount.
[0039] According to another preferred embodiment the inhibiting
compound is a monoclonal antibody, an anti-integrin antibody,
peptides and/or synthetic constructs.
[0040] According to another preferred embodiment the modulating
substance is an enzyme inhibitor.
[0041] According to another preferred embodiment the inhibiting
compound is a matrix metalloproteinase inhibitor.
[0042] According to another preferred embodiment any compound
blocking the factor inducing IL-6 production is administered in a
therapeutically effective amount.
[0043] According to another preferred embodiment any compound
blocking the factor inducing IL-1.beta. production is administered
in a therapeutically effective amount.
[0044] According to another preferred embodiment any compound
blocking the factor inducing IL-10 production is administered in a
therapeutically effective amount.
[0045] According to another preferred embodiment any compound
blocking the factor inducing TNF-.alpha. production is administered
in a therapeutically effective amount.
[0046] According to another preferred embodiment any compound
blocking the factor inducing IL-1Ra production is administered in a
therapeutically effective amount.
[0047] According to another preferred embodiment monoclonal
antibodies directed to enzymes generating immunomodulatory
fragments are administered in a therapeutically effective
amount.
[0048] According to another preferred embodiment at least one
anti-integrin antibody, peptide or construct is administered in a
therapeutically effective amount.
[0049] Further preferred embodiments are as follows.
[0050] According to another preferred embodiment blocking
cross-linking of FcR is carried out using a therapeutically active
amount of FcR antibodies or fragments of monoclonal antibodies
directed to FcR, preferably the FcR cross-linking is obtained by
administering a therapeutically effective amount of at least one
immunoglobulin, more preferably the FcR cross-linking is obtained
by administering a therapeutically effective amount of IgG or
complex bound IgG, and/or the FcR cross-linking is obtained by
administering a therapeutically effective amount of IgA or complex
bound IgA.
[0051] According to a further preferred embodiment a
therapeutically effective amount of Fc part of at least one
immunoglobulin is administered, preferably a therapeutically
effective amount of Fc part of IgG or complex bound IgG is
administered, and/or a therapeutically effective amount of Fc part
of IgA or complex bound IgA is administered.
[0052] According to a further preferred embodiment any
cross-linking of Fc.gamma.R I, Fc.gamma.R II and/or Fc.gamma.R III
is carried out.
[0053] According to a further preferred embodiment FcR is
down-regulated using an inhibitor of its expression.
[0054] According to another, further preferred embodiment blocking
of Fc.gamma.R is carried out by administering a therapeutically
effective amount of anti-Fc.gamma.R I antibodies.
[0055] According to another preferred embodiment at least one
FcR-blocking substance minimising production of interleukin-1
receptor antagonist is administered in an amount necessary to block
the activity of interleukin-1.
[0056] A further aspect of the invention includes a method for
analysing the amount and/or certain pattern of dysregulatory
mechanism substances, including their mRNA, including any inducing
factor, inducing the production of immunoregulatory substances,
including one or more cytokines, including IL-1.beta., IL-1Ra,
IL-6, IL-10, IL-17, TNF-.alpha., and others, whereby the amount of
such dysregulatory mechanism substances is determined in a tissue
sample, whereby the prognosis of a subject suffering from cancer
can be determined and/or the therapeutic efficacy of any
anti-cancer treatment can be predicted and monitored.
[0057] According to a preferred embodiment tissue is whole blood,
serum, plasma, lymphatic fluid, saliva, urine, faeces, ascites,
pleural effusion, pus, as well as any tissue, including
inflammatory cells.
[0058] According to another preferred embodiment any compound
having the ability of inhibiting the activation or activity of
enzymes generating fragments of intra-tumoural tissue are
determined.
[0059] According to another preferred embodiment any fragment or
new epitopes generated by the activity of intratumoural enzymes is
determined in any tissue from a cancer patient.
[0060] According to another preferred embodiment the activity of
any compound having the ability of inhibiting the activation or
activity of enzymes generating fragments is monitored by
determining these fragments or new epitopes exposed by the
enzymatic activity in any tissue from a cancer patient.
[0061] According to another preferred embodiment the inhibiting
compound is a matrix metalloproteinase inhibitor.
[0062] According to another preferred embodiment any compound
blocking production or biological activity of a factor inducing
pathological production of any dys-regulatory mechanism of
immunoregulatory substances, including one or more cytokines,
including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha., and
others, production, is determined.
[0063] According to another preferred embodiment the amount of any
inducing factor or mRNA thereof inducing the production of
immunoregulatory substances, including one or more cytokines
including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha. and
others, found in tissue, is determined by determining the
production of immunoregulatory substances, including cytokines,
including, including IL-1Ra, IL-6, IL-1.beta. and/or TNF-.alpha.
and others produced by PBMC after exposure to these factors.
[0064] According to another preferred embodiment samples are
obtained in a way, including tubes and syringes, not binding or
inactivating immunoregulatory substances, including inducing
factors.
[0065] According to another preferred embodiment the amount of any
inducing factor inducing the production of immunoregulatory
substances, including one or more cytokines including IL-1.beta.,
IL-1Ra, IL-6, IL-10, IL-17, TNF-.alpha., and others, is determined
directly.
[0066] According to another preferred embodiment the
amount/occurrence of any cell bound factor inducing the production
of immunoregulatory substances, including IL-1.beta., IL-1Ra, IL-6,
IL-10, IL-17, TNF-.alpha., and others, is determined.
[0067] According to another preferred embodiment the amount of any
urine present inducing factor inducing the production of
immunoregulatory substances, including IL-1.beta., IL-1Ra, IL-6,
IL-10, IL-17, TNF-.alpha., and others, is determined by using an
urine dip stick containing binding substance/s binding said
inducing factor and/or colour developing reagents to said inducing
factor.
[0068] According to another preferred embodiment the amount of cell
bound immune complexes, CBIC, is determined.
[0069] According to another preferred embodiment peripheral blood
mononuclear cells PBMC being positive for any immunoglobulin
staining are determined.
[0070] According to another preferred embodiment PBMC being
positive for IgG staining are determined.
[0071] According to another preferred embodiment PBMC being
positive for IgA staining are determined.
[0072] According to another preferred embodiment FcR positive to
any immunoglobulin staining is determined, such positive for IgG
staining and/or IgA staining.
[0073] According to another preferred embodiment the production of
O.sub.2.sup.- is determined.
[0074] According to another preferred embodiment down-regulation of
the .zeta.-chain of TCR is determined.
[0075] According to another, further preferred embodiment fine
needle biopsy TIMC (tumour infiltrating mononuclear cell) being
positive to immunoglobulins are determined.
[0076] According to another preferred embodiment fine needle biopsy
TIMC being positive to IgG are determined.
[0077] According to a further preferred embodiment fine needle
biopsy TIMC being positive to IgA are determined.
[0078] According to another preferred embodiment IL-1Ra is
determined.
[0079] According to another preferred embodiment down-regulation of
CD28 on CD4+ and/or CD8+ lymphocytes is determined.
[0080] According to another preferred embodiment down-regulation of
CD80 and/or CD86 is determined.
[0081] According to another preferred embodiment determination of
any other modulation of other immunoregulatory substances is
made.
[0082] According to another preferred embodiment the content of
IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, and/or TNF-.alpha., is
determined by using an assay, to determine the amount of an
inducing factor inducing IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, activity.
[0083] According to another preferred embodiment the assay utilises
any tissue and the determinations are made using any
immuno-cyto-histochemica- l method, any immunoassay including,
ELISA, Elispot, RIA and others any blotting technique, including
Western blotting, Southern blotting and others, any bioassay, any
tissue culture technique, RT-PCR, flow cytometry, cytometric bead
array, DNA microarray and/or proteomics.
[0084] According to another preferred embodiment dys-regulatory
mechanism substances in tissue from cancer patients, which
substances suppress the immune mediated systemic protection
resulting in establishment of micrometastases, are identified.
[0085] According to another preferred embodiment patients suffering
from potential risk are candidates for adjuvant treatment.
[0086] According to another preferred embodiment the invention
encompasses specific staining methods for IgG in PBMC or biopsies,
whereby a first method for determining IgG/IC complexes using a
staining, is characterized in that peripheral blood mononuclear
cells are separated by centrifugation and spun onto microscope
slides; the cells are pre-hydrated using Hank's balanced solution
and Hepes solution and human serum albumin, are fixed in
phosphate-buffered paraformaldehyde supplemented with glucose, are
incubated with biotinylated protein G, followed by incubation with
alkaline phosphatase-labelled streptavidin, are incubated in
alkaline phosphatase substrate in Tris buffer with
dimethylformamide, levamisole and Fast-Red TR salt, are
counterstained in Mayer's haematoxylin and mounted in Glycergel; or
alternatively, after fixation and a washing in Hank's balance
solution containing goat serum, the cells are blocked in goat serum
and are incubated with mouse anti-human IgG monoclonal antibody,
are incubated with Envision, are then incubated with the alkaline
phosphatase substrate, are then counterstained in Mayer's
haematoxylin and are mounted in Glycergel;
[0087] and a second method for determining IgG/IC complexes using a
staining, is characterized in that a tissue sample is fixed using
phosphate-buffered paraformaldehyde in the presence of glucose, is
treated with Hank's balanced solution and Hepes solution, incubated
with primary antibody, mouse IgG1 anti-human CD3, followed by
incubation with goat-anti-mouse immunoglobulin, followed by
incubation with PAP mouse monoclonal antibody; using
3,3'-Diaminobenzidine as a substrate resulting in a brown colour,
whereby the presence of IgG is then identified using biotinylated
protein G by incubation; followed by incubation with alkaline
phosphatase-labelled streptavidin followed by incubation with
alkaline phosphatase substrate, dimethylformamide, levamisole, and
Fast-Red salt, the cells are then counterstained in Mayer's
haematoxylin and mounted in Glycergel producing a a bright red
staining for IgG, whereby double-stained cells appeared as
red-brown
[0088] A further aspect of the invention includes a kit for
quantitative and/or qualitative analysis of amount of and/or
certain pattern of dys-regulatory factor and/or factors inducing
the production and/or activation of immunoregulatory substances,
whereby prognosis of cancer can be determined and the therapeutic
efficacy of any anti-cancer treatment can be predicted and
monitored, comprising an indicator for the presence of said
dys-regulatory factor/s including inducing factor/s.
[0089] According to another preferred embodiment the kit comprises
an indicator for the presence of any factor inducing
immunoregulatory substances, including cytokines, including
IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, and/or TNF-.alpha., and
others, activity.
[0090] According to another preferred embodiment the kit comprises
a nutrient for peripheral blood mononuclear cells and a determinant
for inducing factor for inducing immunoregulatory substances
including inducing factors of IL-1.beta., IL-1Ra, IL-6, IL-10,
IL-17, TNF-.alpha., and others.
[0091] According to another preferred embodiment it comprises a
urine dip stick comprising binding substance/s and/or colour
developing reagents.
[0092] According to another preferred embodiment the kit comprises
determinants for enzymatic degradation products of tumour
substances/extra cellular matrix, ECM.
[0093] According to another preferred embodiment a matrix
metalloproteinaseinhibitor is monitored.
[0094] According to another preferred embodiment the kit comprises
a determinant for dys-regulatory substances in tissue from cancer
patients, which substances suppress the immune mediated systemic
protection resulting in the establishment of micrometastases.
[0095] According to another preferred embodiment the amount of cell
bound immune complexes, CBIC, is determined.
[0096] A still further aspect of the invention includes use of at
least one regulatory mechanism controlling factor of at least one
immunoregulatory substance, including inducing factor of the
production or biological activity of immunoregulatory substances
including cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10,
IL-17, TNF-.alpha., and others, for the production of a
pharmaceutical preparation to be used for therapeutic control and
for minimisation of pathological production of immunosuppresive
immunoregulatory substances, including IL-1.beta., IL-1Ra, IL-6,
IL-10, IL-17, and/or TNF-.alpha., and others or to stimulate
production of immunosupportive immunoregulatory substances in a
patient suffering from a cancer and to enhance the efficacy and/or
possibility of therapeutic treatment of cancer or modulation of
dys-regulatory factors to enhance performance status.
[0097] According to another preferred embodiment a FcR modulating
agent is used in the manufacture of a pharmaceuticai preparation
for controlling immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17, and/or
TNF-.alpha., and others, production in a patient suffering from
cancer by therapeutically modulating FcR activity.
[0098] According to another preferred embodiment a FcR modulating
agent is used in the manufacture of a pharmaceutical preparation
for controlling immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, production in a patient suffering from
cancer is modulated by therapeutically blocking FcR/Fc.gamma.R
activity.
[0099] According to another preferred embodiment a FcR modulating
agent is used in the manufacture of a pharmaceutical preparation
for controlling immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, production in a patient suffering from
cancer is modulated by cross-linking FcR/Fc.gamma.R activity.
[0100] According to another preferred embodiment at least one
immunoglobulin, FcR antibodies or fragments of antibodies or
synthetic constructs including peptides directed to FcR is used in
the manufacture of a pharmaceutical preparation for blocking or
cross-linking FcR cross-linking.
[0101] According to another preferred embodiment an agent
modulating Fc.gamma.R I, Fc.gamma.R II and/or Fc.gamma.R III used
to stimulate IL-2 stimulation of clonal expansion of lymphocytes is
used in the manufacture of a pharmaceutical preparation.
[0102] According to another preferred embodiment FcR antibodies or
fragments of FcR antibodies directed to FcR is used in the
manufacture of a pharmaceutical preparation for blocking
cross-linking of FcR.
[0103] According to another preferred embodiment anti-Fc.gamma.R I,
Fc.gamma.R II and/or Fc.gamma.R III antibodies is used in the
manufacture of a pharmaceutical preparation for blocking of
Fc.gamma.R.
[0104] According to another preferred embodiment a compound being
able to down-regulate the expression of FcR is used in the
manufacture of a pharmaceutical preparation for down-regulating
FcR.
[0105] According to another preferred embodiment at least one
FcR-blocking substance minimising production of interleukin-1
receptor antagonist is used in the manufacture of a pharmaceutical
preparation for blocking the activity of interleukin-1.
[0106] According to another preferred embodiment at least one
FcR-modulating soluble receptor, fragment, peptide or synthetic
construct directed to the Fc-part of immunoglobulins is used in the
manufacture of a pharmaceutical preparation.
[0107] According to another preferred embodiment at least one
FcR-modulating enzyme inhibitor is used in the manufacture of a
pharmaceutical preparation.
[0108] According to another preferred embodiment at least one
FcR-inhibiting matrix metalloproteinase inhibitor is used in the
manufacture of a pharmaceutical preparation.
[0109] According to another preferred embodiment any compound
blocking production or biological activity of any factor inducing
pathological production of one or more cytokines is used in the
manufacture of a pharmaceutical preparation for blocking a factor
inducing pathological production of such cytokines.
[0110] According to another preferred embodiment any factor
inducing IL-6 production is used in the manufacture of a
pharmaceutical preparation for blocking a factor inducing
pathological production of such cytokine.
[0111] According to another preferred embodiment any factor
inducing IL-1.beta. production is used in the manufacture of a
pharmaceutical preparation for blocking a factor inducing
pathological production of such cytokine.
[0112] According to another preferred embodiment any factor
inducing IL-10 production is used in the manufacture of a
pharmaceutical preparation for blocking a factor inducing
pathological production of such cytokine.
[0113] According to another preferred embodiment any factor
inducing IL-17 production is used in the manufacture of a
pharmaceutical preparation for blocking a factor inducing
pathological production of such cytokine.
[0114] According to another preferred embodiment any factor
inducing TNF-.alpha. production is used in the manufacture of a
pharmaceutical preparation for blocking a factor inducing
pathological production of such cytokine.
[0115] According to another preferred embodiment any factor
inducing IL-1Ra production is used in the manufacture of a
pharmaceutical preparation for blocking a factor inducing
pathological production of such cytokine.
[0116] According to another preferred embodiment a compound having
the ability of inhibiting the activation and/or activity of enzymes
generating immunomodulatory fragments is used in the manufacture of
a pharmaceutical preparation for inhibiting the activation or
activity of enzymes generating immunomodulatory fragments.
[0117] According to another preferred embodiment antibodies
directed to enzymes generating immuno-modulatory fragments are used
in the manufacture of a pharmaceutical preparation.
[0118] According to another preferred embodiment at least one
monoclonal antibody, anti-integrin antibody, peptide and/or
synthetic construct thereof is used in the manufacture of a
pharmaceutical preparation.
[0119] A further aspect of the invention includes a pharmaceutical
composition comprising a regulatory mechanism controlling factor of
an inducing factor of the production or biological activity of
immunoregulatory substances including one or more cytokines, for
the production of a pharmaceutical preparation to be used for
therapeutically control and minimise pathological production of
immunosuppresive immunoregulatory substances including one or more
cytokine, or or to stimulate production of an immunosupportive
immunoregulatory substance in a patient suffering from a cancer to
enhance the efficacy and/or possibility of therapeutic treatment of
cancer, optionally in combination with therapeutically inert
additive to enhance performance status.
[0120] According to another preferred embodiment a FcR modulating
agent is present in a pharmaceutical preparation for controlling
immunoregulatory substances, including one or more cytokine
production in a patient suffering from cancer by therapeutically
modulating FcR activity.
[0121] According to another preferred embodiment a FcR modulating
agent is used in the manufacture of a pharmaceutical preparation
for controlling immunoregulatory substances, including one or more
cytokines, including IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
TNF-.alpha., and others, production in a patient suffering from
cancer is modulated by therapeutically blocking FcR/Fc.gamma.R
activity.
[0122] According to another preferred embodiment at least one
immunoglobulin, FcR antibodies or fragments of antibodies or
synthetic constructs including peptides directed to FcR is used in
the manufacture of a pharmaceutical preparation for blocking or
cross-linking FcR activity.
[0123] According to another preferred embodiment an agent
modulating Fc.gamma.R I, Fc.gamma.R II and/or Fc.gamma.R III is
present to stimulate IL-2 stimulation of clonal expansion of
lymphocytes.
[0124] According to another preferred embodiment anti-Fc.gamma.R I
antibodies is present in a pharmaceutical preparation for blocking
of Fc.gamma.R.
