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Biomedical subjects

B Wollenberg

Publications and source records attributed to B Wollenberg.

At least 37 records · Page 2Linked to original sources

Reversed portal vein pulsatility on Doppler ultrasound secondary to an iatrogenic mediastinal haematoma.

The Doppler ultrasound pattern of reversed pulsatile flow (RPF) of the portal vein (PV) is strongly associated with high atrial pressure. Tricuspid regurgitation is considered to be the main cause of RPF in patients with chronic heart disease, but the precise pathomechanism of this PV flow pattern has not yet been resolved. We describe for the first time a RPF of the PV in a young patient with a mediastinal haematoma after inadvertent puncture of the subclavian artery. In this patient, transcutaneous echocardiography demonstrated normal valves without any tricuspid regurgitation as well as normal diameters of the cardiac cavities. The RPF of the PV in this patient resolved spontaneously within 7 days. An increased hepatic outflow resistance with transmission of hepatic artery pulsations across arterioportal communications seems the most likely pathomechanism to explain our finding.

Adult↗

The Fc-region of a new class of intact bispecific antibody mediates activation of accessory cells and NK cells and induces direct phagocytosis of tumour cells.

Bispecific antibodies (bsAb) are considered as promising tools for the elimination of disseminated tumour cells in a minimal residual disease situation. The bsAb-mediated recruitment of an immune effector cell in close vicinity of a tumour cell is thought to induce an antitumoural immune response. However, classical bispecific molecules activate only a single class of immune effector cell that may not yield optimal immune responses. We therefore constructed an intact bispecific antibody, BiUII (anti-CD3 x anti-EpCAM), that not only recognizes tumour cells and T lymphocytes with its two binding arms, but also binds and activates Fcgamma-receptor positive accessory cells through its Fc-region. We have demonstrated recently that activated accessory cells contribute to the bsAb-induced antitumoural activity. We now analyse this stimulation in more detail and demonstrate here the BiUII-induced upregulation of activation markers like CD83 and CD95 on accessory cells and the induction of neopterin and biopterin synthesis. Experiments with pure cell subpopulations revealed binding of BiUII to CD64+ accessory cells and CD16+ NK cells, but not to CD32+ B lymphocytes. We provide further evidence for the importance of the Fc-region in that this bispecific molecule stimulates Fcgamma-R-positive accessory cells to eliminate tumour cells in vitro by direct phagocytosis.

Antibodies, Bispecific↗

Tumor cell-derived prostaglandin E2 inhibits monocyte function by interfering with CCR5 and Mac-1.

The cyclooxygenases (COX)-1 and COX-2 are key enzymes in the conversion of arachidonic acid to prostaglandins and other eicosanoids. Whereas COX-1 is expressed ubiquitously, COX-2 is an immediate-early gene often associated with malignant transformation, and a role for the COX enzymes in tumor initiation and promotion is discussed. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and indomethacin that block COX-1 and -2 have been shown to have beneficial effects for tumor patients. Therefore, these compounds have gained interest also among oncologists. However, the molecular mechanism by which NSAIDs inhibit carcinogenesis is not clearly understood. The prostaglandin-dependent and -independent effect may both account for their antineoplastic action. We show here that tumor cells derived from different tumors regularly produce prostaglandin E(2) (PGE(2)) interfering with the function of monocytes. In particular, PGE(2) inhibits the potential of monocytes to migrate in the direction of a chemotactic stimulus and to adhere to endothelial cell. This inhibition is most probably due to a modulation of the chemokine receptor CCR5 and the beta2-integrin Mac-1. Both down-regulation of CCR5 and reduced expression of Mac-1 may diminish the potential of peripheral blood monocytes to leave blood vessels and invade target tissues. Since both dysfunctions can be restored with NSAIDs, our findings help to explain the molecular chemopreventive action of NSAIDs on tumor formation and progression.

Anti-Inflammatory Agents, Non-Steroidal↗

Simultaneous activation of T cells and accessory cells by a new class of intact bispecific antibody results in efficient tumor cell killing.

