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Antibody-dependent cellular cytotoxicity-mediated serotherapy against murine neuroblastoma. II. In vitro and in vivo treatment using effector cells from normal and X-irradiated humans.

Human peripheral lymphocytes (HLc) have been studied in vitro as possible effector cells in an antibody-dependent cellular cytotoxicity (ADCC) reaction. HLc were found to be active against murine neuroblastoma cells (MNB) inoculated into the flank of syngeneic mice. Both the time of onset of tumor appearance and the mean survival time of tumor-bearing host mice were beneficially influenced. Occasional animals could be cured of up to 10(5) tumor cells (1--10 cells of MNB are lethal). This level of tumor cytotoxicity approaches that of tolerance-dose chemotherapy and is without demonstrable side-effects. HLc from patients who had just received = 3,000 rads fractionated therapeutic X-irradiation were equally effective as HLc from control non-irradiated donors when assayed at equivalent HLc : tumor cell ratios. HLc could also inhibit MNB tumor cell growth in the ascitic form, confirming in vivo activity. Overall, HLc appeared almost as active as rat spleen cells in mediating a useful anti-tumor ADCC. This approach may ultimately prove useful in man, especially in the peritoneal cavity, and is currently limited only by the need to develop appropriate antisera. It is proposed and emphasized that such antisera need not necessarily be directed at tumor-specific antigens. Organ-specific antibodies such are already known to develop spontaneously in some human auto-immune diseases might be equally useful and are a naturally occurring potential source of appropriately expressed genetic material.

Animals↗

Antibody-dependent cellular cytotoxicity-mediated serotherapy against murine neuroblastoma. I. In vitro and in vivo treatment using normal, gamma-irradiated and immune-stimulated rat effector cells.

The in vitro and in vivo activity has been investigated of antisera prepared against a murine (C-1300) neuroblastoma line (MNB) capable of differentiation. An antibody-dependent cellular cytotoxicity (ADCC) reaction was employed using rat spleen cells (RSC). ADCC activity in vitro (using 51Cr-release) was shown, but a maximum of only 50% of the immunologically releasable 51Cr was achieved. Nevertheless, in vivo (syngeneic mouse-tumor flank assay) significant delays were obtained in tumor onset and lethality. Under ideal circumstances, i.e., coating of tumor cells prior to inoculation and high RSC effector cell ratios, a significant number of animals could be cured of substantial tumor burdens (10(6) cells). While close proximity of the site of injection of effector cells was required (ectopic injections of RSC were ineffective), the anti-MNB ADCC was shown to be quite active in vivo without external precoating of the cells with antisera. RCS obtained from BCG-treated rats were more numerous and slightly more effective. RSC obtained from gamma-radiated animals retained normal activity. With appropriate antisera this approach could be useful under selected clinical circumstances.

Adjuvants, Immunologic↗

Symposium on infectious complications of neoplastic disease (Part II). Immunoprophylaxis and serotherapy of bacterial infections.

Immunologic approaches to the prevention and treatment of bacterial infections date back to the antecedent century. Recent interest and controversy has centered about the efficacy of gram-negative bacillary vaccines, antiserum against endotoxin, and pneumococcal vaccines. Immunization of cancer patients with Pseudomonas lipopolysaccharide vaccines has yielded inconsistent results. Factors limiting the further application of this approach are the poor immune responses in neutropenic patients and the marked pyrogenicity and pain associated with vaccine administration. Similarly, patients being treated for neoplasms of the hematopoietic system are not likely to show good antibody responses to pneumococcal antigens, even though they are not toxic. Pneumococcal immunization appears to be effective, at least as measured in terms of antibody titers, in those patients with lymphoma who have not undergone splenectomy and are not receiving chemotherapy at the time of immunization. The most reliable approach towards immunoprophylaxis may be the passive one, with antibody being produced in normal donors. The antibodies are short-lived, and this type of prophylaxis still needs to be evaluated in controlled trials. In a recently completed controlled therapeutic trial, the therapeutic application of an antiserum against core endotoxin antigens resulted in a significant reduction in deaths and increased recovery from shock complicating gram-negative sepsis. However, antiserum failed to protect cancer patients or neutropenic subjects.

Bacterial Infections↗

Pioneers of anti-venomous serotherapy: Dr Vital Brazil (1865-1950).

Dr Vital Brazil was a great humanitarian and pioneer of medical science. His main work arose from his concern with poisonous snakebite accidents to labourers working the land. Vital Brazil estimated that, at the beginning of this century, deaths due to crotaline snakebites in the State of São Paulo, Brazil, were nearly 3000 per year, representing a mortality rate of about 25%, the majority being due to bothropic envenomation. After reading a report of Calmette's anti-Naja serum, Vital Brazil raised monovalent serum against the venom of Bothrops jararaca and the venom of Crotalus durissus terrificus. In 1989 this led to the first demonstration of the specificity of anti-venomous serum and later, the first production of polyvalent serum for therapeutic use. As Director of the newly founded Institute Butantan in São Paulo, Vital Brazil was actively engaged in every aspect of serotherapeutic treatment. This included organizing a unique system of exchanging anti-ophidic serum for snakes as well as a wide-ranging teaching programme. His many outstanding contributions to the fields of immunology, public health, toxinology and herpetology required not only a very high level of observational, deductive and practical ability but also an unswerving vision and sense of duty; this was allied to great administrative skill and exceptional energy.

Antivenins↗

The treatment of the scorpion envenoming syndrome: the Saudi experience with serotherapy.

