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Phase I study of iv mycobacterial cell wall skeleton and cell wall skeleton combined with trehalose dimycolate.

A phase I study to determine the toxicity and immunologic effects of iv administered aqueous suspensions of mycobacterial cell wall skeleton (CWS) and CWS combined with trehalose dimycolate (TDM) was performed. A total of 26 patients received suspensions of either CWS or CWS/TDM given iv every 1 or 2 weeks in set doses of either 100, 250, 500, or 1000 micrograms/m2. The major dose-limiting side effects for both preparations were fever and chills at a dose of 1 mg/m2. This was more severe with the combined CWS/TDM. There was no renal or pulmonary toxicity. There was evidence of hepatic toxicity, with increases in the alkaline phosphatase and gamma glutamyl transferase, especially with high doses of CWS/TDM. Both the CWS and CWS/TDM groups had an increase in their wbc count. In the patients receiving CWS alone, there was a decrease in the peripheral blood monocytes. In the CWS/TDM group, there was an increase in the serum lysozyme, suggesting macrophage activation. No antitumor effect was seen in this phase I study. Aqueous suspensions of CWS and CWS/TDM can be administered safely iv over a period of time, with evidence of an effect on hematologic parameters.

Animals↗

Immunotherapy of a guinea pig hepatoma with mycobacterial vaccines: comparison of BCG cell walls and cell wall skeletons.

BCG cell wall skeletons (SK) derived from BCG cell walls (CW) by treatment with proteolytic enzymes and organic solvents were tested for their potency to cause regression of a transplanted guinea pig hepatoma. On a weight basic, SK were as effective as CW in causing tumor regression, and they, as well as purified protein derivative of mycobacteria, provoked delayed cutaneous hypersensitivity reactions in animals immunized with CW or with SK. On a weight basis, CW were more active than SK in eliciting delayed cutaneous hypersensitivity in sensitized guinea pigs whether the animals were immunized with CW or with SK. In unimmunized animals the inflammatory response to intradermally administered CW was greater than that evoked by SK. CW and SK provoked delayed cutaneous hypersensitivity reactions of similar strength in animals immunized with living BCG. This study provided no compelling reasons for using SK instead of CW in clinical trials of cancer treatment by mycobacterial vaccines.

Animals↗

Induction of a tumor necrosis factor-like activity by Nocardia rubra cell wall skeleton.

Nocardia rubra cell wall skeleton (N-CWS) stimulated adherent cells harvested from the peritoneal cavities of thioglycollate-treated mice to produce cytotoxic activity. Depletion of macrophages from the adherent cells by 2-chloroadenosine or silica abrogated the production of this cytotoxic activity, whereas treatment of the adherent cells with anti-Thy-1.2 antibody and complement did not. This suggested that macrophages were the producer cells of the activity. Cytotoxic activity became detectable as early as 2 h after N-CWS treatment and reached peak activity at 9 h, then declined to a lower level, indicating rapid onset without persistent effects. N-CWS-induced cytotoxic factors have a fairly narrow temperature range, pH optimum for storage, and are sensitive to pronase and trypsin. By using column chromatography, N-CWS-induced cytotoxic factors were compared in detail with tumor necrosis serum obtained from Bacillus Calmette-Guérin endotoxin-treated mice. Both toxins were found to be nearly identical with respect to their behavior in ion-exchange, gel filtration, and concanavalin A affinity columns. N-CWS also induced human peripheral blood lymphocytes to release cytotoxic activity. Monocytes predominantly participated in production of this activity as confirmed by treatment with monoclonal antibody and complement. The cytotoxic activity was completely neutralized by anti-human tumor necrosis factor antiserum, but not by anti-human lymphotoxin antiserum. The fact that human peripheral blood lymphocytes release tumor necrosis-like factors after stimulation with N-CWS might account for the antitumor effects of this agent.

Animals↗

Binding of mutagens by fractions of the cell wall skeleton of lactic acid bacteria on mutagens.

