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Effect of culture supernatants from two cancer cell lines on healthy donors’ monocytes.
Effect of culture supernatants from two cancer cell lines on healthy donors’ monocytes.
P S. Novellino, Y G. Trejo, M. Beviacqua, R H. Bordenave
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    "textoCompleto" => "<p class="elsevierStylePara">Effect of culture supernatants from two cancer cell lines on healthy donors&#39;&#39; monocytes</p><p class="elsevierStylePara"><span class="elsevierStyleBold">P&#46; S&#46; Novellino&#42;&#44; Y&#46; G&#46; Trejo&#42;&#44; M&#46; Beviacqua&#42;&#44; R&#46; H&#46; Bordenave&#42;&#42;</span> and <span class="elsevierStyleBold">L&#46; S&#46; Rumi&#42;</span></p><p class="elsevierStylePara">&#42;Laboratorio de Inmunolog&#237;a&#46; Instituto de Biolog&#237;a y Medicina Experimental &#40;IByME&#41;&#46; Buenos Aires&#46; Argentina&#46; &#42;&#42;Hospital de Agudos &#34;I&#46; Iriarte&#34;-Quilmes&#46; Pcia&#46; de Buenos Aires&#46; Argentina&#46;</p><p class="elsevierStylePara">Correspondence&#58;<br></br> L&#237;a S&#46; Rumi M&#46;D&#46; Ph&#46;D&#46;<br></br> Instituto de Biolog&#237;a y Medicina Experimental<br></br> Vuelta de Obligado 2490 - &#40;1428&#41; Buenos Aires<br></br> Argentina</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold">RESUMEN</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Antecedentes&#58;</span> es ampliamente conocido el hecho de que las c&#233;lulas de cultivo secretan a su medio diferentes factores que pueden alterar tanto sus propios metabolismos y funciones as&#237; como el de otras c&#233;lulas&#46; En el presente trabajo evaluamos el efecto de sobrenadantes de cultivo provenientes de dos l&#237;neas celulares&#44; Calu-1 &#40;carcinoma epidermoide de pulm&#243;n&#41; y A-427 &#40;adenocarcinoma de pulm&#243;n&#41; sobre monocitos perif&#233;ricos sangu&#237;neos &#40;MO&#41; de 20 donantes sanos &#40;HD&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">M&#233;todos y resultados&#58;</span> los MO fueron incubados con los sobrenadantes o con medio solamente &#40;controles&#41; durante dos o 18 horas&#46; Fueron determinadas la expresi&#243;n de ant&#237;genos HLA-DR por inmunofluorescencia directa&#44; la formaci&#243;n de intermediarios reactivos del ox&#237;geno &#40;capacidad de reducci&#243;n del nitroazul de tetrazolio&#41; y la capacidad fagoc&#237;tica &#40;sistema <span class="elsevierStyleItalic">Candida albicans</span> -anti-<span class="elsevierStyleItalic">Candida albicans</span>&#41;&#46; Estas determinaciones fueron tambi&#233;n hechas en MO de 16 pacientes con c&#225;ncer de pulm&#243;n avanzado &#40;LCP&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Resultados&#58;</span> los porcentajes de expresi&#243;n &#40;media &#177; ES&#41; fueron&#58; HLA-DR&#40;&#43;&#41;MO&#58; Calu-1 &#61; 30 &#177; 2&#59; A-427 &#61; 31 &#177; 2&#59; LCP &#61; 52 &#177; 3 &#40;p &#60; 0&#46;0001 <span class="elsevierStyleItalic">vs</span> HD&#58; 77 &#177; 1&#37;&#41;&#59; NBT&#40;&#43;&#41;MO&#58; Calu-1 &#61; 47 &#177; 1&#44; A-427 &#61; 49 &#177; 1&#44; LCP &#61; 56 &#177; 2 &#40;p &#60; 0&#46;01 <span class="elsevierStyleItalic">vs</span> HD&#58; 43 &#177; 2&#37;&#41;&#44; Ph&#40;&#43;&#41;MO&#58; Calu-1 &#61; 38 &#177; 3&#44; A&#61;427 &#61; 39 &#177; 2&#44; LCP &#61; 32 &#177; 3 &#40;p &#60; 0&#46;0001 <span class="elsevierStyleItalic">vs</span> HD&#58; 50 &#177; 1&#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Conclusiones&#58;</span> concluimos que este modelo <span class="elsevierStyleItalic">in vitro</span> reproduce caracter&#237;sticas encontradas en MO de pacientes con c&#225;ncer