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Biosystems Engineering and Control Group 20

8043537

Clinical value of amniotic fluid interleukin-6 determinations in the management of preterm labour.

To ascertain whether the determination of amniotic fluid interleukin-6 (IL-6) concentrations would be a useful clinical test in the management of women with preterm contractions. The labour and delivery unit and the Fetal Diagnostic Centre at the University of Utah. Pregnant women at various stages of gestation in the third trimester. Amniotic fluid samples were collected from women experiencing one of four clinical scenarios: 1. term pregnancy, not in labour with no evidence of intrauterine infection; 2. normal term labour with no evidence of infection; 3. preterm labour with no evidence of infection and undelivered within one week of sampling; and 4. preterm labour and delivered within seven days of sample collection. Amniotic fluid was obtained by amniocentesis or at the time of amniotomy or hysterotomy. IL-6 in each specimen was determined by a specific rapid ELISA. Amniotic fluid IL-6 levels, given as mean (SEM) in the four groups of women listed were: 1. term pregnancy, not in labour: 20.9 (7.2) pg/ml (n = 60); 2. normal term labour with no infection: 554 (90.7) pg/ml (n = 46); 3. preterm labour with no evidence of infection, undelivered: 47.0 (17.2) pg/ml (n = 35); and 4. preterm labour, delivered: 456.7 (101.7) pg/ml (n = 40). There was no significant difference in the means of amniotic fluid IL-6 for the term labour and preterm labour delivered groups. In general, amniotic fluid IL-6 levels during term labour increased with advancing cervical dilation. There was no correlation of cervical dilation and amniotic fluid IL-6 levels in women having preterm delivery. Receiver-operator curves revealed optimal IL-6 levels for discrimination of labour at term to be 50 pg/ml and for preterm delivery to be 200 pg/ml. IL-6 can readily be detected in the amniotic fluid of most women who are in active labour, regardless of gestational age. Our data suggest that amniotic fluid IL-6 determinations may be clinically useful in the management of preterm labour.

8043536

The definition of pre-eclampsia.

Redman and Jefferies have proposed a revised definition of pre-eclampsia which is based on absolute blood pressure levels and an increment from the baseline in the first half of pregnancy. There is no requirement for proteinuria. This definition should facilitate the distinction between nonproteinuric pre-eclampsia and other causes of nonproteinuric gestational hypertension, such as chronic essential hypertension. 1. To determine whether the blood pressure criteria of Redman and Jefferies can select women with characteristics of pre-eclampsia from the group of women with gestational hypertension by the current criteria of the International Society for the Study of Hypertension in Pregnancy (ISSHP). 2. To determine the level of agreement between the classification system proposed by Redman and Jefferies and that of the ISSHP. A prospective study. Obstetric unit, Dudley Road Hospital, Birmingham, UK. Six hundred and ninety-two healthy nulliparous women and 11 women with chronic hypertension antedating pregnancy. 1. Differences in maternal characteristics and obstetric outcome among women with gestational (nonproteinuric) hypertension by the ISSHP criteria, meeting (and failing to meet) the Redman and Jefferies' blood pressure criteria. 2. The proportion of women classified as normal, proteinuric pre-eclampsia, and chronic hypertension on the basis of both Redman and Jefferies' criteria and the current ISSHP criteria. There were 55 women with gestational hypertension alone by the ISSHP criteria, of whom 33 met Redman and Jefferies' blood pressure criteria for pre-eclampsia. This group of 33 women had characteristics of nonproteinuric pre-eclampsia, compared with the remaining 22 women in the ISSHP gestational hypertension category who had characteristics of chronic hypertension. The group of 33 were significantly younger and less obese, had significantly lower blood pressure at their first antenatal visit and their obstetric outcome was poorer. The Redman and Jefferies' blood pressure criteria identified as normal 99.5% (95% CI, 98.6% to 99.9%) of women who were also characterised as normal on the basis of the ISSHP criteria (622/625). There were 12 women with proteinuric pre-eclampsia by the ISSHP criteria of whom 11 (92%; 95% CI, 62% to 99.8%) met Redman and Jefferies' blood pressure criteria for pre-eclampsia. None of the 11 women with chronic hypertension antedating pregnancy met these criteria. In this population the blood pressure criteria for pre-eclampsia proposed by Redman and Jefferies select women with features of pre-eclampsia (i.e., proteinuria and relatively poor outcome) and, in particular, they enable a distinction to be made between nonproteinuric pre-eclampsia and other causes of gestational hypertension.

8043535

A comparative study of the fetal electrocardiogram recorded by the STAN an Nottingham systems.

To compare the T:QRS ratio recorded by the STAN and Nottingham fetal electrocardiogram (FECG) monitors. Prospective observational study. London teaching hospital delivery suite and research unit. The T:QRS ratios generated by the STAN and Nottingham FECG monitors were simultaneously recorded and compared using signals generated from a computer-produced ECG signal and signals from 11 term fetuses recorded during labour. There was an acceptable level of agreement between the two systems with the computer-generated signals, but it was not clinically acceptable with the signals from the fetuses recorded during labour. Disagreements in the T:QRS values were probably due to differences in the reference points for the measurement of the S-T segment and T-wave height. The different points of reference for measurement of S-T segment and T-wave height can explain poor agreement between the two methods of FECG waveform analysis. The suggested adopted points of reference are those corresponding to adult electrocardiographic methodology.

