The immunogenic role of tyrosinase in melanoma has been already proved, and results presented in this work are in accordance with previously published papers on the presence of anti-tyrosinase antibodies in the serum of control people as well as in patients with melanoma or vitiligo [22–24]. The direct importance of immunity to mushroom tyrosinase for the melanoma disease is obtained from the study in which it is reported that mice immunized with mushroom tyrosinase generated a high titer of anti-tyrosinase antibodies which after the inoculation of melanoma cells developed a lower number of lung metastases compared with an unvaccinated control group .
Melanin is an antigen whose role in immune control of melanoma is proved in vivo. It is important to note that although melanin is an intracellular pigment, anti-melanin IgM antibodies labeled with (188) Re were reported to be successful in directed radionuclide to melanoma tumor, in radioimmunotherapy of experimental metastatic melanoma .
New in this work are the data that the different levels of immunoglobulin isotypes (IgM, IgA or IgG) are found in melanoma or vitiligo patients compared with controls.
The statistically significant low levels of IgM anti-tyrosinase and IgM anti-melanin autoantibodies in melanoma patients and slight elevation in IgM anti-melanin autoantibodies in patients with vitiligo compared to healthy controls, point to the importance of IgM autoantibodies for both: the control of malignant disease, as well as for the destruction of melanocytes in vitiligo.
Enhanced levels of anti-melanin IgA autoantibodies which are preferentially found even in the presence of normal levels of FcAlphaRI (CD89) positive immunocompetent cells, in majority of melanoma patients with metastatic disease point to their disability in immunological suppression of malignant process (through ADCC) and even indicate their blocking –immunosuppressive action. This result appears to be an explanation of the findings reported earlier that the intensity of anti-melanoma cell-mediated cytotoxicity in melanoma patients, in the presence of autologous serum, was significantly lower in comparison to that found in control subjects and vitiligo patients . This was attributed to the presence of some factors from melanoma patient's sera which contribute to impairment of the cytotoxicity of autologous PBMC, while other factors from the serum of vitiligo patients and control subjects enhanced their PBMC anti-melanoma cytotoxicity. In the light of results of this work, these factors present in melanoma patient's sera could be the blocking IgA anti-melanin antibodies, which are found in majority of melanoma patients, and the absence (lower levels) of these IgA antibodies from the vitiligo patients and control subject’s sera.
The lower percentage of NK cells, and of the percentage of CD16 positive immunocompetent cells in melanoma patients found in this work, point to the already known deficiency of these cell subpopulations and to the suppressed role of NK and of IgG mediated ADCC in the antitumor immunity in melanoma patients [27, 28].
But it need to be emphasized that the ratio of the percentages of granulocytes and percentages of lymphocytes is statistically higher in patients with melanoma in relation to healthy people as well as to people with vitiligo.
Healthy person with the highest anti-melanin IgM level reported that she consumed approximately 100 g of edible mushrooms twice weekly, while the other one with the highest anti-melanin IgG level consumed approximately 100 g of edible mushrooms twice monthly and took additionally, every day 4 mg of the antioxidant astaxanthin (Oriflame).
In accordance to the presented data, results from this work set up the question whether the additional simple approach – a diet consisting of the consummation of 50 g cooked edible mushrooms twice weekly in the meal, along with prescribed oncological therapy, might induce the appropriate effective immune response: anti-melanin or anti-tyrosinase IgM or IgG in melanoma patients patients (with low percentage of granulocytes) in order to prevent metastatic disease? Undesired type of enhance blocking- IgA immunity was shown to be possible to be downregulated by the consumption of cocoa [29, 30], while antioxidant astaxanthin enhanced IgM and IgG biosynthesis, as it was shown in vivo; the therapy with Rituximab might also be taken into consideration .
Till now the role of nutrition in the control of melanoma was already reported. Recent results from a randomized phase II trial in melanoma patients indicate a significant benefit for patients treated with dacarbazine in combination with fermented wheat germ extract in terms of progression free survival and overall survival .
The use of diclofenac and nimesulide could be the option for in the inflammation suppression as it was shown that these agents do not have adverse effects; they do not stimulate in vitro B16F1 melanoma cell proliferation . From the other side, as the neutrophil activation is implicated in the pathogenesis of inflammatory processes, the use of the known antioxidant and inhibitor of neutrophil respiratory burst N- acetylcysteine may be taken into consideration as the better option for the inflammation suppression .