Infusion Of Interleukin-2 Research Articles

Efficacy of Recombinant Bovine Interleukin-2 as an Adjunct to Dry Cow Therapy

Recombinant bovine interleukin-2 was tested as adjunct therapy to intramammary infusion of antibiotics at drying off. Cows were assigned randomly within three commercial herds to either recombinant bovine interleukin-2 or PBS treatment groups at drying off. Ninety-five cows received intramammary infusions of 1mg of recombinant bovine interleukin-2 in each quarter immediately preceding intramammary infusion of a product for antibiotic therapy of dry cows. Ninety-four cows received intramammary infusion of 10ml of endotoxin-free PBS in each quarter immediately preceding the antibiotic therapy. Cure rates for IMI present at drying off did not differ between cows treated with recombinant bovine interleukin-2 and those treated with PBS. Intramammary infusion of recombinant bovine interleukin-2 did not affect the rate of new IMI during the dry period. Milk production and SCC during the first 3 mo of lactation subsequent to therapy did not differ between treatment groups. Intramammary infusion of recombinant bovine interleukin-2 was not effective as an adjunct to antibiotic therapy for dry cows.

A Phase IA/IB Trial of Anti-CD3 Murine Monoclonal Antibody plus Low-Dose Continuous-Infusion Interleukin-2 in Advanced Cancer Patients

Preclinical studies have shown that anti-CD3 antibodies can enhance the in vitro activation of human T lymphocytes in combination with low-dose interleukin-2 (IL-2) and induce the in vivo rejection of murine tumors. A Phase IA/IB trial combining a murine monoclonal antibody, anti-CD3 antibody (OKT3), with low-dose continuous-infusion IL-2 was conducted in cancer patients to define the toxicity and immunologic effects of this combination. OKT3 administered weekly as a 15-min infusion at dose levels of 10, 100, 200, 400, and 600 micrograms/m2 was followed 18 h later by a 100-h infusion of IL-2 at 3 MIU/m2/day for 3 consecutive weeks. When feasible, patients also received the IL-2 course without OKT3 to assess the effects of OKT3 on the IL-2 regimen within the same patient. Thirty patients were enrolled onto the study, with 24 completing the OKT3/IL-2 course and 18 completing both OKT3/IL-2 and IL-2 alone courses. OKT3 administration was associated with acute hypotension with fevers of > 40 degrees C and in two patients cerebral vascular infarcts. At 600 micrograms/m2 OKT3, these toxicities were dose limiting. In a dose-dependent manner, OKT3 induced the transient release of tumor necrosis factor (TNF) and IL-6 into the serum and a profound lymphopenia. OKT3 did not significantly enhance the toxicity of this schedule of IL-2 administration. All solid tumor patients treated at 100-600 micrograms/m2 OKT3 showed induction of a human anti-murine antibody response prior to the third week of treatment. A patient with renal cell cancer treated at the 600-micrograms/m2 OKT3 dose level experienced a 4-month partial remission, and two mixed responses were observed in a sarcoma and a melanoma patient treated at 100- and 400-micrograms/m2 OKT3 dose levels, respectively. Most importantly, we were unable to demonstrate that the addition of OKT3 enhanced immune activation within peripheral blood based upon the magnitude of rebound lymphocytosis, increase in CD56+ or CD3+, CD25+ lymphocytes, induction of natural killer, lymphokine activated killer, or cytolytic T lymphocyte cytotoxicity, or release of serum cytokines (TNF, IL-6) or soluble CD25 (as assayed 24 h following IL-2 infusion). Therefore, this approach was ineffective at enhancing the immunologic effects of a low-dose continuous-infusion IL-2 regimen and will not be pursued further in clinical trials.

Changes in bovine mammary-secretion composition during early involution following intramammary infusion of recombinant bovine cytokines.

