Hans-Dieter Kleine

Autologous bone-marrow stem-cell transplantation for myocardial regeneration

Implantation of bone-marrow stem cells in the heart might be a new method to restore tissue viability after myocardial infarction. We injected up to 1.5x10(6) autologous AC133+ bone-marrow cells into the infarct border zone in six patients who had had a myocardial infarction and undergone coronary artery bypass grafting. 3-9 months after surgery, all patients were alive and well, global left-ventricular function was enhanced in four patients, and infarct tissue perfusion had improved strikingly in five patients. We believe that implantation of AC133+ stem cells to the heart is safe and might induce angiogenesis, thus improving perfusion of the infarcted myocardium. See Commentary page 11

Dendritic cell subsets in human bronchoalveolar lavage fluid after segmental allergen challenge

Background: Dendritic cells control pulmonary immune reactions. Characteristics of dendritic cells in human bronchoalveolar lavage fluid (BALF) after allergen challenge are unknown. Methods: 7 patients with allergic asthma (median 23 years, range 19–25 years) underwent segmental challenge and were lavaged 10 min and 24 h after challenge. Dendritic cell subsets and surface markers in BALF and in peripheral blood were analysed using four-colour flow cytometry. Results: Plasmacytoid dendritic cells (pDCs, median 0.06%, range 0.01–0.08%) and myeloid dendritic cells (mDCs, median 0.47%, range 0.27–0.87%) were detectable in BALF from control segments. CD1a-positive dendritic cells in BALF were identified as a subpopulation of mDCs. Both pDCs (median 0.56%, range 0.09–1.83%) and mDCs (median 1.82%, range 0.95–2.29%) increased significantly in BALF 24 h (p = 0.018 compared with the control segments for pDCs and mDCs), but not 10 min, after allergen challenge. The percentage increase in pDCs was higher than that of mDCs after allergen challenge, as reflected by an enhanced pDC:mDC ratio after allergen challenge. In peripheral blood, there was a significant decrease in mDCs (p = 0.038) and a trend to a decrease in pDCs (p = 0.068) 24 h after allergen challenge. Analysis of dendritic cell surface molecules showed that after allergen challenge, BALF dendritic cells have a less mature phenotype compared with BALF dendritic cells from control segments. Conclusion: Using a comprehensive strategy to analyse dendritic cell subsets in human BALF, we have shown for the first time that both myeloid and plasmacytoid dendritic cells accumulate in the airway lumen after allergen challenge in patients with asthma.

Cytokine mRNA Levels and Lymphocyte Infiltration in Pancreatic Tissue During Experimental Chronic Pancreatitis Induced by Dibutyltin Dichloride

There is little information available regarding the role of inflammatory cells in the pathogenesis of chronic pancreatitis. Therefore, we analyzed the local cytokine profile and infiltrating lymphocytes in a rat model of chronic pancreatitis. Experimental pancreatitis was induced by a single intravenous application of dibultyltin dichloride (DBTC). During a time course of two months we observed the mRNA expression of cytokines using competitive RT-PCR. Lymphocytes were characterized by immunohistochemistry, FACS analysis, and the lymphocyte proliferation test. IL-1β, IL-6, IL-5, and IL-10 were immediately up-regulated in the acute phase of disease, while lymphocyte-restricted expression of IL-2, IL-2R, and IFN-γ was only found in the chronic course. Among the infiltrating lymphocytes, CD4+ cells dominated, but during the chronic process there was an increase of CD8+ cells, resulting in a reduced CD4/CD8 ratio. Mitogen-induced activation of isolated mesenteric lymph node cells increased during the chronic inflammation. Our results suggest that in experimental pancreatitis acute inflammatory reactions are followed by a T-lymphocyte-mediated process.

Interferon-alpha inhibits cell cycle progression by Ba/F3 cells through the antagonisation of interleukin-3 effects on key regulators of G1/S transition

The molecular mechanisms of interferon-alpha (IFN-alpha)-mediated cell growth inhibition are incompletely understood. Here, we have analysed how IFN-alpha interferes with the interleukin-3 (IL-3)-stimulated cell cycle progression by Ba/F3 cells. The antiproliferative cytokine caused a delay in cell cycle progression, which correlated with a diminished activation of the cyclin-dependent kinases 2 and 4 in IL-3-stimulated cells. While IFN-alpha did not affect the expression of p27(Kip1) and p21(Waf1), it efficiently inhibited the IL-3-induced expression of D-type cyclin and cyclin E proteins. No IL-3-antagonistic effects of the IFN, however, were observed at the mRNA level of cyclin expression. Furthermore, IFN-alpha suppressed the IL-3-induced release of E2F transcription factors from the retinoblastoma protein (pRb) and enhanced pRb-mediated transcriptional repression. The growth factor-antagonistic action of IFN-alpha correlated with a strong stimulation of protein kinase R expression, suggesting that inhibition of protein synthesis plays a pivotal role in IFN-alpha-mediated inhibition of cell cycle progression.

