Thymus-Derived Lymphocytes in Patients With Bilharzial Urinary Bladder Cancer: Brief Communication

The purpose of the present study was to determine the levels of peripheral blood thymus·derived (T) lymphocytes in a series of 43 Egyptian patients with bilharzial bladder cancer and 15 with chronic bilharziasis and to compare these to normal Egyptian controls. Both active and total T·cell rosettes were significantly reduced in patients with stages III and IV bladder cancer, whereas only total T·cell rosettes were reduced in patients with stages I and II disease when compared to normal controls. Patients with chronic bill'!arziasis had intermediate values between those with cancer and normal controls, but this difference was significant only for total T·cell rosettes. Only those patients with advanced disease (stages III and IV) had significantly lower percentages of active T·lymphocytes when compared to patients with bilharziasis. Since total T·cell levels were reduced significantly in cancer patients with both early (stages I and II) and advanced (stages III and IV) disease when compared to normal controls and patients with bilharziasis, only the number of active T·cells could be correlated with the clinical stage of disease. -J Nail Cancer Inst 59: 355-357,1977. Recent studies indicate that patients with bladder cancer may have decreased immunocompetence as measured by impaired delayed cutaneous hypersensitivity to skin test agents such as dinitrochlorobenzene (1-3) and tuberculin (4), reduced responsiveness of peripheral blood lymphocytes to phytohemagglutinin (2, 3), and decreased levels of thymus· derived (T) lymphocytes in their peripheral blood (4, 5). The relationship between chronic infection with Schistosoma haematobium and carcinoma of the urinary bladder has long been recognized (6). Only more recently has it been appreciated that chronic schistosomiasis also may be associated with impairment of immunologic func· tion as manifested by decreased responsiveness of lymphocytes to both phytomitogens (7) and specific antigens (8). Conversely, there may be increased humoral antibody production directed against parasite-associated antigens, the formation of immune complexes, and the development of a multiplicity of immunopathologic lesions (9). Patients with bilharzial bladder cancer, therefore, may be doubly at risk to develop severe impairment of immunologic function, since cancer and chronic infection are both independently associated with varying levels of immunoincompetence. The purpose of the present study was to investigate one specific parameter that is associated with immune function, circulating T-cell levels, and to attempt to relate these to the clinical stage of the patient's cancer. MATERIALS AND METHODS Patients. Forty-three patients with urinary bladder cancer, 35 males and 8 females with a mean age of 42.7 years (range, 26-65 yr), were included in the present study. They had no previous treatment for their tumors, and all were clinically staged according to the Wallace classification (10). Twenty-nine patients were grouped in stages I and II, VOL. 59, NO.2, AUGUST 1977 12 in stages III and IV, and 2 could not be staged. All patients had a positive history of urinary bilharziasis, and none had been given any type of antibilharzial treatment for at least 1 month prior to this study. None of the patients had received blood transfusions or anti· inflammatory or immunosuppressive drugs. The diagnosis of carcinoma of the bladder was confirmed by histologic examination after either curative or palliative surgery. Another group of 15 patients with S. haematobium infec· tion, 13 males and 2 females with a mean age of 41.5 years (range, 28-53 yr), also were studied. Urine specimens from all of these patients were positive for S. haematobium ova. None of the patients had hepatosplenomegaly or ascites, and their stools were free from S. mansoni ova. Cystoscopy was performed in each patient to explore the bladder wall for any bilharzial lesions, and a biopsy specimen was ob· tained in each case for histopathologic examination in order to exclude malignancy. None of the patients had received antibilharzial treatment for at least 1 month prior to this in· vestigation. A third group of 21 individuals with no significant history of disease served as normal controls. They included 18 males and 3 females. with a mean age of 33.5 years (range, 23-50 yr). E-roseUe assay. --...: Lymphocytes were separated by FicollHypaque density gradient centrifugation according to the method of BfSyum (11). Lymphocyte concentration was adjusted to 4 X 106 cells/ml in Hanks' balanced salt solution supplemented with 15% fetal bovine serum. Two types ofTcell populations were examined by means of the spon· taneous E'rosette assay system (12), modified from that previously described by Yu et a1. (13). The "active" T-cell population (E,) was enumerated by mixing 0.2 ml of the lymphocyte suspension with an equal volume of a 0.5% suspension of washed SRBC. incubating the mixture at 37 0 C for 1 hour. and then centrifuging at 200 X g for 5 minutes. The cell pellet was gently resuspended, and one drop of a 1 % toluidine blue solution was added. The suspension was transferred to a hemacytometer ABBREVIATIONS USED: E or SRBC = sheep red blood cell(s); RFC = rosette·

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