This study was designed to determine whether intramammary infusion of recombinant bovine interleukin-1 beta or interleukin-2 had any adverse influence on bovine mammary function during the early non-lactating period. Mammary glands of eight Jersey cows were infused with either 10 micrograms of interleukin-1 beta or 1.0 mg of interleukin-2 following abrupt cessation of milking. Mammary secretions from each gland were collected from cows frequently during early involution and evaluated for changes in secretion composition. Percentage of milk fat and solids-not-fat during the experimental period was variable for all treatments. Percentage of protein increased throughout the study for all treatments, but mammary glands treated with interleukin-1 beta had higher protein percentages. All interleukin-treated mammary glands had lower concentrations of lactose than controls. Mammary secretions from interleukin-1 beta treated glands had higher concentrations of lactoferrin at 7 and 14 days of involution. Similarly, mammary secretions from interleukin-2 treated glands had higher concentrations of serum albumin on day 3 of involution and throughout the remainder of the study. Concentration of citrate and the citrate: lactoferrin molar ratio generally decreased throughout the study for all treatment groups. Concentration of alpha-lactalbumin in mammary secretions decreased throughout the study and was not different between treatment groups. Though significant changes in mammary secretion composition due to the presence of cytokines were observed in this study, resulting in an apparent acceleration of involution, there was no indication that these changes adversely affected normal bovine mammary function during the early non-lactating period.

Acute effects of continuous infusions of human recombinant interleukin-2 on serum thyroid hormone concentrations in dogs

The effect of human recombinant interleukin-2 (IL-2) on serum thyroid hormone concentrations in dogs was studied. Four normal adult dogs received two consecutive weekly cycles of continuous infusions of 3 × 10 6 U m −2 daily for four days per week (days 1 to 4 and 8 to 11). The serum concentrations of IL-2, thyroxine (T4) and 3, 5, 3′- triiodothyronine (T3) were measured before and on days 2, 3 and 4, and 9, 10 and 11 of the infusions. There was a significant decrease in the mean serum concentrations of T4 and T3 at all times during the infusion of IL-2; the serum T4 concentrations decreased by 50 to 75 per cent and serum T3 by 70 to 80 per cent of the pretreatment concentrations in all the dogs. No antithyroglobulin antibodies were detected in the serum of any of the dogs on days 10 and 11 of the infusions. The concentrations of circulating thyroid hormones decreased rapidly in the dogs during the infusion of IL-2, as in the euthyroid sick syndrome.

Treatment of low-grade non-Hodgkin?s lymphoma with continuous infusion of low-dose recombinant interleukin-2 in combination with the B-cell-specific monoclonal antibody CLB-CD19

Treatment of low-grade non-Hodgkin?s lymphoma with continuous infusion of low-dose recombinant interleukin-2 in combination with the B-cell-specific monoclonal antibody CLB-CD19

Serum Levels of Cytokines and Soluble Cytokine Receptors in Patients with Metastatic Renal Cell Carcinoma or Malignant Melanoma Receiving IL-2/Interferon-α Combination Therapy

Elevated serum levels of soluble tumour necrosis factor receptor (sTNFR-55) and (at a lesser degree) of sTNFR-75 were found in most of the patients with metastatic renal cell carcinoma (RCC) or malignant melanoma (MM) before immunotherapy and with further increase during treatment (intravenous infusions of interleukin-2 [IL-2] and subcutaneous interferon-alpha [IFN-alpha]). In the majority of the patients with MM the pretreatment serum levels of IL-2 and soluble IL-2 receptor (sIL-2R) were increased, whereas fewer patients with RCC presented with increased serum levels of IL-2 and sIL-2R. Twelve days' treatment with IL-2/IFN-alpha, with a rest on days 6 and 7, resulted in a consistent further increase in the serum levels of sIL-2R and sTNFRs. In most patients the increase of sIL-2R and sTNFRs lasted for at least 3 weeks after treatment discontinuation. The clinical significance of the increase remains unknown.

Induction of interleukin-1 receptor antagonist in rhesus monkeys after intraamniotic infection with group B streptococci or interleukin-1 infusion

