Use of immunofluorescence tests for TdT in human hematologic malignancy.
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Biomedical subjects
Publications and source records attributed to M S Coleman.
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Newborn C57BL mice exposed to RadLV at birth were followed and periodically sampled for thymus and bone marrow TdT activity. Tumors detected at or before 100 days had mostly low TdT levels. Large thymic lymphocytic tumors detected after 100 days had elevated total TdT content per gland. Serial samples showed a changing TdT pattern with time. The mid period shifted from low levels to normal-to-high levels for both TdT content and total TdT per gland. No unusual bone marrow TdT activity change preceded the appearance of thymomas. TdT marks a unique precursor cell highly sensitive to RadLV associated with lymphomagenesis. RadLV induced both TdT+ and TdT- thymic lymphomas and both types were found to occur after lymphoma initiation by injection of RadLV into newborns.
Terminal transferase (TdT) activity and antigen have been measured in 267 specimens of human bone marrow and peripheral blood by using a biochemical assay for enzymatic activity and an immunofluorescence test for antigen. Oligo p(dA)50 and dGTP were used as reagents in the biochemical assay and either rabbit anti-calf TdT or rabbit anti-human TdT was used as the primary antibody for immunofluorescence. Because both false-positive and false-negative detection of TdT antigen occurs, the biochemical assay of TdT activity is considered the standard against which immunofluorescence assays must be measured. If specimens of cells contained TdT activity, then the immunofluorescence detected antigen in 91% of cases (rabbit anti-calf TdT) and 95% of cases (rabbit anti-human TdT). When no TdT activity was detected, the immunofluorescence test was positive in 7.8% of cases (rabbit anti-calf TdT) and 5.2% of cases (rabbit anti-human TdT). When air-dried slices were shipped by air mail to a distant location before being stained for immunofluorescence, TdT antigen was detected in only 33% of matched pair cases which contained TdT activity. From this study, the authors conclude that with current methodology, immunofluorescence tests for TdT antigen must be carried out on slides prepared in the testing laboratory and that such tests are reliable in more than 90% of cases. However, because a small percentage of results are false positives and false negatives, the authors suggest that if a patient's clinical response is not consistent with the immunofluorescence TdT result, an enzymatic assay for TdT activity be carried out.
Whether the level of terminal deoxynucleotidyl transferase (TdT) activity in mononuclear cells from bone marrow and peripheral blood has prognostic significance has been analyzed prospectively in 164 children with T and non-T, non-B marked acute lymphoblastic leukemia (ALL). TdT was measured at diagnosis to assess its value as a predictor of duration of remission and length of survival. It was measured repeatedly during remission to assess whether it could predict relapse. Ninety-seven percent of the children achieved a complete remission of their disease, and 40% relapsed during the study. The level of TdT activity in blasts at diagnosis varied 1000-fold from patient to patient. There was no statistically significant relationship between TdT activity in cells at diagnosis and the achievement of complete remission, the duration of remission, or length of survival. TdT activity was significantly increased in the bone marrow of 65% of patients at the time of marrow morphological relapse, but was rarely increased in marrow from patients with isolated testicular or central nervous system relapse. Wide fluctuations in TdT activity were characteristically seen in mononuclear cells from the marrow and peripheral blood of patients with ALL at all stages of their disease. An isolated high value of TdT activity in the bone marrow or peripheral blood cannot be taken as evidence of impending relapse. Quantitative measurements of TdT activity alone on mononuclear cells from bone marrow and peripheral blood are helpful in differential diagnosis, but cannot guide therapy of children with ALL.
The combination of 2'-deoxycoformycin (DCF), a potent adenosine deaminase (ADA) inhibitor, and 9-beta-D-arabinofuranosyladenine (Ara-A) was used in a patient with acute nonlymphocytic leukemia refractory to all conventional modes of therapy. DCF was given by periodic iv injections to ablate ADA activity. Ara-A was given by continuous iv infusion at an initial dose of 1.5 mg/kg/day, with progressive increases to 6 mg/kg/day. With adequate ADA suppression (less than 2 x 10(-2) mumols of inosine/hr/10(6)h cells), the Ara-A decreased the absolute peripheral blood myeloblast count from 36,332 to 780/microliter. The patient experienced no renal, hepatic, or neurologic complications during therapy.
The EMT6 tumor of Balb/C mice was studied in vivo for irradiation response. It showed a typical, progressive Gompertzian growth mode in control tumors, and, after irradiation with 2000, 4000 or 6000 rad, a regression and regrowth pattern. This solid tumor model was studied with serial DNA-polymerase (DNA-P) alpha and B assays after irradiation-perturbed growth. The DNA-P activity was traced during growth and injury-regrowth to study its behavior as a potential marker for tumor activity. DNA-P alpha level fell after high dose irradiation, remained low during the early regeneration period, and rose again after a regrowth pattern was established. The changes in activity followed DNA-S activity by H3TDR uptake. DNA-P B activity did not change after irradiation.