de pulm&#243;n&#44; ya que los sobrenadantes de cultivo indujeron en MO normales caracter&#237;sticas fenot&#237;picas y funcionales tambi&#233;n encontradas en los MO de los pacientes analizados&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Palabras clave&#58;</span></span> Monocitos&#46; L&#237;neas celulares de c&#225;ncer de pulm&#243;n&#46; Sobrenadantes de cultivo&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">SUMMARY</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Background&#58;</span> it is well known that culture cells secrete to their medium different factors that can alter their own as well as other cells&#39;&#39; metabolism and functions&#46; In the present study we evaluated the effect of culture supernatants originated from two cancer cell lines&#44; Calu-1 &#40;lung epidermoid carcinoma&#41; and A-427 &#40;lung adenocarcinoma&#41; on peripheral blood monocytes &#40;MO&#41; from 20 healthy donors &#40;HD&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Methods and results&#58;</span> MO were incubated with supernatants or with medium only &#40;controls&#41; during 2 or 18 hours&#46; There were determined the expression of HLA-DR antigen by indirect immunofluorescence technique&#44; the formation of reactive oxygen intermediates &#40;NBT reduction capacity&#41; and the phagocytic capacity &#40;<span class="elsevierStyleItalic">Candida albicans-</span> anti <span class="elsevierStyleItalic">Candida albicans</span> system&#41;&#46; These determinations were made also in MO from 16 patients with advanced lung cancer &#40;LCP&#41;&#46; Percentages of expression &#40;media &#177; SE&#41; were&#58; HLA-DR &#40;&#43;&#41; MO&#58; Calu-1 &#61; 30 &#177; 2&#59; A-427 &#61; 31 &#177; 2&#59; LCP &#61; 52 &#177; 3 &#40;p &#60; 0&#46;0001 <span class="elsevierStyleItalic">vs</span> HD&#58; 77 &#177; 1&#37;&#41; NBT &#40;&#43;&#41;MO&#58; Calu-1 &#61; 47 &#177; 1&#59; A-427 &#61; 49 &#177; 1&#59; LCP &#61; 56 &#177; 2 &#40;p &#60; 0&#46;01 <span class="elsevierStyleItalic">vs</span> HD&#58; 45 &#177; 2&#37;&#41;&#44; Phagocytic MO&#58; Calu-1 &#61; 38 &#177; 3&#59; A-427 &#61; 39 &#177; 2&#59; LCP &#61; 32 &#177; 3 &#40;p &#60; 0&#46;0001 <span class="elsevierStyleItalic">vs</span> HD&#58; 50 &#177; 1&#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Conclusions&#58;</span> we conclude that this <span class="elsevierStyleItalic">in vitro</span> model reproduced characteristics found in MO from lung cancer patients&#44; since culture supernatants induced in normal MO phenotypic and functional characteristics also found in MO from patients analyzed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Key words&#58;</span></span> Monocytes&#46; Lung cancer cell lines&#46; Culture supernatants&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Interaction between tumor cells and the immune system of the host includes a complex network of cytokines and soluble factors that one and another secrete to modify each other&#39;&#39;s metabolisms and funtions&#46;</p><p class="elsevierStylePara">The host&#39;&#39;s cellular antitumor response includes cytotoxic T cells&#44; NK and monocytes&#47;macrophages &#40;1&#44; 2&#41; and their activation leads to the exocytosis of mediator molecules onto the surface of the tumor cells&#46; In this regard&#44; there can be mentioned tumor necrosis factor-alpha &#40;TNF-&#42;&#41;&#44; whose action leads cells to apoptosis &#40;3&#44; 4&#41; interferons&#44; that exert antiproliferative &#40;5&#41; and immunoregulatory actions &#40;6-8&#41;&#44; and prostaglandin E<span class="elsevierStyleInf">2</span> &#40;PGE<span class="elsevierStyleInf">2</span>&#41;&#44; who play a role