Interleukin-1 receptor antagonist is a natural inhibitor of interleukin-1, a cytokine implicated in the initiation of preterm labor after intraamniotic infection. The effects of intraamniotic infection and interleukin-1 infusion on the appearance of interleukin-1 receptor antagonist in amniotic fluid and fetal and maternal plasma were assessed with a monkey model. On day 130 of pregnancy four chronically catheterized rhesus macaques received intraamniotic inoculations of group B streptococci, three monkeys received intraamniotic infusions of recombinant human interleukin-1 beta, and three monkeys received buffered saline solution infusions. At timed intervals samples of amniotic fluid, fetal plasma, and maternal plasma were assayed for interleukin-1 beta and interleukin-1 receptor antagonist by immunoassays. Uterine activity was continuously monitored by intraamniotic pressure catheters and by electromyographic activity. Interleukin-1 receptor antagonist, but not interleukin-1 beta, was present in the amniotic fluids of all monkeys before intervention. Infection induced the appearance of interleukin-1 beta and an increase in interleukin-1 receptor antagonist in the amniotic fluid. Interleukin-1 beta infusion resulted in a similar increase in the intraamniotic concentration of interleukin-1 receptor antagonist. Both infection and interleukin-1 beta infusion were followed by the transient appearance of interleukin-1 receptor antagonist in the plasma of all fetuses. The subsequent decrease in plasma levels was paralleled by increased amniotic fluid levels of interleukin-1 receptor antagonist. Interleukin-1 beta and interleukin-1 receptor antagonist were not detected in maternal plasma. Both infection and interleukin-1 infusion induced preterm labor in all treated animals. Interleukin-1 receptor antagonist is a normal component of monkey amniotic fluid. Intraamniotic infection or the appearance of interleukin-1 beta in the amniotic fluid results in increased production of interleukin-1 receptor antagonist. Under physiologic conditions interleukin-1 receptor antagonist in amniotic fluid may inhibit interleukin-1-induced preterm labor.

Histamine in immunotherapy of advanced melanoma: a pilot study.

Sixteen patients with advanced metastatic malignant melanoma were treated with a high-dose infusion of interleukin-2 (IL-2; 18 x 10(6) IU/m-2 day-1) together with daily subcutaneous (s.c.) injections of interferon alpha (IFN alpha; 3 x 10(6) U/m-2 day-1) in 5-day cycles. Nine of these patients were given histamine (1 mg s.c.) twice daily during treatment with IL-2 and IFN alpha. In the seven patients who did not receive histamine, one partial response (that is a reduction of more than 50% in the total tumour burden) was observed in a patient with skin and lymph node melanoma. In the eight histamine-treated patients evaluable for response, four partial responses were observed. Two other patients showed regression at one site of metastasis but tumours remained unchanged at other sites. Two histamine-treated patients showed complete resolution of extensive liver metastasis. Sites of response in histamine-treated patients also included the subcutis, lymph nodes, skeleton, spleen and muscle. Lung melanoma did not respond to histamine/IL-2/IFN alpha. Three patients with lung tumours responded with significant (more than 50%) reduction of the volume of soft-tissue tumours, suggesting that the response to histamine may be organotropic. Survival was significantly prolonged in patients receiving histamine. Our data suggest that treatment with histamine may improve the antitumour efficacy of immunotherapy in metastatic melanoma.

Different effects of continuous infusion of interleukin-1 and interleukin-6 on the hypothalamic-hypophysial-thyroid axis

Different effects of continuous infusion of interleukin-1 and interleukin-6 on the hypothalamic-hypophysial-thyroid axis

Biologic and clinical effects of continuous infusion interleukin-2 in patients with non-small cell lung cancer : Ardizzoni A. Bonavia M. Viale M. Baldini E. Mereu C. Verna A et al. Department of Medical Oncology, Isto. Nazionale Ricerca sul Cancro, Viale Benedetto XV, 10, 16132 Genova. Cancer 1994;73:1353–1360

Biologic and clinical effects of continuous infusion interleukin-2 in patients with non-small cell lung cancer : Ardizzoni A. Bonavia M. Viale M. Baldini E. Mereu C. Verna A et al. Department of Medical Oncology, Isto. Nazionale Ricerca sul Cancro, Viale Benedetto XV, 10, 16132 Genova. Cancer 1994;73:1353–1360

Treatment of Patients With Metastatic Melanoma With Autologous Tumor-Infiltrating Lymphocytes and Interleukin 2

