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Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a small glycoprotein growth factor which stimulates the production and function of neutrophils, eosinophils and monocytes. GM-CSF can be produced by a wide variety of tissue types, including fibroblasts, endothelial cells, T cells, macrophages, mesothelial cells, epithelial cells and many types of tumor cells. In most of these tissues, inflammatory mediators, such as interleukin 1, interleukin 6, tumor necrosis factor or endotoxin, are potent inducers of GM-CSF gene expression, which occurs at least partly by post-transcriptional stabilization of the GM-CSF mRNA. The biological effects of GM-CSF are mediated through binding to cell surface receptors, which appear to be widely expressed by hematopoietic cells and also by some non-hematopoietic cells, such as endothelial cells. Receptor expression is characterized by low number (20-200/cell) and high affinity (Kd = 20-100 pM). At least two different functional classes of GM-CSF receptor have been identified. The neutrophil GM-CSF receptor exclusively binds GM-CSF, while interleukin 3 competes for binding of GM-CSF to a second class of receptors detected on some leukemic cell lines, such as KG1 and MO-7E. Signal transduction involves activation of a tyrosine kinase and possibly G protein-coupled stimulation of Na+/H+ exchange. The exact relationship of the two receptors needs further clarification.

Gamma interferon induced surface expression of interleukin 2 (IL-2) receptors on normal human monocytes and the monocytoid cell lines U937 and HL60. These receptors were detected by anti-IL-2 receptor monoclonal antibodies, and U937 IL-2 receptors were indistinguishable from T lymphocyte IL-2 receptors by immunoprecipitation. Also, U937 IL-2 receptors bound biologically active IL-2. These results suggest a role for monocyte IL-2 receptors in T cell/monocyte interaction during an immune response.

The expression of HLA-DR antigens by normal myeloid progenitor cells (CFU-GM) has been linked to inhibition of colony growth by prostaglandin E (PGE), while resistance to the inhibitory effects of PGE in chronic myeloid leukemia (CML) has been attributed to a lower fraction of HLA-DR+ CFU-GM in this disease. However, we have previously shown that virtually all CFU-GM in normal bone marrow (NBM) as well as CML peripheral blood express HLA-DR antigens, which raises the possibility that these surface molecules may not be the sole determinants of a progenitor cell's sensitivity to PGE. In order to evaluate the relationship between HLA-DR expression and prostaglandin inhibition, we partially purified NBM progenitor cells using fluorescence-activated cell sorting to prepare cell fractions with high and low HLA-DR antigen density. Normal progenitor cells with high DR density tended to form monocyte colonies in agar culture, whereas the low DR density fraction was enriched for granulocyte colony-forming cells. Inhibition by PGE was greatest in the high DR+ fraction and was largely restricted to monocyte progenitor cells. Inhibition of CFU-GM by PGE was less in CML than in NBM, but this decreased inhibition correlated with a significantly lower number of monocyte-CFU in CML. These data suggest that high HLA-DR antigen density may select for normal progenitor cells that are committed to monocyte differentiation and are, therefore, more likely to be inhibited by PGE. The relative deficit of monocyte progenitor cells in CML may partially explain the phenomenon of PGE resistance in this disease.

The generation of an immune response involves the interaction of monocytes and T cells, but the events which regulate this interaction are not well understood. Culture of human peripheral blood monocytes in vitro induces low level surface expression of the p55 protein of the IL-2R and the expression of this receptor can be enhanced significantly by exposure to IFN-gamma. The addition of IL-2 to IFN-gamma-treated monocytes was shown to augment subsequent IL-1 beta secretion in the presence or absence of LPS. These effects could be partially blocked by anti-p55-IL-2R mAb. Nuclear "run on" assays and Northern analysis to probe for IL-1 beta transcripts showed enhanced IL-1 beta gene transcription and mRNA accumulation by monocytes treated with IFN-gamma and IL-2 but not in cultures that were obtained from monocytes treated with IL-2 alone. These results suggest that the T cell lymphokines IFN-gamma and IL-2 may act in a sequential fashion on monocytes to amplify the immune response by establishing a positive feedback circuit.

The effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on bone-marrow and peripheral-blood progenitor cells was investigated in a three-phase study in 13 patients with sarcoma. In the first phase patients were given GM-CSF alone. In phase II, which started a week after completion of phase I, patients received a course of cytotoxic chemotherapy, then a course of GM-CSF. Phase III consisted only of cytotoxic chemotherapy. GM-CSF (phase I) alone produced an 18-fold increase in peripheral blood granulocyte-macrophage colony-forming units (CFU-GM) and an 8-fold increase in erythroid burst-forming units (BFU-E) in the peripheral blood. GM-CSF had no effect on bone-marrow CFU-GM and BFU-E in the group as a whole. Three patients were investigated after phases II and III. GM-CSF increased the absolute number of peripheral blood CFU-GM by approximately 60-fold compared with the pretreatment baseline. These effects of GM-CSF may be of clinical importance with regard to facilitating the harvest of peripheral blood progenitor cells for autotransplantation.