Bispecific Abs (bsAb) are promising immunological tools for the elimination of tumor cells in minimal residual disease situations. In principle, they target an Ag on tumor cells and recruit one class of effector cell. Because immune reactions in vivo are more complex and are mediated by different classes of effector cell, we argue that conventional bsAb might not yield optimal immune responses at the tumor site. We therefore constructed a bsAb that combines the two potent effector subclasses mouse IgG2a and rat IgG2b. This bispecific molecule not only recruits T cells via its one binding arm, but simultaneously activates FcgammaR+ accessory cells via its Fc region. We demonstrate here that the activation of both T lymphocytes and accessory cells leads to production of immunomodulating cytokines like IL-1beta, IL-2, IL-6, IL-12, and DC-CK1. Thus this new class of bsAb elicits excellent antitumor activity in vitro even without the addition of exogenous IL-2, and therefore represents a totally self-supporting system.

Animals↗

Gene therapy--phase I trial for primary untreated head and neck squamous cell cancer (HNSCC) UICC stage II-IV with a single intratumoral injection of hIL-2 plasmids formulated in DOTMA/Chol.

Recombinant IL-2 protein has shown many immunostimulatory effects in a variety of human tumors. However, the clinical use of rIL-2 is limited by common and serious side effects after systemic administration. IL-2 expression plasmids may circumvent these drawbacks, producing high local IL-2 concentrations that cause limited or no systemic side effects. Due to the superficial growth of squamous cell carcinoma of the head and neck (HNSCC) are readily accessible for direct intratumoral injection and therefore an optimal target for such a gene therapy approach. There has been evidence for local and systemic activation of immune cells by peritumoral injections of IL-2 in patients with advanced HNSCC (Whiteside et al. 1993; Cortesina et al. 1994; De Stefani et al. 1996). We now perform a placebo-controlled, dose-rising study of the safety and tolerability of a single intratumoral injection of hIL-2 plasmid at four dose levels formulated in DOTMA/Chol in patients with primary untreated head and neck squamous cell cancer (HNSCC) TNM stage II-IV. The patients will be monitored for the occurrence of any adverse reactions to the given medication. In addition, we will determine whether the intratumoral administration of the plasmid induces and or enhances tumor-specific host responses at the immunological and or clinical level.

Carcinoma, Squamous Cell↗

Impairment of T-cell activation in head and neck cancer in situ and in vitro: strategies for an immune restoration.

BACKGROUND: The rationale for the study was based on the hypothesis that decreased or absent expression on tumor cells of adhesion molecules, the class I or class II major histocompatibility complex (MHC) molecules, or costimulatory molecules might be responsible, in part, for the poor ability of squamous cell carcinoma of the head and neck (SCCHN) to induce generation of antitumor effector cells in vitro and in vivo. OBJECTIVE: To investigate expression of intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function associated antigen-3 (LFA-3) and distribution of the costimulatory molecules, B7.1, B7.2, and CD40, and of class I and class II MHC molecules on SCCHN cells in situ and on SCCHN cell lines. SETTING: University medical centers. DESIGN: Expression of ICAM-1, LFA-3, MHC molecules, B7.1, B7.2, and CD40 was evaluated in human SCCHN biopsy specimens by immunohistochemistry and on SCCHN cell lines by flow cytometry. To confirm our hypothesis that impaired T-cell activation observed in patients with SCCHN is caused by the absence of costimulatory B7 molecules, a B7-negative SCCHN cell line was transduced with the B7.1 gene, using a retroviral vector, and tested in mixed lymphocyte tumor cocultures. RESULTS: In contrast to abundant expression of ICAM-1, LFA-3, class I MHC molecules, and CD40, the absence of B7.1, B7.2, and class II MHC molecules on tumor cells was observed in situ and in vitro. Lymphocytes and antigen-presenting cells in inflammatory infiltrates surrounding tumor cell clusters expressed both costimulatory and adhesion molecules. The SCCHN lines negative for B7.1 and class II MHC antigens failed to induce proliferation of T cells in mixed lymphocyte tumor cocultures. However, when these cell lines were transduced with the B7.1 gene, their ability to induce T-cell proliferation in mixed lymphocyte tumor cocultures was restored. CONCLUSIONS: The absence of B7 protein or class II MHC antigen expression on human SCCHN cells is responsible for the failure of these tumors to induce proliferation of T cells in vitro. Transduction of the B7.1 gene into SCCHN restores the ability of the tumor to induce T-cell proliferation in vitro.