8043530

Auditory sensory gating, hippocampal volume, and catecholamine metabolism in schizophrenics and their siblings.

Schizophrenia may result from the concerted action of several pathophysiological factors. This pilot study compared the distribution of measurements of three such putative factors in 11 schizophrenics and their siblings: a neurophysiological deficit in auditory sensory gating, diminished hippocampal volume, and increased catecholamine metabolism. Abnormal auditory sensory gating was found in all schizophrenics in the 11 families studied and in 8 of their 20 siblings. Compared with the schizophrenics, the clinically unaffected siblings with abnormal auditory gating had larger hippocampal volume. There was no similar difference for the siblings with normal gating. The siblings with abnormal auditory gating also had lower homovanillic acid levels than the other siblings. The data suggest that a familial neuronal deficit, identified by diminished sensory gating, may be a necessary, but not sufficient factor in the pathogenesis of schizophrenia. Individuals with this deficit are generally clinically unaffected, except for schizophrenics, who also have other abnormalities, such as diminished hippocampal volume and increased catecholamine metabolism.

8043528

Further evidence for olfactory identification deficits in schizophrenia.

Forty-seven schizophrenic patients and 36 normal controls, matched for smoking history, were administered the University of Pennsylvania Smell Identification Test (UPSIT) and the Picture Identification Test (PIT). Amongst subjects successfully completing the PIT, non-smoking schizophrenic patients had significantly lower UPSIT scores than non-smoking controls. Smoking history and diagnosis did not interact to produce any pronounced effect. No significant gender difference was found. These results suggest schizophrenics display decreased olfactory identification even if likely confounders are adequately controlled.

8043527

Factors affecting rehospitalisation rates of chronic schizophrenic patients living in the community.

Eighty-eight [corrected] patients selected from a depot neuroleptic clinic in the hospital outpatients department were assessed clinically on various demographic and clinical variables with a view to determining the factors that may contribute to high rates of rehospitalisation amongst schizophrenics in remission. It was found that rehospitalisation rates during the preceding 5 years correlated with an early age of onset of illness, severity of positive and affective symptoms, current neuroleptic dose and total AIMS score, all reflecting the severity of underlying psychotic disorder and the neuroleptic treatment required to treat the psychosis. Poor compliance with neuroleptic prophylaxis was not found to be of importance in contributing to high relapse rates in this sample. It was concluded that patients who repeatedly relapse may do so because of the clinical characteristics of their illness.

8043526

Premorbid adjustment in schizophrenia: implications for psychosocial and ventricular pathology.

Premorbid adjustment in schizophrenia is thought important (1) as a predictor of current pathology and course, and (2) as a psychosocial expression of brain pathology preceding psychosis. Its valid and reliable measurement, however, pose a major challenge. To address this issue we interviewed 12 chronic male schizophrenic veterans and their first degree relatives, plus 12 age and social class of origin matched normal controls and their relatives, using the Cannon-Spoor et al. Premorbid Adjustment Scale (PAS), for which we developed our own semi-structured interview. Objective data from school records were also obtained. Schizophrenic's PAS scores were significantly poorer, irrespective of whether PAS scores were based on information from subjects, first degree relatives or from 'combined sources'. PAS scores were worse at all developmental epochs, with a marked divergence beginning in late adolescence. Worse premorbid adjustment in schizophrenia was also highly correlated with current clinical state, more current negative symptoms, less independent living and longer duration of hospitalization. Additionally, worse premorbid adjustment in schizophrenia was associated with larger Magnetic Resonance (MR) Ventricular Brain Ratio (VBR) in an exploratory analysis using a subset of these patients. Premorbid adjustment, rigorously measured, is poorer in schizophrenics than in normal controls and correlates with psychosocial and ventricular pathology in schizophrenia.

8043525

Prognostic value of initial subtype in schizophrenic disorders.

The prognostic value of the subtype diagnosis at the initial episode was investigated in 148 narrowly defined schizophrenic patients. Every initial episode was classified according to multiple criteria: DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first rank symptoms. Patients were followed up on average 23 years later (range 10-50 years). Different aspects of long-term outcome were evaluated (global functioning, social adjustment, negative social consequences). In 93% of the patients persisting alterations were found at the end of the observation time. The influence of the predominant clinical features at the initial episode on various aspects of long-term outcome was found to differ depending on which of the four diagnostic systems was used. The highest power for discrimination was found for the subtypes of DSM-III-R, while the presence of first rank symptoms had no prognostic value. It was found that patients with an initial paranoid or positive episode had a significantly better long-term outcome than patients initially having a disorganised/hebephrenic or catatonic episode. The frequency of negative social consequences was not influenced by the initial subtype, with the exception of permanent hospitalisation.

8043524

Cortical cholinergic markers in schizophrenia.