[0125] According to another preferred embodiment a compound being
able to down-regulate the expression of FcR is present in the
pharmaceutical preparation for down-regulating FcR.
[0126] According to another preferred embodiment at least one
FcR-blocking substance minimising production of interieukin-1
receptor antagonist is present in the pharmaceutical preparation
for blocking the activity of interleukin-1.
[0127] According to another preferred embodiment at least one
FcR-modulating soluble receptor is used.
[0128] According to another preferred embodiment at least one
FcR-modulating enzyme innibitor is used.
[0129] According to another preferred embodiment at least one
FcR-inhibiting matrix metalloproteinase inhibitor is used.
[0130] According to another preferred embodiment a compound having
the ability of inhibiting the activation of enzymes generating
immunomodulatory fragments is present in the pharmaceutical
preparation for inhibiting the activation of enzymes generating
immunomodulatory fragments.
[0131] According to another preferred embodiment any factor
inducing IL-6 production is used.
[0132] According to another preferred embodiment any factor
inducing IL-1.beta. production is used.
[0133] According to another preferred embodiment any factor
inducing IL-10 production is used.
[0134] According to another preferred embodiment any factor
inducing IL-17 production is used.
[0135] According to another preferred embodiment any factor
inducing TNF-.alpha. production is used.
[0136] According to another preferred embodiment any factor
inducing IL-1Ra production is used in the manufacture of a
pharmaceutical preparation for
[0137] According to another preferred embodiment a compound
blocking a factor inducing pathological production of
immunoregulatory substainces, including one or more cytokine
production is present in the pharmaceutical preparation for
blocking a factor inducing pathological production of such
immunoregulatory substances.
[0138] According to another preferred embodiment antibodies
directed to enzymes generating immuno-modulatory fragments are
present.
[0139] According to another preferred embodiment at least one
monoclonal antibody, anti-integrin antibody, peptide and/or
synthetic construct thereof, is used.
IMMUNOREGULATORY MECHANISMS OF RELEVANCE FOR THE PRESENT
INVENTION
[0140] Published data and the experimental results originally
presented below are compatible with dys-regulation of the immune
system in cancer patients described herein. Flow-chart 1 shows a
summary of the immunoregulatory mechanisms described in this
invention. Connections between FcR mediated and dysregulatory
factor mediated mechanisms are shown with Roman numericals.
[0141] There are two main categories of receptors through which IC
can modulate the immune system, receptors for the Fc-part of
immunoglobulins and complement receptors. IC can activate
complement and receptors for various complement factors are
expressed on different types of cells of the immune system.
However, large ICs are more complement activating than small ones,
which are more immunosuppressive. Thus, binding of complement
factors activated by ICs is not a major pathway for induction of
immunosuppression.
[0142] It has been demonstrated beyond any doubt that
Fc.quadrature.R binding (Geissmann et al., 2001; Wolf et al., 1996)
and cross-linking of Fc.gamma.R plays a major role in normal immune
regulation. (Gessner et al., 1998; Deo et al., 1997; Lin et al.,
2001; Ravetch and Bollag, 2001). These receptors can be either
stimulatory or inhibitory and their cross-linking modulates the
production of a large number of cytokines by peripheral blood
mononuclear cells (PBMC).
[0143] Immune complexes, ICs, can influence the activity of various
types of cells of the immune system. The effect is highly dependent
on the type of cell, which is involved and the characteristics of
the immune complexes. In particular the size and whether the immune
cells are exposed to soluble or solid phase IC seems to be of
importance. Immunocomplexes can be either immunostimulatory or
inhibitory depending on their sizes and interaction with different
FcRs on immune cells. Large ICs have been demonstrated to be
stimulatory whereby small complexes in antigen excess have been
demonstrated to be inhibitory to mitogen induced proliferation
(e.g. Gupta and Morton, 1981). It has been demonstrated that there
is a correlation between the tumour burden and the
immunosuppressive activity of immune complexes.
[0144] Serum blocking factors (SBRs) play a major role in
immunosuppression in cancer. They have been shown to inhibit both
cytotoxic and proliferative activity of lymphocytes from cancer
patients (Baldwin, 1976; Bansal et al., 1976; Hellstrbm and
Hellstrom, 1974). SBRs were demonstrated to be immunocomplexes
(ICs), as their inhibitory activity was lost after dissociation at
low pH, but reappeared after reconstitution at neutral pH (Sjogren
et al.,1971). Tumour associated antigens can frequently be bound in
IC (Kirkwood and Vlock, 1984; Vlock and Kirkwood, 1985). Removal of
ICs from cancer patient sera, using protein A, also reduced the
inhibitory effect of these sera.
[0145] Data on the prognostic significance of circulating
immunocomplexes (CICs) in cancer are somewhat conflicting. In some
reports a good correlation to the tumour stage and prognosis has
been demonstrated, whereby in others no such correlation was
discovered. Based on the results herein this is hardly surprising.
The methods used to determine CIC were quite unspecific and were
developed to measure only circulating IC. ICs are bound to a large
number of cell receptors and the modulatory function of the ICs is
mediated via these receptors. It is therefore highly reasonable
that ICs are bound to these receptors and that there will be no
circulating IC until the receptors are saturated. Thus, cell bound
IC will have a profound influence on the function of receptor
bearing cells even in the absence of CICs.
[0146] Th1 helper cells are considered to support the development
of cytotoxic activity against the tumour. In malignant tumours,
however, a predominance of Th2 over Th1 helper cells has been
demonstrated repeatedly. Cross-linking of Fc.gamma.Rs is of
importance also for this diversion of the immune system, as
cross-linking induces production of PEG2 (e.g. Berger et al. 1996),
which favours a Th2 situation with production of IL-4, IL-10, etc.
IL-4 then inhibits the immune reactivity to the tumour partly by
down-regulating monokine production in general, but also by
stimulating the production of IL-1Ra . Further, IL-4 stimulates the
expression of the inhibitory Fc.gamma.R II, CD32b, and inhibits
expression of the stimulatory receptor CD32a (Pricop et al., 2001).
Thus blockade of the Fc.gamma.R mediated triggering of the Th2
predominance in malignant tumours would certainly improve the
immune reactivity to the tumour.
[0147] Cross-linking of Fc.gamma.R by IC can result in activation
or inhibition. The latter can be mediated in several ways:
[0148] expression of B7 on monocytes, necessary for co-stimulation
in activation of T-cells, is down-regulated;
[0149] increased production of pro-inflammatory monokines,
IL-1.beta., IL-6, TNF-.alpha. by monocytes;
[0150] production by monocytes of various substances inhibiting the
immune reactivity, e.g., PGE.sub.2, TGF-.beta., sTNF-.alpha.R, and
IL-1Ra;
[0151] oxidative burst of O.sub.2.sup.- radicals, resulting in
down-regulation of the .zeta.-chain of the T-cell receptor;
[0152] down-regulation of IL-12;
[0153] production of interleukin-1 receptor antagonist (IL-1Ra),
which blocks the activity of interleukin-1, necessary for
immunostimulation, and expression of endothelial adhesion
molecules, necessary for recruitment of inflammatory/immune
effector cells to the tumours;
[0154] modulation of endothelial cell function.
[0155] Despite that these facts have been known for a very long
period of time, it has so far not been suggested that modulation of
FcRs/Fc.gamma.Rs is a very attractive therapeutic principle for
treatment of the immune system in cancer patients in order that
FcR/Fc.gamma.R mediated immunosuppression is relieved, and the
therapeutic efficacy can be significantly improved.
[0156] In the present invention, interleukin-2 (IL-2) stimulated
proliferation of PBMC and IL-1Ra production and was chosen as
relevant markers for Fc.gamma.R mediated
immunostimulation/suppression.
[0157] It is shown below, that solid phase IgG (mimicking large
ICs) together with IL-2 results in a significantly increased
proliferative response to PBMCs from healthy individuals, as well
as cancer patients compared to cultures where solid phase binding
was blocked by pre-incubation with human serum albumin (HSA). This
effect is most clearly shown when the culture plates were
pre-coated with HSA/IgG allowing a high degree of cross-iinking of
Fc.gamma.R. The proliferative response to IL-2 could be normalised
in cancer patients (compared to controls) using this technique. A
stimulatory effect of solid phase IgG was also seen when IgG from
serum in the culture medium is allowed to bind to the surface of
culture wells. This effect is very clear in cultures of PBMCs from
healthy individuals but in about 50% of the cancer patients this
stimulation is lost. This stimulatory effect in healthy individuals
can be inhibited by adding serum from cancer patients to the
culture medium. The mechanism for increased proliferative response
to IL-2 in the presence of Fc.gamma.R cross-linking is reasonably
due to an increased production of supportive cytokines.
[0158] In this model blockade of Fc.gamma.R I (CD64), II (CD32),
and III (CD16) with F(ab ')2 fragments of monoclonal antibodies
directed to these receptors showed that the enhanced proliferative
response was inhibited mainly by anti-Fc.gamma.R I antibodies.
These F(ab ')2 fragments thus block the receptors in a way similar
to that of small immunocomplexes, ICs.
[0159] An immunoregulatory role of CD64 has been demonstrated by
(Sutterwala et al., 1998; Szabo et al., 1990 and 1991). The
mechanism for the inhibitory effect of anti-CD64 F(ab ')2 fragment
as described below in cultures on solid phase IgG is presumably due
to a difference in affinity of the F(ab')2 fragment and the Fc-part
of IgG. A higher affinity of the antibody to the receptor will
allow blockade of the receptor despite the competition with solid
phase IgG. However, if the immunosuppression of PBMC from cancer
patients (low proliferative response to IL-2) is due to Fc.gamma.R
blockade by IC, this can actually be overcome by culturing patient
PBMC together with IL-2 on solid phase IgG, that is cross-linking
of a few Fc.gamma.R, will be substituted for by a larger number of
Fc.gamma.Rs resulting in stimulation.
[0160] Based on these considerations one inhibitory mechanism,
blockade of Fc.gamma.R I, can be overcome by providing more
extensive cross-linking similar to what is achieved in cultures
with solid phase IgG.
[0161] The immunomodulatory role of cross-linking of Fc.gamma.R by
solid phase IgG has furthermore been shown by analysing cytokine
production in short term cultures of PBMCs with solid phase bound
IgG, which in healthy individuals inhibited the production of IL-6.
Similarly, in PBMC cultures from both cancer patients and healthy
individuals (less frequently) the production of IL-6, IL-1.beta. as
well as TNF-.alpha. were frequently markedly increased when binding
of serum IgG was blocked by pre-incubation of the culture wells
with HSA. In accordance with these results the production of
IL-1Ra, which is induced by IC or solid phase IgG, was reduced in
cultures where solid phase binding of IgG was blocked by
pre-incubation with HSA.
[0162] Interleukin-1 (IL-1) plays a fundamental role for the
initiation of an immune response. However, in order to avoid an
over-reactivity of the immune system, there are several ways, in
which the immunostimulatory activity of IL-1 can be kept under
control, e.g., soluble IL-1 receptors, and IL-1 receptor antagonist
(IL-1Ra), a very potent inhibitor of IL-1 mediated activity (Arend
et al., 1998; Dinarello, 1997). The inhibitory role of IL-1Ra has
been clearly demonstrated in studies on autoimmune diseases and
rejection after allogen organ transplantation.
[0163] The most potent inducer of IL-1Ra is IC. As demonstrated
below the production of IL-1Ra is significantly increased by PBMCs
isolated from cancer patients. Thus, cell bound immuno-complexes
(CBICs), have been demonstrated to be involved in the
dys-regulation of the immune system in cancer patients.
[0164] IL-1Ra obviously plays a central role in down-regulation of
immune reactivity. As demonstrated here it is frequently expressed
in large areas of malignant tumours. This finding is highly
compatible with the occurrence of tissue bound IgG in the tumours
as IC or solid phase IgG are the most potent inducers of this
cytokine.
[0165] Thus two inhibitory mechanisms based on modulation of
Fc.gamma.R will be shown below, viz. blockade of Fc.gamma.R, which
inhibits IL-2 stimulation of clonal expansion of lymphocytes, and
induction of the inhibitory cytokine IL-1Ra. In addition, a more
extensive cross-linking of Fc.gamma.R results in normalisation of
the suppressed IL-2 induced proliferation in cancer patients.
[0166] As pointed out below a large number therapeutic strategies
can be used to avoid this type of down-regulation (Bowles et al.,
1997; Fridman et al., 1993). It is demonstrated herein that
blocking Fc.gamma.R II (CD32) by a monoclonal F(ab)-fragment
significantly reduces the production of IL-1Ra. An alternative
therapeutic option is to inhibit the intra-tumoural protease
activity, which is known to enhance the efficacy of Fc.gamma.R II
interaction (Isashi et al., 1998; van derWinkel et al., 1989).
[0167] Thus, the inhibitory effect due to binding of IC to
Fc.gamma.R can be treated using various techniques, e.g. by
blocking the inhibitory receptors (see below), by down-modulating
the sensitivity of receptors by protease inhibitors or by
overcoming the inhibitory effects using more competitive
binders/more extensive cross-linking of the receptors. These
strategies will be the base for efficient, new therapeutic
strategies to overcome immunosuppression in cancer patients.
[0168] An increased serum concentration of IL-6 is often found in
cancer patients, especially in patients with advanced disease
(Barton, 2001; Blay et al., 1992; Blay et al., 1997; Gadducci et
al., 2001; Walther et al., 1998). The source of serum IL-6 is still
somewhat unclear and it is generally assumed to be derived from the
tumour. It is shown herein that this cytokine is produced in large
amounts, in short term cultures, by PBMCs from cancer patients and
to a much lesser extent, or not at all, by unstimulated PBMCs from
healthy individuals. A high serum concentration of IL-6 is
generally related to a paraneoplastic syndrome, poor response to
immunotherapy and some types of chemotherapy, as well as a poor
prognosis.
[0169] It is shown that large amounts of IL-6 is produced by PBMCs
from about 50% of the cancer patients, as shown in malignant
melanoma, renal cell carcinoma, and colorectal cancer. An increased
production of IL-6 is also found in patients with only a minimal
tumour burden, as about 50% of the patients with radically resected
stage III melanoma have a significantly increased production of
IL-6.
[0170] IL-6 is a pleiotropic cytokine, which acts as an autocrine
growth factor in for example renal cell carcinoma and multiple
myeloma. It promotes the inflammatory response, induces acute phase
reactants as well as IL-1Ra and is involved in the detrimental
chronic inflammatory reaction in patients with malignant tumours.
It is thus a good marker for dysregulation of the immune system in
cancer patients and the paraneoplastic syndrome.
[0171] Production of IL-6 can be induced in various ways, e.g., by
IL-1.beta., and TNF-.alpha., and under certain circumstances also
by cross-linking of FcR/Fc.gamma.R. The degree of cross-linking is
of importance for the regulatory effect on the production of IL-6.
As shown below, the degree of cross-linking achieved by solid phase
binding of serum IgG (from a culture medium) inhibits production of
IL-6, as pre-coating the culture wells with HSA (thereby blockIng
the binding of IgG) results in a significantly higher production of
IL-6 in about 30% of cancer patients with various diagnoses.
Similarly, IL-6 production was significantly inhibited in cultures
of PBMCs from healthy individuals when the culture wells were
coated with IgG instead of HSA alone.
[0172] The mechanism by which isolated PBMCs continue to produce
IL-6 in vitro has so far been unresolved. It is shown herein that
serum from cancer patients added to PBMCs from healthy individuals,
who by themselves do not produce IL-6, induce the production of
large amounts of IL-6. As Fc.gamma.R cross-linking modulates the
production of IL-6, sera known to induce this cytokine, were
adsorbed by a surplus of protein-G Sepharose to remove all IgG.
These adsorbed sera still induced the production of IL-6 even to a
greater extent than before adsorption. These results are compatible
with that described herein, that is, a reduced interaction of IgG
with PBMCs increase IL-6 production. This IL-6 inducing factor has
been further characterised by fractionated ultrafiltration, which
demonstrates a factor having a molecular weight of less than 50 kD.
This factor has also been identified in the urine from cancer
patients. The source of this factor was studied and various tumours
were minced and extracted with physiological buffers. An IL-6
inducing factor, IL-6IF, is identified in about 60% of the analysed
tumours. Similarly, an IL-6 inducing activity has been found in
culture conditioned media from squamous cell carcinoma cell lines
from the oral cavity.
[0173] Thus this factor, IL-6IF, which has been found in serum and
urine, seems to be produced intratumourally. It is neither
IL-1.beta., TNF-.alpha. or interleukin-17, as these cytokines could
not be found in fractions inducing IL-6.
[0174] The identification of IL-6IF in the urine opens interesting
diagnostic possibilities. Based on the urine concentration of
IL-6IF a simple diagnostic test can be developed which will give
essential information about prognosis and the likelihood of
therapeutic success, in particular for treatment where IL-6 is
related to a poor response rate. This test will of course also be
extremely valuable when it comes to treatment strategies dealing
with the elimination of IL-6IF/treatment of the chronic
inflammatory reaction in cancer patients.
[0175] Similar to the situation with IL-6 we have also found
inducing activity for TNF-.alpha. IL-1.beta. and IL-10 in serum and
ultra-filtered urine. The number of inducing factors is for the
moment unknown but TNF-.alpha. inducing activity was found in
samples not inducing IL-6. Thus, reasonably several inducing
factors are involved in dysregulation of the immune system in
cancer.
[0176] The immunosuppressor factor in trauma patients (Easter et
al., 1988; Hoyt et al., 1988) was also found to inhibit migration
of inflammatory cells. This mechanism might be of importance in
immunosuppression in cancer as in untreated patients, inflammatory
cells recruited to the tumour generally are found in the stromal
areas surrounding the tumour nodules presumably because of
inhibition of their migration close to the tumour cells. As
fibronectin is of importance for migration it can be envisioned
that if the cell receptors normally binding to fibronectin or other
ECM-substances in the migration process are blocked by fragments of
these substances the cells will no longer be able to migrate. In
this context the phenomenon of leukocyte adherence inhibition is of
interest as PBMCs from cancer patients under certain conditions
demonstrate a highly reduced ability to adhere to plastic or glass
surfaces.
[0177] IL-6 has by others been shown to be an inducer of IL-1Ra.