Adult↗

[The diagnosis of stages T1 and T2 in laryngeal carcinoma with multislice spiral CT].

The purpose of the study was to preoperatively investigate small laryngeal carcinomas using multi-slice spiral CT (MSCT) and subsequent multiplanar reconstructions (MPR) and to compare the results to the detailed spread found at surgery and histology. Nine patients with small (T1, T2) laryngeal cancer were investigated on a MSCT scanner (Siemens plus 4 Volume Zoom, Siemens). A 4 x 1 mm collimation, 120 kV, 200 mAs and a 0.5 seconds rotation time were used, allowing a coverage of the entire larynx in approximately 10 seconds within a single breathhold. Multiplanar reconstruction's (MPR) in sagittal and coronal plane were reconstructed in all patients and rated in consensus reading. In 8 of nine patients, the glottic spread was detected by MSCT, in one cause of a supraglottic tumor a glottic invasion was excluded. The infiltration of the anterior commissure, the infiltration into the subglottic space and the extension into the hypopharynx was correctly assessed in all patients. MSCT was not able to predict infiltration of the arythnoids in two patients. The use of multi-slice spiral CT for the preoperative assessment of small laryngeal tumors shows great promise. The detection or exclusion of subtle spread of these tumors into the supra- or subglottic space and along the glottic level was possible with high accuracy. As the examination time is short, artifacts are rare and multiplanar reconstructions gain in clinical importance.

Carcinoma↗

[In search of new treatment methods for head-neck carcinoma].

During the past decades the clinical prognosis of head and neck squamous cell cancer has remained unchanged. This indicates that new therapeutic strategies are needed. Cancer prevention strategies focusing on the elimination of carcinogenic substances could help to lower the incidence of this disease. Documentation of the clinical outcome in tumor registers could help to establish a better understanding of tumor biology and adequate treatment of different tumor types. Nevertheless the most promising approach at the current time seems to be the development of new immunotherapeutic treatment regiments. One possible way of future cancer treatment could be the application of bispecific antibodies that redirect immune effector cells to the tumor. A second approach could be in vivo gene therapy with direct intratumoral injections of a gene coding for interleukin-2. This should help to reactivate tumor-suppressed immune effector cells.

Carcinoma, Squamous Cell↗

[Induction of antitumor immune response in the mouse model after vaccination with B7.1 expressing tumor cells].

The aim of the study was the induction of an antitumor immune response by genetic modification of tumor cells. This was done by transfecting the costimulatory molecule B7.1 into a murine tumor cell line SCCVII/SF in order to increase T cell recognition and to install an immunologic memory. One cohort of immunocompetent mice C3 H/HeN were injected with B7.1 expressing tumor cells, while the control group received parental B7.1 negative tumor cells. In a second step those immunized mice were rechallenged by parental tumor cells and tumor growth was compared to a new control group. Transfection with B7.1 prohibits outgrowth of the SCCVII cell line. Animals that have been vaccinated in this way are partially immune towards a secondary exposition to B7.1 negative tumor cells. Outgrowth of this recurrent tumor is slowed down. Such an immunization builds up an immunologic memory. Vaccination with B7.1 expressing tumor cells lead to a partial protective tumor immunity in the SCCVII-C3 H/HeN mouse model.

Animals↗

Changes in head and neck tumor hypoxic fraction during split-course radiochemotherapy.