Cortical cholinergic deficits have been implicated in the cognitive deficits produced by a variety of neurodegenerative diseases including Alzheimer's disease (AD). Recent studies have suggested that many of the chronically institutionalized geriatric schizophrenic patients are also cognitively impaired. In this postmortem study we compared cholinergic marker activity in six different cortical regions derived from elderly controls, chronically institutionalized geriatric schizophrenic patients, and AD patients. All of the Alzheimer's disease cases met neuropathological criteria for AD, while none of the schizophrenic cases met criteria for AD. Cholinergic marker activity (choline acetyltransferase and acetylcholinesterase) was significantly diminished in the AD cohort but not in the schizophrenic cohort. Additionally, cortical choline acetyltransferase activity was significantly and negatively correlated with Clinical Dementia Rating scores (CDR), whereas no such correlations were evident in the schizophrenic cohort. These results suggest that cognitive deficits in geriatric schizophrenics are not due to diminished cortical cholinergic activity.

8043523

Serum antibodies to nicotinic acetylcholine receptors in schizophrenic patients.

Although elevated serum levels of antibodies to the nicotinic acetylcholine receptor (nAChR) have been reported in neuroleptic treated patients with tardive dyskinesia, such antibodies have not been determined in comparable nondyskinetic patients. Using a toxin-binding inhibition assay, we examined serum anti-nAChR antibody levels in 17 DSM-III-R chronic schizophrenic patients, seven of whom had persistent tardive dyskinesia, and 10 normal controls. On the average, anti-nAChR antibody levels were significantly higher in schizophrenic patients than in normal controls, but but not differ between patients with and without tardive dyskinesia and was not related to age, sex, or duration of illness in patients.

8043522

Smooth pursuit eye movements and express saccades in schizophrenic patients.

Abnormalities of saccades such as disinhibition have been hypothesized as one cause of smooth pursuit eye movement (SPEM) dysfunctions in schizophrenia. Thus, we studied saccadic eye movements in schizophrenics with SPEM dysfunction. Subjects were divided into three groups: 10 normal control subjects, 10 schizophrenic subjects without SPEM dysfunction and 10 schizophrenic subjects with SPEM dysfunction characterized by a cogwheel appearance. Visually guided saccades in gap and overlap paradigms (Saslow, 1967) were examined and saccadic reaction times (SRTs) were measured in all subjects. Only schizophrenics with SPEM dysfunctions tended to manifest excessive reflexive saccades, named express saccades (Fischer, 1987), in the gap paradigm. Moreover, most of them were also found to have express saccades in the overlap paradigm, whereas normal subjects and schizophrenic subjects without SPEM dysfunction did not show such phenomena under the same conditions. In particular, most express saccades in the overlap paradigm in schizophrenics with SPEM dysfunction, were found in movements to the right.

8043521

Quantitative effects of typical and atypical neuroleptics on smooth pursuit eye tracking in schizophrenia.

Smooth pursuit eye movement (SPEM) gain, total saccades, and subtypes of saccades were quantified from the visual pursuit tracking of 26 fluphenazine-treated patients with schizophrenia and 42 normal controls. Tracking was repeated in 16 patients who underwent a placebo-controlled, double-blind crossover comparison of fluphenazine and clozapine. Fluphenazine-treated patients showed significant reduction in SPEM gain and significant increases in both total, intrusive, and anticipatory saccades and in saccadic amplitude, when compared to controls. Clozapine significantly reduced SPEM gain and significantly increased total and catch-up saccades, when compared to placebo or fluphenazine. High amplitude of intrusive saccades in drug-free patients predicted poor response to clozapine, suggesting that intact frontal cortical function may enable optimal clozapine response.

8043520

Commonality of the gene programs induced by effectors of apoptosis in androgen-dependent and -independent prostate cells.

Prostate tissue is composed of both androgen-dependent and -independent cells. To identify the gene program induced by effectors of apoptosis in both of these cell types, we performed differential hybridization on a complementary DNA library prepared from an androgen-independent prostate cancer cell line, AT-3, exposed to ionomycin. Five distinct complementary DNAs representing ionomycin-inducible genes, designated prostate apoptosis response (par) -1, -2, -3, -4, and -5, were identified. Nucleotide sequencing identified par-1 as the rat homologue of a serum- and oxidative stress-inducible gene, 3CH134/erp/CL100; par-2 as the injury-inducible gene HB-EGF encoding a heparin-binding epidermal growth factor-like growth factor; par-3 as the serum-inducible gene cyr-61; whereas par-4 and par-5 were novel, as judged by a GenBank search. par-1, -3, -4, and -5 were also induced in rat ventral prostate following castration, which causes androgen ablation, leading to apoptosis of androgen-dependent prostate cells. Pretreatment of rats with nifedipine prior to castration abrogated inducible expression of the par genes, indicating that their expression was downstream to Ca2+ elevation. Further characterization of these genes revealed that induction of par-4 is apoptosis specific: it is not induced by effectors of growth stimulation, oxidative stress and necrosis, or growth arrest in prostate cells. Together, par-1, -3, -4, and -5 represent an apoptosis response gene program common to both androgen-dependent and -independent prostate cells. Thus, cell death programs in prostate cells are comprised of genes specifically associated with apoptosis as well as those with multifunctional roles in growth regulation. Since elevation of intracellular Ca2+ is central to apoptosis in many cell types, we predict that par genes will be important components of diverse effector-driven apoptotic pathways.