in tumor associated immune suppression &#40;9&#41;&#46; In some cases&#44; these factors combine to induce cells from the environment&#44; like blood vessel cells&#44; participate in the anti-tumor response secreting&#44; for example&#44; nitric oxide &#40;NO&#41; &#40;10&#41;&#46; On the other side&#44; tumor cells respond to this situation secreting inhibitory cytokines&#44; like TGF-&#223; &#40;11&#44; 12&#41; or IL-10 &#40;13&#41;&#44; and perform a series of events to evade from the immune system&#46;</p><p class="elsevierStylePara">Previous works showed that soluble factors from normal lung cells stimulate angiogenesis and tumor growth <span class="elsevierStyleItalic">in vivo&#44;</span> and also favor the <span class="elsevierStyleItalic">in vitro</span> survival of tumor cells treated with cytotoxic drugs &#40;14&#41;&#46;</p><p class="elsevierStylePara">The purpose of this study was to determine the effect of two culture supernatants from lung cancer cell lines on healthy donor&#39;&#39;s monocytes&#46; We report that this <span class="elsevierStyleItalic">in vitro</span> model reproduced characteristics found in MO from lung cancer patients&#44; since culture supernatants induced in normal MO phenotypic and functional characteristics also found in MO from patients analyzed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIALS AND METHODS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cell lines and culture conditions</span></p><p class="elsevierStylePara">Calu-1 &#40;lung epidermoid carcinoma&#41; and A-427 &#40;lung adenocarcinoma&#41; cell lines were obtained from American Type Culture Collection &#40;ATCC&#44; USA&#41;&#46; Cells were cultured in 25 cm<span class="elsevierStyleSup">2</span> tissue culture flasks &#40;Falcon&#41; with a nutrient mixture of RPMI-1640 medium &#40;Gibco&#41; supplemented with 0&#46;1&#37; of bovine sero-albumin &#40;BSA&#41;&#44; in a 5&#37; CO<span class="elsevierStyleInf">2</span>-containing 37&#176; C atmosphere&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conditioned media</span></p><p class="elsevierStylePara">When cell culture was semiconfluent&#44; supernatants from Calu-1 &#40;S&#47;Calu-1&#41; and from A-427 &#40;S&#47;A-427&#41; cell lines were withdrawn and stored at 4&#176; C until its use&#46; Both supernatants were a kind gift from Dr&#46; D&#46; E&#46; Bonfil&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Isolation of peripheral blood mononuclear cells &#40;PBMCs&#41;</span></p><p class="elsevierStylePara">PBMCs were obtained from EDTA-anticoagulated-venous blood from 20 healthy donors &#40;HD&#41; and 16 lung cancer patients &#40;LCP&#41; &#40;clinical stages III and IV&#41;&#44; by centrifugation over Ficoll-Hypaque &#40;16&#41; gradient &#40;1&#44;076 Hg&#47;ml&#41;&#46; Cells harvested from the interphase were washed 3 times with phosphate-buffered saline &#40;PBS&#41; for 10 minutes at 500 g and resuspended in 2 ml of RPMI-1640 medium &#40;Gibco&#41; containing 1&#37; of heat-inactivated fetal calf serum &#40;FCS&#41;&#44; 100 IU&#47;ml of penicillin and 100 mg&#47;ml of streptomycin&#44; designated as complete medium &#40;CM&#41;&#46; Cell concentration was adjusted to 1 x 10<span class="elsevierStyleSup">6</span>&#47;ml&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Isolation of monocytes</span></p><p class="elsevierStylePara">Samples of 1 x 10<span class="elsevierStyleSup">6</span> PBMCs in CM were cultured in glass 8-well-Lab-Tek chambers &#40;Nunc&#41; for 2 hours in the same conditions described above&#46;</p><p class="elsevierStylePara">Thereafter&#44; the non-adherent cells were removed by 3 washes with CM&#46; At this point&#44; the