Studies of human tumor-infiltrating lymphocytes (TILs) derived from patients with a variety of histologic types of cancer have demonstrated that cellular immune reactions against established malignancy exist in humans. We report the results of using autologous TILs plus high-dose bolus interleukin 2 (IL-2), with or without the concomitant administration of cyclophosphamide, in the treatment of 86 consecutive patients with metastatic melanoma. From May 1987 through December 1992, 86 patients (38 female and 48 male) with metastatic melanoma were treated (145 courses) with autologous TILs plus high-dose intravenous bolus IL-2 (720,000 IU/kg every 8 hours). TILs plus IL-2 were administered in two cycles separated by approximately 2 weeks. Two treatment cycles constituted one treatment course. Patients received a maximum of 15 doses of IL-2 per cycle given every 8 hours until grade 3 or 4 toxicity was reached that could not easily be reversed by standard supportive measures. All patients received concomitant medications to abrogate some of the side effects of IL-2 administration: acetaminophen (650 mg every 4 hours), indomethacin (50 mg every 8 hours), and ranitidine (150 mg every 12 hours). Fifty-seven of the 86 patients received a single intravenous dose of 25 mg/kg cyclophosphamide approximately 36 hours before receiving the first intravenous infusion of TILs plus IL-2. Six weeks after treatment, all known sites of disease were evaluated. The overall objective response rate in these patients was 34% and was similar in patients receiving TILs and IL-2 alone (31%) or in conjunction with cyclophosphamide (35%). There was no significant difference in the objective response rate in patients whose therapy with high-dose IL-2 had failed (32%) compared with patients not previously treated with IL-2 (34%). The frequency of response to treatment was greater in those patients who were treated with TILs from younger cultures (P = .0001), TILs with shorter doubling times (P = .03), and TILs that exhibited higher lysis against autologous tumor targets (P = .0008). Patients who received TILs generated from subcutaneous tumor deposits had higher response rates (49%) compared with those receiving TILs from lymph nodes (17%; P = .006). There was one treatment-related death due to respiratory insufficiency. Treatment with TILs and IL-2 with or without cyclophosphamide can result in objective responses in about one third of patients with metastatic melanoma. The side effects of treatment are transient in most patients, and this treatment can be safely administered. These results illustrate the potential value of immune lymphocytes for the treatment of patients with melanoma.

T-cell receptor repertoire in colorectal adenocarcinoma patients with hepatic metastases and its changes induced by preoperative adjuvant interleukin-2 therapy.

The liver is the primary site for colorectal metastases and hepatic resection often fails to cure these patients. Little is known about T-cell immune response in these patients or its changes after interleukin-2 (IL-2) infusion. Using polymerase chain reaction methodology, we investigated T-cell receptor (TCR) V alpha and V beta gene segment subfamily usage in tumor, hepatic tissue, and blood of six patients undergoing hepatic resection and, in addition, in six patients receiving preoperative adjuvant IL-2 therapy (randomized phase I trial). The objectives were (a) to analyze the TCR repertoire in patients undergoing hepatic resection (without IL-2), (b) to analyze the TCR repertoire in patients undergoing hepatic resection after IL-2 therapy, (c) to analyze the effects of preoperative IL-2 infusion on the tumor-infiltrating lymphocyte (TIL) TCR repertoire by comparing TCR V gene segment usage in IL-2-treated versus nontreated patients, and (d) to analyze the effect of IL-2 infusion on the peripheral blood mononuclear cell (PBMC) TCR repertoire by comparing TCR V gene segment expression in pre- versus posttreatment PBMC of IL-2-treated patients. With regard to the first objective, we observed an unrestricted use of V alpha and V beta gene segment subfamily specificities in tumor hepatic tissue and blood of patients undergoing hepatic resection. In addition, we found that some V alpha and V beta specificities were overexpressed in tumor compared with hepatic tissue and blood, suggesting that the corresponding T-cell subpopulations were expanded at the tumor site. In IL-2-treated patients, in whom the tumor and liver were heavily infiltrated by T lymphocytes, the TIL TCR repertoire was also highly diverse and roughly similar to that detected in hepatic tissue and blood, except for a few overexpressions. To analyze the effect of IL-2 on TIL, we next compared the data obtained in IL-2-treated versus nontreated patients. No significant difference between the two groups was observed. Finally, no major changes in the PBMC TCR repertoire were found after IL-2 infusion. Further studies are needed to identify discrete T-cell subpopulations in these patients that may participate in either tumor immune surveillance or active immunotherapy mechanisms triggered by systemic IL-2 infusion.

Symptomatic interleukin-2-induced cholecystopathy in patients with HIV infection.