A variety of monocyte functions are modulated by the T cell lymphokine interferon-gamma (IFN-gamma). We assessed the capacity of IFN-gamma to induce release of granulocyte-monocyte stimulating factors (CSF-GM) from highly purified monocyte preparations. Whereas secretion of CSF-GM by monocytes is negligible in the absence of T cells, CSF-GM secretion is inducible when concentrations of IFN-gamma as low as 10 U/ml are present. This effect could be abrogated by specific neutralizing monoclonal antibody to IFN-gamma and was restricted to monocytes, as resting T cells failed to secrete detectable CSF-GM in response to IFN-gamma. The response of monocyte preparations to IFN-gamma was biphasic in that concentrations greater than 250 U/ml did not induce detectable CSF-GM activity. However, this was shown to be due to the release of a humoral inhibitor of G/M-progenitor cells, and not necessarily due to a lack of CSF-GM secretion.

Interferon-gamma induces surface expression of interleukin 2 (IL2) receptors on human monocytes and the monocytic cell line U937. Freshly prepared peripheral blood monocytes and U937 cells were found to lack detectable IL 2 mRNA, but exposure of these cells to interferon-gamma induced IL 2 receptor message at 6 h of culture. At least two IL 2 receptor transcripts were detected (3.5 and 1.5 kb) in both monocytes and U937 cells, similar in size to IL 2 receptor transcripts in activated T cells. These results show that interferon-gamma induces expression of the monocyte IL 2 receptor gene.

In this study, we have examined the effects of autologous monocytes and T-lymphocytes on gamma-interferon (gamma-IFN)-induced inhibition of granulocyte-monocyte progenitor cells (CFU-GM) in vitro. Depletion of adherent cells from the mononuclear fraction of normal bone marrow (NBM) resulted in a significant reduction in the inhibitory effects of gamma-IFN on CFU-GM growth, whereas T-lymphocyte depletion had no effect. Adding back autologous monocytes to the underlayer fraction of agar culture resulted in a concentration-dependent enhancement of gamma-IFN-induced CFU-GM inhibition that did not require cell-cell contact. Adding back autologous T-lymphocytes had no effect and did not synergize with monocytes in enhancing gamma-IFN-induced inhibition. Based on the use of indomethacin and the pattern of CFU-GM subset growth, it was determined that prostaglandin E was unlikely to be the humoral inhibitory factor involved in this process. However, the effects of monocytes were completely reversed in the presence of a neutralizing monoclonal antibody to tumor necrosis factor (TNF), suggesting that monocyte-derived TNF was responsible for the enhancement of gamma-IFN-induced CFU-GM inhibition. This observation was further supported by the ability of gamma-IFN to induce an eightfold increase of baseline monocyte TNF secretion in agar culture. These data suggest that gamma-IFN may inhibit progenitor cell growth in vitro through indirect humoral mechanisms involving monocyte-derived TNF, as well as through direct inhibitory effects on CFU-GM proliferation. Because monocytes are a component of the bone marrow microenvironment, the ability of gamma-IFN to induce biologically relevant levels of monocyte-derived TNF may play an important role in the negative regulation of hematopoiesis.

Cells from most cases of acute myeloblastic leukemia (AML) proliferate in vitro in response to one or more colony-stimulating factor (CSF). Previous studies have suggested that some AML cells can produce their own CSFs, but the frequency of this phenomenon is unclear. In this study, Northern blot hybridization was used to detect mRNA transcripts for granulocyte-monocyte CSF (GM-CSF), granulocyte-CSF (G-CSF), and macrophage-CSF (M-CSF) in 22 randomly selected cases of AML. Ten cases expressed one CSF transcript (generally M-CSF), one case expressed two CSF transcripts, and six cases expressed all three. The expression of CSF transcripts did not significantly correlate with the French-American-British classification, with the possible exception that four of the five cases expressing all three CSF mRNAs were FAB M1. Six cases had autonomous growth of clonogenic cells in agar, and all six cases expressed one or more type of CSF transcript. None of the five evaluated cases lacking all three CSF transcripts had autonomous growth. However, there were many cases in which CSF transcripts were present and no autonomous growth was observed. In response to exogenously added human recombinant CSFs, 11 of 18 cases proliferated in response to GM-CSF, 8 of 18 cases in response to G-CSF, and 0 of 10 cases in response to M-CSF. Response to a CSF was not significantly correlated with the presence or absence of CSF transcripts, particularly for M-CSF. These results show that CSF transcripts are frequently detected in AML, although with a substantial degree of heterogeneity. It is possible that CSF production contributes to unregulated growth in some cases of AML.

