In vitro, neopterin is excreted by human monocyte-macrophage after induction by supernatants from activated T-lymphocytes or by recombinant interferon-y. In vivo, it represents a noninvasive test for activation of cellular immune reactions.
In order to investigate the stages of cellular immune reactions in malignancy the urinary neopterin levels were measured by high performance liquid chromatography in 115 cases of malignancies including solid tumors (cancer of stomach, lung, liver, urinary bladder and uterine cervix) and, haematologic tumors (myelogenous and lymphocytic leukemias, Hodgkin´s and non-Hodgkin´s lymphomas and multiple myeloma).
Results obtained were as follows:
1) Urinary neopterin levels in 73 normal subjects, 43 males and 30 females, were 119.0 21.7 mol/mol creatinine and the difference between the levels in male and female was not significant statistically.
2) Urinary neopterin level in 71 patients with solid tumor was significantly elevated to 401.3 201.1 pmol/mol creatinine compared to normal (3.4 folds of normal) and the levels in stomach, lung, liver, urinary bladder,breast and uterine cervix cancers were 4.0, 3.9, 3.4, 4.6, 4.0 and 2.6 folds of normal levels, respectively.
3) Elevations in urinary neopterin were correlated to stage of tumor in patients with carcinoma of uterine cervix.
4) In active haematologic tumors (leukemias, lymphomas and multiple myeloma), urinary neopterin levels also significantly elevated to 562.1 304.7 mol/mol creatinine, 4.7 folds of normal.
5) In remissioned haematologic tumors, urinary neopterin level was 191.1 70.6 mol/mol creatinine which was significantly lower than the level in active state while significantly higher than the levels in normal.
The results indicate the presence of macrophages stimulated by interferon-y in patients with malignancy and suggest that the presence of these cells in associated with poor prognosis. Urinary neopterin levels were elevated regardless of type of tumor and tend to change in proportion to the progress and activities of tumor. Therefore, urinary neopterin levels can not be put to use as a specific marker for the diagnosis of maligant tumor, but can be regarded as a valuable market- for the state of celluar immunity and the activity of tumor cells or prognosis of the disease.
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