purity of the MO adhered was more than 93&#37;&#44; as judged by an immunofluorescent assay&#44; using an anti-CD13 monoclonal antibody &#40;mAb&#41; &#40;Sigma Diagnostic&#41; which reacts with more than 90&#37; of MO&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Incubation of MO with supernatants</span></p><p class="elsevierStylePara">MO from HD adhered were gently washed with PBS and then incubated for 18 hours with S&#47;Calu-1 or S&#47;A-427 &#40;final concentration 20&#37; v&#47;v&#41;&#46; Controls consisted in MO incubated only with RPMI-1640 medium supplemented with 0&#46;1&#37; of BSA&#46; After that&#44; the different assays described below were performed&#46; Samples of adhered MO from HD&#44; inmediately after 2 hours of culture were also evaluated&#46; The same methodologies were performed in MO from LCP&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Determination of HLA-DR-positive MO &#40;HLA-DR&#43;MO&#41; &#40;Indirect immunofluorescence&#41;</span></p><p class="elsevierStylePara">Adhered MO were washed and incubated with a 1&#58; 20 diluted mAb against HLA-DR antigen &#40;DAKO Corporation&#41; for 30 minutes at 4&#176; C&#46; After washing 3 times with CM&#44; FITC-conjugated rabbit anti-mouse F &#40;ab&#39;&#39;&#41;<span class="elsevierStyleInf">2</span> IgG &#40;DAKO Corporation&#41; 1&#58;20 diluted was added and cells were incubated for 30 minutes at 4&#176; C&#46; Thereafter&#44; cells were washed and the percentage of cells expressing HLA-DR antigen was read in an epifluorescent microscope &#40;total count&#58; 200 cells&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Determination of MO with phagocytic activity</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Preparation of the Candida-anti Candida system &#40;Ca-anti Ca&#41;</span></p><p class="elsevierStylePara">There were employed <span class="elsevierStyleItalic">Candida albicans</span> cells &#40;Ca&#41; from a 24-hour split in Sabouraud medium<span class="elsevierStyleItalic">&#44;</span> autoclaved in 1 atm for 35 minutes&#46; There were resuspended in PBS and conserved at -20&#176; C until their utilization&#46; Ca-anti Ca was prepared incubating 1 x 10<span class="elsevierStyleSup">7</span> Ca in 0&#46;1 ml of anti-Ca serum &#40;DAKO Corp&#46;&#41; 1&#58;400 diluted for 30 minutes at 37&#176; C&#46; Thereafter&#44; the cell suspension was centrifugated &#40;500 g&#41; and the pellet obtained was resuspended in 0&#46;2 ml of RPMI-1&#44;640 medium&#44; storing at 4&#176; C until its use&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Phagocytosis assay</span></p><p class="elsevierStylePara">Adhered MO were incubated with 0&#46;1 ml of the Ca-anti Ca at different times &#40;between 30-240 minutes&#41; to determine the optimum time of phagocytosis &#40;after 30 minutes of incubation&#44; MO phagocyted the 50&#37; of CA&#41;&#46; Then&#44; cells were fixed with 100&#37; methanol for 3 minutes and were stained with May Gr&#252;nwald-Giemsa&#46; Cells were read at optical microscope&#44; considering as positive those MO with at least one Ca ingested&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Determination of MO with nitrobluetetrazolium &#40;NBT&#41; reduction capacity &#40;ROI production&#41;</span></p><p class="elsevierStylePara">MO adhered were incubated in a 5&#37; CO<span class="elsevierStyleInf">2</span> containing atmosphere at 37&#176; C&#44; with a mixture of 0&#46;1 ml of human normal plasma &#40;activated with <span class="elsevierStyleItalic">Escherichia coli</span> endotoxin&#41;&#44; 1 ml of NBT solution &#40;final concentration 15&#37; v&#47;v&#41; and 0&#46;1 ml of M199 culture medium&#46; After that&#44; it