This study explored patterns of oxygen distribution in human tumors during primary radiochemotherapy. Patients with positive nodes from head and neck squamous cell carcinoma (n = 15) were investigated before therapy, before and after a 2-week respite, and at the end of the treatment. Intratumoral tissue oxygen tension (pO2) was measured with sterile polarographic needle electrodes and a computerized histography system. The 2 lowest pO2 classes, ie, 0 and 5 mm Hg, were designated the hypoxic fraction, and the mean and median pO2 were evaluated for each tumor. In the beginning, a marked variability in tissue pO2 was found. The initial size of the hypoxic fraction ranged from 0% to 61% of measured values. At the end of treatment, 4 tumors showed an increase in mean pO2, and 7 tumors a lower mean pO2 in comparison to the initial values. However, an impressive finding was that the hypoxic fraction of 9 tumors became smaller during the pause, 1 tumor showed no change, and 1 showed an increase in hypoxic fraction. The results show that there is a widely distributed tissue oxygenation with marked hypoxic zones in human neck nodes. During radiochemotherapy, tissue oxygenation changed, with great intertumor variability. A tendency toward a decrease of the hypoxic fraction after the respite could be seen. This change in tumor oxygenation during therapy needs further evaluation.

Adult↗

Absence of B7.1-CD28/CTLA-4-mediated co-stimulation in human NK cells.

Recent studies have suggested that B7-CD28 interactions provide co-stimulatory signals for activation of NK cells. Transduction of the B7.1 (CD80) gene into tumor cells has been shown to trigger proliferation and cytotoxicity of murine NK cells and a human NK cell line, YT2C2. Therefore, transduction of the B7.1 gene into CD80-negative human squamous cell carcinomas of the head and neck (SCCHN) and its stable expression was expected to upregulate proliferation and cytotoxic activities of human NK cells. However, expression of the B7.1 receptors, CD28 and CTLA-4, could not be demonstrated on the surface or in the cytoplasm of normal human NK cells, irrespective of the state of their activation. In proliferation experiments or various cytotoxicity assays, utilizing highly purified human NK cells as responder or effector cells, no enhancement of NK cell generation or activity, respectively, by B7.1+ SCCHN was observed relative to non-transduced or LacZ gene-transduced SCCHN. In contrast, co-incubation of B7.1+ SCCHN targets with human NK cells induced significant inhibition of NK cell growth. Thus, the B7.1-CD28/CTLA-4 pathway is not involved in triggering of human adult NK cells.

Abatacept↗

Lack of B7.1 and B7.2 on head and neck cancer cells and possible significance for gene therapy.

Cellular immunity mediated by cytotoxic T-cells plays a key role in host tumor defense. An optimal T-cell recognition is based primarily on the presentation of an antigen in the context with MHC Class I molecules, secondarily co-stimulatory molecules, such as the B7 family, are necessary to initiate maximum stimulation. We examined the quality (immunohistochemically) and quantity (FACS-analysis) of B7 expression on primary and permanently established head and neck squamous cell cancer (HNSCC). Neither on the primary nor on the permanently established HNSCC lines could B7 be detected. The lack of co-stimulatory molecules could be the reason for the low immunogenicity of HNSCC. Future gene transfer of B7 could help to restore the immune function. Transfection of expression plasmids encoding B7 cDNA into the tumor cells by gene therapy might restore tumor-specific immunity as a new tool for cancer eradication in the future.

Journal Article↗

In vitro studies of liposome-mediated gene transfer into head and neck cancer cell lines.

The 5-year survival rate of patients with squamous cell carcinoma of the head and neck (HNSCC) has remained poor despite innovative surgery and new radiation and chemotherapeutic strategies. In such patients, gene therapy relying on the modification of tumor cells by gene transfer may have great potential as a new treatment modality in the therapy of HNSCC. In the present study we developed an in vitro model to show the efficacy and technical feasibility of cationic liposome-mediated gene transfer into HNSCC. Five adherent squamous cell carcinoma cell lines were transfected with SV40- or CMV-promoter-driven CAT (chloramphenicol-acetyl-transferase)-expression plasmids using DOTAP as the liposome carrier. The level of CAT expression was shown to correlate directly with the amount of transfected DNA and could be measured by a CAT-enzyme-linked immunosorbent assay. The results of gene transfer by liposome-DNA complexes obtained for all cell lines showed a dose-dependent efficacy correlating to the amount of DOTAP employed. The data demonstrate the successful in vitro transfection of epithelial cell lines with DNA, suggesting its usefulness as a new tool for head and neck cancer therapy in vivo.

Carcinoma↗

[Receptor mediated gene transfer in squamous epithelial carcinoma of the head-neck area].