However, in the present work based on the available malignant
melanoma and renal cell carcinoma materials no correlation between
IL-6 and IL-1Ra has been found rather the contrary. Fc.gamma.R
cross-linking inhibits production of IL-6 as shown herein and
stimulates IL-1Ra production.
[0178] The role of IL-6IF containing sera in the immunoregulation
in cancer is demonstrated by its effect on the proliferative
response to IL-2. The type of solid phase IgG binding is obviously
of importance for the effect of IL-2. Coating the wells with
purified IgG mixed with HSA gives a more powerful stimulatory
signal than binding of serum IgG from the culture medium (uncoated
cultures). There is thus a marked difference in the proliferative
rate in uncoated cultures and HSA coated cultures with a higher
proliferative activity in the presence of solid phase IgG. This
difference can be inhibited by sera containing IL-6IF, either by
interfering with stimulatory mechanisms or by modulating monocytes
to increased production of inhibitors, such as PGE.sub.2 or IL-1Ra.
The inhibitory effect has not been shown in IgG coated cultures,
probably because the more forceful effect on the proliferative
response to IL-2 under the conditions used.
[0179] The importance of serum factors/soluble factors in
dysregulation of the immune system in cancer is furthermore shown
by the concomitant immunity phenomenon, which means that immune
mediated anti-tumour reactivity can be suppressed in the primary
tumour allowing local progression of this tumour while there is
still a systemic protection against distant metastases (North,
1985). When, however, the tumour burden is increasing the systemic
protection will break down. According to the concept described in
this document there will at a certain tumour burden and/or a
certain intra-tumoural enzymatic activity be a sufficient systemic
concentration of suppressor substances to suppress the immune
mediated systemic protection resulting in the establishment of
micro-metastases. Thus, by analysing these dysregulatory substances
in serum or urine from cancer patients, the patients at high risk
of systemic mlcro-metastases can be identified and these patients
are those who should be offered adjuvant treatment.
[0180] Matrixmetalloproteases (MMPs), frequently found in tumour
tissue, can be induced by inflammatory cytokines and are of
importance for degradation of extra cellular matrix proteins
(ECMs). This activity is considered to be a pre-requisite for
metastatic spread, and neo-angiogenesis. Occurrence of MMPs has, in
several studies been shown to correlate to a poor prognosis.
Obviously, the proteolytic activity of MMPs will result in various
types of degradation products, some of which are known to modulate
angiogenesis and the activity of chemokines. The low molecular
weight fraction, IL-6IF, described herein can be a proteolytic
fragment. The presence of the factor in tumour extracts and in
culture conditioned media from squamous cell carcinoma cell lines
from the oral cavity suggests this origin. It has also been shown
in a large number of studies by others that culture conditioned
media contain immunomodulatory/immunosuppressive factors (e.g.
Mntrier-Caux et al., 1999; Heimdal et al., 2000; Heimdal et al.,
2001). A similar factor with immunosuppressor activity, supposed to
be derived from proteolytic degradation of serum fibronectin, has
been described in trauma patients (Easter et al., 1988; Hoyt et
al., 1988). Factors derived from enzymatic degradation of ECM can
most likely be both stimulatory and inhibitory as various cytokine
patterns have been induced by various fibronectin fragments
(Beezhold and Personius, 1992 ; Lpez-Moratlla et al., 1995;
Takizawa et al., 1995) and also it was recently demonstrated that
the expression of various MMPs in malignant melanoma was related to
therapeutic response and prognosis (Nikkola et al., 2001).
[0181] The generally found immunosuppressive effect of malignant
tumours can thus very well be due to the increased
enzymatic/proteolytic activity of the turnours resulting in various
immunomoduiatory fragments/fragments of ECM or other tumour
substances. In addition to this, the proteolytic activity can also
explain the frequent occurrence of a large number of soluble
factors of importance for immune reactivity in cancer patients
(Salih et al., 2001; Sheu et al., 2001), e.g. sIL-2 receptor,
sTNF-.alpha. receptors, sCD8, sCD4, sICAM-1, sMHC I, sFcR etc.
Intra-tumoural enzymatic activity also seems to be of importance
for activtion of pro-TGF-.beta. to active TGF-.beta. (Huber et al.,
1992). Based on these considerations intra-tumoural proteolytic
activity seems to be a fundamental mechanism by which the malignant
tumour manage to divert the tumour bearers defence to the
disease.
[0182] The occurrence of proteolytic fragments of ECM in serum and
urine from cancer patients (Katayama et al., 1993) also opens the
possibility to identify various types of fragments and analyse
their prognostic significance. Furthermore, the therapeutic
efficacy of matrixmetalloprotease inhibitors (MMPIs) resulting in a
reduction/inhibition of the production of fragments of certain
importance can be determined by analysing the amount of these
fragments in serum or urine. Determination of these fragments will
thus be proper surrogate endpoints for MMPI therapy and have the
potential to significantly increase the therapeutic activity of
these drugs by allowing monitoring whereby efficacious dose
schedules can be developed.
[0183] Dysregulation of the immune system by enzymatic/proteolytic
fragments from various tumour substances (derived from tumour
tissue or plasma proteins) has so far not been described. A large
number of inhibitory as well as stimulatory fragments can be
produced as a result of the intra-tumoural enzymatic activity. This
provides for a new understanding of immunosuppression in cancer
patients and new therapeutic possibilities based on proper
diagnostic tests.
[0184] All together the data of this invention demonstrate
mechanisms whereby dysregulatory factors give rise to a
pathological production of proteolytic enzymes and inflammatory
cytokines, which also induce the production of proteolytic enzymes
by tumour cells, the activity of these enzymes results in an
enhanced release of dysregulatory factors, which then further
enhance the production of inflammatory cytokines and proteolytic
enzymes, thus creating an autocrine loop. The end result of this
loop will then be proteolytic enzymes, which will promote
angiogenesis and the metastasising potential and divert the immune
reactivity to the tumour.
[0185] The dysregulatory inducing factors were further
characterised by using 2D-gel electrophoresis and identified after
fragmentation using masspectrometry and N-terminal sequence
analysis (proteomics technique). The low molecular weight fraction
(<30 kD) from urine was analysed by comparing samples from
normal healthy controls with samples from patients; by comparing
urine samples with and without IL-6 inducing activity; by comparing
samples adsorbed and not adsorbed with a surplus of normal PBMCs
(responding to IL-6IF). Several proteins/fragments of potential
immunoregulatory activity were thereby identified as described
below, e.g. fragments of .beta.2-microglobulin, serum albumin and
immunoglobulin.
[0186] As these fragments were identified based on their adsorption
to PBMCs, demonstrating a high degree of binding, the occurrence of
receptors for these protein fragments/peptides on normal PBMCs
sensitive to IL-6IF can be postulated. As albumin and
.beta.2-microglobulin do not normally bind to these cells, it can
be further postulated that fragmentation of these proteins results
in conformational changes exposing new structures with a specific
binding to receptors on PBMCs. As demonstrated herein. this results
in modulation of the immune system. Thus, the basis for a quite new
mechanism of immunomodulation in diseases characterised by a high
proteolytic activity, e.g. inflammation and cancer, has been
discovered.
[0187] Based on identification of IgG and albumin fragments when
2-D gels were compared as described above, these proteins were
incubated with MMPs under well-defined conditions. IL-6 inducing
activity was found in the supernatants after incubation with MMPs
in two different fragmentation buffers. Inducing activity was
analysed in cultures with normal PBMCs. In particular incubation of
albumin with MMP-1, -2, -3, -13 and incubation of IgG with MMP-2,
-3, -7, -13 released IL-6 inducing/modulating activity. Degradation
of IgG by MMPs has previously been described (Gearing et al., 2002)
and it was suggested that IgG fragments possibly could have a
modulatory activity on antibody dependent cellular cytotoxicity
(ADCC), but the possibility that these fragments have an
immunoregulatory activity in cancer has to our knowledge never been
suggested.
[0188] In an other experiment, fragments of an extra cellular
matrix substance, collagen, was found to have a strong inhibitory
effect on IL-2 induced proliferation.
[0189] It has been described herein described that IL-6IF can be
extracted from malignant tumours, e.g. malignant melanoma, renal
cell carcinoma, colorectal cancer. These results were confirmed in
a new series of experiments, where homogenised tumours were washed
three times in PBS or RPMI in order to collect cytokine inducing
factors already present in the tumours, so called "preformed
inducing factors" (PIF).
[0190] The tumour sections/homogenates (after being thoroughly
washed) were incubated for 24 hours at 37.degree. C. together with
MMP-2. IL-6 inducing activity could then be demonstrated in of
supernatants from several tumours.
[0191] Potentially a large number of proteolytic enzymes can be
involved in degradation of various tumour substances, therefore
adding possible substrates to homogenised, washed tumour tissue
might enhance the production of immunoregulatory factors/fragments.
In order to further explore the nature of immunomodulating
substances/fragments in tumours and based on the observation,
mentioned above, that fragments of albumin, IgG and
.beta.2-microglobulin efficiently binds to normal PBMCs, we added
albumin or IgG to thoroughly washed tumour sections/homogenates and
incubated for 24 h at 37.degree. C. It was then found that addition
of IgG and in particular albumin markedly increased the production
of IL-6IF as determined in PBMC cultures. Control experiments
showed that the enhanced IL-6 inducing activity was not due to any
protective activity of the added proteins. Thus it is herein
demonstrated that immunomodulating IgG and albumin fragments are
produced in the intra-tumoural milieu
[0192] Based on our previous results it might seem amazing that
incubation of PBMCs with IgG fragments results in an increased
production of IL-6 as pre-coating of culture plates with IgG from
serum or an albumin/IgG mixture inhibited IL-6 production. A
reasonable explanation to this effect is that the IgG fragments
produced by proteolytic degradation manage to block the inhibitory
effect of natural IgG. This opens up further interesting
possibilities to modulate FcR mediated immune regulation.
[0193] Further analyses of PIF-fractions by isoelectric focusing
and preparative electrophoresis have identified two fractions with
IL-6 inducing activity, with different pI. Preparative
electrophoresis also identified two fractions, of different
moiecuiar weight, with activity.
[0194] Conclusions
[0195] Factors dys-regulating the immune system in cancer patients
were found in tumour tissue, conditioned culture media from cancer
cell lines, serum and urine.
[0196] Control of the intra-tumoural enzymatic/proteolytic activity
is thus a fundamental mechanism to control the malignant tumour
management of diverting the immune mediated defence system of the
tumour bearer against the disease.
[0197] Thus both Fc.gamma.R cross-linking and dysregulatory
inducing factors (ECM enzymatic/proteolytic fragments) play a
fundamental role in immunosuppression in cancer patients.
Therapeutic control of these dys-regulatory mechanisms will thus
improve quality of life, therapeutic response and increased
over-all survival.
[0198] As IL-6 is only one product of the dys-regulated
inflammatory reaction mentioned herein and often is correlated to
production of other cytokines such as IL-1 and TNF-.alpha.; the
strategy is to block the fundamental dys-regulatory mechanisms in
order to down-regulate the detrimental chronic inflammatory
reaction.
[0199] The present invention is thus not based on suppression of
the activity of e.g., IL-1.beta., IL-1Ra, IL-6, IL-10, IL-17,
and/or TNF-.alpha., and others, but to prevent or minimise their
production.
[0200] Definitions
[0201] In the present description the term "tissue" shall be
understood to encompass whole blood, serum, plasma, lymphatic
fluid, saliva, urine, faeces, ascites, pleural effusion, pus, as
well as any tissue, as such including inflammatory cells.
[0202] In the present description the term cancer means: Any new
and abnormal growth, specifically a new growth of tissue in which
the growth is uncontrolled and progressive.
[0203] Therapeutic Possibilities to Improve Immune Reactivity in
Cancer by Modulation of FcRs
[0204] By modulation of FcR either relief of immunosuppression or
an enhanced immune activation can be achieved as demonstrated in
the present document. Several substances can be used to block FcRs
e.g. antibodies or fragments thereof (e.g. F(ab').sub.2 or
Fab-fragments, of Mab directed to Fc.gamma.R) , peptides (e.g. from
the Fc-part of IgG) or synthetic constructs. The interaction
between receptor binding ligands and the receptor can also be
achieved by blocking the binding site of the ligand by using,
soluble FcRs (recombinant) or peptides or synthetic constructs with
a specific high binding affinity. Finally, the signal transduction
resulting from ligand binding to FcRs can be inhibited by signal
transduction inhibitors. In addition to these modes of interfering
with FcRs, their reactivity is influenced by proteolytic activity
and can thus be modulated by protease inhibitors. In this context
MMPIs can be of special interest.
[0205] Alternatively the ligands of FcRs, immunoglobulins or
complexed immunoglobulins, can be eliminated and their
immunosuppressive activity can thereby be avoided. Recombinant FcRs
or synthetic constructs with this reactivity of proper affinity and
size can be administered in order that CIC (especially small CICs)
are bound and eliminated. To further enhance the elimination of
CICs binders of these substances can be linked to small
microspheres (less than 3-5 mm if diameter, possibly degradable)
which are rapidly taken up by the reticulendothelial
system/monocyte macrophage phagocyte system.
[0206] Another therapeutic possibility is to reduce the number of
FcRs which can have a negative effect of the immune reactivity to
the malignant tumour, e.g. by increasing their shedding or by
down-regulation of their expression.
[0207] An alternative to block FcRs, which result in
down-regulation of the immune reactivity, can, as has been
demonstrated in this document, be to cross-link FcRs in order to
overcome immunosuppression. Several possibilities can be used for
this pupose, e.g. complexed immunoglobulines/monoclonal antibodies
or fragments (Fc) thereof binding to the receptors or synthetic
FcR-binding constructs, cross-linking FcR to a degree (number of
FcRs of one or several types) achieving optimal immune
activation.
[0208] Therapeutic Possibilities to Improve Immune Reactivity in
Cancer by Controlling Dys-Regulatory Inducing Factors.
[0209] Inhibition of the fragment's biological activity (e.g. by
monoclonal antibodies or fragments or synthetic constructs binding
to and inhibiting the biologic activity of the fragments, synthetic
constructs binding to the receptors mediating the biologic effect
of the fragments, blockade of the receptors on immune cells,
protein fragments/peptides interfering with the receptor
interaction of the fragments and thereby inhibiting the biological
activity of the fragments.); Elimination of the fragments from the
body (e.g. by monoclonal antibodies (or fragments) or other
"binders" binding to and eliminating the fragments); Signal
transduction inhibitors, blocking the effect of receptor binding;
Blocking the activity of the "dysregulated signal
substances/cytokines.
[0210] If these factors are generated by enzymatic activity
resulting in release of immunomodulatory fragments, the following
therapeutic possibilities can be envisioned: Inhibition of the
production and activation of the relevant enzymes (e.g. by
anti-integrin antibodies or suitable peptides); Inhibition of these
enzyme activities (e.g. by low molecular weight inhibitors,
monoclonal antibodies or peptides);
[0211] Materials and Methods
[0212] Cytospin preparations for immunocytological demonstration of
IgG Peripheral blood mononuclear cells (PBMC) were separated as
described below and immediately spun down on pre-cleaned microscope
slides in a Shandon Cytospin (Shandon Scientific Ltd, UK) at 1000
RPM for 7 min using 100 .mu.l of the PBMC suspension at
5.times.10.sup.5/ml. The slides were left to dry at room
temperature over night, were then wrapped in parafilm and stored
-70.degree. C. until further processed. The cells were pre-hydrated
in BSS-HSA (Hank's balanced salt solution (BSS, Gibco BRL, UK)
supplemented with 0.01M. Hepes solution and 1% human serum albumin
(HSA, Pharmacia&Upjohn,SE), for 15 minutes, fixed in
phosphate-buffered 4% paraformaldehyde (PFA, Riedel-de Haen Ag,
Germany) supplemented with 5.4 g./l. of glucose for 5 minutes and
then washed three times in BSS-HSA, incubated with biotinylated
protein G (Sigma Chemical Co, US) at 50 .mu.g/ml for 30 minutes,
washed in BSS-HSA followed by incubation with alkaline
phosphatase-labelled streptavidin (Dakopatts AB, SE) at a {fraction
(1/100)} dilution in BSS-HSA for 30 minutes. After washes in Tris
buffered saline (TBS) and incubation for 20 minutes in alkaline
phosphatase substrate consisiting of Naphtol AS-MX Phosphate
(Sigma) in 0.1 M Tris buffer with Dimethylformamide, 1 M Levamisole
(Sigma) and Fast-Red TR salt (Sigma), the sections were again
washed in TBS. They were then counterstained in Mayer's
haematoxylin for 1 minute and mounted in Glycergel (Dakopatts AB).
All incubations were performed in a moist chamber and all antibody
and protein-G solutions were prepared in BSS-HSA. Alternatively,
after fixation and washing in BBS containing 2% goat serum, the
cells were blocked in 10% goat serum for 20 minutes and incubated
with mouse anti-human IgG monoclonal antibody (Nordic Immunology)
at 1 or 10 .mu.g/ml, washed in BSS containing 2% goat serum,
incubated with Envision (Dakopatts AB, SE) for 30 minutes, washed
in TBS and incubated with the alkaline phosphatase substrate for 20
minutes after which the sections were again washed in TBS. They
were then counterstained in Mayer s haematoxylin for 1 minute and
mounted in Glycergel (Dakopatts AB,SE). All incubations were
performed in a moist chamber and all antibody solutions contained
2% normal goat serum.
[0213] Preparation of tumour biopsies and immunological staining of
tissue sections for IgG
[0214] Biopsies from the resected metastases were immediately snap
frozen and stored at -700C until further processed. Frozen tissue
sections, 6-7 .mu.m thick, were fixed with 4% PFA for 5 minutes and
then washed three times in BSS-HSA. For double-staining, sections
were incubated with primary antibody, mouse IgGl anti-human CD3
(Dakopatts AB), at 1 .mu.g/ml for 30 minutes, washed in BSS-HSA
followed by incubation with goat-anti-mouse immunoglobulin
(Dakopatts AB, SE) at a {fraction (1/25)} dilution in BSS-HSA.
Monoclonal mouse IgG1 against an irrelevant antigen (Dakopatts AB,
SE) was used as a negative control. The sections were then
incubated with PAP mouse monoclonal antibody (Dakopatts AB, SE) at
a {fraction (1/25)} dilution in BSS-HSA for 30 minutes.