was made another incubation for 15 minutes at 4&#176; C&#46; Cells were fixed with methanol 100&#37; and dyed with safranin&#46; The lecture was made at optical microscope&#44; considering as positive those MO that contained formazan cristals in their citoplasm&#44; as consecuence of NBT reduction&#46; Results were expressed as percentages&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">Results were analyzed by one-way ANOVA&#44; according to the Instat V1&#46;0 GPIS program&#44; followed by post-hoc comparisons using Bonferroni&#39;&#39;s test&#44; and p values &#60; 0&#46;05 were considered significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Percentage of HLA-DR&#40;&#43;&#41;MO</span></p><p class="elsevierStylePara">Values &#40;expressed as mean &#177; standard error&#44; SE&#41; for HD were&#58; after 2 hours of culture&#58; 77 &#177; 1&#37;&#59; after 18 hours of culture&#58; 54 &#177; 5&#37;&#46; After treatment with supernatants&#44; we observed an statistical significant diminution in HLA-DR expression&#44; resulting for S&#47;Calu-1&#58; &#40;30 &#177; 2&#41;&#37; and for S&#47;A-427&#58; 31 &#177; 2&#37;&#46; LCP value resulted&#58; 52 &#177; 3&#37; &#40;Fig&#46; 1A&#41;&#46;</p><p class="elsevierStylePara"><img src="105v27n4-13003963fig01.gif"></img></p><p class="elsevierStylePara">Figure 1A&#46;--Percentage of HLA-DR&#40;&#43;&#41;MO from HD treated with culture supernatants and from lung cancer patients &#40;LCP&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Percentage of NBT&#40;&#43;&#41;MO</span></p><p class="elsevierStylePara">Values for HD were&#58; after 2 hours of culture&#58; 45 &#177; 2&#37;&#59; after 18 hours&#58; 40 &#177; 1&#37;&#46; In this case&#44; treatment with supernatants showed higher percentages versus untreated cells&#44; being for S&#47;Calu-1&#58; 47 &#177; 1&#37; and for S&#47;A-427&#58; 49 &#177; 1&#37;&#46; Percentage for LCP was 56 &#177; 2&#44; reaching this result levels over the control &#40;Fig&#46; 1B&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><img src="105v27n4-13003963fig02.gif"></img></span></p><p class="elsevierStylePara">Figure 1B&#46;--Percentage of NBT&#40;&#43;&#41;MO from HD treated with culture supernatants and from LCP&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Percentage of phagocytic MO</span></p><p class="elsevierStylePara">We could observe a significant decrease in phagocytic capacity in cells treated with supernatants as in LCP MO&#46; Values for HD were&#58; after 2 hours of culture&#58; 50 &#177; 1&#37;&#59; after 18 hours&#58; 47 &#177; 2&#37;&#59; S&#47;Calu-1&#58; 38 &#177; 3&#37;&#59; S&#47;A-427&#58; 39 &#177; 3&#37;&#46; For LCP&#44; value was&#58; 32 &#177; 2 &#37; &#40;Fig&#46; 1C&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><img src="105v27n4-13003963fig03.gif"></img></span></p><p class="elsevierStylePara">Figure 1C&#46;--Percentage of MO with phagocytic capacity from HD treated with supernatants and from LCP&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The functioning of monocytes depends on their state of maturity and on the balance of regulatory conditions of the environment&#44; these being characterized by the presence of stimulatory or inhibitory agents &#40;15&#41;&#46; These agents determine characteristics like differential expression of membrane antigens and response grade to different stimuli&#46; NBT reduction assay can be considered a measure of MO activation &#40;16&#41;&#46; Using this assay also as a measure of ROI production&#44; we found that treating MO with both supernatants augmented the levels of cells with this capacity&#46; Moreover&#44; LCP MO showed an even higher ROI