Summary:The interaction between Bacillus Calmette-Guerin (BCG) and the host was investigated after repeated intravesicular BCG-therapy for superficial bladder cancer. Studies were performed on (a) the local reaction in the bladder, (b) the systemic reaction, and (c) short and long term interactions in both the bladder and the serum/plasma.The analytes measured included anti-BCG IgA and IgG, fibronectin, lactoferrin, elastase-oci-proteinase inhibitor, myeloperoxidase and oc 2 -proteinase inhibitor. All analytes, with the exception of oc 2 -proteinase inhibitor, were measured in both serum/plasma and urine.An additional group of 94 patients undergoing bronchoalveolar lavage was used for comparison with other diseases affecting mucous membranes. In vitro studies on human bladder in culture were also carried out to study the relationship between BCG, elastase and fibronectin.The results revealed a normal defence reaction, in which IgA and IgG antibodies specific to BCG were produced by the host. Maximal concentrations of all analytes in urine were found about 4 h after BCG instillation.Immunoglobulins, soluble fibronectin, and granulocyte markers all appeared in urine after instillation and all showed a similar time course. The in vitro study showed the synergistic effect of elastase and BCG in stimulating the host defence reaction. The relationship between BCG and fibronectin can be seen as fortuitous but not indicative of the efficacy of BCG-therapy in patients with superficial bladder cancer.
Introduction(2-4), the necessity for the presence of a fibrin clot (3, 5), the saturation of BCG receptors with soluble Although post-operative intravesicular treatment of monomeric fibronectin (6), and the mediation of Tsuperficial bladder cancer with Bacillus Calmette-lymphocytes (7). Studies in these laboratories over the Guerin (BCG) has been carried out for some 15 years past four years have revealed further physiological (1) the exact mode of action of this therapy is still factors which may contribute to the action of BCG not known. Many theories have been postulated, in-in promoting an "anti-tumour" reaction in cases opeluding the interaction between BCG and fibronectin erated for superficial bladder cancer.