Surface Properties of Cancer Cells
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At page 269 of the Journal this week Drs. L. Brent and P. B. Medawar, F.R.S., report on their new approach to the typing problem. Unlike previous methods it is direct and specific for the recipient under consideration. Their test depends on the behaviour of the recipient's lymphocytes after intradermal injection into a potential donor. In guinea-pigs homologous lymphocytes injected intradermally may produce a local reaction similar to the tuberculin response after 24 to 48 hours. This is interpreted as a reaction of the cells against the organism into which they have been injected -that is, a local graft-versus-host reaction. The severity of the skin reaction was graded by size, erythema, hardness, and swelling. There was a close correlation between the behaviour of skin grafts from the injected animals back into the donor of the lymphocytes. In the clinical application of this test lymphocytes from the peripheral blood of the patient would be injected into a panel of possible donors, and the donor selected would be the one with the least severe skin reaction. Brent and Medawar obtained easily reproducible results in guinea-pigs, and since man tends to behave rather similarly to the guinea-pig in his hypersensitivity reactions they consider that the clinical application of the test should be investigated. The main risk of the procedure would be transmission of disease in the cell preparation-for instance, infectious hepatitis or syphilis. It is possible that methods will be found to determine discrete tissue types similar to blood groups, but if Brent and Medawar's method is applicable to man then donor selection may already be much easier. In practice new problems would arise. It would be difficult to prevent pressures being put on individuals to volunteer as donors, and the " reluctant best donor " would provide the doctor with another ethical problem. Perhaps the main value of this test would be to eliminate unsatisfactory donors. This would certainly represent a major advance in clinical renal transplantation.