Adenosine deaminase was purified 3038-fold to apparent homogeneity from human leukaemic granulocytes by adenosine affinity chromatography. The purified enzyme has a specific activity of 486 mumol/min per mg of protein at 35 degrees C. It exhibits a single band when subjected to sodium dodecyl sulphate/polyacrylamide-gel electrophoresis, non-denaturing polyacrylamide-gel electrophoresis and isoelectric focusing. The pI is 4.4. The enzyme is a monomeric protein of molecular weight 44000. Both electrophoretic behaviour and molecular weight differ from those of the low-molecular-weight adenosine deaminase purified from human erythrocytes. Its amino acid composition is reported. Tests with periodic acid-Schiff reagent for associated carbohydrate are negative. Of the large group of physiological compounds tested as potential effectors, none has a significant effect. The enzyme is specific for adenosine and deoxyadenosine, with Km values of 48 microM and 34 microM respectively. There are no significant differences in enzyme function on the two substrates. erythro-9-(2-Hydroxy non-3-yl) adenine is a competitive inhibitor, with Ki 15 nM. Deoxycoformycin inhibits deamination of both adenosine and deoxyadenosine, with an apparent Ki of 60-90 pM. A specific antibody was developed against the purified enzyme, and a sensitive radioimmunoassay for adenosine deaminase protein is described.
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An unusual cytoplasmic distribution of terminal deoxynucleotidyl transferase (TdT) antigen in leukemic cells from two patients who had chronic myelogenous leukemia in blastic phase is described. In most leukemic cells that contain TdT, the intracellular location has been reported to be exclusively nuclear. The cells from these two patients demonstrated TdT staining in both the nucleus and the cytoplasm. The pattern is remarkably similar to that observed in thymocytes, in which bright cytoplasmic staining may also be seen. In the immunofluorescence procedures for detection of TdT in blasts from patients who have chronic myelogenous leukemia, significant cytoplasmic staining should not be mistaken for nonspecific absorption of immunoglobulins or specimen deterioration.
Terminal deoxynucleotidyl transferase was purified to homogeneity from the blasts of eight patients with leukemia and compared with purified transferase from normal human and calf thymus. In two cases phenylmethanesulfonylfluoride was added during purification to reduce proteolysis. Comparative kinetic analyses of the purified enzymes indicated no differences in catalytic properties. There was substantial variation in the molecular structure of terminal transferase on denaturing polyacrylamide gels: (a) a protein that migrated as a single polypeptide with M(r) = 62,000 was isolated from two patients with acute lymphoblastic leukemia and from MOLT-4 cells; (b) a protein that migrated as a single polypeptide with M(r) = 42,500 was isolated from two patients with acute lymphoblastic leukemia; (c) a protein that migrated as a single polypeptide with M(r) = 42,500 was isolated from two patients with chronic myelogenous leukemia in blast crisis; (d) a protein that migrated as two non-identical subunits of M(r) = 27,000 and 10,000, respectively, was isolated from two additional patients with chronic myelogenous leukemia in blast crisis. The subunit structure of d is characteristic of the homogeneous enzymes purified from human and calf thymus. Neutralizing and precipitating antibodies to terminal transferase from human lymphoblasts and calf thymus have been produced in rabbits and goats. Antisera directed against either human or calf antigens neutralize enzymatic activity and precipitate all forms of human terminal transferase. The multiple human forms give reactions of antigenic identity by immunodiffusion, but differ antigenically from the calf enzyme. The multiple forms of terminal transferase could represent physiological processing, artifactual degradation, or isozymes coded by several genes.
Biochemical and immunological properties of lymphocytes were measured repetitively over a period of 40 mo during enzyme replacement by transfusion in a child with adenosine deaminase (ADA) deficiency and severe combined immunodeficiency disease. Catalytically defective ADA protein is present in the child's cells. ADA activity in his lymphocytes is 7 nmol/min per 10(8) cells with 51 ng of ADA protein/10(8) cells by radioimmunoassay. ADA activities in normal cord and adult lymphocytes average 193 and 92 nmol/min per 10(8) cells, respectively, with 429 and 223 ng of ADA protein/10(8) cells. Deoxy(d)ATP accumulates in the patient's erythrocytes and lymphocytes. Transfusion of irradiated packed erythrocytes partially corrects the metabolic defects. Frank metabolic relapse occurs if transfusions are discontinued for several months. The amounts of dATP in erythrocytes and lymphocytes averaged 13 and 2 times normal, respectively, during periods when transfusions were administered every 2-4 wk. Deoxyguanosine triphosphate and deoxycytidine triphosphate in lymphocytes were normal on 11 occasions, but deoxyribosylthymine triphosphate was ninefold increased. On 11 occasions dATP was measured in lymphocytes and erythrocytes isolated simultaneously. There was a positive, but statistically insignificant, correlation between amounts of dATP in the two types of cells (r = 0.25,P > 0.1). The absolute peripheral lymphocyte count was correlated with the activity of ADA in circulating erythrocytes and with the response of lymphocytes to phytohemagglutinin (r = 0.64, P < 0.01; r = 0.49, P < 0.05). Response of lymphocytes to stimulation by phytohemagglutinin in vitro and absolute peripheral lymphocyte counts were not significantly correlated with levels of dATP in the erythrocyte or lymphocyte during periods of intensive therapy. Although there was objective improvement during enzyme replacement, the child remained immunodeficient and biochemically abnormal.
