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Biomedical subjects

L E Spitler

Publications and source records attributed to L E Spitler.

At least 19 recordsLinked to original sources

Penetration of anti-melanoma immunotoxin into multicellular tumor spheroids and cell kill effects.

In order to gain a better understanding of the interaction between immunotoxins and tumor cells at the level of three-dimensional tumor mass, we evaluated the cell kill effects of monoclonal antimelanoma-antibody/ricin-A-chain immunotoxin (ITN) on melanoma cells in multicellular tumor spheroids (MTS) as well as the penetration of ITN into MTS. For Minor melanoma cells in monolayer the ITN exerted cytotoxic effects after as little as 1 h of exposure. Increasing exposure time resulted in progressive increases in cytotoxic activity. In contrast, the cell kill effects of ITN were markedly delayed and reduced when Minor cells were in MTS. The ITN cytotoxic effects on the melanoma MTS were more than 100 fold less than those in monolayer. Patterns of ITN-induced cytotoxicities for Minor and for another melanoma cell line, DND-1A, were comparable. The native ricin A was more active against PC-10 squamous lung cancer cells than Minor cells, whereas the ITN was more cytotoxic against Minor cells than PC-10 cells, thus exhibiting selectivity. An autoradiographic study revealed time-dependent penetration of radiolabeled ITN from the surface of Minor MTS into the core. Incubation for 1 h resulted in the penetration of ITN into only the two or three outer layers of the Minor MTS, and low grain counts. Prolonged exposure resulted in inhomogeneous penetration of ITN into almost the entire melanoma MTS. Penetration of ITN into PC-10 MTS was extremely poor. The reduced cytotoxicity of ITN on melanoma cells in MTS as compared to cells grown in monolayer appears to correlate with its inhomogeneous distribution in the MTS. The delayed cytotoxicity of ITN is also consistent with its slow penetration into the core of the MTS.

Antibodies, Monoclonal

A randomized trial of levamisole versus placebo as adjuvant therapy in malignant melanoma.

We conducted a long-term follow-up (median, 10.5 years) of patients included in a randomized trial of levamisole versus placebo as surgical adjuvant therapy in 203 patients with malignant melanoma. Of the patients randomized, 104 received levamisole, and 99 received placebo. The results show that there is no difference between the treatment and control groups with regard to any of the three end points analyzed. These included disease-free interval, time to appearance of visceral metastasis, and survival. Moreover, there was no significant difference between the treatment and control groups after adjusting for age, sex, or stage of disease.

Adult

Transfer factor therapy in the Wiskott-Aldrich syndrome. Results of long-term follow-up in 32 patients.

Thirty-two patients with the Wiskott-Aldrich syndrome have been treated with transfer factor provided by this laboratory. Apparent clinical benefit was observed in 44 per cent of them. The mean age of the patients who showed clinical benefit was significantly greater than that of the patients who showed no benefit. Conversion of immunologic reactivity correlated with clinical benefit. Thirteen of the patients who received transfer factor are alive, and 17 have died (43 per cent survival). Clinical benefit was correlated with survival. The median survival was greater than five years in the patients who showed clinical benefit, whereas it was 18 months in those who did not show clinical benefit. We conclude that transfer factor caused conversion of immunologic parameters, apparent clinical benefit and prolonged survival in some, but not all, patients with the Wiskott-Aldrich syndrome.

Adolescent

Transfer factor in immunodeficiency diseases.

Results of therapeutic trials of transfer factor in a number of laboratories suggest clinical benefit and enhancement of immunological reactivity in patients with primary or secondary immunodeficiency diseases. Long term follow-up of 32 patients with the Wiskott-Aldrich syndrome suggested that transfer factor caused conversion of immunologic reactivity, apparent clinical benefit, and prolonged survival in some, but not in all patients. In 18 patients with disseminated (Stage III) malignant melanoma treated with surgery and transfer factor, survival was better than would ordinarily be expected for disseminated disease (78% with mean follow-up of 2 years). A randomized trial has been initiated which will answer the question of the efficacy of transfer factor as surgical adjuvant therapy in malignant melanoma. Studies in human subjects suggested that transfer factor does not cause enhancement of reactivity in normal subjects, when evaluated in a controlled, double-blind fashion. Similar controlled studies in immunodeficient patients are necessary to ascertain whether transfer factor does cause enhancement of immune responses in these patients. Based on these observations, a guinea pig model was developed in which transfer factor caused abrogation of tolerance to ABA-Tyrosine.

