From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. Leukocyte Lysozyme Activity in Myelocytic Leukemi By R. E. NOBLE AND H. HUGH FUDENBERG L YSOZYME, A ATIONI POLYPEPTIDE of low moleculr weight, is present in serum nd in certin blood cells. The enzyme is found in grnulocytes nd monocytes but not in lymphocytes, red cells or pltelets.23 Leukocyte lysozyme levels in generl re incresed in monocytic nd decresed in lymphocytic leukemi.46 rying levels hve been reported in the myelocytic nd monomyelocytic leukemis.4 T The vrition in the reported vlues probbly cn be ttributed in prt to differences in the species nd mturity of the leukocytes in the smples ssyed. This report describes the results of lysozyme determintions on leukocytes nd ser from ptients with chronic myelocytic nd cute myeloblstic leukemi.* Lysozyme ctivity ws quntitted by biochemicl technic nd relted to the leukocyte popultion smpled nd the clinicl sttus of the ptient. The results show tht such mesurements provide quntittive index of the extent of the mlignnt process in the circulting grnulocytes nd tht seril ssys of leukocyte lysozyme ctivity furnish vluble prognostic tool in these disorders. MATERIALS AND \IETIIODS linicl Mteril Nine ptients from the Hemtology Service or the ncer Reserch Institute of the University of liforni Medicl enter were selected for study. Six of the ptients hd cute myeloblstic leukemi nd three hd chronic myelocytic leukemi. Leukocyte nd serum lysozyme levels were determined t intervls during 9month period (November 1965 to August 1966). During tht time ll but two of the ptients were treted intermittently with vrious ntileukemic drugs. As control, specimens of serum nd leukocytes from 2 helthy hospitl employees were ssyed in similr fshion. Methods Serum ssy. enous blood, obtined by venipuncture, ws collected into nonheprin From the Section of Hemtology nd immunology, Deprtment of Medicine, University of liforni School of Medicine, Sn Frncisco, liforni. Supported in prt by grnt from the Leukemi Society, inc., nd by grnt from the EdwrcLs Fund, llocted by the ommittee on Reserch, University of liforni School of Medicine, Sn Frncisco. First submitted Feb. 7, 1967; ccepted for publiction Apr11 21, 1967. R. E. NOBLE, M.D., Pii.D.: Fellow in Hemtology, University of liforni School of Medicine. II. HUGH FUDENBERG, M.D.: Professor of Medicine nd Director of the Section of Hemtology nd Immunology, University of liforni School of Medicine. #{176}Nodistinction ws mde between cute mycloblstic nd cute monomyeloblstic leukemi in this report; such cute letikemic processes re referred to s cute mycloblstic leukemi. 465 Bi.oon, oc. 3, No. 4 (OcmIIF:I1 ), 1967
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. 466 NOBLE AND FUDENBEEG ) E ) if) U) (. i. :E z.u I,, N. U 1 if) if) II %1Uf %f)cr)c = ) U) U) if) if) N. r. ) ii) U) N. N. N. N. U N. N. N. fj f) U) i t.r.i ( 1 ii) &
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. LEUKOYTE LYSOZYME ArIITY IN LEUKEMIA 467 ized tube nd llowed to clot. The serum ws removed, nd.5mi. smples were ssyed for lysozyme ctivity by the method of Smolelis nd Ilrtsell.8 Leukocyte Assy. enous blood, 8 ml., ws collected directly vi 19guge needle into siliconized heprinized test tube continign 2 ml. of 5 per cent solution of dextrn (moleculr weight, 2275,) in physiologic sline. The red cells were llowed to settle for 3 minutes. The upper phse ( contining the leukocytes ) ws then removed nd centrifuged t 16 r.p.m. for 5 minutes in Servll 551 centrifuge. The white cell sediment ws gently wshed twice with physiologic sline, suspended in smll volume of the sline solution, nd counted. The cell popultion of ech smple ws determined by differentil counting of Wrightstined smer of the suspension. At lest 1 cells in ech preprtion were counted. In some instnces considerble difficulty ws encountered in identifying the cell type. The cell suspension ws then sonicted in highfrequency sound Sonifier ( Brnson Instruments, Dnbury, onn. ). Smples of the sonicte were ssyed for lysozyme ctivity by the method of Smolelis nd Hrtsell.8 The lysozyme concentrtion of the leukocytes, ug./1 cells, ws determined. The lysozyme content of 1 leukocytes other thn lymphocytes ( nonlymphocytic leukocytes) ws then clculted. RESULTS The lbortory dt on the 2 control subjects re listed in Tble 1. As shown, the lysozyme ctivity of norml leukocytes rnged from 3.3 to 7.2 g.i 16 cells nd tht of norml nonlymphocytic leukocytes from 3.6 to 8.4 g.i 16 cells. No immture cells were present in the peripherl blood of these subjects. The serum lysozyme levels vried from 6 to 15,sg./ml. The