This study reports the clinical and radiologic findings in seven patients infected with HIV who had 10 consecutive episodes of symptomatic cholecystopathy induced by infusion of interleukin-2. Ten episodes of right upper quadrant pain associated with gallbladder wall thickening were seen in seven of 29 HIV-infected patients who received IV interleukin-2. Patients received 6-18 million IU/day of continuous interleukin-2 infusion for 5 days. Patients with right upper quadrant pain underwent sonographic examinations, which were interpreted prospectively. Medical records and previous sonographic studies were reviewed retrospectively. Follow-up was obtained through outpatient visits and sonography. Right upper quadrant pain during these 10 episodes of cholecystopathy usually developed 4-5 days after starting infusion of interleukin-2. Sonography during that time showed gallbladder wall thickening (mean thickness, 12.4 mm; range, 5-18 mm) and a wide variety of sonographic appearances. Tenderness during sonography was focal in six episodes, diffuse in one, and absent in three. Sludge was identified in one episode; calculi were not seen. Findings on radionuclide biliary scans were normal in three cases. Symptoms abated rapidly in every case after infusion of interleukin-2 was reduced or stopped. No surgery was necessary. When treatment was repeated, three patients had recurrent episodes, with clinical courses and sonographic aberrations showing little variance from the initial episodes. Follow-up sonography in three episodes showed a maximal thickness of the gallbladder wall of 4 mm. No patient had a history or laboratory evidence of intrinsic biliary disease. Symptomatic thickening of the gallbladder wall during infusion of interleukin-2 can exactly mimic other forms of acalculous cholecystitis, except that when associated with interleukin-2 the thickening is rapidly reversible and surgery is not required. Radionuclide scans can be useful in clinical decision making. The process appears to be benign, and cessation of interleukin-2 therapy, along with close clinical observation, appears to be the appropriate treatment.

Sepsis Therapy Trials

Solid experimental and clinical data place interleukin 1 (IL-1) directly in the midst of the cascade of mediators leading to organ system dysfunction and death in sepsis. For example, infusion of IL-1 into animals produces hypotension and organ system dysfunction, a pattern similar to that seen clinically in severe infection.¹Increased circulating levels of IL-1 appear to signal a poor prognosis in patients with sepsis.²In several animal models of endotoxemia or bacteremia, survival is improved when the actions of IL-1 are blocked by infusion of the naturally occurring IL-1 receptor antagonist (IL-1ra).^3,4Perhaps most important, an unblinded, placebo-controlled study of IL-1ra therapy in critically ill patients with sepsis demonstrated a reduction in 28-day all-cause mortality from 44% in the placebo group to 16% in patients receiving high-dose IL-1ra therapy.⁵ See also p 1836. In this issue ofTHE JOURNAL, Fisher et al⁶report the

Lymphocyte Protein Synthesis In Vivo: a Measure of Activation

1. The 'flooding' dose technique was used to measure rates of lymphocyte protein synthesis after infusion of [1-13C]leucine (20 atoms % enrichment, 4 g/70 kg body weight). Lymphocyte protein synthesis was measured in healthy subjects and in patients with metastatic colorectal cancer before and during infusion of recombinant interleukin-2. Rates of protein synthesis were compared with thymidine uptake in vitro and phenotypic analysis of lymphocytes. 2. The median rate of lymphocyte protein synthesis in four healthy subjects was 9% (range 7.2-11.4%/day) and in seven patients with colorectal cancer was 6.4% (range 4.2-8.2%/day). After recombinant interleukin-2 treatment the median rate of lymphocyte protein synthesis was 27.8% (range 25.2-33.7%/day). 3. The increased rates of lymphocyte protein synthesis in vivo, after recombinant interleukin-2 infusion, corresponded with increased rates of thymidine uptake and changes in the phenotypic expression of lymphocytes, but these were less consistent than the measured rates of protein synthesis. 4. It is concluded that lymphocyte activation is accompanied by a marked increase in lymphocytic protein synthesis which may have important implications for whole body protein metabolism. Furthermore, measurement of lymphocyte protein synthesis may provide a determination of lymphocyte activation in vivo.