3,3'-Diaminobenzidine (DAB, Sigma) was used as a substrate, which
resulted in a brown colour. The presence of IgG was then identified
using 1 or 10 .mu.g/ml biotinylated protein G (Sigma) which was
incubated for 30 minutes, washed in BSS-HSA, followed by incubation
with alkaline phosphatase-labelled streptavidin (Dakopatts AB, SE)
at a {fraction (1/100)} dilution in BSS-HSA for 30 minutes. After
washes in TBS and incubation with alkaline phosphatase substrate
for 20 minutes, the sections were again washed in TBS. They were
then counterstained in Mayer's haematoxylin for 1 minute and
mounted in Glycergel (Dakopatts AB, SE). All incubations were
performed in a moist chamber and all antibody and protein-G
solutions were prepared in BSS-HSA. The alkaline phosphatase
staining resulted in a bright red staining for IgG. Double-stained
cells appeared as red-brown.
[0215] Preparation of tumour biopsies and immunological staining of
tissue sections for interleukin-1 receptor antagonist (IL.1Ra).
Paraffin sections, 6-7 .mu.m thick, were de-paraffinised by cooking
in a pressure cooker in BSS with 0.01 M Hepes solution and 1%
saponin (Sigma) (BSS-saponin) for 6 minutes. The sections were
first blocked with 10% normal human AB-serum before staining and
were then incubated with biotinylated goat IgG antibodies directed
either to interleukin-la or interleukin-1 receptor antagonist (both
from R&D Systems, UK) at 10 .mu.g/ml over night, washed in
BSS-saponin, incubated with alkaline phosphatase-labelled
streptavidin (DAKO, SE) at a {fraction (1/100)} dilution in
BSS-saponin containing 2% human AB-serum for 30 minutes. After
washes in TBS and incubation with the alkaline phosphatase
substrate for 20 minutes, the sections were again washed in TBS and
were then counterstained in Mayer s haematoxylin for 1 minute and
mounted in Glycergel (Dakopatts, Sweden). All incubations were
performed in a moist chamber and all immunoglobulin solutions were
prepared in BSS-saponin containing 2% human AB-serum. Staining for
interleukin-la was used as a negative control in this context.
[0216] Preparation of peripheral blood mononuclear cells (PBMC)
Venous blood was drawn from healthy volunteers or from cancer
patients in glass vacuum tubes with acid dextrose citrate solution
A as an anti-coagulant (Vacutainer, Becton & Dickinson, N.J.).
Erythrocytes were removed by sedimentation on 2% dextrane T500
solution (Amersham Pharmacia Biotech AB, SE) in 0.9% NaCl.
Mononuclear cells were then isolated by Ficoll-paque Plus
(Pharmacia AB, SE) density gradient centrifugation after which the
cells were washed twice in RPMI1640 Dutch's modification (RPMI)
(Gibco BRL, Scotland) with 2% human serum albumin (HSA) (Pharmacia
& Upjohn, SE). Cell viability was assessed by exclusion of
0.05% Trypan Blue and was always above 95%. The cell suspension was
stained with Turks solution and the number of lymphocytes and
monocytes in the PBMC preparation were counted in a hemocytometer.
PBMCs were suspended in RPMI with 2% HSA and the cell concentration
were adjusted to 5.times.10.sup.5 lymphocytes/ml.
[0217] PHA stimulated proliferation of PBMC with and without
chlorambucil Venous blood was drawn at the indicated time points
from RCC patients undergoing IL-2 (Proleukin, Chiron, NL) therapy.
Mononuclear cells were isolated by Ficoll-Isopaque (Pharmacia, SE)
density gradient centrifugation. 5.times.10.sup.4 PBMC in a final
volume of 200 .mu.l were seeded into round-bottomed microtiter
plates (Corning Inc. NY, US) in culture medium consisting of RPMI
1640 supplemented with 100 IU/ml Penicillin, 100 .mu.g/ml
Streptomycin (Flow laboratories) and 10% heat-inactivated,
autologous fresh serum. Phytohemagglutinin (PHA, Sigma Chemical Co,
MO, US), at a final concentration of 20 .mu.g/ml, and Chlorambucil
(CHL, Sigma), at a final concentration of 1 .mu.g/ml, were then
added. Cells were cultured for 3 days in a humidified 5% CO.sub.2
atmosphere at 37.degree. C. Proliferation was assayed by
incorporation of 1.6 .quadrature.Ci/well of [.sup.3H]thymidine
(Amersham Int, UK) during the last 18 hr. Mean values of dpm
(disintegrations per minute) of triplicate cultures were used for
the calculations.
[0218] Measurement of TNF-.quadrature..quadrature.in PHA stimulated
cultures PHA-stimulated cultures with or without chlorambucil (1
.quadrature.g/ml) were set up in parallel as described above for
mitogen-stimulated cultures. Supernatants were collected after 72
hours and cells were removed by centrifugation for 5 minutes at
4000 RPM. The SNs were frozen immediately and stored at -70.degree.
C. The amount of TNF-.alpha. in the SNs was evaluated with an ELISA
kit from Immunotech S.A., FR, according to the manufacturer's
instructions. The lower limit of detection in this assay was 10
.mu.g/ml.
[0219] Pre-coating of culture plates with HSA and HSA/IgG
Round-bottomed, 96-well tissue culture plates (Costar, Corning Inc.
NY, US) were pre-coated with HSA only or HSA and pooled human IgG
for intravenous injection (Gammagard, Baxter AS, DK). HSA was
diluted in RPMI1640 without supplements to a concentration of 10
mg/ml. In some experiments, 1 mg/ml IgG was mixed into a solution
of 9 mg/ml HSA in RPMI (HSA/IgG). 200 .mu.l of HSA or HSA/IgG were
then added to each well of the plate. The plates were incubated at
4.degree. C. for 30 minutes after which the wells were washed twice
with 200 .mu.l of RPMI1640. The coated plates were used
immediately.
[0220] IL-2 induced proliferation of PBMC in uncoated and coated
culture plates
[0221] 100 .mu.l of RPMI1640 supplemented with 200 IU/ml
penicillin, 200 .mu.l/ml streptomycin, 4 mM L-glutamine (all from
Sigma Chemical Co. MO, US) and 20% heat-inactivated human serum
(autologous or from cancer patients) were added to uncoated, HSA or
HSA/IgG coated tissue culture microtiter plates. PBMC, isolated
from healthy individuals or patients with metastatic renal cell
carcinoma, were diluted in RPMI/2% HSA at a concentration of
5.times.10.sup.5/ml and 100 .mu.l were added to the microtiter
wells. Interleukin-2 (IL-2, Proleukin, Chiron, NL), at a final
concentration of 120 IU/well, was added to some wells. Cells were
cuitured for 7 days in a humidified, 5% CO.sub.2-atmosphere at
37.degree. C. Proliferation was assayed by incorporation of 1.6
.mu.Ci/well of [3H]-thymidine (Amersham Int., UK) during the last
18 hrs. Mean values of dpm (disintegrations per minute) of
triplicates were used for the calculations.
[0222] Inhibition of IL-2 induced proliferation of PBMCs by
monoclonal antibodies to Fc.gamma.R.
[0223] Cultures for IL-2 induced proliferation were set up with
PBMC from healthy individuals as described above with the exception
that the PBMC were first pre-incubated with antibodies against
human Fc.gamma.R as follows: PBMC, at a concentration of
5.times.10.sup.5/ml in RPMI/2% HSA, were incubated at room
temperature for 30 minutes with 25 .mu.g/ml of F(ab')2 mouse
anti-human CD16 (Fc.gamma.R III), CD 32 (Fc.gamma.R II), or CD 64
(Fc.gamma.R I) (all purchased from Ancell Co. MN, US). 100 .mu.l of
the respective antibody-containing cell suspension was then added
to the microtiter wells.
[0224] Generation of cell culture supernatants for monokine
determination 100 .mu.l of culture medium consisting of RPMI1640
supplemented with 200 IU/ml penicillin, 200 .mu.g/ml streptomycin,
4 mM L-glutamine (Sigma Chemical, MO, US) and 20% fresh
heat-inactivated autologous serum were added to un-coated or
-pre-coated microtiter plates followed by 100 .mu.l of PBMC
suspension (5.times.10.sup.4 lymphocytes) in RPMI/2% HSA. In some
experiments Lipoplysaccharide (LPS, Sigma Chemical Co, MO, US) was
added at a concentration of 0.05 ng/ml. Cells were cultured in a
humidified, 5% CO.sub.2 atmosphere at 37.degree. C. Supernatants
(SNs) were harvested after 24 hrs and residual cells were removed
by centrifugation in a refrigerated centrifuge (Beckman) at
2600.times.g for 5 minutes. SNs were frozen and stored at
-70.degree. C. until monokine concentrations were measured by
ELISA.
[0225] Monokine ELISAs
[0226] Monokines were assessed by ELISA using the DuoSet ELISA
development system for human IL-6, TNF-.alpha. or IL-1.beta.
(R&D Systems Europe, Ltd. UK) following the manufacturer's
recommended procedures. Lower limit of detection was 3.1 .mu.g/ml
for IL-6, 15.6 pg/ml for TNF-.alpha. and 3.9 .mu.g/ml for
IL-1.beta.. IL-10 was detected with a kit from Diaclone Research,
FR. The lower limit of detection was 5 .mu.g/ml. Human IL-1Ra was
detected with a quantitative sandwich ELISA using a monoclonal
mouse anti-human IL-1Ra as capture antibody and a biotinylated goat
anti-human IL-1Ra as developing antibody (both from R&D
Systems). Briefly, enhanced binding 96-well microtiter plates
(Labsystems AB, SE) were coated overnight at room temperature with
10 .mu.g/ml of capture antibody diluted in PBS. After washing in
PBS with 0.05% Tween 20 (Sigma Chemical, MO, US) plates were
blocked with a blocking buffer consisting of 1% bovine serum
albumin (BSA, Sigma), 5% sucrose (Sigma) and 0.05% NaN.sub.3 in
PBS. PBMC culture SNs or recombinant human IL-1Ra standard (R&D
Systems) were diluted in 0.1% BSA and 0.01% Tween 20 in PBS
(dilution buffer) and incubated over night at room temperature.
After washing, the biotinylated-developing antibody was added at
100 ng/ml in dilution buffer. This was incubated for 1 hr at room
temperature. Plates were washed and alkaline phosphatase
(ALP)-conjugated Extravedin (Sigma), at a dilution of 1:10000 in
Tris buffered saline with 0.1% BSA was added. Following incubation
for 1 hr at room temperature, plates were washed and the amount of
bound IL-1Ra was measured by hydrolysis of paranitrophenyl
phosphate (Sigma). Optical density was read at dual wavelengths,
405 nm and 570 nm, respectively, in a Multiscan EX microplate
reader (Labsystems). The lower limit of detection in this assay was
39 pg IL-1Ra/ml
[0227] Inhibition of IL-1Ra Production by PBMC with Antibodies
against Fc.gamma.R II PBMCs, isolated from healthy volunteers were
pre-incubated at 1.times.10.sup.6/ml in RPMI1640+2% HSA with 5 or
50 .mu.g/ml of azide-free, mouse anti-human CD32 Fab (Medarex Inc.
NJ, US) for 1 hr at 37.degree. C. under gentle agitation. The cells
(5.times.10.sup.5/well) were immediately seeded onto s uncoated or
HSA/IgG coated tissue culture microtiter plates in RPMI1640 with
10% heat-inactivated, pooled human AB sera. Supernatants were
harvested after 24 hrs, as described under "generations of cell
culture supernatants", and the production of IL-1Ra was measured by
ELISA.
[0228] Inhibition of IL-1Ra Production by PBMC with Tosyl
[0229] PBMC (2.times.10.sup.6/ml) from healthy volunteers were
pre-incubated with various concentrations of Na-p-Tosyl-L-lysine
chloromethyl ketone (Tosyl, Sigma) diluted in RPMI1640/20% HSA for
30 minutes at 37.degree. C. after which the cell suspensions were
washed three times in RPMI/2% HSA. 100 .mu.l of culture medium
consisting of RPMI1640 supplemented with 200 IU/ml penicillin, 200
.mu.g/ml streptomycin, 4 mM L-glutamine (all from Sigma) and 20%
fresh heat-inactivated autologous serum were added to the HSA or
HSA/IgG pre-coated microtiter plates followed by 100 .mu.l of the
PBMC suspensions (5.times.10.sup.4 lymphocytes) in RPMI/2% HSA.
Cells were cultured in a humidified, 5% CO.sub.2 atmosphere at
37.degree. C. Viability of cultured PBMCs were also assessed after
24 hrs by Trypan blue exclusion and found to be 100%. SNs were
harvested after 24 hrs and residual cells removed by centrifugation
in a refrigerated centrifuge at 2600.times.g for 5 minutes. SNs
were frozen and stored at -70.degree. C. until IL-1Ra concentration
was determined by ELISA.
[0230] Preparation of samples for testing of monokine-inducing
activity Below it will be described the handling of various samples
that were co-cultured with PBMCs from healthy individuals in order
to assess monokine-inducing activity. The sampies included human
serum and urine (collected from cancer patients and normal healthy
individuals), extracts from tumour biopsies and conditioned media
from human tumour cell lines. The numbers assigned to patient
samples and control PBMcs in the result tables are only valid for
that particular table.
[0231] Affinity Chromatography of Human Sera with Protein G-Coupled
Sepharose
[0232] Heat-inactivated human serum was passed over a HiTrap
protein G-Sepharose HP affinity column (Amersham Pharmacia Biotech
AB, SE). The non-binding fraction was eluted with RPMI1640, giving
a final dilution effect of 1/5 (20% ) of the original serum. 200
IU/ml penicillin, 200 .mu.g/ml streptomycin, 4 mM L-glutamine (all
from Sigma) were added. The eluate was then sterile filtered with a
0.45 .mu.m Millex syringe filter (Millipore Co. MA, US) and used
immediately for culture with control PBMC. 100 .mu.l medium with
20% original serum or with 20% protein G non-binding serum from the
same source was added to uncoated or HSA-coated microtiter plates
together with 100 .mu.l PBMC suspension (5.times.10.sup.5/ml).
Cell-free SNs were harvested after over-night incubation and tested
for monokine activity by ELISA, as described above.
[0233] Ultra Filtration
[0234] All ultra filtrations were carried out using Amicon
Centriplus centrifugal filter devices (Millipore Co. MA, US)
sterilised by autoclave. Filters with a 3000, 50000, or 100000
molecular weight cut-off were used. The Centriplus filters were
washed with RPMI1640 prior to use. The Centriplus filters were spun
on a refrigerated centrifuge with a swing-out rotor at
3000.times.g. Retentates were recovered by inverse centrifugation
at 2000.times.g.
[0235] Serum Samples
[0236] Sera, collected from cancer patients or from normal healthy
individuals, were heat-inactivated for 30 minutes at 56.degree. C.
and frozen at -70.degree. C. After thawing, sera were diluted in
RPMI1640 to a concentration of 20% and either used unfiltered or
ultra-filtered, as described below, in co-culture experiments for
monokine-induction with control PBMC. Ultra filtered serum
fractions consisted of filtrates from 100000 mw cut-off filters,
retentates or filtrates from 50000 mw cut-off filters or retentates
from serum fractions that had been sequentially spun on a 50000 mw
cut-off filter followed by concentration on a 3000 mw cut-off
filter. Retentates were reconstituted in RPMI1640 with 200 IU/ml
penicillin, 200 .mu.g/ml streptomycin, 4 mM L-glutamine (Sigma) to
their original volume. 100 .mu.l of diluted sera (20% ) or ultra
filtered serum fractions were added to uncoated or HSA-coated
microtiter plates together with 100 .mu.l PBMC suspension
(5.times.10.sup.5/ml). Cell-free SNs were harvested after
over-night incubation and tested for monokine activity by ELISA, as
described above.
[0237] Urine Samples
[0238] Approximately 15 ml of urine were collected from cancer
patients with renal cell carcinoma or malignant melanoma or from
normal healthy individuals. The samples were centrifuged for 10
minutes at 3000.times.g followed by filtration over a 0.45 .mu.m
Millex-HV syringe filter (Millipore). Next the samples were ultra
filtered through a 50000 mw cut-off Centriplus filter and the
filtrate concentrated on a 3000 mw cut-off filter. The volume of
the retentate, collected from the 3000 mw filter was adjusted to 1
ml with RPMI1640. The sample was then again filtered on a 0.45
.mu.m Millex-HV syringe filter and frozen at -70.degree. C.
Immediately before co-culture with normal PBMC, the samples were
thawed and buffer exchange was performed to RPMI1640 with 200 IU/ml
penicillin, 200 .mu.g/ml streptomycin, 4 mM L-glutamine (Sigma) by
gel filtration over a Sephadex-G25 (PD-10) desalting column
(Pharmacia, SE).
[0239] Extracts from Tumour Biopsies
[0240] Human tumour biopsies from patients with renal cell
carcinoma, malignant melanoma or colon carcinoma, were embedded in
glycergel (Dakopatts AB, SE) and frozen at -70.degree. C. For
generation of tumour extracts, approximately 8 to 20, 50 .mu.m
cryostat sections were cut and transferred to 4 ml of cold RPM1640
with 200 IU/ml penicillin, and 200 .mu.g/ml streptomycin
(RPMI/PEST) (Gibco BRL) and kept on ice. The sections were
centrifuged and resuspended in 0.5 ml fresh RPMI/PEST after-which
they were disaggregated in a Medimachine (Dako A/S, DK) using a
sterile Medicon 50 .quadrature.m unit. The disaggregated sample was
suspended in 2 ml RPMI/PEST, vortexed and kept on ice for 0.5 to 2
hrs. The sample was centrifuged 10 minutes at 300.times.g and the
supernatant was harvested. The supernatant was then filter
sterilised through a 0.45 .mu.m Millex-HV syringe filter
(Millipore). For generation of extracts from fresh tumour biopsies,
a newly excised biopsy (about 5 mm.sup.3) was disaggregated in a
Medimachine (Dako AS), using a sterile Medicon 50 .mu.m unit and
resuspended in a total volume of 5 ml TCN buffer (50 mM Tris, 50 mM
NaCl, 10 mM CaCl.sub.2+200 IU/ml penicillin and 200 .mu.g/ml
streptomycin). The cell suspension was incubated on ice for 1 hr.