8043519

Serum response element-regulated transcription in the cell cycle: possible correlation with microtubule reorganization.

The transcriptional response to growth factors and other mitogenic signals is mediated by the serum response elements (SREs) located in the promoters of many immediate early genes, including the c-fos and beta-actin genes. We investigated SRE-regulated transcription in cell cycle-synchronized nuclei and found that a SRE-regulated reporter gene was transcribed actively during G1 and, surprisingly, during G2-M as well. One possible mechanism involved in the latter event is microtubule reorganization. Microtubule disassembly is mimicked by microtubule-disrupting drugs, and we found that these drugs, including colchicine, nocodazole, and vinblastine, could activate SRE-dependent reporter genes, as well as the c-fos protooncogene, in asynchronously growing cells. Taken together, our results suggested a possible relationship between cytoplasmic microtubule dynamics and cell cycle gene expression. Although the detailed molecular mechanisms of drug action are not known, protein phosphorylations may be involved, since drug-induced stimulation could be abrogated by several protein kinase inhibitors. Furthermore, the overexpression of mitogen-activated protein kinase ERK1 could superinduce the stimulation of SRE-dependent reporter gene expression by colchicine and suggests that the microtubule disassembly signal may be transduced by microtubule-associated kinases.

8043517

Transcriptional regulation of neu by RB and E1A in rat-1 cells.

Functional inactivation of the tumor-suppressing retinoblastoma gene (Rb) is involved in the etiology of many types of human cancers, including hereditary retinoblastomas. The neu gene is a dominant transforming oncogene, and we previously found that the Rb-encoded protein (RB) suppresses neu-induced transformation in NIH3T3 cells by repressing transcription of the neu oncogene. We report here that RB was unable to repress neu oncogene transcription in Rat-1 cells but could functionally antagonize transcriptional repression of neu by the adenovirus E1A. Mutant forms of RB that have mutations in either the E1A-binding or carboxy-terminal regions had less or no antagonizing effects on E1A-mediated repression of neu in Rat-1 cells. Results of focus-formation assays showed that the transformation activity of the neu oncogene in Rat-1 cells could be regulated by E1A and RB in accordance with their transcriptional regulation activities. The data demonstrate that RB can regulate transcription of neu in a negative or positive manner depending on the cell type. Carboxy terminus of RB as well as the E1A-binding region can mediate transcriptional regulation. Based on these results, we propose a model for the complex transcriptional regulation of neu by RB and E1A.

8043518

Constitutive cJun expression induces partial macrophage differentiation in U-937 cells.

Previous studies have shown that phorbol ester induced macrophage differentiation in the leukemic cell line U-937 is tightly linked to the expression of the c-jun protooncogene and the generation of AP-1 transcriptional activity. We expressed the c-jun protooncogene in U-937 cells to examine the role of c-jun in the differentiation of these cells. AP-1 DNA binding activity and the expression of AP-1 controlled downstream genes were increased in all clones expressing exogenous cJun. More importantly, these transfectants showed evidence of differentiation as measured by the acquisition of phagocytic capacity, although they did not develop morphological changes associated with differentiation such as adherence. Furthermore, they became committed to terminal differentiation after significantly shorter exposures to phorbol esters than did control cell lines. These data show that cJun expression induces partial differentiation along the macrophage pathway in U-937 cells.

8043516

Bcl-2 expressed using a retroviral vector is localized primarily in the nuclear membrane and the endoplasmic reticulum of chicken embryo fibroblasts.

A complementary DNA for human bcl-2 was cloned into the replication competent avian retrovirus vector RCASBP, and the resulting virus was used to express human Bcl-2 protein at high levels in chicken embryo fibroblasts. The expression of Bcl-2 did not transform or significantly alter the longevity of the chicken embryo fibroblasts in the presence of normal amounts of serum. However, the expression of Bcl-2 blocked c-Myc-induced apoptosis in these cells. Fractionation of the infected chicken embryo fibroblasts indicated that the protein was distributed equally between nuclear and high density cytoplasmic membranes. Immunofluorescence analysis by confocal microscopy and immunoelectron microscopy showed that the Bcl-2 protein was primarily associated with the nuclear membrane and with the endoplasmic reticulum. Reduced amounts of the protein were associated with other membranes in the cytoplasm. These data show that, in this system, the Bcl-2 protein associates with the nuclear membrane and intracytoplasmic membranes but is not preferentially associated with mitochondria.

8043515

The protein product of the oncogene bcl-2 is a component of the nuclear envelope, the endoplasmic reticulum, and the outer mitochondrial membrane.