The binding effect of cells and cell fractions, cell wall skeleton, cytoplasm, whole cells, and cell wall skeleton treated by lysozyme and alpha-amylase at 37 degrees C for 5 h, on Trp-P-1 (3-amino-1,4-dimethyl-[5H]pyrido [4,3-b]indole) and Trp-P-2 (3-amino-1-methyl-[5H]-pyrido[4,3-b]indole) were investigated. The cell and cell wall skeleton of Streptococcus cremoris Z-25 had greater binding activity, but cytoplasm and extract of cell wall skeleton did not bind Trp-P-1 and Trp-P-2. When the cells or cell wall skeleton were treated with lysozyme and alpha-amylase, unbound Trp-P-1 and Trp-P-2 concentrations were greater than that of the untreated control. It is possible that cell walls may be involved in the binding of mutagenic pyrolyzates to lactic acid bacteria. The cell wall skeleton of S. cremoris Z-25, Lactobacillus acidophilus IFO 13951, and Bifidobacterium bifidum IFO 14252 showed binding of Trp-P-1, 2-amino-6-methyldipyrido(1,2-a:3',2'- d)imidazole, 2-amino-5-phenylpyridine, 2-amino-3-methylimidazo(4,5-f)quinoline, 2-amino-3,4-dimethylimidazo(4,5-f) quinoline, and 2-amino-3,8-dimethylimidazo(4,5-f)quinoxaline. The cell wall skeleton of S. cremoris group and Streptococcus lactis also showed the binding activity with A N-nitrosodimethylamine. The binding of Trp-P-1 to cell walls was very high, and the binding of mutagenic pyrolyzates was variable with different bacterial species. The peptidoglycan complex and polysaccharides liberated from cell wall skeleton of S. cremoris Z-25 showed strong binding of Trp-P-2. Peptidoglycans has a binding effect of about 19.86 micrograms/mg; polysaccharides had a binding effect of 14 micrograms/mg.

Bifidobacterium↗

In vivo activation of functional properties in mouse peritoneal macrophages by Nocardia rubra cell wall skeleton.

Exudative cells in the peritoneal cavity of mice, particularly polymorphonuclear leukocytes significantly increased 1 day after intraperitoneal injection of Nocardia rubra cell wall skeleton (N-CWS). Macrophages and lymphocytes significantly increased 4 to 7 days after injection. N-CWS also enhanced peritoneal macrophage functions such as phagocytosis of latex particles, production of superoxide anion, production and secretion of lysosomal enzymes such as beta-glucuronidase, lysozyme and acid phosphatase, phagocytosis and intracellular killing of bacteria, and in vitro chemotaxis. The phagocytic function of the reticuloendothelial system was also enhanced. These results indicate that macrophages were activated in vivo by N-CWS.

Animals↗

Adjuvant and antitumor activities of Nocardia cell-wall skeletons.

The adjuvant activity of the cell-wall skeletons prepared from eight species (ten strains) of Nocardia was determined by Brunner's method using allogeneic cell-mediated cytotoxicity test. The antitumor activity of the cell-wall skeleton of N. rubra, which showed the most potent adjuvant activity, was examined using EL-4 leukemia and MH-134 hepatoma cells in syngeneic mice. Its results suggest that the cell-wall skeleton of N. rubra is more potent than BCG cell-wall skeleton as the immunotherapeutic agent for cancer immunotherapy in man. The chemical properties of the cell-wall skeleton of N. rubra were also described.

Adjuvants, Immunologic↗

Effect of Nocardia rubra cell wall skeleton on T-cell-mediated cytotoxicity in mice bearing syngeneic sarcoma.

Cell-mediated cytotoxicity against syngeneic MC104 fibrosarcoma cells was detected in C57BL/6N mice 7 days after tumor inoculation in the hind foot. This cytotoxicity was undetectable by Day 14 in the Winn test using spleen and draining popliteal lymph node (DPLN) cells. Similar results were obtained with the 51Cr release assay following in vitro activation of these lymphoid cells with mitomycin C-treated tumor cells. The antitumor cytotoxicity was shown to be mediated by T-cells. Spleen but not DPLN cells from 14-day tumor bearers enhanced tumor growth in the Winn test, suggesting the presence of immunosuppressor cells in the spleen. Two intralesional injections of 50 microgram of cell wall skeleton (CWS) of Nocardia rubra on Days 2 and 7 resulted in apparent tumor growth inhibition and prolongation of the survival period of tumor bearers. DPLN cells from tumor bearers treated with N. rubra CWS exhibited significant recovery in the cytotoxicity tested on Day 14, whereas the recovery in that of spleen cells was not apparent. The cytotoxicity augmented by N. rubra CWS was specific to MC104 tumor cells and was shown to be mediated by T-cells. These cytotoxic T-cells were shown to be able to localize not only in DPLN but also in the spleen and tumor in mice receiving the intralesional immunotherapy with N. rubra CWS. These results suggest that T-cell-mediated cytotoxicity against syngeneic tumor can be augmented by N. rubra CWS and might play an important role in the systemic development of its antitumor effect, although the effector cell increase in the spleen might be suppressed by splenic suppressor cells during tumor growth.

Animals↗

Randomized controlled study of chemoimmunotherapy of acute myelogenous leukemia (AML) in adults with Nocardia rubra cell-wall skeleton and irradiated allogeneic AML cells.