In a colony of marmosets (Callithrix jacchus), all fifteen infants from five sets of triplet births were successfully reared with their parents. Two supplemental feedings were given each infant daily. As an alternative to hand-rearing or foster rearing, the supplemental feeding method eliminated the time-consuming process of hand caring for an infant on a 24-hour per day basis.
A deficiency of adenosine deaminase, an enzyme important in purine nucleoside catabolism, is associated with a severe combined immunodeficiency disease in children. Inhibition of this enzyme in vitro and in vivo results in an impairment in lymphoblast proliferation. We have investigated the pharmacologic inhibition of this enzyme by 2'-deoxycoformycin in 15 patients with hematologic malignancies. Biochemical consequences of the administration of this agent were closely monitored in erythrocytes, nucleated peripheral blood and bone marrow cells, serum, and urine. A marked rise in erythrocyte dATP was accompanied by a depletion of ATP in those patients exhibiting toxicity. Most patients excreted large amounts of deoxyadenosine but not adenosine in the urine. Serum deoxyadenosine rose in patients demonstrating a marked decrease in cell mass. The biochemical disturbances and clinical toxicity, including hepatic, renal, and conjunctival abnormalities, were usually reversible. Central nervous system toxicity, which potentially was the most serious consequence, was associated with high erythrocyte dATP/ATP ratios and high levels of cerebrospinal fluid deoxyadenosine. In patients with lymphoma and leukemia, objective responses were observed but were short-lived. Patients with chronic lymphocytic leukemia receiving weekly low doses of the drug demonstrated minimal toxicity and some efficacy. The chemotherapeutic potential o 2'-deoxycoformycin, as either a single agent or in combination with Ara-A, merits further exploration.
Terminal deoxynucleotidyl transferase (TDT) activity was measured in bone marrow lymphoblasts obtained at diagnosis from 168 consecutive patients with childhood acute leukemia. Absolute concentrations of TDT were increased (greater than or equal to 20 units/10(8) blasts) in samples from 98 of 112 assessable patients with acute lymphocyte leukemia (ALL). The values ranged from less than 1 to 1502 units/10(8) blasts with a median of 90 units contrasted with less than 1 to 219 units (median, 2.6 units) in studies of children without leukemia. Results of an immunofluorescence assay were in good agreement with enzymatic detection of the polymerase. Among 115 patients with adequate marrow smears, 105 had TDT-positive blasts. By contrast, in most children with acute myelogenous leukemia, TDT activity was either undetectable or less than 10 units/10(8) blasts. Although the highest levels of TDT were found in blasts with the common ALL phenotype, quantitative determinations were not significantly related to the major immunological subtypes of ALL or to morphological features or periodic acid-Schiff reactivity of the lymphoblasts. The probability that a newly diagnosed case of leukemia would be ALL was 90% if TDT levels were greater than 20 units/10(8) blasts. We conclude that absolute concentrations of TDT, as determined in this study, are of little value in identifying subclasses of ALL. The immunofluorescence assay, which is much less expensive and easier to perform than the enzyme assay, should prove useful for confirming the diagnosis of ALL and for detecting extramedullary sites of leukemic infiltration.
Purine nucleoside phosphorylase (EC 2.4.2.1) has been purified 715-fold from human granulocytes by formycin B affinity chromatography. The purified enzyme has a subunit molecular weight of 32,800 +/- 1,300 and an estimated native molecular weight of 102,000, which indicates a trimeric subunit structure. The purified enzyme migrates as a single band upon denaturing and nondenaturing polyacrylamide gel electrophoresis. Its amino acid composition has been determined. Isoelectric focusing of the purified enzyme produces three protein bands with isoelectric pH values of 5.8 to 6.1. The purified enzyme catalyzes the phosphorolysis of inosine, deoxyinosine, guanosine, and deoxyguanosine with apparent Km values of 0.21 mM, 0.32 mM, 0.21 mM, and 0.24 mM, respectively. The ribonucleosides and deoxyribonucleosides of adenine and the pyrimidines are not substrates. There are no major differences in metabolism of ribonucleosides and deoxyribonucleosides. Purine nucleoside phosphorylase activity is inhibited by formycin B in a competitive manner and by adenine in a mixed noncompetitive manner. Antiserum to the purified protein has been prepared and is useful in the immunochemical assay of phosphorylase over the range 10 to 100 ng of protein.
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