The sample contained 2.7.times.10.sup.6 cells/ml with a viability
of 15%. A cell-free supernatant was harvested after the cells had
been pelleted for 10 minutes at 300.times.g. The supernatant was
then filtered through a 0.45 .mu.m Millex-HV syringe filter
(Millipore). Supernatants, extracted from frozen or fresh biopsies
were then ultra filtered as described above. Before co-culture with
control PBMC, the TNC buffer was exchanged to RPMI1640 with 200
IU/ml penicillin, 200 .mu.g/ml streptomycin, 4 mM L-glutamine
(Sigma) by gel filtration over a Sephadex-G25 (PD-10) desalting
column (Pharmacia). SNs, 100 .mu.l, were added to uncoated
microtiter plates together with 100 .mu.l PBMC suspension
(5.times.10.sup.5/ml). Cell-free SNs were harvested after
over-night incubation and tested for monokine activity by ELISA, as
described above.
[0241] Conditioned Media from Tumour Cell Lines
[0242] Established human, squamous cell carcinoma cell lines,
UT-SCC-10 and UT-SCC-20A (a gift from Dr. R. Grenman, University of
Turku, Finland) were cultured in 5 ml media consisting of
Dulbecco's modified Eagle's medium (DMEM) supplemented with 1 mM
L-glutamine, 18 mM Hepes, 0.9% non-essential amino acid solution,
100 IU/ml penicillin, 100 .mu.g/ml streptomycin (all from Gibco)
and 100/% heat-inactivated human AB-serum (DMEM) in 25 cm.sup.3
cell culture flasks (Costar) at 37.degree. C. and 5% CO.sub.2. The
medium was decanted off and replaced every 2 to 3 days. When the
cells had reached confluence they were trypsinated and reseeded in
new flasks. The decanted medium was centrifuged at is 1000.times.g
to remove residual cells and debris and then ultra filtered on
Centriplus filters with a 50000 mw cut-off. The filtrate was then
concentrated on a 3000 mw filter. In some experiments the retentate
from the 50000 mw cut-off filter was also saved. Retentates were
resuspended in RPMI1640 to 2.5 ml. Before culture with PBMCs the
medium was exchanged to RPMI1640 with 200 IU/ml penicillin, 200
.mu.g/ml streptomycin, 4 mM L-glutamine (Sigma) by gel filtration
over a Sephadex G-25 (PD-10) desalting column (Pharmacia). In some
experiments parallel culture flasks containing only culture medium
and no tumour cell lines were set up as a control. Supernatants
from these flasks were treated exactly the same as supernatants
from flasks containing cells. Filtrates and retentates were saved
at 4.degree. C. before co-culture with normal PBMC. SNs, 100 .mu.l,
were added to uncoated or HSA-coated microtiter plates together
with 100 .mu.l PBMC suspension (5.times.10.sup.5/ml). Cell-free SNs
were harvested after over-night incubation and tested for monokine
activity by ELISA, as described above.
[0243] Affinity chromatography with gelatine-coupled Sepharose
[0244] Pre-swelled gelatine Sepharose 4B (Pharmacia Biotech AB, SE)
was washed three times in PBS or RPMI1640. 0.3-0.5 ml Sepharose gel
was incubated together with the 3-50 kD fractions of ultra filtered
serum, diluted in 2-2.5 ml RPMI1640 for 30 minutes at room
temperature. The gel was mixed gently by inversion approximately
every 10 minutes. An equal portion of the ultra filtered serum
sample was incubated in parallel without gelatine Sepharose, as a
negative control. The gel was allowed to settle and the supernatant
collected. Buffer exchange to RPMI1640 with 200 IU/ml penicillin,
200 .mu.g/ml streptomycin, 4 mM L-glutamine (Sigma) was performed
by gel filtration over a Sephadex-G25 (PD-10) desalting column
(Pharmacia) followed by filtration on a 0.45 .mu.m Millex-HV
syringe filter (Millipore). SNs, 100 .mu.l, were added to uncoated
microtiter plates together with 100 .mu.l of control PBMC
suspension (5.times.10.sup.5/ml). Cell free SNs were harvested
after over-night incubation and tested for monokine activity by
ELISA as described above.
[0245] Sample Preparation for Proteomics
[0246] Urine samples (100-450 ml) from cancer patients or healthy
controls were ultra centrifuged on Jumbosep centrifugal devices
(Pall Life Science, MI, US) using a 30 K membrane insert or
alternatively, with a Proflux M12 system using a 30 K Pellicon 2
mini filter (Millipore, Mass., US) followed by concentration on
Jumbosep with a 3K membrane insert. The urine fraction, 3-30 KD,
was tested for monokine-inducing activity as previously described
herein. Protein concentrations were determined by Bio-Rad protein
assay (Bio-Rad Laboratories, CA, US). Samples were desalted over a
Sephadex-G25 (PD-10) column (Amersham Biosciences, SE), lyophilised
and dissolved in rehydration buffer (8M urea, 4% CHAPS, 10 mM DTT,
0.5% v/v IPG buffer and a trace of orange G). Samples were
centrifuged to remove undissolved material.
[0247] 2-DE Gel Electrophoresis
[0248] 2-DE was performed in a horizontal 2-DE set-up
(Multiphore/IPGphore, Pharmacia Biotech, SE) as described (Lindahl
M. et.al 1998) based on isoelectric focusing (IEF) in the first
dimension and molecular mass in the second dimension. Briefly,
samples (230 .mu.g, 350 .mu.g, 600 .mu.g) were applied to IPG gels,
pH 4-7, (Amersham Pharmacia Biotech, SE) and focused overnight for
48000 Vh. SDS-PAGE was then carried out with 16% T/1% C
polyacrylamide casted slab gels. Molecular weight standards were
included in each run. Separated proteins were detected by Coomassie
blue staining or SYPRO Ruby staining. The protein patterns in the
gels were analyzed as digitised images using a CCD (Charged-Coupled
Device) camera (1340.times.1040 pixels) in combination with a
computerized imaging 12-bit system, PDQuest Version 6.1.0, in the
case of fluorescent stained gels using UV scanning illumination
mode (Fluor-S Multi-imager, Bio-Rad). The amount of protein in a
spot was assessed as background-corrected optical density,
integrated over all pixels in the spot and expressed as integrated
optical density (IOD).
[0249] Mass Spectrometry
[0250] Tryptic digests of excised protein spots were performed
using MALDI_TOF MS (Voyager-DE PRO, Applied Biosystems, CA, US) as
previously described (Ghafouri B. et al. 2002)
[0251] Electrotransfer and N-terminal Sequence Analysis
[0252] Selected protein spots were electro transferred to PVDF
membranes and subjected to N-terminal sequence analysis by Edman
degradation in a Procise cLC or a Procise HT sequencer (PE-Applied
Biosystems) at the Protein Analysis Center, Karolinska Institute,
Stockholm, Sweden.
[0253] Proteomics on PBMC-adsorbed urine fractions from cancer
patients PBMC were prepared from buffy coat peripheral blood from
normal controls as described above. Monokine production by the
PBMCs in response to urine fractions from cancer patients was
verified as described above. Remaining PBMC were frozen at
-70.degree. C. until use. For adsorption of urine fractions, the
PBMCs were thawed and washed carefully in cold phosphate buffered
saline (PBS). Approximately 50.times.10.sup.6 PBMC were added to
2.7 or 2.6 ml, respectively, of ultra centrifuged (3-30 KD) urine
fractions pooled from two patients with renal cell carcinoma or
from one patient with malignant melanoma. Unabsorbed urine
fractions, used as controls, received the equivalent volume of PBS
without PBMC. The urine fractions were incubated for 11/2 hour at
4.degree. C. The PBMC were then removed by centrifugation. The
adsorbed urine fractions were tested for monokine-inducing activity
in fresh, normal PBMC as described above. Remaining urine fractions
were stored at -70.degree. C. until determination of protein
concentration and analysis with 2-D gel electrophoresis, mass
spectrometry and N-terminal sequencing as described above.
[0254] Fragmentation of IgG and Serum Albumin using Matrix
Metalloproteinases (MMPs)
[0255] MMP -1, -2, -13 (R&D Systems) and MMP-3 and -7
(Chemicon, UK) were activated according to instructions of the
manufacturer. 1-50 ng/ml of the indicated MMPs were then incubated
with 1 mg/ml of either human serum albumin (HSA, Octapharma, SE) or
pooled human IgG for intravenous injection (IvIg, Gammagard,
Baxter, DK) as substrate in RPMI or in 50 mM Tris-HCl, pH 7.5
(containing 0.15 M NaCl, 10 mM CaCl.sub.2 and 0.05% Brij35). The
mixtures were incubated for 5-20 hours at 37.degree. C. Parallel
incubations of MMP or the substrates alone, in respective buffer,
were set up as controls. The mixtures were buffer exchanged to RPMI
as described previously and filtered through a 0.45 .mu.m Millex-HV
syringe filter (Millipore, Mass., US). Storing of mixtures, when
needed, was performed at -70.degree. C. until analysing by
gel-electrophoresis and testing for monokine inducing activity in
fresh, normal PBMC as described above.
[0256] IL-2 Induced Proliferation of PBMC in the Presence of
Collagen/Collagen Fragments
[0257] Purified collagen from human skin (Sigma) at a concentration
of 100 .quadrature.g/ml was incubated in 100 mM Tris-HCl, pH 7.6,
containing 0.15 M NaCl, 10 mM CaCl.sub.2 and 0.05% Brij35 over
night at 37.degree. C. The buffer was then exchanged to RPMI1640 by
gel filtration through a Sephadex-G25 (PD-10) column (Amersham
Biosciences) and filtered through a 0.45 .mu.m Millex-HV syringe
filter (Millipore) and frozen at -70.degree. C. until use. The
collagen was tested for effect on IL-2 stimulated proliferation of
PBMC from healthy donors in the presence of autologous serum as
described. Final concentration of collagen in the proliferation
assay was 26 ug/ml.
[0258] Homogenisation of Tumour Biopsies
[0259] Frozen, human tumour biopsies, embedded in Tissue-Tek OCT
Compound (Sakura, NL) or cryostat sections from patients with renal
cell carcinoma, malignant melanoma or colon carcinoma were
transferred to 3-10 ml of cold RPMI or PBS with 200IU/ml penicillin
and 200 .mu.g/ml streptomycin (RPMI/PEST, PBS/PEST) (Gibco BRL) and
kept on ice. The tissue was washed three times by centrifugation
and resuspension in 3-10 ml cold RPMI/PEST or PBS/PEST. The
pelleted, washed tissue was cut into pieces of approximately the
same size and each piece was homogenised using a Mikro-Dismembrator
U (B. Braun Biotech International, GE). The tissue was transferred
to a PTFE shaking flask together with 1 ml RPMI/PEST or PBS/PEST
and a tungsten carbide grinding ball and homogenised during 15-20
seconds with a shaking frequency of 1500-2000 RPM. The homogenised
tissue suspension was transferred to a test tube and kept on
ice.
[0260] Extraction of Preformed Immunomodulationg Factors (PIF) from
Homogenised Tumour Tissue
[0261] Human tumour biopsies or cryostat sections were homogenised
as described above. The homogenous tissue suspension was washed
three times by centrifugation in a final volume of 1.5 ml, 10 ml or
23 ml cold PBS/PEST or RPMI/PEST, as appropriate. The supernatants,
containing PIF, was collected, pooled and kept on ice. PIF was then
filtered through a 0.45 .mu.m Millex-HV syringe filter (Millipore)
and stored at -70.degree. C. Before testing for monokine inducing
activity in fresh, normal PBMC as described above, PIF was buffer
exchanged to RPMI as described previously and filtered through a
0.45 .mu.m Millex-HV syringe filter (Millipore).
[0262] Homogenised, Washed Tumour Tissue Incubated with Matrix
Metalloproteinase-2
[0263] The collection, washing and homogenisation of tumour cryo
sections (3.times.300 .mu.m) were carried out as described above.
The pelleted tumour tissue was suspended in 0.5 ml cold RPMI/PEST.
MMP-2 (R&D Systems, UK), activated according to instructions
from the manufacturer, was added at a final concentration of 5
ng/ml. The tumour tissue suspension was incubated with MMP-2 for 20
h at 37.degree. C. and the supernatant collected after
centrifugation. Parallel incubation of tumour tissue with no
addition of MMP-2 was set up as a control. The mixtures were buffer
exchanged to RPMI by gel filtration through a Sephadex-G25 (PD-10)
column (Amersham Biosciences, SE) and filtered through a 0.45 .mu.m
Millex-HV syringe filter (Millipore, Mass., US). Finally, the
mixtures were analysed by gel-electrophoresis and tested for
monokine inducing activity in fresh normal PBMC as described
above.
[0264] Homogenised Tumour Tissue and PIF Incubated with Serum
Albumin or IgG
[0265] The pelleted homogenised tumour tissue formed during
preparation of PIF (se above) was kept on ice and stored at
-70.degree. C. PIF were prepared as described above. In one
experiment, the homogenised sections were washed once more to
collect a fourth supernatant, used as a control reflecting the IL-6
inducing activity in tumour sections before incubation. The fourth
supernatant was divided into two parts, to one of which was added
20 mg/ml of HSA and directly frozen at -70.degree. C. The mixtures
of homogenised tumour tissue with 20 mg/ml HSA or with 10 mg/ml
pooled human IgG for intravenous injection (IvIg), as well as the
mixtures of PIF with 20 mg/ml HSA or with 10 mg/ml IvIg, all in
RPMI/PEST, were incubated for 18-21.5 h at 37.degree. C. Parallel
incubations of tumour tissue and PIF with no addition of HSA or
IvIg, as well as RPMI/PEST with addition of HSA or IvIg, were set
up as controls. The mixtures were centrifuged and supernatants
collected. The supernatants were buffer exchanged to RPMI as
described previously and filtered through a 0.45 .mu.m Millex-HV
syringe filter (Millipore, Mass., US) and stored at -70.degree. C.
until testing for monokine inducing activity in fresh, normal PBMC
as described above.
[0266] Statistical Analysis
[0267] Comparisons of the means of different patient groups or
different test occasions were performed using an unpaired t-test.
Time to progression and survival was analyzed using the
Kaplan-Meier method and Logrank test.
[0268] Comparisons between the proliferative response to PHA in
different groups or at different test occasions were done on
logarithmated mean values of dpm of triplicates using unpaired
t-test. For the determination of the effect of addition of CHL on
the proliferative response of PHA-stimulated PBMCs, a modulation
index (MI) was calculated according to the following formula:
MI=log (dpm PHA+drug/dpm PHA).
[0269] Results on Immunoregulatory Mechanisms of Relevance for the
Present Invention
[0270] Demonstration of Intratumoural IL-1Ra
[0271] As described above IL-1Ra is a potent inhibitor of immune
stimulation/reactivity as it blocks the activity of IL-1. It is
therefore of considerable importance that it is frequently
expressed by tumour cells and tumour infiltrating mononuclear
cells. Based on the results presented in the above, it is highly
reasonable to assume that tissue bound IgG is the inducer of this
cytokine. Thus either tissue bound antibodies or intra-tumourally
precipitated ICs can play a major role in intra-tumoural
down-regulation of the immune response. FIG. 1 shows melanoma
biopsies stained for the expression of IL1Ra. Different patterns
are hereby found, viz. A) tumour cells are generally stained with
some positive infiltrating mononuclear cells, and B) large numbers
of infiltrating cells staining for IL-1Ra, tumour cells only
faintly positive.
[0272] Production of IL-1Ra in Cultures of PBMC
[0273] Production of IL-1Ra can be induced by some cytokines (Tilg
et al., 1994), but Fc.gamma.R cross-linking by solid phase IgG or
ICs seems to be the most efficient inducer of this substance. It
has been shown that in cultures where binding of IgG to the surface
of the culture well is allowed (uncoated wells) the production of
IL-1Ra is significantly enhanced (p<0.0001) compared to cultures
where binding of IgG has been reduced by pre-coating with HSA. This
immunomodulatory effect has been studied in healthy individuals,
patients with malignant melanoma and renal cell carcinoma (FIG. 2).
If purified human IgG is added to the HSA in coated wells
(HSA/IgG), IL-1Ra production by control PBMC is restored. Based on
these results it is obvious that solid phase IgG will play a major
role in immune regulation.
[0274] In cultures where the wells have been pre-coated with HSA
(FIG. 3A) a significant difference in IL-1Ra production was found
between PBMCs from normal healthy individuals (K; n=46) and
melanoma (MM1; n=43) and renal cell carcinoma patients (RCC 1;
n=37) with metastatic disease (p=0.017 and p<0.008,
respectively). In melanoma patients with radically resected stage
III disease (MM 0; n=29) there was only a slight increase in IL-1Ra
production. These results provides evidence for an immunomodulating
role of cell bound IgG/ICs and that sera from cancer patients
contain factors which are bound to PBMCs and are more potent in
inducing IL-1Ra than serum factors from normal healthy individuals.
It is reasonable to believe that this serum factor is comprised of
complexed IgG. In cultures where PBMCs are exposed to solid phase
serum IgG (FIG. 3B, uncoated wells) the production is significantly
increased as described above and differences between healthy
individuals and cancer patients are masked.
[0275] The occurrence of tissue bound IgG exposing the Fc-parts, in
tumour tissue inducing production of IL-1Ra as described herein is
thus highly relevant to the down-regulation of the anti-tumour
immune reactivity.
[0276] Inhibition of IL-1Ra production by anti-CD32 fragments.
Based on the results described above blockade of the receptor(-s)
involved in the induction of IL-1Ra production is a therapeutic
strategy. It is demonstrated that pre-incubation of PBMCs from
normal, healthy individuals and cancer patients with an anti-CD32
Fab fragment before these cells were set up in cultures on either
uncoated or HSA/IgG coated microtitre plates significantly inhibits
the production of this cytokine.