The protein product of the oncogene bcl-2 is a potent inhibitor of apoptotic cell death. The Bcl-2 protein has variously been reported to reside in the nuclear envelope and endoplasmic reticulum or exclusively in the inner membrane of mitochondria. We therefore undertook a detailed analysis of the intracellular distribution of Bcl-2 by immunofluorescence, immunogold electron microscopy, and subcellular fractionation in three mouse cell lines expressing a human bcl-2 transgene and measured its importation into isolated mitochondria. By these methods, the protein was localized to the nuclear envelope, the endoplasmic reticulum, and the outer mitochondrial membrane. Any proposal for the mechanism by which Bcl-2 inhibits apoptosis must therefore accommodate the fact that Bcl-2 localizes to cytoplasmic membranes facing the cytosol.

8043514

Specific role for protein kinase C beta in cell differentiation.

A critical role for protein kinase C (PKC) in signal transduction events has been well established. On the other hand, emerging evidence also suggests a role for regulation of PKC levels in mediating long term cellular functions. In human leukemia cell line HL-60, the action of 1,25-dihydroxyvitamin D3 results in transcriptional up-regulation of PKC beta (within 8-12 h) (L. M. Obeid et al., J. Biol. Chem., 265: 2370-2374, 1990). In this study, the role of PKC beta in the regulation of proliferation and differentiation was studied. 1,25-Dihydroxyvitamin D3 caused an increase in PKC beta I, beta II, and, to a lesser extent, PKC alpha, as determined by Western blot analysis. This increase was accompanied by inhibition of proliferation and induction of differentiation. The addition of a 25-base pair antisense oligonucleotide directed against the 5' coding sequence of PKC beta attenuated up-regulation of PKC beta I and beta II levels in response to 1,25-dihydroxyvitamin D3. This antisense oligonucleotide, but not sense oligonucleotide or antisense oligonucleotide to PKC alpha, caused inhibition of 1,25-dihydroxyvitamin D3-induced differentiation by 25-45%. On the other hand, inhibition of cell proliferation by 1,25-dihydroxyvitamin D3 was minimally affected by the addition of antisense oligonucleotides. These results identify a role for PKC beta in cell differentiation and underscore the significance of transcriptional activation of PKC as a mechanism for long-term regulation of PKC. The results also distinguish signaling pathways involved in cell differentiation from those involved in antiproliferation.

8043513

A role for zeta protein kinase C in nerve growth factor-induced differentiation of PC12 cells.

Studies were undertaken to compare the signal-induced redistribution of conventional protein kinase C (cPKC) to nonclassical protein kinase C (nPKC) family members in response to phorbol 12-myristate 13-acetate (PMA) or nerve growth factor (NGF) treatment of PC12 cells. cPKC-alpha and -beta and nPKC-delta and -epsilon were predominantly cytoplasmic, whereas PKC-zeta displayed approximately equal distribution between the cytoplasm and membrane fraction. Treatment of PC12 cells with PMA induced rapid translocation of both c- and nPKC isoforms to the membrane fraction, although the kinetics varied between isoforms with epsilon being most sensitive, followed by delta > zeta > alpha. Both PKC-epsilon and delta translocated in the presence of minute concentrations of PMA, whereas cPKC was less sensitive, and PKC-zeta was least sensitive. NGF treatment, on the other hand, induced translocation of cPKCs and delta and epsilon nPKC, albeit with differential magnitude, whereas PKC-zeta was found predominantly in the cytoplasm. Chronic treatment of PC12 cells with PMA (1 microM) caused a rapid disappearance of alpha, beta, delta, and epsilon PKC isoforms, whereas the expression of PKC-zeta was unaltered over 4 days. NGF induced an increase in cytoplasmic PKC-zeta in control, or PMA down-regulated PC12 cells. Moreover, the increase in cytoplasmic PKC-zeta was blocked by pretreatment with sphingosine (2.5 microM). Furthermore, PKC-zeta was activated by NGF in PMA down-regulated PC12 cells, as determined by the extent of epsilon-peptide phosphorylation using a permeabilized cell assay. In addition, the zeta-pseudosubstrate peptide inhibited NGF-induced activation of PKC-zeta.(ABSTRACT TRUNCATED AT 250 WORDS)

8043512

Transgenic mice provide genetic evidence that transforming growth factor alpha promotes skin tumorigenesis via H-ras-dependent and H-ras-independent pathways.