clinicl nd experimentl dt on the nine leukemic ptients re summrized in Tble 2. Three of the six ptients with myeloblstic leukemi (ses 1, 2 nd 3) died during the 9month study period. When these three ptients were first studied, the totl leukocyte nd nonlymphocytic leukocyte lysozyme levels were decresed; differentil counts showed few or no immture cells. With the occurrence of blstic crisis leding to deth, the leukocyte lysozyme ctivity dropped to extremely low levels. This sequence of events in se 1 is shown grphiclly in Figure 1. In two other ptients with cute myeloblstic leukemi (ses 4 nd 5), decresing levels of totl leukocyte lysozyme ctivity were found during excerbtions of disese nd rising levels during remissions. The lysozyme ctivity of the nonlymphocytic leukocytes showed prllel chnges, but the decreses nd increses were generlly greter in degree. Essentilly norml totl leukocyte nd nonlymphocytic leukocyte lysozyme levels were present in the remining ptient with cute myeloblstic leukemi (se 6) nd the three ptients with chronic myelocytic leukemi (ses 7, 8 nd 9). All these ptients were in good helth t the termintion of the study. In three of the six ptients with cute myeloblstic leukemi (ses 1, 4 nd 6), the lysozyme content of the serum ws incresed t some time during the study period (Tble 2). Incresed serum levels were lso found in two of the three ptients with chronic myelocytic leukemi (ses 8 nd 9). In the three ptients who died, the serum lysozyme level ws norml or low shortly before deth occurred. DIscussIoN The studies on the leukemic ptients demonstrte prllel in generl be
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From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. LEUKOYTE LYSOZYME ATIITY IN LEUKEMIA 469 N..4? 3 N. 6 6o..w. v 2E. > ;> > >.. ini c3 t fl UI N r t to.to r i U) r to c r i to to if) N. N. N. r l N. ucu),;;.,; o. if) 3 2 9 N. to N. N. N. N. N., r. ir. tr., N. i,.. i. Ni 1..,. N. N. N. N. N. N. N. N.
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. 47 NOBLE AND FUDENBER ci. to..* I I Ni 1. o N S... Ut U).2 u. N b 2 HI 2.E U) e o,,j o U) = Ni Ni U U ). e.i I...L) I S N. Ni Ni 8 If) I U
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. LEUKOYTE LYSOZYME ATIITY IN LEUKEMIA 471 WB OUNT x LYSOZYME ATIITY % IMMATURE ELLS (,g./16 ELLS) () DATES 966) Fig. 1.Reltionship between peripherl white cell count, percentge of immture cells nd leukocyte lysozyme levels in ptient with cute myelocytic leukemi (se 1). tween the mturity of the grnulocytes nd their lysozyme content. onsiderble evidence now indictes tht lysozyme is contined in the lysosoml or grnulr frction of polymorphonucler leukocytes.9 1#{176} Therefore myeloblsts, which re devoid of grnules, would be expected to be lcking in lysozyme ctivity. This is borne out by the findings in se 2. Shortly before the ptient s deth, the leukocyte popultion consisted lmost entirely of myeloblsts (92 to 1 per cent). In three determintions t tht time, no leukocyte lysozyme ctivity could be detected. The technic used in this study for quntittive estimtion of leukocyte lysozyme ctivity is esy to perform nd reltively rpid. In some cses it proved more ccurte mens of detecting immturity of grnulocytes thn qulittive morphologic exmintion of peripherl blood. For exmple, in studies on Jnury 5 nd Februry 9, 1966, in se 1 nd on November 12 nd 17, 1965, in se 2 (Tble 2), no immture leukocytes were found by differentil counting, lthough quntittive determintions showed decrese in the iysozyme ctivity of totl leukocytes nd nonlymphocytic leukocytes, indicting dvnced disese. These dt suggest tht seril determintions of leukocyte lysozyme ctivity by this technic should be vluble djunct in the clinicl mngement nd prognosis of ptients with myelocytic leukemi. Previous reports tht serum lysozyme concentrtions re usully incresed in cute myeloblstic nd monomyeloblstic leukemis nd in chronic grnulocytic leukemi4 5 1 2 were confirmed by the present study. Unpublished dt from our lbortory re in greement with the finding by other investigtors tht serum lysozyme levels re usully decresed in cute lymphoblstic leukemi.4 5 The results of the present study, however, lso show tht serum lysozyme levels my fluctute widely in cute or chronic myeloblstic leukemi nd my be low, norml or high. Severl fctors my ccount for such fluctutions. These include the bsolute number nd the mturity of the lysozymecontining leukocytes present, the rte of synthesis or destruction of