1TABLE 1 Effect of antibodies to Fc.gamma.R II, anti-CD32 Fab, on
IL-1Ra production by normal PBMC Anti-hu CD32 Fab effect on Anti-hu
CD32 Fab effect on cultured PBMC on uncoated cultured PBMC on
HSA/IgG culture plates precoated culture plates Anti-hu Anti-hu
Anti-hu Anti-hu CD32, CD32, CD32 CD32 None 5 .mu.g/ml 50 .mu.g/ml
None 5 .mu.g/ml 50 .mu.g/ml Ctrl 1.sup.1) .sup. N.D..sup.4) N.D.
N.D. 6275 N.D. 2210 Ctrl 2 .sup. 2985.sup.3) N.D. 725 6620 N.D.
1530 Ctrl 3 4905 2380 560 3075 925 570 Ctrl 4 6014 N.D. 1926 4969
N.D. 1782 Ctrl 5 N.D. N.D. N.D. >10 000 N.D. 5824 Ctrl 6 N.D.
N.D. N.D. >10 000 N.D. >10 000 Pat. 1.sup.2) 4330 3095 2200
4195 1520 630 Pat. 2 1180 700 685 1170 735 910 Pat. 3 2870 1415 870
1350 340 180 Pat. 4 >10 000 N.D. 3260 N.D. N.D. N.D.
.sup.1)Control PBMC from healthy donors .sup.2)PBMC from cancer
patients .sup.3)IL-1Ra, pg/ml .sup.4)Not done Note: All PBMCs were
pre-incubated with anti-human CD32 Fab 1.o hr, 37.degree. C. before
culturing.
[0277] Thus various strategies, which interfere with the
cross-linking of the IL-1Ra inducing Fc receptor, are the base of
therapeutic strategies, which will relieve immunosuppression and
thereby improve the prospect for successful immunostimulating
treatment.
[0278] Modulation of Fc.gamma.R activity by protease inhibitors It
has been demonstrated that proteolytic activity increases the
reactivity of Fc.gamma.RII (Isashi et al., 1998 ; van der Winkel et
al., 1989). The proteolytic activity is enhanced in malignant
tumours; thus protease inhibitors will reduce the reactivity of
CD32. Herein it is demonstrated that culturing PBMCs in the
presence of non-toxic concentrations of a protease inhibitor,
Tosyl, resulted in a significantly reduced production of the immune
inhibitory cytokine ILlRa. Thus inhibition of intra-tumoural
proteolytic activity offer an excellent therapeutic strategy for
treating cancer. FIG. 4 shows inhibition of ILlRa production by
Tosyl. The effect of Tosyl on IL-1Ra production by PBMC from
healthy individuals (n=9) in 10% autologous sera cultured in
microtiter plates pre-coated with A) HSA, and B) HSA/IgG.
[0279] Immunostimulation by Fc.gamma.R Cross-Linking
[0280] It is demonstrated herein that PBMC cultured on HSA/IgG
coated microtitre plates have a dramatically enhanced proliferative
response to IL-2 in both normal healthy individuals and cancer
patients compared to cultures in HSA coated wells. A similar effect
is found when cultures, where IgG from serum in the culture medium
is allowed to bind to the microtitre plates (uncoated cultures) and
HSA coated cultures are compared. FIG. 5 shows IL-2 induced
proliferation by PBMC from normal healthy individuals (first three
bars) and PBMC from RCC patients (last three bars) cultured in 10%
autologous sera on uncoated and pre-coated microtiter plates.
Significant (p<0.011) difference in proliferation between PBMC
from healthy individuals and RCC patients on uncoated plates.
[0281] As the same effect on IL-2 induced proliferations are seen
in HSA/IgG coated cultures and uncoated cultures; this effect is
due to the same mechanism. Solid phase IgG results in a broad
cross-linking, which can elicit stimulation of the immune response
in normal healthy individuals by eliciting a cytokine cascade
including TNF-.alpha. and IL-1, which sensitises the response to
IL-2 (increased numbers of receptors). This model reflects the
situation when opsonised antigens or large ICs elicits an immune
response. In HSA coated wells this stimulatory cross-linking can
not take place, which results in a significantly lower response to
IL-2. Alternatively, the difference in IL-2 induced proliferative
response can be due to an immunomodulatory effect by the
cross-linking per se and not a stimulatory cytokine cascade.
Inhibitory signals in monocytes/macrophages might be overcome by
broad cross-linking of Fc.gamma.R.
[0282] In cancer patients stimulation by Fc.gamma.R cross-linking
(uncoated cultures) does not properly support the proliferative
response to IL-2, as demonstrated above. The type of cytokines
produced can be inhibitory and does not support an optimal response
to IL-2. Preliminary data suggests that serum factor(-s) is of
importance for the reduced response of PBMCs from cancer patients
in uncoated cultures (FIG. 6).
[0283] Effect of Fc.gamma.R blockade on IL-2 stimulated
proliferation The stimulatory effect in HSA/IgG coated cultures is
to various degree inhibited by F(ab')2 Mabs directed to
Fc.gamma.Rs, in particular to Fc.gamma.R I (CD64). This can reflect
the effect of small inhibitory ICs.
2TABLE 2 Inhibition of IL-2 induced proliferation of PBMC with
F(ab')2 monoclonal antibodies against Fc receptors. Anti-FcRec Mab
Coat HSA Uncoated Coat HSA/IgG Experiment 1 None .sup. 30 361 1) 65
030 146 337 Anti-CD16 62 072 84 173 109 417 Anti-CD32 35 106 82 628
126 363 Anti-CD64 30 526 3 219 25 533 Experiment 2 None .sup. 16
315.sup.1) 97 446 102 863 Anti-CD16 10 315 39 023 97 572 Anti-CD32
26 976 56 226 93 153 Anti-CD64 19 634 35 620 45 858
.sup.1)3H-Thymidine uptake in counts per minute (cpm) on day 7.
Mean of triplicate wells.
[0284] Background in wells without IL-2 did not exceed 750 cpm.
[0285] Flow cytometry was performed to verify binding of the
F(ab')2 monoclonal antibodies to PBMC. The inhibitory anti-CD64
antibodies bound to a higher percentage of monocytes that
anti-CD16, but fewer monocytes than anti-CD32 antibodies, in both
experiments. Furthermore, the mean fluorescent intensity of both
anti-CD16 and anti-CD32 binding was higher than anti-CD64 in both
experiments. Thus, increased binding of the anti-CD64 F(ab')2
antibody, compared to anti-CD16 and anti-CD32 does not explain the
inhibitory effect.
[0286] Effect of Fc.gamma.R cross-linking on the production of IL-6
in cultures of PBMC
[0287] These results follow under the discussion of modulation of
IL-6 production.
[0288] The culture model described above provides for excellent
opportunities of studying immunosuppressive regulatory mechanisms
in cancer patients.
[0289] Cell bound IgG/ICs in tumor tissue and on PBMCs from cancer
patients As IC in cancer patients cause dys-regulation of the
immune system, it is important, using suitable diagnostic tools, to
identify patients with this kind of dys-regulation in order that
patients, who are most likely to respond to therapeutic strategies
based on elimination of Fc.gamma.R inhibitory signals, can be
selected. In this context determination of cell-bound ICs (CBIC) is
the important invention as these might very well have full activity
even in the absence of CIC (circulating immuno complex).
[0290] CBIC can be directly demonstrated by means of
[0291] IgG+PBMC (peripheral blood mononuclear cells)
[0292] IgG+TIMC (tumour infiltrating mononuclear cells,
demonstrated in surgical or fine needle biopsies, FNA)
[0293] CBIC can also be demonstrated by means of functional
parameters such as
[0294] production of O.sub.2.sup.-
[0295] down-regulation of the .zeta.-chain of TCR
[0296] down-regulation of CD80 and/or CD86
[0297] induction of IL-1Ra,demonstrated in biopsies and FNA
[0298] induction of other monokines,
[0299] whereby a number of these parameters can be demonstrated
immunohistochemically.
[0300] Immune complexes (ICs) can be determined in different ways.
Standard methods for determining circulating ICs (CIC) are by
indirect non-functional parameters as complement binding and
activation, PEG-precipitation, phagocytosis, platelet
aggregation.
[0301] Determination of CIC, to obtain prognostic information or to
diagnose possible occurrence of ICs modulating the immune system,
is likely to be irrelevant, as IC has to be bound to cellular
receptors to have any immunomodulatory effect. Thus CBIC will have
full immunomodulatory effect long before the amount of ICs is
enough to saturate these receptors and ICs appear in the
circulation. In the present case direct methods has been used to
demonstrate the presence of cell/tissue bound IgG or ICs.
[0302] Two methods based on the binding of either a monoclonal
antibody or protein G to the Fc part of IgG were used to
demonstrate the occurrence of tissue bound IgG or IC. The Mab was
directed to the Fc part of all subclasses of human IgG and protein
G was genetically modified, binding only to the Fc part of IgG.
Thus CBIC can be demonstrated using flow cytometry, or CBIC on
blood cells has been demonstrated using immunocytochemistry (IHC)
on cytospin preparations. Further CBIC has been demonstrated in
tumour tissue (tumour cells, endothelium, tumour infiltrating
inflammatory cells) using IHC.
[0303] If the immunohistochemical distribution pattern of stained
IgG/IC exclusively coincides with the pattern of the low affinity
receptors for IgG (CD16 and CD32) the identified substance is
considered being IC. Otherwise it is not possible to discriminate
between IgG and IC as the monoclonal antibody and protein G might
be able to bind to monomeric IgG as well. However, if IgG is bound
to the tissue directly or in IC might be of minor importance as it
will anyhow be recognised as "solid phase" IgG.
[0304] Immunocytochemistry of Tumour Tissue
[0305] Several quite different staining patterns have been found in
biopsies from untreated and treated melanoma metastases. In the
majority of untreated and treated metastases with a poor
infiltration of inflammatory cells and with no or only minor tumour
regressive changes IgG was found in perivascular areas of the
intra-tumoural micro-vessels. In these patients--tumours--the
endothelial cells of larger vessels were stained indicating a
systemic distribution of IC as endothelial only express CD32 and
the bound IgG has to be in the form of complexes. FIG. 7 shows
tumour biopsies stained for the presence of tissue bound IgG/IC
(red) and T-lymphocytes (brown) using a double staining technique
with recombinant protein G (not binding to albumin). Different
staining patterns are shown, viz. A) staining of vascular
areas/endothelial cells and some lymphocytes for IgG. Some
lymphocytes are not stained for IgG/IC. Low numbers of tumour
infiltrating mononuclear cells, B) a diffuse staining of the tumour
tissue for IgG/IC, whereby the majority of the lymphocytes are not
stained for IgG/IC, C) staining tumour infiltrating macrophages and
some lymphocytes for IgG/IC, but tumour cells are generally
negative, D) extensive staining of vascular areas for IgG/IC with
very low numbers of infiltrating mononuclear cells.
[0306] These results show that tissue bound IgG exposing Fc parts,
are inversely correlated to the presence of tumour infiltrating
mononuclear cells and hence plays a major role in the
down-regulation of the immune response to the tumour.
[0307] Immunocytochemistry of PBMC
[0308] Based on the results described above the occurrence of IC
binding circulating blood cells was studied in cytospin slides
stained using the two methods described. Preliminary results show
that a very low frequency of positive monocytes was found in .he
majority of heaIthy individuals in contrast to patients with
cancer. As monocytes from healthy individuals were generally
negative the stained IgG represents IC indicated by the staining of
platelets. (FIG. 8).
[0309] Chronic inflammatory reaction in cancer using IL-6 as a
marker Chronic inflammatory reaction is often found in cancer
patients. Interleukin-6 is a proinflammatory cytokine of importance
for the initiation of immune reactivity (Barton, 1996; Barton,
2001). However, in cancer patients, its occurrence has a number of
detrimental effects. Inflammatory cells, vascular endothelium and
several types of tumour cells produce it. It has activity as
autocrine growth factor in at least some malignancies, e.g.,
myeloma and renal carcinoma. It can interfere with the cytotoxic
activity of cisplatinum (Borsellino et al., 1995; Mitzutani et al.,
1995). It participates in the induction of acute phase reactants,
e.g., fibrinogen and CRP. In this context it can be involved in a
positive regulatory loop as the production of fibrin split products
have been found to be inducers of IL-6. This is one of the
cytokines, which seems to be involved in the paraneoplastic
syndrome of cancer patients and high serum levels of this cytokine
are often associated with poor response to immunotherapy. Besides,
these cytokines are not produced in healthy individuals. In cancer
patients, however, PBMCs (as shown above) are triggered to produce
considerable amounts of IL-6 in vivo and continue to do so also in
vitro. Except for cytokines, such as IL-1.beta., IL-17 and
TNF-.alpha., a cross-linking of Fc.gamma.R is a mechanism by which
monocytes are triggered to produce IL-6. Thus, CBIC is of
importance for the dys-regulation of the immune system in
cancer.
[0310] Various cytokines, IL-1.beta., IL-6, TNF-.alpha., PGE.sub.2,
TGF-.beta. are often increased in cancer patients. (Mocellin et
al., 2001) Several of these IL-1.beta., IL-6, and TNF-.alpha. are
supposed to be involved in the paraneoplastic syndrome
characterized by low-grade fever, anorexia, weight-loss, and
fatigue.
[0311] An increased systemic concentration of IL-6 has been
reported to correlate with a poor prognosis and poor response to
chemotherapy (Borsellino et al., 1995; Mitzutani et al., 1995).
Furthermore, it is well documented that patients with high IL-6
serum levels (increased CRP) can not be successfully treated with
immunotherapy. (Blay et al. 1992; Deehan et al., 1994; Lissoni et
al., 1999; Tartour et al., 1996).
[0312] PGE.sub.2 is well known to be a potent inhibitor of immune
reactivity. Thus patients with high serum levels of PGE.sub.2
before treatment or having an increased production of PGE.sub.2
during the early treatment period will not respond to
immunotherapy. (Deehan et al., 1994)
[0313] An increased production of O.sub.2.sup.- radicals by
monocytes has been demonstrated to down-regulate the .zeta.-chain
of the T-cell receptor resulting in a non-functional state of these
cells. (Kono et al., 1996;Otsuji et al., 1996)
[0314] Therapeutic control of the dys-regulatory mechanisms of IL-6
production will thus improve quality of life, therapeutic response
to immuno- and chemotherapy, and increase over-.alpha.ll
survival.
[0315] As IL-6 is only one product of the dys-regulated
inflammatory reaction mentioned, and often correlates to production
of the other cytokines such as IL-1.beta. and TNF-.alpha., the
strategy is to find the fundamental dys-regulatory mechanisms and
block them in order to completely down-regulate the inflammatory
reaction.
[0316] IL-6 production in cancer patients, correlation to prognosis
The present analysis includes IL-6 production from PBMCs from three
types of cancer patients. As shown in Table 3, 30 patients with
radically resected stage III melanoma (MMO), 43 patients with
previously untreated metastatic melanoma (MR1) 36 with previously
untreated metastatic renal cell carcinoma (RCC1) and 46 patients
with primary colorectal cancer (CRC) were studied. The cytokine
production is, compared to that of healthy individuals (K),
significantly increased in all categories. It is obvious that IL-6
production is not restricted to patients with advanced disease as
IL-6 is produced also by PBMCs from patients with primary
colorectal cancers and radically resected stage III melanoma (MM
0), whereby in the latter group no metastatic lesions could be
demonstrated by clinical or radiological investigations. A
correlation between IL-6 production by PBMCs and other clinical
parameters was demonstrated for colorectal cancer and renal cell
carcinoma.
[0317] The serum concentration of IL-6 was determined in melanoma,
colon and renal cell carcinoma patients and was generally below the
detection limit of the ELISA-technique used. In only a few cases
measurable amounts of IL-6 were found but these were quite
negligible compared to those found in cultures.
3TABLE 3 Production of IL-6 by PBMCs from healthy individuals and
various types of cancer patients. t-test No of Mean value compared
Group patients pgIL-6/ml +SE with controls K 49 214 85 -- MM 0 30
2444 978 p > 0.0001 MM 1 43 3838 1279 p > 0.0001 RCC 1 36
4003 935 p > 0.0001 K 12 379 133 -- CRC 46 5973 1362 p =
0.042
[0318] Colorectal Cancer
[0319] As shown in FIG. 9, the IL-6 production increases with more
advanced primary tumour, the difference between T2N0 and T3-4N0
achieved statistical significance after stimulation with bacterial
lipopolysaccharide (LPS) (p=0.05). Also the lymph node status had
an impact on the production of this cytokine with higher IL-6
production by PBMCs from patients with lymph node metastases
(p=0.02). FIG. 9 shows the production of IL-6 by PBMCs from
different subsets of colorectal cancer patients, viz. A), without
LPS stimulation and B) with LPS stimulation.
[0320] In renal cell carcinoma IL-6 production is of prognostic
significance as evident from FIG. 10. Patients that
produced<2500 pg/ml IL-6 in short term cultures (n=18) showed
significantly longer survival than patients that produced>2500
pg/ml (n=23).
[0321] Effect of Fc.gamma.R cross-linking on IL-6 production by
PBMCs in vitro The culture conditions have a marked impact on the
production of IL-6. If IgG from serum in the culture medium was
allowed to bind to the surface of the culture wells, the IL-6
production was significantly lower, compared to cultures, wherein
the wells were pre-coated by HSA, in about one third of the
patients with malignant melanoma and colorectal cancer (both
malignancies analysed together, p=0.001).
[0322] The inhibitory effect of Fc.gamma.R cross-linking was
further demonstrated in PBMC cultures from healthy individuals
wherein the culture wells were either pre-coated with HSA/IgG or
HSA alone. Also in this situation, solid phase IgG significantly
reduced the production of IL-6 by PBMCs from some individuals (FIG.
11). Fc.gamma.R cross-linking induced by solid phase IgG thus
inhibits production of IL-6 in some patients.
[0323] The occurrence of this phenomenon in cultures with PBMCs
from healthy individuals, as well, is not surprising, as this
evidently is one of the normally occurring immunoregulatory
mechanisms, the magnitude of which is increased in cancer patients.
The difference between patients with and without this type of
inhibition is evidently due to triggering of the monocytes or due
to the influence of other factors. One explanation may be that a
high concentration of a serum factor can induce IL-6 production
despite the inhibitory action of Fc.gamma.R cross-linking. At low
concentrations of this factor, the inhibitory action of Fc.gamma.R
cross-linking will take over.