The epidermal growth factor receptor (EGFR), which mediates the mitogenic activity of transforming growth factor alpha (TGF-alpha), has been shown to activate Ras in cultured cells through well-defined intermediary proteins. To examine the in vivo relationship between EGFR and Ras, chemical carcinogenesis of TGF-alpha transgenic mouse skin was chosen as an experimental model. Transgenic mice overexpressing TGF-alpha in a wide variety of epithelial tissues by virtue of a metallothionein promoter demonstrate a multitude of premalignant and neoplastic lesions but not spontaneous skin tumors. Transgenic skin was initiated with a single dose of 7,12-dimethylbenz[a]anthracene (DMBA), shown previously to induce, in concert with a tumor promoter, murine papillomas that consistently contain specific H-ras mutations. Virtually all DMBA-treated TGF-alpha transgenic mice, but not treated control animals, developed hyperplasias, papillomas, sebaceous adenomas, and more infrequently, sebaceous and squamous cell carcinomas. Therefore, TGF-alpha functions as an autonomous tumor promoter in DMBA-initiated transgenic skin. Skin tumors could be separated into two mutually exclusive genetic classes. In tumors harboring mutant H-ras, TGF-alpha transgene expression was relatively low and essentially unchanged relative to untreated skin; however, only 42% of skin tumors contained mutations in H-ras. Conversely, in most tumors with wild-type H-ras, transgenic TGF-alpha transcripts were enhanced 10- to 20-fold. These results suggest that strong constitutive EGFR stimulation, through TGF-alpha transgene overexpression, can substitute functionally for mutational activation of H-ras in skin tumorigenesis. Moreover, because H-ras mutational activation could not induce skin tumors without TGF-alpha transgene activity, simultaneous stimulation of an EGFR-mediated H-Ras-independent pathway appears to be required for tumor development as well.

8043511

NUB-7: a stable I-type human neuroblastoma cell line inducible along N- and S-type cell lineages.

Human NB cell lines express features of one or more of three recognizable phenotypes that include N-type (neuroblastic), S-type (Schwannian), and I-type (intermediate phenotype) cells. The I-type cell, which shares properties of both N- and S-type cells, is thought to represent the progenitor cell from which the other two cell types are derived. The MYCN amplified NB cell line NUB-7, established in our laboratory, is now shown to be composed principally of I-type cells. The observed phenotype was stable in culture and was representative of the original surgically resected tumor. The I-type cell designation was established based on morphological characteristics, the coexpression of various N-type (neurofilaments, peripherin, GAP-43, NCAM, MYCN) and S-type cell (vimentin, laminin, fibronectin) markers, and the relatively high level of expression of these markers in comparison to five predominantly N-type, one S-type, and one N/S mixed NB cell lines. Dibutyryl cyclic AMP and retinoic acid induced enhanced expression of N- and S-type phenotypes, respectively, in NUB-7 as supported by specific morphological changes, reduced growth, and changes in the levels of expression of both N- and S-type markers. Our studies with the NUB-7 cell line have now provided convincing evidence for the existence of a bipotential progenitor of N- and S-type cells in NB. As well, the NUB-7 cell line may also represent the tumor counterpart of a sympathetic ganglion progenitor cell.

8043510

Receptor chimeras indicate that the met tyrosine kinase mediates the motility and morphogenic responses of hepatocyte growth/scatter factor.

The met protooncogene is a receptor tyrosine kinase for hepatocyte growth factor/scatter factor (HGF/SF). HGF/SF is a multifunctional cytokine secreted mainly by mesenchymal cells that stimulates movement, invasion, and morphogenesis of some epithelial and endothelial cells and mitogenicity of others. Although the met receptor tyrosine kinase is a high affinity receptor for HGF/SF, it is not known whether this receptor can mediate the pleiotropic functions of HGF/SF. To investigate this in epithelial cells that normally respond to HGF/SF, we generated a chimeric receptor containing the extracellular domain from the colony stimulating factor 1 (CSF-1) receptor fused to the transmembrane and cytoplasmic domain of the met receptor. We show that the CSF-MET chimera, when expressed in Madin-Darby canine kidney (MDCK) epithelial cells, is fully functional. Treatment of MDCK cells expressing the chimera with CSF-1 leads to cell dissociation and scattering, as well as invasion and tubule formation of cells grown in collagen matrices. This effect is dependent on a functional met kinase. Stimulation of the receptor chimera with CSF-1 leads to activation of the met kinase and tyrosine phosphorylation of the chimeras in vivo, whereas a kinase inactive mutant chimera shows no biological response to CSF-1. These findings demonstrate that stimulation of the met kinase is sufficient and essential to mediate the motogenic, invasive, and morphogenic responses of MDCK cells to HGF/SF and that this is a suitable system for a detailed analysis of the molecular signaling events involved in these responses.

8043509

Corticosteroid receptors in lymphocytes: a possible marker of brain involution?

A similarity has recently been found between the regulation of corticosteroid receptors in brain and in lymphoid tissue. We have studied the regulation of corticosteroid receptors in human mononuclear leukocytes as a possible marker of brain involution. Type I corticosteroid receptors are down regulated by excess of mineralocorticoids (primary and secondary hyperaldosteronism, pseudohyperaldosteronism) and of glucocorticoids (Cushing's syndrome). Type II corticosteroid receptors are not reduced by excess of endogenous corticosteroids (Cushing's syndrome). In normal adults there is a direct significant correlation between plasma cortisol and Type I and between plasma cortisol and Type II receptors in mononuclear leukocytes, while in Cushing's syndrome the correlation is inverse between plasma cortisol at 8 a.m. and Type II receptors. In an aged population the mean numbers of Type I and of Type II receptors are lower and plasma cortisol is higher than in adult controls, but the increase of plasma cortisol is not followed by a clinical picture of hypercorticism. Corticosteroid Type I and Type II receptors are inversely correlated with age. After dexamethasone suppression (1 mg at 11 p.m.) Type I receptors always decrease in controls while the response of Type II is not homogeneous. In an aged group of patients, both receptors are reduced by dexamethasone. We conclude that the decrease with age of corticosteroid receptors is possibly related to a physiological involution of corticosteroid receptors and that this reduction does increase plasma cortisol concentration, without affecting the glucocorticoid effector mechanism.