A protocol for treatment of scorpion sting based mainly on antivenom therapy was applied nation-wide in Saudi Arabia. At least 5 x 1 ml ampoules of antivenom diluted in 20-50 ml saline were injected slowly i.v. in all patients confirmed to have scorpion stings or suspected stings with systemic manifestations. A list of drugs was specified to be used in adjunctive therapy, when required. Analysis of 1033 cases at Al-Baha region, 791 cases at Al-Qassim region and more than 600 cases from 12 central and specialist hospitals in the Central Province revealed impressive results. Except for a 12-year-old boy who was inadequately treated with antivenom and died from pulmonary oedema, haematemesis, severe neurotoxicity and circulatory failure, no other fatalities occurred. The incidence of pulmonary oedema, hypertension, hypotension, cardiac dysrhythmias and neurological symptoms requiring drug therapy following antivenom administration was very slight. The period of stay in the hospital was reduced; most patients were symptom-free within 1-2 days. The early reaction to antivenom administration was lower than expected, amounting to 6.6% and 1.7% among Al-Qassim and Al-Baha victims, respectively. The severity of the reaction in both groups was low, consisting mainly of skin rashes, urticaria, wheezing and bronchial secretion, but no anaphylaxis. About 13.8% of Al-Baha victims were previously treated with antivenom but only 1.7% of the patients showed positive skin tests. This might be due to the low protein content of the antivenom and the action of the venom in releasing massive amounts of catecholamines.

Animals↗

Potential use of serotherapy in the prevention and treatment of infection with the human immunodeficiency virus.

While prevention of infection with the human immunodeficiency virus (HIV) using prophylactic immunization and treatment with anti-viral drugs would appear to be the methods of choice for the prevention and treatment of this infection, neither safe and effective vaccines nor anti-viral agents have yet been developed. A third approach should thus be considered which could be employed both for prophylaxis and treatment of this disease. This approach utilizes specific, anti-HIV antibodies, passively administered, to prevent and/or slow the infectious process. The disadvantages of using xenogeneic antibodies and the advantages of using human antibodies are discussed. The need for large quantities of human antibodies to HIV necessitates the production of cell lines producing these antibodies. The various techniques of producing these lines are summarized. Finally, preliminary data supporting the feasibility of producing human cell lines producing antibody to HIV are presented.

Acquired Immunodeficiency Syndrome↗

Effects of antivenom serotherapy on hemodynamic pathophysiology in dogs injected with L. quinquestriatus scorpion venom.

In dogs, scorpion venom causes an immediate increase in cardiac output that declines below baseline values within one hour. We tested the hypotheses that antivenom given before venom injection may prevent changes in cardiac output, while antivenom given after the inotropic stage of envenomation cannot reverse cardiac output decline. Twenty-five anesthetized, mechanically ventilated dogs were given 0.1 mg/kg i.v. venom of the scorpion Leiurus quinquestriatus. The dogs were randomized into 4 groups: 5 dogs were given venom alone (control group) and 6 dogs were given 6 ml of antivenom one minute before venom injection while 8 and 6 dogs were given 6 ml of antivenom 20 and 60 min after venom injection, respectively. Parameters reflecting respiratory and circulatory functions were measured for 180 min after venom injection. Scorpion venom caused a gradual decrease in heart rate, an initial elevation of systemic and pulmonary blood pressure and cardiac output followed by a decline in these parameters. PO2, pH and HCO3- gradually decreased, while PCO2 gradually increased from baseline. Antivenom given before venom injection prevented all the effects induced by the venom. Antivenom given at 20 and 60 min after venom injection had no effect on cardiac output and HCO3- decline, but caused an increase in heart rate, PO2 and pH and a decrease in PCO2. We assume that antivenom clears free toxins from the circulation, and since cardiac output and HCO3- did not improve after this clearance, we conclude that following intravenous venom injection, heart and circulation are rapidly affected by the toxins or by other substances released by the venom which do not respond to antivenom. Improvements in respiration and heart rate with antivenom given after venom injection may be secondary to reversion of cholinergic effects of the venom. Improvement in respiration may be also explained by reversion of the toxic effects on Ca2+ activated K+ channels of bronchial smooth muscle. All these effects may be secondary to clearance of toxins by the antivenom.

Animals↗

Doctor Albert Calmette 1863-1933: founder of antivenomous serotherapy and of antituberculous BCG vaccination.

In 1891 in Saigon (now Ho Chi Minh City), Dr. Albert Calmette established the first daughter Pasteur Institute for the protection of the local population against rabies and smallpox. Inspired by the discovery of diphtheria antitoxin by Behring, Calmette studied ways of raising serum against cobra venom. In 1895, now in Lille at the second daughter institute that he established, Calmette produced anticobra serum for therapeutic use that was to revolutionize the treatment of snakebite worldwide. The incidence of tuberculosis in the working class of the industrial north shocked Calmette. In response, firstly he organized an antituberculous dispensary to provide assistance to the sick and help limit the spread of the disease by improving social hygiene and secondly he devoted himself, with the assistance of Camille Guérin, to obtaining an attenuated live strain of tubercle bacilli with fixed biological characteristics for use as a vaccine. Such a strain developed during repeated passage of a culture of Mycobacterium bovis grown on a bile potato medium. In 1919, Dr. Albert Calmette took up the appointment of Sub-Director of the Pasteur Institute of Paris. Prolonged trials of BCG (Bacille Calmette-Guérin) vaccine showed it to be safe and vaccination of very young infants born of tuberculous mothers commenced in 1921. The use of BCG vaccine as a prophylactic against tuberculosis spread world-wide and has remained important in combatting this scourge.

Adjuvants, Immunologic↗