Child

Altered regulation of mitogen responsiveness by suppressor cells in multiple sclerosis.

Suppression of the lymphocyte response to concanavalin A (Con A), phytohaemagglutinin (PHA) and protein A from Staphylococcus aureus (SpA) by Con A-induced suppressor cells was measured in twenty-four patients with recently active-recovering multiple sclerosis (MS), twelve with inactive MS and twenty-three healthy controls. Patients with recently active disease displayed significantly greater suppression of the response to Con A. Suppression of the responses to PHA and SpA did not differ among the groups. Lymphocyte stimulation in cultures not showing suppression was similar in all three types of subjects. These results suggest a disturbance of lymphocyte regulation in patients with recently active-recovering MS and illustrate the potential usefulness of measuring the suppression of responsiveness to several mitogens.

Adult

Disseminated Cryptococcus treated with transfer factor.

Cardiac toxic reactions and pulmonary consolidation in the left lower lobe developed in a patient who was receiving amphotericin B therapy for cryptococcal meningitis. Following surgical resection of the lobe, multiple subcutaneous cryptococcal abscesses appeared. Flucytosine administered intravenously failed to eradicate the lesions. Transfer factor therapy and multiple drainage procedures elimniated the skin abscesses. Transfer factor therapy was administered for one year; the patient was asymptomatic 16 months after therapy was discontinued.

Abscess

Experimental allergic encephalitis: study of cellular immunity during disease suppression.

Administration in complete Freund's adjuvant of encephalitogenic protein (EP), derived from central nervous tissue to guinea pigs, regularly results in the development of experimental allergic encephalitis (EAE) which leads to the death of the animals. Administration of EP in incomplete Freund's adjuvant at an appropriate time will completely suppress the clinical development of disease. Results reported herein show that animals receiving suppressive injections of EP for 7 days show depression of lymphocyte DNA synthesis and macrophage migration inhibition, but not of skin reactivity, in response to EP immediately following the injections, and subsequently show recovery of lymphocyte reactivity but do not develop clinical manifestations of EAE. Humoral or other factors may prevent the development of disease in these animals. Guinea pigs receiving injections of EP for 14 days show profound and prolonged depression of lymphocyte reactivity to EP and macrophage migration inhibition. Possible mechanisms for these results include a diminished number or function of reactive cells or activity of a population of cells with the capacity to suppress cellular immune responses. Nonspecific suppression of reactivity to an unrelated antigen during the suppressive injections was not observed.

Animals

Effect of levamisole as a surgical adjuvant therapy for malignant melanoma.

The preliminary results of a trial in progress are reported. Two hundred patients have been enrolled in a randomized, double-blind, placebo-controlled trial of levamisole in malignant melanoma. A median followup of 20 months has been reached. Endpoints of the study include disease-free interval, interval free of visceral disease, and survival. Overall, there is a trend in favor of the levamisole group with regard to all three endpoints, but the difference is not significant. Significant differences between the control and levamisole groups are found at some, but not all, time intervals when the analysis includes only patients with stage II disease (positive lymph nodes at the initiation of the study). Although these preliminary results are encouraging, at the present time the overall curve for patients with stage II disease is not statistically significantly different when analyzed by the method of Mantel.

Clinical Trials as Topic

International symposium on levamisole in rheumatoid arthritis. A review of short and longterm effects on articular manifestations.

Reports of 28 authors with a total of nearly 1,000 enrolled patients have been reviewed regarding changes in clinical manifestations of disease in rheumatoid arthritis during short term and long term administration of levamisole. Global clinical improvement was observed in 60% of patients after three months and in 75% of patients after six months of drug treatment. There was no significant difference in response whether the drug was given in a continuous daily or intermittent weekly fashion. The longest observation times extend to 3 1/2 years. An optimal effect is usually reached between six and 12 months of treatment, after which time no further improvement is observed. After cessation of drug administration, the rate of deterioration varies with the length of previous exposure.

Arthritis, Rheumatoid

Combined immunotherapy of malignant melanoma. Unusual survival following cerebral metastasis.

