title: Perioperative immunomodulation with Flt3 kinase ligand or a whole tumor cell vaccine is associated with a reduction in lung metastasis formation after laparotomy in mice.
abstract: BACKGROUND
  Laparotomy has been associated with temporary postoperative immunosuppression and accelerated tumor growth in experimental models. In a previous murine study, a whole cell vaccine plus the adjuvant monophosphoryl-lipid A was shown to be effective in decreasing the number of lung metastases that develop after laparotomy. This study was conducted to assess the impact of the adjuvant fetal liver tyrosine kinase 3 (Flt3) ligand on perioperative tumor growth when used alone or with a tumor cell vaccine.
  
  
  METHODS
  An intravenous tumor cell injection lung metastases model was used. Sixty female A/J mice were divided into six equal groups designated (1) anesthesia control (AC), (2) AC with Flt3 ligand (ACFlt3), (3) sham laparotomy (OP), (4) OP with Flt3 ligand (OPFlt3), (5) OP with vaccine (OPVac), and (6) OP with Flt3 ligand and vaccine (OPFlt3Vac). Groups 2, 4, and 6 received daily intraperitoneal injections of Flt3 ligand (10 microg/dose with carrier) for 5 days before and 5 days after surgery. Groups 1 and 3 received similar injections of saline on the same schedule. Groups 5 and 6 were vaccinated with irradiated whole Ta3Ha tumor cells intraperitoneally three times before and twice after surgery. Immediately after surgery, all mice were injected with 10(5) Ta3Ha tumor cells via a tail vein. After 14 days, the mice were sacrificed and their lungs and tracheas were excised en bloc. Specimens were stained and counterstained with India ink and Fekete solution, and surface metastases were counted by a blinded observer. Differences between study groups were determined by analysis of variance. The peritumoral inflammatory cell infiltrate of some Flt3 and control specimens was also assessed.
  
  
  RESULTS
  Regarding laparotomy, Flt3 ligand (mean, 1.22 metastases), whole cell vaccine (1.12 metastases), and the combination of these two agents (0.1 metastases) were each effective in significantly decreasing the number of surface lung metastases compared with surgery alone (9.88 metastases, P < .05 for all comparisons). There were no differences between the various treatment groups in regards to number of metastases. Only the combination of Flt3 and the vaccine significantly lowered the incidence of tumors (number of mice with > or =1 tumors). Histologic analysis revealed that the Flt3-treated mice demonstrated increased numbers of antigen-presenting cells surrounding the tumors compared with controls.
  
  
  CONCLUSIONS
  Perioperative treatment with either Flt3 ligand or a whole cell tumor vaccine significantly reduced the number of lung metastases after laparotomy. The combination of the Flt3 ligand and the vaccine also decreased the incidence of metastases and was the most effective treatment. Further studies regarding perioperative immune modulation in the setting of cancer appear warranted.
authors.affiliation: Laparoscopic Physiology Laboratory, Department of Surgery, College of Physician and Surgeons, Columbia University, New York, NY 10016, USA. cartej08@med.nyu.edu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Carter
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Feingold
authors.forename: Anthony
authors.initials: A
authors.lastname: Oh
authors.forename: Irena
authors.initials: I
authors.lastname: Kirman
authors.forename: Peer
authors.initials: P
authors.lastname: Wildbrett
authors.forename: George
authors.initials: G
authors.lastname: Stapleton
authors.forename: Zishan
authors.initials: Z
authors.lastname: Asi
authors.forename: Ryan
authors.initials: R
authors.lastname: Fowler
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.forename: Emina H
authors.initials: EH
authors.lastname: Huang
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fine
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000230:Adenocarcinoma; D000276:Adjuvants, Immunologic / Q000494:pharmacology*; D000704:Analysis of Variance; D000818:Animals; D019496:Cancer Vaccines / Q000494:pharmacology*; D005260:Female; D007813:Laparotomy; D008175:Lung Neoplasms / Q000517:prevention & control* / Q000556:secondary; D008325:Mammary Neoplasms, Experimental / Q000473:pathology*; D008565:Membrane Proteins / Q000494:pharmacology*; D051379:Mice; D011897:Random Allocation
chemical_list: D000276:Adjuvants, Immunologic; D019496:Cancer Vaccines; D008565:Membrane Proteins; C084881:flt3 ligand protein