The effect of immunotherapy with Nocardia rubra cell-wall skeleton (N-CWS) on remission duration and survival of adults with acute myelogenous leukemia (AML) was studied in a prospective randomized controlled study. After having been induced into complete remission and having been consolidated, 73 patients were randomized either to maintenance chemotherapy or maintenance chemotherapy plus immunotherapy with N-CWS and irradiated allogeneic AML cells. Thirty-four patients in the chemotherapy group and 32 in the chemoimmunotherapy group were evaluable. Six months after the closure of the study, the immunotherapy showed a borderline beneficial effect on remission duration (P = 0.080) and on survival length (P = 0.098). When the data were analyzed at 30 months after the entry, there was a borderline significant difference in remission duration (P = 0.080) between the two groups, prolonging the 50% remission period by 110 days; but no significant difference in survival length (P = 0.314), although the 50% survival was 168 days longer in the chemoimmunotherapy group. However, there were 4 (18.2%) 5-year relapse-free survivors among 22 patients (11 in each group) who had been diagnosed more than 5 years before the time of the present analysis, and all of them belonged to the chemoimmunotherapy group (P = 0.090). Thus, immunotherapy with N-CWS and irradiated allogeneic AML cells seems to be active in the treatment of adult AML when used for maintenance therapy in combination with chemotherapy.

Adolescent↗

Immunotherapy of human lung cancer with BCG cell-wall skeleton.

Effect of BCG cell-wall skeleton (BCG-CWS) on the recovery of responsiveness of lymphocytes and the survival period was studied in patients with lung cancer. (a) Responsiveness of lymphocytes as demonstrated by proliferative response to phytohemagglutinin (PHA) or microcytotoxicity test with cultured cells of a bronchogenic carcinoma was depressed in the patients at later stages of cancer and it was restored by treatment with BCG-CWS in many of such patients. (b) Survival period of the patients at later stages such as III or IV was prolonged by treatment with BCG-CWS. Such an effect was detected even in the patients with carcinomatous pleuritis. (c) A close correlation was found between the reactivity such as PHA response or cytotoxicity and clinical course of the patients given BCG-CWS. Assay system with PHA response and microcytotoxicity test appears to be reliable in anticipating the prognosis and in following clinical course after the BCG-CWS treatment.

Adenocarcinoma↗

Suppression of autochthonous tumors by mixed implantation with Nocardia rubra cell-wall skeleton and related bacterial fractions.

Antitumor activities of the cell-wall skeleton of Nocardia rubra and related bacterial fractions in autochthonous tumor-host system were tested on autografts of spontaneous mammary adenocarcinoma in SHN mice and of 3-methylcholanthrene-induced fibrosarcoma in ICR/JCL mice. The oil-attached cell-wall skeleton of N. rubra was the most effective in suppressing the autografts of the mammary adenocarcinoma but less of the fibrosarcoma, when the autografts were mixed with oil-attached preparation and implanted subcutaneously in the original host, while peptidoglycolipid of Mycobacterium tuberculosis Aoyama B was the most suppressive on the autografts of the fibrosarcoma but not on the mammary tumor autografts. The cell-wall skeleton of Mycobacterium bovis BCG slightly suppressed the autografts of the fibrosarcoma. Presensitization of tumor-bearing mice with the cell-wall skeleton of N. rubra resulted in a more marked suppression on autografts of both tumors than without the presensitization, but local destruction of these tumor autografts did not induce recognizable systemic immunity to the respective tumors. Intralesional injection of cell-wall skeleton of N. rubra showed prolongation of survival days of mice with fibrosarcoma.

Adenocarcinoma↗

In vitro activation of bovine macrophage and peripheral blood mononuclear cells by Nocardia rubra cell wall skeleton (N-CWS).

Nocardia rubra cell wall skeleton (N-CWS) was used for immunotherapy to bovine leukemia virus (BLV)-positive cattle with enlarged subcutaneous lymphatic nodules. Electron microscopical observations showed the infiltration of macrophage and T cells around N-CWS treated lesions. Antitumor effect induced by N-CWS was examined in vitro. The maximum cytolytic activity of macrophage was observed, when the cells were incubated with 10 micrograms/ml of N-CWS. Chemiluminescence response of peripheral blood mononuclear cells (PBMC) using N-CWS as stimulant was observed with a high level of activity for a long period, 5 hr. Mitogenic effect of N-CWS to PBMC was observed in the presence of macrophages but not without macrophages. Furthermore, interleukin 2 activity was recognized in supernatant of PBMC cultured with N-CWS. Maximum cytotoxic T lymphocyte response was induced when PBMC were cultured with 0.1 micrograms/ml of N-CWS.