High-dose etoposide phosphate and G-CSF mobilizes peripheral blood stem cells in patients that previously failed to mobilize

Abstract Ten consecutive patients in our unit who had failed to mobilize a sufficient stem cell yield after either an initial or several mobilization regimens received high-dose etoposide phosphate (1500–2000 mg/m2) followed by granulocyte colony-stimulating factor (G-CSF; 10 μg/kg per day) to stimulate mobilization. Eight of the ten patients were apheresed. A median of 2.1×106 CD34+/kg (range 0–5.2) was collected. The number of CD34+ cells/μl peripheral blood (pB) was significantly increased compared to the first-line mobilization [median 13.0 (range 2.68–29) versus median 4.76 (range 1.36–12);P<0.05]. Besides hematotoxicity and four cases of infection (WHO grade 3), no major side effects were seen. The median duration of neutropenia was short (5 days, range 0–10), which is important in heavily pretreated patients. These results indicate that high-dose etoposide phosphate with G-CSF is safe, well tolerated, and may be effective in peripheral blood stem cell (PBSC) mobilization in patients who had previously failed to mobilize.

Methotrexate-albumin and aminopterin-albumin effectively prevent experimental acute graft-versus-host disease.

Background. During the last several years, major progress has been made in developing targeted chemotherapy using cytotoxic drugs covalently bound to human serum albumin (HSA). We explored the activity of two antifolates methotrexate (MTX) and aminopterin (AMPT) bound to HSA in prophylaxis and treatment of experimental acute graft-versus-host disease (aGVHD). Methods. In all, 113 female F1 hybrid BN/Lew-rats were irradiated with 8.2 Gy (n=103) or 9.9 Gy (n=10). One day after irradiation each rat received 4×107 bone marrow cells and 1.5×107 spleen T-cells from female Lew-rats. GVHD prophylaxis consisted of MTX-HSA 2 mg/kg (n=25), MTX-HSA 0.5 mg/kg (n=8), AMPT-HSA 0.65 mg/kg (n=8), MTX 0.5 mg/kg (n=17), or native HSA (n=39) given intraperitoneally (IP) on days 0, 4, 8, and 12. Treatment of aGVHD consisted of MTX-HSA 2 mg/kg (n=8) or AMPT-HSA 0.5 mg/kg (n=8) given intraperitoneally at the time of onset of aGVHD and subsequently every fourth day (a total of four doses). Results. All animals receiving native HSA developed lethal aGVHD. Prophylactic treatment with MTX-HSA 2 mg/kg prevented aGVHD in 18 of 25 animals and in 6 of 8 receiving AMPT-HSA. In contrast, five out of nine rats receiving free MTX died due to aGVHD. The survival rates in the prophylactic MTX-HSA 2 mg/kg and AMPT-HSA groups were significantly higher compared to the MTX and control groups (P<0.05), while non hematologic toxicity of MTX-HSA was not detectable. AMPT-HSA at a dose of 0.65 mg/kg as well as MTX at a dose of 0.5 mg/kg were associated with temporary weight loss and lethargy. Conclusions. The albumin conjugates MTX-HSA and AMPT-HSA effectively prevent experimental aGVHD.

Treatment with campath-1H for relapsed chronic lymphocytic leukemia after allogeneic peripheral blood stem cell transplantation does not abrogate the development of chronic GVHD.

The graft vs. leukemia (GVL) effect is one of the most important factors of anti‐tumor activity after allogeneic hematopoetic stem cell transplants (alloSCT). Its effectiveness depends mainly on the tumor biology as well as the tumor burden. Patients with a high tumor burden may not respond to GVL‐effect despite otherwise sensitive biology. Campath‐1H is known as an effective treatment of chronic lymphocytic leukemia (CLL). Due to its ability to induce profound immunosuppression, it has also been used as part of conditioning regimens before alloSCT. We report a patient, who received campath‐1H in combination with docetaxel for treatment of chemotherapy and donor lymphocyte infusion resistant CLL after alloSCT, who developed shortly after discontinuation of treatment with campath‐1H severe eosinophilia of the peripheral blood and typical clinical as well as histological signs of cutaneous chronic graft vs. host disease followed by complete clearance of CLL. The clinical course demonstrates the impact of the tumor burden on the GVL‐effect, as well as the effectiveness of campath‐1H in the presence chemo‐resistance in a patient with CLL. Furthermore, the GVL effect was not abrogated by the use of campath‐1H.

Rare coincidence of hypertriploid chromosome number and aberrant coexpression of the lymphoid-associated antigen CD5 in acute myeloid leukaemia FAB M0

Rare coincidence of hypertriploid chromosome number and aberrant coexpression of the lymphoid-associated antigen CD5 in acute myeloid Leukaemia FAB M0