[0324] The evidence given shows the interaction of the two
immunoregulatory mechanisms described herein based on the analysis
of the results of the different experiments carried out.
[0325] Occurrence and Characterisation of a Serum Factor Inducing
IL-6 Production by PBMCs
[0326] Production of IL-6 by PBMCs from in particular cancer
patients in vitro, means that either are the producing cells
triggered in vivo and maintain this status when placed in culture
or there is a serum factor which continuously stimulates production
of IL-6. In order to discriminate between these two alternatives,
sera from cancer patients, with a high IL-6 production in
autologous PBMC cultures, were used in the medium of five cultures
with PBMCs from healthy individuals. A high IL-6 production was
induced in all these cultures demonstrating occurrence of an IL-6
inducing serum factor.
4TABLE 4 IL-6 inducing activity in sera from cancer patients
cultured with PBMCs from healthy individuals with blood group 0.
Sera IL-6, pg/ml Patient 1 13129 Patient 2 2440 Patient 3 5313
Patient 4 4951 Patient 5 25276 Control 1.sup.1) 31.2 Control 2 31.2
Control 3 31.2 Patient 6.sup.2) 115 Patient 7.sup.2) 31.2
.sup.1)Control from healthy individuals .sup.2)Sera from patients
who did not produce IL-6 in vitro None of the control PBMC made
detectable amounts IL-6 when cultured with autologous, normal
sera.
[0327] Effect of ProteinG-Sepharose affinity chromatography of sera
on IL-6 inducing activity
[0328] As cancer patients have an increased incidence of CIC and as
it has been shown that cross-linking of Fc.gamma.R can induce IL-6
production by monocytes, the IgG fraction was removed from these
sera using affinity chromatography with proteinG-Sepharose. When
sera treated in this way were tested in cultures with PBMCs from
the same healthy individuals, the IL-6 production was not only
maintained but also even increased.
5TABLE 5 Effect of ProteinG-Sepharose affinity chromatography of
sera on IL-6 inducing activity Autologous Patient sera 1 Patient
sera 2 Patient sera 3 sera (CC.sup.1) (CC) (MM.sup.2) -- Prot G
Prot G -- Prot G -- Prot G Control <31.2.sup.3 .sup. N.D..sup.4
5313 8599 4951 12648 PBMC 1 Control <31.2 N.D. 9551 15243 13099
18618 PBMC 2 Control <31.2 <31.2 25276 30316 PBMC 3 Control
<31.2 <31.2 11342 12806 PBMC 4 .sup.1CC = colon carcinoma
.sup.2MM = malignant melanoma .sup.3pg/ml of IL-6 .sup.4N.D. = not
done
[0329] Patient sera 3 did not contain detectable, endogenous IL-6.
Patient sera 1 and 2 were not tested for endogenous IL-6.
[0330] Thus, CIC are not involved in inducing IL-6 production, but
either CIC or IgG obviously modulate the production as it increased
when IgG was removed from the culture medium. This is compatible
with the results above where Fc.gamma.R cross-linking by solid
phase IgG inhibited IL-6 production. When IgG is removed from the
culture medium, the inhibitory effect is relieved. Affinity
chromatography with proteinG-Sepharose had no effect on control
sera not inducing IL-6 production. Determination of IgG after
affinity chromatography did not find detectable amounts of IgG
(<0.01 mg/ml).
[0331] Characterisation of IL-6 inducing factor (IL-6IF) by
ultrafiltration In order to confirm that CIC are not the inducer of
IL-6 production by PBMCs in cancer patients and also to further
characterise the IL-6 inducing factor, sera from cancer patients
and healthy individuals were diluted (1:5) and ultrafiltered with a
filter cut-off at 100, 50 and 3 kD. In some analyses only a factor
with a molecular weight of less than 50 kD was identified, whereas
in others IL-6IF was at least to some extent also found in the
other fractions, but this activity could always be demonstrated in
the less than 50 kD fraction. IL-6 inducing activity was generally
not found in the fraction with a molecular weight of less than 3
kD. These results show that IL-6IF has a low molecular weight and
thus IgG or CIC can not be involved. The occurrence of this factor
in some experiments, also in fractions having a molecular weight
>50 kD, indicates either that the IL-6 inducing activity can
depend on molecules of different sizes or that a small factor is
bound to other serum proteins. The former case is compatible with
the assumption that this factor is a proteolytic fragment of some
large molecule, and that the activity is present in fragments of
different sizes. If the IL-6IF were a small fragment it is
certainly likely that it is bound to other serum proteins as it
would otherwise immediately be excreted in the urine.
6TABLE 6 Activity of ultrafiltered serum fractions Activity of
ultrafiltered serum fractions from cancer patients that previously
had a stimulating effect on autologous cells and control serum from
healthy individuals unfiltered <50 kD.sup.1) <3 kD Control
sera 1.sup.2) .sup. .sup. <31.2.sup.3) 461 101 Control sera 2
<31.2 394 40 Control sera 3 <31.2 74 42 Patient sera 1.sup.4)
<31.2 1264 43 Patient sera 2 <31.2 1404 <31.2 Patient sera
3 34 212 <31.2 Patient sera 4 13 129 9480 N.D..sup.5) Patient
sera 5 2440 986 N.D. .sup.1)Size of ultrafiltered proteins
.sup.2)Control serum from healthy individuals .sup.3)IL-6, pg/ml
.sup.4)Serum from cancer patients with malignant melanoma
.sup.5)N.D. = not done (Note: All serum fractions were cultured
with PBMC from healthy individuals with blood group 0. None of the
serum fractions had IL-6 activity when cultured without PBMC)
[0332] The fractions obtained during ultrafiltration of sera
described above were also analysed using PAGE electrophoresis of
reduced proteins. In the fractions with the highest IL-6 activity a
band having a molecular weight of about 20 kD was identified. This
was either very weak or not present in all fractions of control
sera or patient sera with no IL-6 inducing activity.
[0333] Affinity chromatography of serum using gelatine-Sepharose To
further characterise the IL-6IF and also to demonstrate a possible
similarity to the "immunesuppresive factor" described by others
(Easter et al., 1988;Hoyt et al., 1988) its binding to
gelatine-Sepharose was studied. Despite a surplus of the binding
gel, IL-6 inducing activity was not reduced when serum, prepared in
this way was tested in cultures with control cells.
[0334] IL-6 Inducing Activity in Urine
[0335] As IL-6IF was found to have a molecular weight of less than
50 kD, it is assumed that this factor will at least, to some extent
be excreted in the urine. Thus the less than 50 kD fraction was
prepared and concentrated using the 3 kD filter. When these
fractions from cancer patients were tested for IL-6 production in
cultures with PBMCs from healthy individuals an IL-6 inducing
activity was found.
7TABLE 7 IL-6 inducing activity in ultrafiltered fractions (3 to 50
kD) from urine of cancer patients and healthy individuals Urine
Control Control Control from Control PBMC 1 PBMC 2 PBMC 3 PBMC 4
Patient 1053.sup.2 1 (RCC.sup.1) Patient >2000 2 (RCC) Patient
1716 3 (RCC) Patient >2000 4 (RCC) Patient >2000 5 (MM.sup.3)
Control 1 698 291 Control 2 -- 497 .sup.1RCC = Renal cell carcinoma
.sup.2IL-6, pg/ml .sup.3MM = malignant melanoma None of the control
PBMCs produced detectable amounts (<31.2 pg/ml) of IL-6 when
cultured without urine fractions.
[0336] The identification of IL-6IF, or any other inducing factor
of an immunoregulatory substance, in the urine opens interesting
diagnostic and therapeutic possibilities. When concentration of
IL-6IF of urine is related to the serum concentration a simple
diagnostic test is made which provides essential information about
prognosis and the likelihood of therapeutic success. The diagnosis
will also be of value to determine treatment strategies dealing
with the elimination of IL-6IF--treatment of the chronic
inflammatory reaction in cancer patients.
[0337] IL-6 Inducing Activity in Tumour Extracts
[0338] The origin of IL-6IF is so far unknown. However, it is
related to the presence of a malignant tumour. The observation that
IL-6IF has a low molecular weight is compatible with its being an
enzymatic fragment of some large molecule. It is assumed that this
factor is produced in the tumour or by substances released from the
tumour. In order to verify this, tumours were minced using a
stainless steel mesh and extracted in physiological buffer during
various times. In fact, 5 out of 7 analysed tumours produced the
factor when the extracts were tested in cultures of PBMCs from
healthy individuals. These findings are in agreement with the
increased enzymatic activity of tumours as well as the poor
prognosis of patients with a high expression of several proteolytic
enzymes.
8TABLE 8 IL-6 inducing activity in extracts from frozen tumour
biopsies and fresh tumour Tumour extracts IL-6 produced by control
PBMC CC 1 .sup. 564.sup.1) MM 1 313 RCC 1 <31.2 RCC 2 <31.2
RCC 3 1078 RCC 4 1025 RCC 5.sup.2) 1554 .sup.1)pg/ml .sup.2)Fresh
biopsy None of the tumour extracts contained detectable endogenous
IL-6 activity None of the control PBMCs produced detectable amounts
of IL-6 when cultured in autologous sera without tumour extracts.
All control PBMCs produced >1200 pg/ml of IL-6 when cultured in
the presence of Lipopolysaccharide (LPS).
[0339] IL-6 Inducing Activity in Conditioned Culture Media from
Tumour Cell Lines
[0340] Immunomodulating factors have been identified in large
numbers at studies of either tumour extracts or conditioned culture
media from tumour cell lines. It has now turned out that IL-6IF is
produced by squamous cell carcinomas from the oral cavity.
Conditioned media were collected and tested using PBMCs from
healthy individuals as described. An IL-6 inducing activity was
demonstrated and this will facilitate studying therapeutic
possibilities such as reduction of IL-6IF by inhibiting different
types of tumour related enzymes, such as MMPIs.
9TABLE 9 IL-6 inducing activity in ultrafiltered (3 to 50 kD)
condition media from a squamous cell carcinoma (SCC) cell line
grown in media with fetal calf serum (FCS) or pooled human AB-sera
from two different batches AB7, and AB8, respectively. No PBMC
Conditioned Control Control Control Control Control Control
(endogenous media PBMC 1 PBMC 2 PBMC 3 PBMC 4 PBMC 5 PBMC 6
activity) UT- 1559.sup.1) 925 <31.2 SCC- 10 in FCS Media
221.sup. <31.2 <31.2 FCS, no cells UT- >2000 1753 287 SCC-
10 in AB7 Media 939 718 <31.2 AB7, no cells UT- 3043 6821
<31.2 SCC- 10 in AB 8 Media <31.2 2975 <31.2 AB8, no cells
.sup.1)IL-6, pg/ml
[0341] Similar to the situation with IL-6 we have also found
inducing activity for TNF-.quadrature. and IL-1.beta. (Table 10)
and IL-10 in serum and ultrafiltered urine. IL-10 was found in four
sera/serum fractions and one urine fraction also inducing IL-6. In
addition, one serum and one urine fraction inducing IL-6 did not
induce IL-10.
10TABLE 10 TNF-.alpha. and IL-1.beta. inducing activity in IL-6
inducing serum and ultrafiltered urine from cancer patients IL-6
TNF-.alpha. IL-1.beta. Source Control PBMC pg/ml pg/ml pg/ml
Patient serum 1 None <31.3 N.D. N.D. Patient serum 1 PBMC 1
13129 1774 414 Patient serum 2 None <31.2 86 8 Patient serum 2
PBMC 2 153 153 14 Patient serum 2 PBMC 3 2440 762 136 Patient urine
1 None <31.2 <31.2 <7.8 Patient urine 1 PBMC 4 >2000
123 147 Patient urine 1 PBMC 5 >2000 199 128 Patient urine 2
None <31.2 <31.2 <7.8 Patient urine 2 PBMC 4 >2000 166
>500 Patient urine 2 PBMC 5 >2000 582 >500 N.D. = not done
None of the control PBMCs made detectable levels of IL-6,
TNF-.alpha. or IL-1.beta., when cultured in autologous serum.
[0342] Possibility to predict therapeutic response to drug therapy
of cancer based on induction of cytokines.
[0343] We have previously shown that an immune status that
correlates to response to immunotherapy can be identified by
analysing the effect of immunomodulating drugs on PHA stimulated
PBMCs from renal cell carcinoma patients. An increased
proliferation in cultures where cimetidine is added identifies
responders to interferon-.alpha.lpha and a reduced proliferative
response to chlorambucil identifies responders to interleukin-2
(FIG. 12). Now we demonstrated that there is a correlation between
the effect of chlorambucil on the proliferative response to PHA and
on the production of TNF-.alpha. in this type of cultures (FIG.
13). Thus, in non-responders TNF-.alpha. production is more
stimulated than in responders. This opens up the possibility to
analyse the pattern of inducing factors for these two subsets of
patients and thereby identify responders to immunotherapy.
[0344] Characterisation of Dysregulating Factors
[0345] Analysis of Cytokine Inducing Factors in Urine
[0346] As described above factors inducing IL-1.beta., IL-6, IL-10
and TNF-.alpha. have been identified in the 3-30 kD fraction in
tumour extracts, conditioned culture media from cancer cell lines,
and cancer patient sera and urine. These urine factors were further
characterised by using 2D-gel electrophoresis and identified after
fragmentation using masspectrometry and N-terminal sequence
analysis.
[0347] Comparison between healthy controls and cancer patients
Comparisons were made between a pool of 11 healthy controls
(control pool) and four individual controls and 1. a pool of one
breast and one pancreas cancer patient, 2. a pool of two renal cell
carcinoma patients and 3. three individual melanoma patients.
[0348] Proteins or fragments of proteins found in the urine
fraction from different types of cancer patients but not in healthy
controls are shown in Table 11. Some proteins/fragments were found
in the urine of several different cancer patients, e.g.
albumin/albumin fragments, CD59, plasma retinol binding protein and
prostaglandin D2 synthase
11TABLE 11 Proteins/protein fragments found in urine fractions from
cancer patients, but not in the pool of healthy controls
Breast/pancreas Renal cell Malignant Proteins cancer carcinoma
melanoma Albumin fragments X Albumin fragments X Albumin fragments
X Albumin fragments X Albumin fragments X Albumin fragments X
Albumin fragments X Albumin fragments X Albumin fragments X Albumin
fragments X Albumin fragments X Albumin fragments X Albumin
fragments X Alpha-amylase, pancreatic X chain 1 Beta microsemino
protein X CD59 X X X Extracellular superoxide X dismutase Heparan
sulphate proteoglycan X (Perlecan) Immunoglobulin gamma 1 X chain,
C region Immunoglobulin kappa light X chain, C region
Immunoglobulin kappa light X chain, C region Immunoglobulin kappa
light X chain, C region Immunoglobulin kappa light X chain, C
region Immunoglobulin kappa light X chain, C region
Inter-alpha-trypsin-inhibitor- , X fragment of chain 2
Lithostathine 1 alpha X Plasma retinol binding protein X X
Prostaglandin D2 synthase X X X Secreted LY-6/uPar related X
protein/Anti-neoplastic urinary protein Splice isoform 2 of
tropomysin X alpha 3 chain Zinc-alpha-2-glycoprotein, X fragment of
chain 3
[0349] Comparison between Urine Fractions with and without IL-6
Inducing Activity
[0350] In order to further characterise and identify the cytokine
inducing factors, comparisons were made between urine samples from
melanoma patients with and without IL-6IF activity. As shown in
Table 12 several fractions were present in considerably higher
amount in urine with IL-6 inducing activity.
12TABLE 12 Comparison between melanoma patients with and without
IL-6 inducing activity. Proteins over represented in urine fraction
from patient with IL-6 inducing activity Alternative protein/s
Protein according to spot on Protein/protein fragment analysed
masspectormetry 2D gel by masspectometry analysis 1
Beta-microsemino protein 2 CD59 3 CD59 4 CD59 5 Colipase Inhibin
beta 6 Extracellular superoxide dismutase 7 Heparan sulphate
proteoglycan (Perlecan) 8 Immunoglobulin kappa light chain 9
Immunoglobulin superfamily LIR-D1 precursor member 8 10 IL-13
receptor alpha-1 chain Urokinase plasmin activator surface 11
Inter-alpha-trypsin inhibitor, chain 2 Endoplasmic reticulum
protein ERP29 12 Lithostathine 1 alpha 13 Lithostathine 1 alpha
[0351] Analyses of urine fractions before and after adsorption with
PBMCs Identification of inducing factors was next done in two
experiments by adsorbing urine, containing IL-6IF, with purified
PBMCs from healthy controls. The cells chosen for adsorption were
shown to be stimulated to produce IL-6 by these urine fractions.
The IL-6 inducing activity was significantly reduced by the
adsorption procedure (Table 13).
13TABLE 13 IL-6 and TNF-alpha inducing activity in adsorbed and
unabsorbed urine fractions Urine fraction pooled from two renal
cell carcinoma patients Urine fraction added to IL-6 TNF-alpha
control Control Control Control Control Control Control PBMCs PBMC
1 PBMC 2 PBMC 3 PBMC 1 PBMC 2 PBMC 3 None <31.2.sup.1) 392
<31.2 <31.2 225 67 Unadsorbed 778 942 1433 74 207 179
Adsorbed 311 1031 620 <31.2 59 49 Urine fraction from a patient
with malignant melanoma Urine fraction added to IL-6 TNF-alpha
control Control Control Control Control Control Control PBMCs PBMC
4 PBMC 5 PBMC 6 PBMC 4 PBMC 5 PBMC 6 None 167 <31.2 <31.2 94
121 <31.2 Unadsorbed >2000 >2000 55 348 531 38 Adsorbed
1187 1365 <31.2 78 203 <31.2 .sup.1)pg/ml The urine fractions
did not contain endogenous IL-6 or TNF-alpha.
[0352] In agreement with this, several proteins disappeared or were
found in significantly reduced amounts in the adsorbed fractions as
shown in 2D-gel electrophoresis (FIG. 14 and 15). Reduction in the
amount of the proteins was recorded visually and confirmed using
densitometry. Adsorbed proteins were identified using
masspectrometry. In addition the amino acid sequence of nine
proteins/fragments was determined using the Edman sequencing
technique. The identified proteins are shown in Table 14 and 15.