An 18-year-old woman was found to have solitary cerebral, choroidal, and pulmonary metastases of malignant melanoma three years after excision of a primary malignant melanoma. The cerebral metastasis was excised, and the patient's condition was treated with CNS irradiation followed by combined immunotherapy with transfer factor and Bacille bilié de Calmette-Guérin. The transfer factor donor was her father, who showed cellular immunity to melanoma extracts on in vitro testing. Histologic examination of the pulmonary nodule, which was excised after the initiation of immunotherapy, revealed a dense lymphocytic infiltrate associated with the metastatic melanoma. The patient is currently free of detectable melanoma more than three years after the cerebral metastasis. Studies in a second patient also demonstrated the appearance of inflammatory infiltrate in metastatic melanoma following transfer factor therapy.

Adolescent

Plasmapheresis and immunosuppressive drug therapy in myasthenia gravis.

Plasmapheresis combined with prednisone and azathioprine therapy produced striking clinical improvement in five patients with myasthenia gravis who still had moderate to severe disability despite thymectomy, high-dose prednisone therapy and optimal doses of cholinesterase inhibitors. Serial determinations of titers of serum antibody toward the acetylcholine receptor demonstrated a fall to 21 +/- 5 per cent (mean +/- S.D.) of the original levels concurrently with the patients' increasing strength. Clinically improved patients maintained lowered titers, whereas clinical relapses were associated with a rebound in titer. Our results suggest that plasmapheresis will find a place in the management of patients with myasthenia gravis, and they implicate antibodies to acetylcholine receptor as a pathogenic factor in this disease.

Acetylcholine

Treatment of Bechçet's syndrome with transfer factor.

Six patients with Behçet's syndrome were treated with transfer factor (TF) from randomly selected donors. Mucocutaneous symptoms and signs were predominant at the time that TF injections were started. Three patients showed great improvement, one moderate improvement, and one was unresponsive to multiple injections of TF from different donors. One case was uninterpretable because of concomitant administration of high doses of prednisone and chlorambucil and brief treatment with TF. These results indicate that TF therapy may be beneficial in some patients with Behçet's syndrome and that a trial of TF is warranted at least in the absence of severe ocular or neurologic manifestations.

Adult

Transfer factor therapy in ataxia--telangiectasia.

The effects of weekly doses of transfer factor in four patients with ataxia--telangiectasia were investigated following a total course of 2 months therapy. Transfer factor administration showed no influence on the absolute lymphocyte counts, T-cell rosettes or antibody titres to EBV, but it caused conversion of skin-test reactivity and production of MIF to various antigens. There was a dissociation in blastic transformation response, the skin-test responses and MIF production. Serum interferon levels were low before, and 2, 6 and 24 hr after, therapy. Clinically no improvement in infections was observed following transfer factor therapy.

Antibodies, Viral

Immunotherapy in infectious disease, autoimmunity and cancer.

The clinical and immunologic effects of transfer factor and of levamisole were evaluated in over 200 patients with a variety of diseases. With transfer factor, the most encouraging results were observed in patients with the Wiscott-Aldrich syndrome, chronic mucocutaneous candidiasis, coccidioidomycosis, Behcet's disease and malignant melanoma. With levamisole, the most promising results were observed in patients with recurrent aphthous stomatitis, rheumatoid arthritis and herpes simplex infections, especially ocular herpes. Immunologically, transfer factor usually caused conversion of skin test reactivity and conversion of in vitro tests of cellular immunity as well, whereas levamisole caused increases in skin test reactivity without a parallel change in in vitro para meters, suggesting that the two agents may have different mechanisms of action. In a limited number of patients with multiple sclerosis, reactivity to three viral antigens was found to be lower than that in normal subjects, as measured by lymphocyte stimulation. Following levamisole therapy, this reactivity increased to normal levels, but the patients did not show clinical benefit.

Autoimmune Diseases

Cellular immune reactivity in patients with rheumatoid arthritis and effects of levamisole.

Cellular immune reactivity was examined in control subjects and in 16 patients with rheumatoid arthritis before and after administration of levamisole. Prior to levamisole treatment, this population of patients with rheumatoid arthritis had diminished cellular immunity as measured by skin test reactivity, lymphocyte stimulation by antigen and by PHA, lymphocyte count and percentage and absolute numbers of long-incubation rosette-forming cells (RFC). Administration of levamisole caused enhancement of skin test reactivity and flares at dinitrochlorobenzene (DNCB) test sites which were not paralleled by an increase in lymphocyte stimulation by the same antigens in vitro or enhancement in the PHA response. The increase in lymphocyte count and RFC was borderline (p = .06). Of the 16 patients who received levamisole for three months, nine patients showed at least one physical sign of improvement, five patients remained unchanged, and two patients experienced progression of their disease.

Adult