production&#44; raising up their values over control levels&#46; These facts are in agree with data from Hedley and Currie &#40;17&#41;&#44; who found that ROI production was augmented in patients with malignant melanoma&#46;</p><p class="elsevierStylePara">In previous works&#44; we have demonstrated a relationship between HLA-DR expression and ROI production in MO from untreated cancer patients&#44; attribuiting these alterations to the enhanced production of immune complexes &#40;18&#44; 19&#41;&#46;</p><p class="elsevierStylePara">Gruner et al &#40;20&#41; studied the influence of the phagocytic stimulum on the expression of HLA-DR&#44; suggesting that the diminished expression of this antigen in MO could be a consecuence of ROI production&#46; Our results showed a dimished percentage of phagocytic activity in MO from LCP&#46; These data are in agree with studies done by Merendino &#40;21&#41;&#44; who demonstrate that in patients with metastasic carcinoma&#44; phagocytic capacity was deteriorated&#46; The diminished phagocytic capacity also found in supernatant-treated monocytes leads us to suppose that some soluble agent may be affecting MO function&#44; resembling this situation that found in MO from LCP&#46;</p><p class="elsevierStylePara">In our work&#44; we verified the well-known fact that cultured monocytes diminish the expression of class II antigens &#40;22&#41;&#44; situation induced by phenomena of adherence&#46; The marked diminution of HLA-DR&#40;&#43;&#41;MO found in cells treated with both supernatants&#44; also found in LCP&#44; may be explained by the presence of soluble factors in the supernatants that cause an alteration in HLA-DR expression&#46; This fact may be due to interleukin-10&#44; an inhibitory cytokine&#44; that down-regulates the expression MHC class II antigen on monocytes &#40;23&#41;&#44; by affecting the antigen complex arrival and recicling at the plasma membrane &#40;24&#41;&#46;</p><p class="elsevierStylePara">The fact that we cannot found any differences between both supernatants talks about a common way in which the molecule &#40;or molecules&#41; in the supernatant exert the inhibitory effect on monocytes&#44; or that the same agent is present in both of them&#46; Huang et al found that non-small cell lung cancer-derived soluble factors and exogenous prostaglandin E<span class="elsevierStyleInf">2</span> treatment&#44; enhance the production of interleukin-10 in peripheral blood lymphocytes &#40;25&#41;&#46; These cell lines also constitutively produce PGE<span class="elsevierStyleInf">2</span>&#46; Also&#44; there have been found elevated levels of prostaglandin-E &#40;PGE&#41; or its metabolites in plasma from cancer patients or tumor bearing-animals &#40;26&#41; being this factor one of the principal molecules that takes part in the inhibition of the expression of HLA-DR &#40;27&#41;&#46;</p><p class="elsevierStylePara">The data showed above let us suppose that IL-10 and PGE<span class="elsevierStyleInf">2</span> are both candidate molecules to be present in A-427 and Calu-1 supernatants&#44; representing this a probable mechanism by which lung cancer cells may escape from host immune surveillance&#46; In conclusion&#44; in this <span class="elsevierStyleItalic">in vitro</span> model&#44; culture supernatants induced in normal MO phenotypic and functional alterations&#44; similar to those found in peripheral MO from lung cancer patients&#46; Investigations in this field continue at this moment in our laboratory&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold">REFERENCES</span></p><p class="elsevierStylePara">1&#46;Graubert TA&#44; 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