Amazingly, the majority of these fractions were found to be
fragments of normally occurring proteins, such as IgG,
.beta.2-microglobulin and serum albumin.
14TABLE 14 Proteins/protein fragments adsorbed from an
IL-6-inducing urine fraction pooled from two patients with renal
cell carcinoma by purified normal PBMC. Fragment starting with Spot
Protein Sequenced position 1 Albumin fragment No NA 2 Albumin
fragment No NA 3 Albumin fragment No NA 4 Albumin precursor Yes 253
5 Albumin precursor Yes 253 6 Albumin precursor Yes 253 7 Albumin
precursor Yes 517 8 Albumin precursor Yes 101 9
Alpha-1-microglobulin Yes 21 10 Alpha-1-microglobulin Yes 21 11
Beta-2-microglobulin Yes 22 12 Beta-2-microglobulin Yes 47 13 IgG
kappa light chain No NA 14 IgG kappa light chain No NA 15 IgG kappa
light chain No NA 16 Zinc-alpha-2- No NA glycoprotein NA = Not
applicable
[0353]
15TABLE 15 Proteins/protein fragments adsorbed from an
IL-6-inducing urine fraction from a patient with malignant melanoma
by purified normal PBMC. Alternative protein/s according to mass
Spot Protein spectometry analysis 1 Colipase chain 1 Inhibin beta B
chain 2 CD59 3 Extracellular superoxide dismutase 4 IL-13 Receptor
alpha chain 1 Urokinase plasminogen activator 5 Similar to
cytokeratin 8 IgG heavychain v region, Cell division protein
kinase, GMP reductase 2, Vacuolar protein sorting 26 8 Tumor
endothelial marker 1 precursor
[0354] As these fragments were identified based on their adsorption
to PBMCs, demonstrating a high degree of binding, the occurrence of
receptors for these protein fragments/peptides on normal PBMCs
sensitive to IL-6IF can be postulated. As albumin and
132-microglobulin do not normally bind to these cells, it can be
further postulated that fragmentation of these proteins results in
conformational changes exposing new structures with a specific
binding to receptors on PBMCs. As demonstrated herein this results
in modulation of the immune system. Thus, the basis for a quite new
mechanism of immunomodulation in diseases characterised by a high
proteolytic activity, e.g. inflammation and cancer, has been
discovered.
[0355] In conclusion, a large number of fragments, which were not
consistently present in urine from healthy control persons, were
found in urine from cancer patients. A difference in low molecular
weight urine fragments was found between two patients, the urine of
whom was either IL-6 inducing or not. This might reflect a
significant difference in tumour related proteolytic activity in
these two patients. Furthermore, several of these fragments could
be adsorbed by PBMCs and different fragments were adsorbed in the
two experiments presented herein, again indicating a difference in
tumour related proteolytic activity between different patients. As
a large number of fragments are generated the further
characterisation of dysregulatory inducing factors was done using
preparative proteomics, allowing determination of functional
activity during preparation, that is after isoelectric focusing and
preparative gel-electrophoresis.
[0356] Fragmentation of IgG and Serum Albumin using Matrix
Metalloproteinases (MMP)
[0357] Based on the results described above on the binding of IgG
and albumin fragments to PBMCs, IgG or serum albumin was incubated
with MMPs under well-defined conditions. Two different buffer
systems were used in these experiments (FIG. 16). The supernatants
were analysed using gel-electrophoresis and their cytokine inducing
activity was analysed in cultures with normal PBMCs. As
demonstrated in FIG. 16 several MMPs released fragments of IgG and
serum albumin, which induced or modulated IL-6 inducing production.
In particular, MMP-1, -2, -3, -13 released active fragments from
albumin and MMP-2, -3, -7 and -13 from IgG.
[0358] Immunomodulating Activity of Extracellular Matrix Substance
(ECM) Fragments
[0359] In another experiment, fragments of an extra cellular matrix
substance, collagen, was added to IL-2 stimulated cultures of PBMCs
from healthy donors. Commercially available collagen contained a
large number of fragments and these fragments were found to have a
strongly inhibitory effect on IL-2 induced proliferation (FIG.
17).
[0360] Extraction of Cytokine Inducing Factors from Tumour
Tissue
[0361] We have, in this document, described that IL-6IF can be
extracted from malignant tumours, e.g. malignant melanoma, renal
cell carcinoma, colorectal cancer. These results were confirmed in
a new series of experiments, where homogenised tumours were washed
three times in PBS or RPMI in order to collect cytokine inducing
factors already present in the tumours, so called "preformed
inducing factors" (PIF).
[0362] The occurrence of cytokine inducing factors in these
washings was determined in short term cultures with normal PBMCs.
As shown in Table 16, a high IL-6 inducing activity was repeatedly
found in the PIF-fractions. These fractions were then further
analysed using isoelectric is focusing and preparative
electrophoresis.
16TABLE 16 Induction of IL-6 production in PBMCs from healthy blood
donors by factor/s extracted from homogenised tumours by RPMI, so
called preformed inducing factors, PIF. Two PIF fractions were
tested on PBMCs from 9 and 14 controls, respectively. As can be
seen, these fractions efficiently induce production of IL-6 whereas
cultures with the buffer, RPMI, alone showed no or only a very low
inducing activity. IL-6 Tumor production PIF Control (pg/mL)
preparation PBMCs RPMI RPMI + LPS RPMI + PIF 1 1 <6.25 >400
>400 1 2 <6.25 >400 >400 1 3 <6.25 >400 >400 1
4 <6.25 >400 >400 1 5 <6.25 >400 >400 1 6
<6.25 >400 >400 1 7 <6.25 >400 >400 1 8 <6.25
>400 >400 1 9 <6.25 >400 >400 2 10 <6.25 >400
>400 2 11 14 >400 >400 2 12 35 >400 >400 2 13 13
>400 >400 2 14 <6.25 >400 >400 2 15 <6.25 >400
>400 2 16 <6.25 >400 >400 2 17 <6.25 >400 >400
2 18 20 >400 >400 2 19 217 >400 >400 2 20 38 >400
>400 2 21 21 >400 >400 2 22 14 >400 >400 2 23 109
>400 >400
[0363] Release of Cytokine Inducing Factors by Incubation of
Homogenised, Washed Tumour Tissue with MMPs
[0364] In order to reduce the amount of preformed cytokine inducing
factors (PIFs) present in the tumours, tissue sections/homogenates
were thoroughly washed before addition of proteolytic enzymes, such
as MMPs. The tumour sections/homogenates were then incubated for 20
hours at 37.degree. C. IL-6 inducing activity of the supernatants
was then analysed in cultures of normal PBMCs. As shown in FIG. 18,
addition of MMP-2 modulated the release of IL-6 inducing activity.
In gel electrophoresis of these supernatants, the albumin band was
found to be better preserved in incubations, to which MMP-2 was
added. This is reasonably due to an effect of MMP-2 on the
degradation of enzymes degrading albumin. It can thus be concluded
that MMPs can degrade tumour tissue substances into fragments with
cytokine inducing activity. The effect of MMP-2 on the preservation
of albumin in these incubations also demonstrates that proteolytic
enzymes are involved in the regulation of the intra-tumoural
proteolytic activity. A complex interaction of proteolytic enzymes
is thus demonstrated and this results in generation and/or
modulation of the production of dysregulatory inducing factors.
[0365] Increased production of cytokine inducing factors by
addition of IgG or serum albumin to washed tumour
homogenates/tissue sections. In order to further explore the nature
of immunomodulating substances/fragments in tumours and based on
the observation, mentioned above, that fragments of albumin, IgG
and .beta.2-microglobulin efficiently binds to normal PBMCs, we
added albumin or IgG to thoroughly washed tumour
sections/homogenates and incubated for 18-22 h at 37.degree. C. It
was then found that addition of IgG and in particular albumin
markedly increased the production of cytokine inducing factors as
determined in PBMC cultures (FIG. 19). In order to rule out that
the effect of adding albumin to these incubations was due to a
protective action, such as reducing loss because of proteolytic
degradation or binding to plastic surfaces, albumin was added to
fresh PIF-fractions and incubated at 37.degree. C. for 18 h.
Compared to parallel incubations with no addition of albumin, the
IL-6 inducing activity was lower when albumin was added, which
shows that the markedly increased IL-6 inducing activity after
adding albumin to washed homogenates is not due to any protective
activity of albumin but rather that albumin acts as a substrate for
intra-tumoural proteolytic enzymes. Thus it is demonstrated that
immuno-modulating IgG and albumin fragments are produced in the
intra-tumoural milieu.
[0366] Based on our previous results it might seem somewhat amazing
that incubation of PBMCs with IgG fragments results in an increased
production of IL-6 as pre-coating of culture plates with IgG from
serum or an albumin/IgG mixture inhibited IL-6 production. A
reasonable explanation to this apparent discrepancy in effect is
that the IgG fragments manage to block the inhibitory effect
natural IgG. Thus resulting in an enhanced pathological production
of IL-6. This opens up interesting possibilities to modulate FcR
mediated immune regulation.
[0367] Analysis and Characterisation of Immunomodulating Factors in
Tumour Extracts using "Preparative Proteomics"
[0368] Further analysis of PIF-fractions by isoelectric focusing
and preparative electrophoresis has identified two fractions with
IL-6 inducing activity, with different pI. Preparative
electrophoresis also identified two fractions, of different
molecular weight, with activity.
[0369] Abbreviations
[0370] ALP; Alkaline phosphatase
[0371] APC; Antigen presenting cell
[0372] BSA; Bovine serum albumin
[0373] BSS; Hank's balanced salt solution
[0374] CBIC; Cell bound immune complex
[0375] CIC, Circulating immune complex
[0376] ConA; Concanavalin A
[0377] CRC; Colorectal carcinoma
[0378] CRP; C-reactive protein
[0379] CTL; Cytotoxic T-lymphocyte
[0380] DAB; 3,3'-Diaminobenzidine
[0381] ECM; Extracellular matrix
[0382] ELISA; Enzyme linked immunosorbent assay
[0383] ESR; Erythrocyte sedimentation rate
[0384] FcR; Fc receptor
[0385] GAH; Goat anti-human IgG antibody
[0386] HSA; Human serum albumin
[0387] IC; Immune complex
[0388] IHC; Immunohistochemistry
[0389] ICAM-1; Intracellular adhesion molecule-1
[0390] IL-1.beta.; Interleukin-1.beta.
[0391] IL-4; Interleukin-4
[0392] IL-6; Interleukin-6
[0393] IL-10; Interleukin-10
[0394] IL-12; Interleukin-12
[0395] IL-17; Interleukin-17
[0396] IL-1Ra; Interleukin-1 receptor antagonist
[0397] IL-6IF; Interleukin-6 inducing factor
[0398] LPS; Lipopolysaccharide
[0399] MHC 1; Major histocompatibility complex 1
[0400] MM; Malignant melanoma
[0401] MMP; Metalloprotease
[0402] NK-cell; Natural killer cell
[0403] PAP; Peroxidase anti-peroxidase
[0404] PBMC; Peripheral blood mononuclear cell
[0405] PBS; Phosphate buffered saline
[0406] PFA; Paraformaldehyde
[0407] PGE2; Prostaglandin E.sub.2
[0408] PHA; Phytohemagglutinin A
[0409] RCC; Renal cell carcinoma
[0410] RIA; Radioimmuno assay
[0411] RtPCR; Reverse transcriptase polymerase chain reaction
[0412] SBR; Serum blocking factors
[0413] TAA; Tumour associated antigen
[0414] TAM; Tumour infiltrating macrophage
[0415] TBS; Tris buffered saline
[0416] TGF-.beta.; Transforming growth factor beta
[0417] Th1; T helper 1
[0418] Th2; T helper 2
[0419] TIL; Tumour infiltrating lymphocyte
[0420] TIMC; Tumour infiltrating mononuclear cell
[0421] TNF.alpha.; Tumour necrosis factor .alpha.
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[0485] Figure Legends
[0486] FIG. 1 shows melanoma biopsies stained for the expression of
IL1Ra. Different patterns are hereby found, viz. A) tumour cells
are generally stained with some positive infiltrating mononuclear
cells, and B) large numbers of infiltrating cells staining IL-1Ra,
tumour cells only faintly positive.
[0487] FIG. 2 shows production of IL-1Ra in short term cultures of
PBMC from healthy controls and cancer patients. The effect of
pre-coating of the culture wells is shown.
[0488] FIG. 3 shows comparison of IL-1Ra production by PBMCs from
healthy individuals and melanoma and renal cell carcinoma patients,
cultured in A) HSA pre coated wells or B) uncoated wells.
[0489] FIG. 4 shows inhibition of IL1Ra production by Tosyl. The
effect of Tosyl on IL-1Ra production (mean .+-.S.E.) by PBMC from 9
healthy individuals in 10% autologous sera cultured in microtiter
plates pre-coated with A) HSA, and B) HSA/IgG.
[0490] FIG. 5 shows IL-2 induced proliferation in healthy
individuals and RCC patients. IL-2 induced proliferation (mean
.+-.S.D.) by PBMC from normal healthy individuals (grey bars, 21-29
individuals) and PBMC from RCC patients (black bars, 12-18
individuals) cultured in 10% autologous sera on uncoated and
pre-coated microtiter plates. Significant (p=0.011) difference in
proliferation between PBMC from healthy individuals and RCC
patients on uncoated plates, but not on HSA coated or on HSA/IgG
coated plates. Significant (p=0.0045) difference in proliferation
between PBMC from RCC patients cultured on uncoated and HSA/IgG
coated plates.
[0491] FIG. 6 shows normal PBMC cultured in autologous sera (black
bars) or sera from cancer patients (open bars) in the presence of
IL-2. Proliferation was measured by 3H-uptake on day 7. Patients 88
and 124 had previously been shown to induce high levels of IL-6
production, whereas patient 112 did not.
[0492] FIG. 7 shows tumour biopsies stained for the presence of
tissue bound IgG/IC and T-lymphocytes using a double staining
technique with recombinant protein G (not binding to albumin).
Different staining patterns are shown, viz. A) staining of vascular
areas/endothelial cells and some lymphocytes for IgG. Some
lymphocytes are not stained for IgG/IC. Low numbers of tumour
infiltrating mononuclear cells, B) a diffuse staining of the tumour
tissue for IgG/IC, whereby the majority of the lymphocytes are not
stained for IgG/IC, C) staining tumour infiltrating macrophages and
some lymphocytes for IgG/IC, but tumour cells are generally
negative, D) extensive staining of vascular areas for IgG/IC with
very low numbers of infiltrating mononuclear cells.
[0493] FIG. 8 shows cytospins of PBMC from two patients with
malignant melanoma stained for the presence of IgG/IC, using
recombinant protein-G (A) or monoclonal directed against the
Fc-part of IgG.
[0494] FIG. 9 shows IL-6 production by PBMCs from different subsets
of colorectal cancer patients. A) without LPS stimulation and B)
with LPS-stimulation.
[0495] FIG. 10 shows survival in renal cell carcinoma patients
according to IL-6 production by PBMCs in short term cultures where
the microtitre plates were coated with HSA. High production is
>2500 pg/ml.
[0496] FIG. 11 shows inhibition of IL-6 production by IgG.
Production of IL-6 by control PBMCs after culture on uncoated
tissue culture wells (n=37), HSA-coated (n=37), or wells coated
with HSA/IgG (n=36).
[0497] FIG. 12 shows the effect of chlorambucil on PHA-induced
proliferation of PBL from RCC patients before treatment with IL-2.
Modulation Index (MI) was calculated as described under Materials
and Methods. The assays were performed at the following time
points: 1) before start of treatment, 2) one week later, 48 hours
after five days of IL-2 treatment, 3) after one week without IL-2
administration and 4) after an additional week, 48 hours after
another five days of IL-2 treatment combined with chlorambucil.
[0498] FIG. 13 shows the effect of chlorambucil (CHL) on
TNF-.alpha. production and proliferation of PHA-stimulated PBMC
from RCC patients. PBMC were cultured with PHA in the presence or
absence of CHL for 72 hours and the cellular .sup.3H-uptake and the
TN-.alpha. concentration in cell-free culture supernatants were
assessed. Modulation Index was calculated as described under
Materials and Methods. Each circle represents one patient.
[0499] FIG. 14. 2D gel electrophoresis of PBMC-adsorbed and
unadsorbed urine fractions pooled from two patients with renal cell
carcinoma. 230 ug of protein was loaded per 2D gel. Separated
proteins (based on isoelectric focusing in the first dimension and
molecular mass in the second dimension) were detected by SYPRO Ruby
staining.
[0500] FIG. 15. 2D gel electrophoresis of PBMC-.alpha.dsorbed and
unadsorbed urine fractions from a patient with malignant melanoma.
350 ug of protein was loaded per 2D gel. Separated proteins (based
on isoelectric focusing in the first dimension and molecular mass
in the second dimension) were detected by SYPRO Ruby staining.
[0501] FIG. 16. Generation of IL-6 inducing factors by incubation
of IgG (A and C) and albumin (B and D) with MMPs. Two experiments
using different buffer systems are shown (as described in Material
and Methods). The substrates were incubated with MMPs for 20 hours
in experiments A, B, C and for 5 hours in experiment D. The
production of IL-6 was then tested in cultures of PBMCs from
healthy controls.
[0502] FIG. 17. Effect of collagen/collagen fragments on the
proliferative response (measured as incorporation of .sup.3H-TdR)
of normal PBMCs to IL-2. As can be seen a strong inhibitory effect
was demonstrated in two out of three experiments.
[0503] FIG. 18. Modulation of IL-6 inducing factors by incubation
of homogenised, washed tumour tissue with MMP-2. A and B represent
two separate experiments with two different tumour tissues in each.
The effect of this enzyme varies, dependent on the intra-tumoural
milieu of different tumours, but it is clearly shown that MMP-2 has
a modulatory effect on the production of IL-6 inducing
factor/activity, which was tested in cultures of PBMCs from healthy
controls.
[0504] FIG. 19. Generation of IL-6 inducing factors/activity by
incubation of IgG and albumin with homogenised, washed tumour
tissue. A and B represent two separate experiments. As shown in
these two experiments adding IgG and in particular albumin to
tumour tissue markedly increases the production of IL-6 inducing
factor/activity, which was tested in cultures of PBMCs from healthy
controls.
* * * * *