BACKGROUND: The "Adeno-Virus-Enhanced-Receptor-Mediated" (AVET)-System uses the receptor-mediated endocytosis route to introduce DNA into mammalian cells. By the help of a replication defective adenovirus with endosomolytic activity the coentry of receptor-bound DNA particles is faciliated. The transport to the nucleus followed by gene expression is multifold enhanced. METHODS: Two different permanent cell lines from head and neck squamous cell cancer were transfected with the reportergene for luciferase with either AVET or different liposoms in vitro. RESULTS: In comparison it becomes obvious, that AVET shows a multifold higher transfection rate in vitro than the liposomal formulations applied. CONCLUSIONS: AVET could be used for efficient transfection of epithelial cells, that are fairly reluctant to DNA transfer. Further trials in the mouse model must prove a possible application in vivo.

Adenoviruses, Human↗

Serum levels of intercellular adhesion molecule-1 in squamous cell carcinoma of the head and neck.

Soluble intercellular adhesion molecule-1 (s-ICAM-1) was measured in the sera of 131 patients with primary and 50 patients with recurrent squamous cell cancer of the head and neck (HNSCC). 30 patients with benign ear, nose and throat diseases served as controls. s-ICAM-1 levels in serum are high in patients with HNSCC, particularly in the advanced tumor stages (UICC IV). Highest levels can be measured at the time of tumor recurrence and locoregional lymph node metastases. The sensitivity (95% specificity) of s-ICAM-1 (cutoff-level: 473 ng/ml) is 4% at primary diagnosis and 12% for recurrent disease. A coefficient of correlation for s-ICAM-1 in combination with SCC, carcinoembryonic antigen and CYFRA 21-1 indicates that no correlation can be found of s-ICAM-1 compared with traditional tumor markers. Due to overlapping values in control and patient groups s-ICAM-1 is not suitable for a specific clinical use in HNSCC.

Antigens, Neoplasm↗

Localization of transforming growth factor-beta-expressing cells and comparison with major extracellular components in aural cholesteatoma.

Transforming growth factor-beta (TGF-beta) plays an important role in the regulation of extracellular matrix (ECM) deposition by stimulating the synthesis of individual matrix proteins like tenascin and fibronectin. Cholesteatoma shows significant changes in the ECM, supporting the view of a disturbed cell-matrix interaction. The purpose of our present study was to evaluate the distribution of TGF-beta in comparison to the deposition of tenascin, fibronectin, and collagen as major components of the ECM in cholesteatoma (n = 12) by means of histochemistry and immunohistochemistry. We found TGF-beta in lymphocytes and fibrohistiocytes in the stroma of 7 cholesteatomas. In corresponding sections, a marked expression of tenascin and fibronectin was seen manifesting as a continuous band along the epidermal-stromal junction, extending to the deeper stroma. In addition, in those cases of TGF-beta expression, beginning collagen fibril formation was seen in adjacent deeper stroma layers, indicating beginning stromal fibrosis. These results suggest that TGF-beta may be involved in the stimulation of the synthesis of tenascin, fibronectin, and collagen. Furthermore, the enhanced expression of tenascin and fibronectin provides evidence for a deregulated cell-matrix interaction in cholesteatoma associated with the enhanced proliferative process of cholesteatoma formation.

Cholesteatoma, Middle Ear↗

[Somatic gene therapy in squamous epithelial carcinomas of the head-neck area].

Gene therapy is an important new approach to the treatment and prevention of human diseases. Somatic gene therapy involves the introduction of novel genetic material into somatic cells to express therapeutic gene products. Two main strategies in somatic gene therapy of cancer are applied: the genetic correction of the defect, or the elimination of cancer cells by cytotoxic drugs or the immuno system. Gene transfer can be accomplished by physical and chemical methods or nonreplicating viruses. The different transfer systems vary strongly in their efficiency of transfection, plasmid maintenance, and protein expression. The clinical application could be performed in two ways: Firstly, by in vivo application of genome modifying substances injected directly into the tumour; secondly, by ex vivo application of genetically modified tumour cells as a tumour vaccine. The following review will discuss some of the gene therapy strategies that could be effective in managing head and neck cancer.

Carcinoma, Squamous Cell↗