Animals↗

Effect of Nocardia and Mycobacterium cell-wall skeleton on autochthonous tumor grafts.

Cell-wall skeleton of Nocardia rubra and of Mycobacterium bovis BCG in the oil-attached form, when injected mixes with autografts of spontaneous mammary adenocarcinoma or of methylcholanthrene-induced sarcoma of mice, suppresses the growth of tumor autografts to a demonstrate extent. The BCG whole cell wall showed no effect. The local destruction of tumor autografts did not induce recognizable systemic immunity to the respective tumors. These findings are commended upon from immunological and chemical points of view.

Adenocarcinoma↗

Association of macrophage activation with antitumor effect on rat syngeneic fibrosarcoma by Nocardia rubra cell wall skeleton.

The antitumor activities of the cell wall skeleton (CWS) of Nocardia rubra were demonstrated for syngeneic fibrosarcoma (AMC-60) in ACI/N rats in regard to macrophage activation. In the 24-hr cytolytic test, activated macrophages which were fractionated from peritoneal exudate cells induced by i.p. injection of Nocardia CWS showed significant cytolytic activity for [125I]iododeoxyuridine-labeled tumor cells. Activated macrophages also strongly inhibited [3H]thymidine incorporation into the tumor cells during the 24-hr cytostatic test. When tumor cells were inoculated s.c. with activated macrophages in the Winn-type transfer assay, subsequent tumor growth was significantly inhibited. Repeated i.p. injection of the CWS seemed to enhance these antitumor activities of macrophages. The therapeutic effect of Nocardia CWS was assessed with the ascites tumor and with the solid tumor inoculated i.m. into the hind leg. In the former treatment, repeated i.p. injections completely prevented the accumulation of ascites fluid and resulted in prolongation of the survival period. The peritoneal macrophages harvested from these survivors had a strong cytolytic activity for tumor cells in the cytolytic test. In the latter treatment, repeated intratumoral injections inhibited the growth of primary tumor and prevented metastasis. Furthermore, peritoneal resident macrophages from these tumor-bearing rats treated intratumorally with the CWS were found to be cytolytic for tumor cells in the cytolytic test.

Animals↗

Successful treatment of the patients with malignant pleural effusion with BCG cell-wall skeleton.

The usefulness of the cell-wall skeleton of Mycobacterium bovis BCG (BCG-CWS) to the management of malignant pleural effusion is demonstrated in this report. In two patients with malignant pleurisy the oil-attached BCG-CWS reduced the pleural effusion in volume when injected intrapleurally. The following intradermal injections of BCG-CWS into the bilateral upper arms repeated monthly prevented the reaccumulation of the effusion and improved other clinical conditions of the patients. The possible mechanism responsible for this effect is discussed in relation to previous experimental and clinical studies.

BCG Vaccine↗

Effect of Nocardia rubra cell wall skeleton on murine interferon production in vitro.

Nocardia rubra cell wall skeleton (N-CWS) induced alpha- plus beta-interferons (IFN-alpha/beta) in resident peritoneal cells and bone marrow cells from normal mice. N-CWS also induced IFN-alpha/beta and IFN-gamma in the cultures of thioglycollate-elicited peritoneal cells. When induced with N-CWS, the mixed cultures of thioglycollate-elicited macrophages and spleen cells produced high titered IFN-gamma. Both macrophages and lymphocytes present in spleen cells (non-T, non-B, asialo-GM1-positive) were essential for the production. Immunofluorescence staining with anti-IFN-gamma antiserum showed the presence of IFN-gamma in lymphocytes but not in macrophages, suggesting that lymphocytes were producer cells and macrophages were accessory cells. Because IFN-gamma is an important lymphokine in immune response, the ability of N-CWS to stimulate IFN-gamma production may account for a significant portion of the antitumor activity of this agent.

Animals↗

Macrophage dependency of T-lymphocyte mitogenesis by Nocardia rubra cell-wall skeleton.

The mitogenic activity of the cell-wall skeleton (CWS) of Nocardia rubra on purified splenic T-cells (thymus-derived lymphocytes) was investigated. N. rubra CWS showed remarkable mitogenic activity on normal spleen cells of C57BL/6J mice at concentrations ranging from 10 to 100 microgram per milliliter of culture medium, while, on purified splenic T-cells, N. rubra CWS did not act as an mitogen at any concentration. However, mitogenic activity of N. rubra CWS on T-cells was restored if purified splenic T-cells was reconstituted with X-irradiated peritoneal exudate cells (macrophages). The above results suggest the necessity of macrophages for T-lymphocyte activation by N. rubra CWS as well as PHA-P or Con A.

Animals↗