8043508

Involvement of corticosteroids in the processing of stressful life-events. A possible implication for the development of depression.

In a sub-population of endogenously depressed patients, disturbances of the hypothalamic-pituitary-adrenal axis can be observed. Increased cortisol and CRH levels combined with normal ACTH concentrations have often been reported. Corticosteroids appear to play a role in the mood changes, in depressed subjects. However, their mechanism of action is unknown. In animal experiments, the involvement of corticosteroids in stressor-induced learning was investigated. Three paradigms were used. In the Porsolt swimtest an animal had to learn to adapt to an inescapable situation. In the lithium chloride conditioned taste aversion an animal learned to avoid sugar water. In the amphetamine sensitization a second injection of amphetamine caused a potentiated response, because of conditioning. All three conditions appeared to be stressful because they induced a corticosterone release. When adrenalectomized (ADX) mice were compared to control animals it appeared that, in all three paradigms, their memory function was disturbed. The data indicated that this was a specific glucocorticoid-mediated effect since corticosterone and dexamethasone injections were able to reverse the ADX-induced deficit. The ADX-induced disturbances were only observable at moderate stress levels. More severe stressors (lower water temperature in the Porsolt swimtest, higher lithium chloride and amphetamine doses) also made ADX mice remember their previous experiences. The results suggest that corticosteroids are involved in the consolidation of stressful events and the corresponding coping responses. They play, however, only a role in the case of moderate stressors. In ADX animals no stressor-induced corticosterone increase can occur and therefore these animals only remember severe stressors. In a depressed patient basal steroid levels are increased and consequently very mild stressors, which induce only a small extra steroid release, will be remembered. The remembering of all these negative experiences might be of importance for the development and maintenance of the depression.

8043507

Brain formation of oestrogen in the mouse: sex dimorphism in aromatase development.

Steroid sex hormones have an organizational role in gender-specific brain development. Aromatase, converting testosterone (T) to oestradiol-17 beta (E2), is a key enzyme in the brain and the regulation of this enzyme is likely to determine availability of E2 effective for neural differentiation. In rodents, oestrogens are formed very actively during male perinatal brain development. This paper reviews work on the sexual differentiation of the brain aromatase system in vitro. Embryonic day 15 mouse hypothalamic culture aromatase activity (AA: mean Vmax = 0.9 pmol/h/mg protein) is several times greater than in the adult, whereas apparent Km is similar for both (approximately 30-40 nM). Using microdissected brain areas and cultured cells of the mouse, sex differences in hypothalamic AA during both early embryonic and later perinatal development can be demonstrated, with higher E2 formation in the male than in the female. The sex differences are brain region-specific, since no differences between male and female are detectable in cultured cortical cells. AA quantitation and immunoreactive staining with an aromatase polyclonal antibody both identify neuronal rather than astroglial localizations of the enzyme. Kainic acid eliminates the gender difference in hypothalamic oestrogen formation indicating, furthermore, that this sex dimorphism is neuronal. Gender-specific aromatase regulation is regional in the brain. Oestrogen formation is specifically induced in cultured hypothalamic neurones of either sex by T, since androgen has no effect on cortical cells. Androgen is clearly involved in the growth of hypothalamic neurones containing aromatase. It appears that differentiation of the brain involves maturation of a gender-specific network of oestrogen-forming neurones.

8043506

An alpha 1 adrenergic mechanism mediates estradiol stimulation of LHRH mRNA synthesis and estradiol inhibition of POMC mRNA synthesis in the hypothalamus of the prepubertal female rat.

We showed previously that the surge of luteinizing hormone-releasing hormone (LHRH) induced by estradiol-17 beta (E2) in the female rat can be blocked by an alpha 1 adrenergic antagonist. The aim of the present study was to determine whether this was due to a direct action of E2 on noradrenergic projections to LHRH neurons or whether it also involved other systems such as the arcuate pro-opiomelanocortin (POMC) neurons which are thought to inhibit LHRH biosynthesis and release. The experimental preparation was the prepubertal female rat in which an LHRH surge is induced by pregnant mare serum gonadotropin. Prazosin was used as a specific alpha 1 adrenergic antagonist and LHRH and POMC mRNA concentrations and cell numbers, in the medial preoptic area and rostral arcuate nucleus, respectively, were determined by in situ hybridization. Prazosin significantly reduced the total number of LHRH mRNA expressing cells, and increased the total number of POMC mRNA expressing cells and the concentration of POMC mRNA per cell. These results suggest that the inhibition of E2-stimulated LHRH biosynthesis and release by alpha 1 adrenergic blockade may be mediated by two mechanisms; (i) increased POMC synthesis leading to inhibition of LHRH neurons and (ii) direct inhibition of a stimulatory alpha 1 adrenergic/LHRH mechanism.