An increase in the dose of chemotherapy enhances the response of many experimental and clinical cancers, but the extent of dose escalation is often limited by myelosuppression. In preliminary trials, recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) has augmented leukocyte numbers and function, but the optimal dose is not established. We treated 16 adults who had inoperable or metastatic sarcomas with escalating doses of rhGM-CSF before and immediately after a first cycle of chemotherapy (cycle 1) to assess hematologic response and toxicity. A second cycle of chemotherapy (cycle 2) was given without rhGM-CSF. RhGM-CSF was tolerated well at doses of 4 to 32 micrograms per kilogram of body weight per day. At 64 micrograms per kilogram per day, edema and thrombi around a central venous catheter developed in two of four patients. Leukocyte and granulocyte counts increased significantly during the rhGM-CSF infusion. Neutropenia after cycle 1 was significantly less severe and shorter in duration than after cycle 2 (P less than 0.01). Mean total leukocyte and platelet nadirs were 1.0 and 101 x 10(9) per liter for cycle 1 and 0.45 and 44 x 10(9) per liter for cycle 2 (P less than 0.01), and the median intervals from day 1 of chemotherapy to neutrophil recovery (greater than 0.500 x 10(9) per liter) were 15 and 19 days, respectively (P less than 0.01). The duration of neutropenia was 3.5 days with cycle 1 and 7.4 days with cycle 2 (P less than 0.01). We conclude that rhGM-CSF is tolerated well at doses up to 32 micrograms per kilogram per day and is biologically active in leukopenic patients. It merits further evaluation for the prevention of morbidity from chemotherapy.

A strategy designed to stimulate myeloid leukemic blasts into active cell cycle may increase the effectiveness of S phase-specific agents such as cytosine arabinoside (ARA-C). Since recombinant human granulocyte-macrophage colony stimulating factor (GM-CSF) is known to stimulate the growth of myeloid leukemic cells in vitro, we have evaluated the ability of this growth factor to enhance leukemic clonogenic cell kill in the presence of ARA-C. In seven patients studied, GM-CSF increased the fraction of myeloid leukemic blasts in S phase as measured by propidium iodide DNA staining, bromodeoxyuridine incorporation, or ARA-C suicide techniques. Six of these seven patients demonstrated clonogenic cell growth in agar in response to GM-CSF. In five of these six patients, the combination of GM-CSF and ARA-C treatment in vitro resulted in a significant increase in leukemic clonogenic cell kill when compared to treatment with ARA-C in the absence of GM-CSF. Similar results were observed with the combination of GM-CSF and hydroxyurea, another S phase specific agent, further suggesting that the observed enhancement of cytotoxicity was due to the ability of GM-CSF to increase the number of leukemic cells in S phase. These data provide a rationale for investigating the toxicity and efficacy of combined GM-CSF and ARA-C therapy in patients with high-risk myeloid leukemia.

Human granulocyte-macrophage colony-stimulating factor (GM-CSF) exerts profound effects on the proliferation, differentiation, and effector function of myeloid lineage cells. In contrast to its growth-promoting effects on normal myeloid progenitor cells, we found that GM-CSF unexpectedly inhibited the colony growth of U937 cells in agar culture. Furthermore, medium conditioned by recombinant GM-CSF(rGM-CSF)-treated U937 cells was found to exert an inhibitory effect on subsequent U937 colony growth that was partially due to the presence of tumor necrosis factor (TNF). By Northern blot analysis, rGM-CSF was shown to induce expression of the TNF gene in U937 cells and in T-lymphocyte-depleted, monocyte-enriched peripheral blood mononuclear cells. Furthermore, rGM-CSF was observed to significantly enhance TNF secretion by monocytes stimulated with endotoxin and phorbol myristate acetate (PMA). These data suggest that some of the biological effects of GM-CSF may be amplified through the release of monokines such as TNF.

The bone marrow responds to infection by rapidly producing mature granulocytes and monocytes from a small pool of committed progenitor cells under the influence of a heterogeneous family of glycoproteins termed colony-stimulating factors (CSFs). There are at least four major CSFs (IL-3, GM-, G-, and M-CSF) which are structurally distinct but have a great deal of functional overlap. The humoral signals which regulate the production of CSFs are generated at peripheral sites of infection through the activation of local macrophages and T lymphocytes by the invading pathogen. The monokines IL-1 and TNF are most likely the major humoral factors involved in stimulating CSF secretion by accessory cells in peripheral tissue sites as well as in the bone marrow microenvironment, although the functions of CSFs produced in these two organ compartments is distinct. CSFs secreted by bone marrow endothelial cells and fibroblasts serve to stimulate the proliferation and differentiation of myeloid progenitor cells, while CSFs present in areas of local infection are most likely involved in the activation of mature myeloid cell function. The dual ability of CSFs to both regulate bone marrow proliferation and to stimulate mature myeloid cell function represents a novel mechanism for producing a coordinated host response to infection.