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. 472 NOBLE AND FUDENBERG these cells, nd the contribution to serum lysozyme ctivity by lysozymecontming tissues other thn blood cells ( e.g., kidney, 3 liver, etc.). All the ptients in our smll group who died during the course of study hd low leukocyte nd norml or low serum lysozyme levels shortly before deth occurred. All three died of infectious disese. These observtions, together with the known role of lysozyme in phgocytosis, 4 invite specultion on possible reltionship between diminished lysozyme ctivity nd the incresed susceptibility to infection commonly found in cute leukemic disorders. Sui MARY Leukocyte nd serum lysozyme ctivity ws determined in nine ptients with cute myeloblstic or chronic myelocytic leukemi nd in 2 norml control subjects. Biochemicl ssy nd quntittive estimtion of leukocyte lysozvme ctivity in the ptients demonstrted prllel in generl between the mturity of the grnulocytes nd their lysozyme content. Such determintions pper to provide quntittive index of the extent of the leukemic process in the peripherl grnulocytes nd therefore should be of vlue s guide to prognosis in these disorders. SUMMARIO IN INTERLINGUA Le ctivitte lysozymtic del leucocytos e del sero essev determinte in novem ptientes con cute leucemi myeloblstic o con chronic leucemi myelocytic e in 2 norml subjectos de controlo. Essyge bi ochimic e estimtion quntittive del leuocytic ctivitte lysozymtic demonstrv un prllel, generlmente prlr, inter le mturitte del grnulocytos e br contento de lysozym. Tl determintiones pre provider un indice quntittive del extension del processo leucemic in le grnulocytos peripheric cper consequentepromitte esser de vlor in le prognose de iste disordines.. AKNOWLEDGMENT W e wish to thnk Dr. Rune Stjernholm of the Deprtment of Biochemistry, Western Reserve University, for vluble technicl dvice during the initil phses of this study. REFERENES 1. Alderton,., Wrd, \. H., nd Fevold, H. L.: Isoltion of lysozyme from egg white. J. Biol. hem. 157: 43, 1945. 2. Brnes, J. M.: The enzymes of lymphocytes nd polymorphonucler leucocytes. Brit. J. Exp. Pth. 21:264, 194. 3. Flngn, P., nd Lionetti, F.: Lysozyme distribution in blood. Blood 1:497, 1955. 4. Finch, S.., Gnbsik, F. J., nd Rogowy, \.: Lysozyine nd leukopoiesis. In: Third Interntionl Symposium on Fleming s Lysozyme, Miln, 1964. Miln, esno Boscone, 1964, pp. 15. 5. Perillie, P. E., Kpln, S. S., Lefkowitz, E., nd Finch, S..: Murmidse (lysozyme) ctivity in leukemi. Blood 28:1, 1966 (Abstr.). 6. Nunnri, A., Belfiore, F., nd lfto, M.: L ttivit lisozimic dei leucociti normli e leucemici. Soc. Itl. Biol. Sperimentli 39:714, 1963. 7. Oht, H.: Metbolic responsiveness of humn leukemic leukocytes to phgocytic stimultion. Act Hemt. 33: 28, 1965. 8. Smolelis, A. N., nd Hrtsell, S. E.: The determintion of lysozyme. J. Bct. 58:731, 1949. 9. ohn, Z. A., nd Hirsch, J..: The isoltion nd properties of the specific cytoplsmic grnules of rbbit polymorphonucler leucocytes. J. Exp. Med. 112:983, 196. 1. Hirschhorn, R., nd Weissmnn,.:
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. LEUKOYTE LYSOZYME ATIITY IN LEUKEMIA 473 Isoltion nd properties of humn leukocyte lysosomes in vitro. Proc. Soc. Exp. Biol. Med. 119:36, 1965. 11. Joll#{232}s,P., Sternberg, M., nd Mth#{233},.: The reltionship between serum lysozyme levels nd the blood leukocytes. Isrel J. Med. Sci. 1:445, 1965. 12. Ossermn, E. F., nd Lwlor, D. P.: Serum nd urinry lysozyme (murmidse) in monocytic nd monomyelocytic leukemi. J. Exp. Med. 124:921, 1966. 13. Noble, R. E., nd Brinerd, H. D.: Urine nd serum lysozyme ltertions in cse of cute renl filure. J. Urol. 96:852, 1966. 14. Fleming, A.: On remrkble bcteriolytic element found in tissues nd secretions. Proc. Roy. Soc. Med. 93: 36, 1922.
From www.bloodjournl.org by guest on Februry 2, 216. For personl use only. 1967 3: 465473 Leukocyte Lysozyme Activity in Myelocytic Leukemi R. E. NOBLE nd H. HUGH FUDENBERG Updted informtion nd services cn be found t: http://www.bloodjournl.org/content/3/4/465.full.html Articles on similr topics cn be found in the following Blood collections Informtion bout reproducing this rticle in prts or in its entirety my be found online t: http://www.bloodjournl.org/site/misc/rights.xhtml#repub_requests Informtion bout ordering reprints my be found online t: http://www.bloodjournl.org/site/misc/rights.xhtml#reprints Informtion bout subscriptions nd ASH membership my be found online t: http://www.bloodjournl.org/site/subscriptions/index.xhtml Blood (print ISSN 64971, online ISSN 15282), is published weekly by the Americn Society of Hemtology, 221 L St, NW, Suite 9, Wshington D 236. opyright 211 by The Americn Society of Hemtology; ll rights reserved.