Interleukin-2 Treatment in Lymphoma: A Phase II Multicenter Study

A phase II study was undertaken to assess whether continuous infusion of high-dose recombinant interleukin-2 (rIL-2) alone was active against different histologic subtypes of heavily pretreated lymphoma. Sixty one lymphomas were included in the study. rIL-2 (Roussel UCLAF, Romainville, France) was administered by continuous infusion at 20 x 10(6) IU/m2 for three cycles of 5 days, 4 days, and 3 days, during the first week, third week, and fifth week, respectively. Twenty-four low-grade non-Hodgkin's lymphomas (NHL) were resistant to an anthracycline-containing regimen. Twenty-three intermediate and high-grade NHL were refractory to initial treatment or to salvage therapy. Seven Hodgkin's diseases were refractory to at least three regimens or relapsed after autologous bone marrow transplantation. Seven mycosis fungoides were refractory to chemotherapy. In low-grade NHL, one complete response (CR) was observed. In aggressive NHL, there were three CRs and two partial responses (PRs). No response was noted in Hodgkin's disease. One CR and four PRs were observed in mycosis fungoïdes. Complete response durations were 23, 20, 17, 12, and 4 months. Grade 4 toxicity was observed in 29 patients leading to arrest of therapy in 12 patients. The response to rIL-2 therapy in lymphoma differs according to histologic subtypes. Five responses were observed in 23 aggressive lymphomas. Five of seven mycosis fungoïdes responded; these preliminary results warrant testing of a larger number of patients.

Interleukin-2 treatment in lymphoma: a phase II multicenter study [see comments

A phase II study was undertaken to assess whether continuous infusion of high-dose recombinant interleukin-2 (rIL-2) alone was active against different histologic subtypes of heavily pretreated lymphoma. Sixty one lymphomas were included in the study. rIL-2 (Roussel UCLAF, Romainville, France) was administered by continuous infusion at 20 x 10(6) IU/m2 for three cycles of 5 days, 4 days, and 3 days, during the first week, third week, and fifth week, respectively. Twenty-four low- grade non-Hodgkin's lymphomas (NHL) were resistant to an anthracycline- containing regimen. Twenty-three intermediate and high-grade NHL were refractory to initial treatment or to salvage therapy. Seven Hodgkin's diseases were refractory to at least three regimens or relapsed after autologous bone marrow transplantation. Seven mycosis fungoides were refractory to chemotherapy. In low-grade NHL, one complete response (CR) was observed. In aggressive NHL, there were three CRs and two partial responses (PRs). No response was noted in Hodgkin's disease. One CR and four PRs were observed in mycosis fungoides. Complete response durations were 23, 20, 17, 12, and 4 months. Grade 4 toxicity was observed in 29 patients leading to arrest of therapy in 12 patients. The response to rIL-2 therapy in lymphoma differs according to histologic subtypes. Five responses were observed in 23 aggressive lymphomas. Five of seven mycosis fungoides responded; these preliminary results warrant testing of a larger number of patients.

Association between biosynthesis of nitric oxide and changes in immunological and vascular parameters in patients treated with interleukin-2.

Hypotension is a dose-limiting side effect of interleukin-2 (IL-2) therapy. This may be due to increased biosynthesis of the potent vasodilator nitric oxide (NO) induced by cytokines such as tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma), which are known to be generated during IL-2 therapy. We describe the relationship between NO biosynthesis and changes in immunological and vascular parameters during IL-2 therapy in 13 patients with metastatic cancer. Plasma concentrations of neopterin and nitrite plus nitrate (NOx) were higher in cancer patients prior to treatment compared with normal subjects (neopterin; 10.8 +/- 1.4 vs. 2.0 +/- 0.4 ng ml-1, P < 0.001: NOx; 45 +/- 6 vs. 28 +/- 2 microM, P < 0.005). Pretreatment TNF-alpha and IFN-gamma plasma concentrations were not significantly different in cancer patients from those in controls. During infusion of IL-2 (18 x 10(6) international units m-2 per day for 5 days) these parameters increased, reaching maximal concentrations at day 3 for IFN-gamma and day 5 for TNF-alpha, neopterin and NOx. The maximal induced NOx correlated with maximal TNF-alpha (r = 0.60, P < 0.04), IFN-gamma (r = 0.63, P < 0.02) and neopterin (r = 0.66, P < 0.01). As plasma NOx concentrations increased, systolic blood pressure fell, reaching a minimum at day 3 despite a continued rise in NOx concentrations. These changes were accompanied by a continuous increase in pulse rate throughout the infusion period. These findings indicate that induction of NO biosynthesis contributes to hypotension induced during IL-2 therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Biologic and clinical effects of continuous infusion interleukin-2 in patients with non-small cell lung cancer

Interleukin-2 (IL-2) has shown antitumor activity in some neoplasms, such as melanoma and renal carcinoma, but toxicity derived from bolus administration is significant, particularly at the cardiorespiratory level. To test feasibility, antitumor activity, pulmonary and systemic immunologic effects, and pulmonary function changes of continuous-infusion recombinant IL-2 given to patients with non-small cell lung cancer, eleven subjects with Stage III-IV disease were treated in a standard pulmonary medicine unit with a dose of 18 million IU/m2/day from day 1 to day 13 with 1-day rest on day 7. A second induction course was given after a 3-week rest. In patients with nonprogressive disease, four maintenance courses of 6 days' duration at the same dose were planned. Immunologic tests, including lymphocyte phenotype analysis and assays for the detection of tumor necrosis factor (TNF) and of anti-IL-2 antibodies, were performed before and after treatment in serum and bronchoalveolar lavage fluid (BAL). Cardiopulmonary function tests, including spirometry, arterial blood gas analysis, diffusion capacity, and echocardiography, were obtained before, during, and after treatment. Twenty-one cycles (15 induction courses plus 6 maintenance courses) were administered. No patient was able to complete the six planned courses, and only 3 patients entered the maintenance phase. Reasons for discontinuation included progressive disease in five cases, toxicity in three cases, and patient request in three cases. The most common side effects were fever, hypotension, oliguria, and elevated serum creatinine and liver enzyme levels. No patient required intubation or intensive care. No objective response was seen, and the median survival time was 10 months. Lymphocytosis and eosinophilia were observed in all patients. Surface marker analysis revealed a statistically significant increase in the percentage of CD3+, CD4+, CD25+ and DR+ cells in peripheral blood. Lymphoid cells derived from BAL disclosed an increased natural killer activity after IL-2 treatment, and TNF was increased in BAL fluid. Pulmonary function tests evidenced an increased alveolar-arterial difference for oxygen allied with a decrease of forced expiratory volume in 1 second, forced vital capacity, and carbon monoxide transfer coefficient consistent with a significant, albeit not clinically relevant, interstitial lung defect. Continuous-infusion IL-2 is feasible in patients with advanced lung cancer even outside an intensive care unit, but overall compliance is poor. Although clinical pulmonary toxicity is negligible, small but statistically significant alterations of the pulmonary function are evident. In addition, this regimen produces a significant activation of the immune system at the pulmonary level.

Influence of interleukin-2 infusion on cell cycle kinetics in the Walker-256 carcinosarcoma

The effect of recombinant human interleukin-2 (IL-2) on tumor cell cycle kinetics was evaluated in rats bearing the Walker-256 carcinosarcoma. Seven days after implantation, tumor-bearing rats were infused intravenously with IL-2 at a dose of 500 mg/kg body weight or 5% dextrose for 6 h. Tumor cell mean DNA synthesis time (TDNA), labeling index, potential doubling time (Tpot), and growth fraction (GF) were determined in vivo by use of bromodeoxyuridine (BrdUrd) pulse labeling and bivariate BrdUrd/DNA analysis using flow cytometry. IL-2 treatment significantly reduced the relative number of S-phase cells by 11.9% and increased the number of cells in the G0/G1 phase by 9.4%. The labeling index was reduced from 41.3 +/- 2.5% to 32.7 +/- 1.2% (P < .01). Estimates of TDNA derived from the change in BrdUrd movement relative to DNA content were not affected by IL-2 treatment. Based on these cytokinetic changes, IL-2 infusion significantly increased tumor Tpot from 15.3 +/- 0.3 h to 21.5 +/- 0.2 h (P < .001) and reduced GF from 1.01 +/- 0.07 to 0.83 +/- 0.01 (P < 0.001). The inhibitory effect of IL-2 infusion on tumor cell growth, which may be either direct or secondarily mediated by other factors, contrasts with other stimulatory effects of this cytokine on lymphoid cell proliferation.