8043505

Steroids and electrical activity in the brain.

Corticosteroid hormones can enter the brain and bind to two receptor subtypes: the high affinity mineralocorticoid receptor (MR) and the glucocorticoid receptor (GR) with approximately 10-fold lower affinity. Under physiological conditions the degree of receptor occupation will range from a predominant MR occupation (at the beginning of the inactive period, under rest) to concurrent activation of MRs and GRs (at the circadian peak and after stress). With in vitro electrophysiological recording techniques we observed that neuronal excitability in the CA1 hippocampal field is under a long-term control of MR- and GR-mediated events. The predominant occupation of MRs is associated with a stable amino acid-carried synaptic transmission; calcium- and potassium-currents are small, as are the responses to biogenic amines. Occupation of GRs in addition to MRs results in a gradual failure of CA1 neurons to respond to repeated stimulation of amino acid-mediated input; ionic conductances and responses to biogenic amines are large. In general, electrical properties recorded when both MRs and GRs are unoccupied (i.e. after adrenalectomy) resemble the responses observed when both receptor types are activated. The corticosterone dependency of electrical properties is thus U-shaped. We conclude that MR occupation may be responsible for the maintenance of information processing in the CA1 field and the stability of the circuit. Additional activation of GRs will initially suppress synaptic activity, but may eventually result in an increased instability and even vulnerability of the neuronal networks.

8043504

The pharmacology of neurosteroidogenesis.

In adrenal cortex and other steroidogenic tissues including glial cells, the conversion of cholesterol into pregnenolone is catalyzed by the cytochrome P450scc located in the inner mitochondrial membrane. A complex mechanism operative in regulating cholesterol access to P450scc limits the rate of pregnenolone biosynthesis. Participating in this mechanism are DBI (diazepam binding inhibitor), an endogenous peptide that is highly expressed in steroidogenic cells and some of the DBI processing products including DBI 17-50 (TTN). DBI and TTN activate steroidogenesis by binding to a specific receptor located in the outer mitochondrial membrane, termed mitochondrial DBI receptor complex (MDRC). MDRC is a hetero-oligomeric protein: only the subunit that includes the DBI and benzodiazepine (BZD) recognition sites has been cloned. Several 2-aryl-3-indoleacetamide derivatives (FGIN-1-X) with highly selective affinity (nM) for MDRC were synthesized which can stimulate steroidogenesis in mitochondrial preparations. These compounds stimulate adrenal cortex steroidogenesis in hypophysectomized rats but not in intact animals. Moreover, this steroidogenesis is inhibited by the isoquinoline carboxamide derivative PK 11195, a specific high affinity ligand for MDRC with a low intrinsic steroidogenic activity. Some of the FGIN-1-X derivatives stimulate brain pregnenolone accumulation in adrenalectomized-castrated rats. The FGIN-1-X derivatives that increase brain pregnenolone content, elicit antineophobic activity and antagonize punished behavior in the Vogel conflict test in rats. These actions of FGIN-1-X are resistant to inhibition by flumazenil, a specific inhibitor of BZD action in GABAA receptors but are antagonized by PK 11195, a specific blocker of the steroidogenesis activation via MDRC stimulation. It is postulated that the pharmacological action of FGIN-1-X depends on a positive modulation of the GABA action on GABAA receptors mediated by the stimulation of brain neurosteroid production.

8043503

Competition for DNA steroid response elements as a possible mechanism for neuroendocrine integration.

For the analysis of a simple steroid-dependent mating behavior, careful response definition, complete neural circuit delineation and placement of estrogen-responsive cells within this circuit have been accomplished. Molecular studies of two relevant genes have emphasized DNA/RNA hybridization assays and DNA binding techniques. For both the rat preproenkephalin gene and the gene for the progesterone receptor, a strong induction by estrogen, tissue specificity of expression and a sex difference in regulation are prominent phenomena. On the rat preproenkephalin promoter, estrogen (ER) and thyroid receptors may compete for a DNA binding site. Likewise, progesterone (PR) and glucocorticoid receptors may compete for the same sites. On the rat PR gene, interactions between ER and AP-1 binding proteins are of special interest. Such interactions could underlay competitions and synergies between steroid hormones and neurally signalled events in the environment.

8043502

Immunocytochemical versus biochemical receptor determination in normal and tumorous tissues of the female reproductive tract and the breast.

The development of highly specific and sensitive monoclonal antibodies directed against human estrogen (ER) and progesterone receptors (PR) provides a new approach in precise histochemical receptor location independent of hormone binding. Over the years receptor determination was the domain of the radioligand-binding assay, in which receptors are measured by tritiated ligand and unbound ligand is removed by the dextran-coated charcoal (DCC) procedure. Presented here are the results and experiences obtained by the classic DCC and the immunocytochemical method in the different normal and tumorous tissues of the female reproductive tract and the breast. The results of both methods were compared, and overall concordance of the results was found to vary considerably among the different types of tissue analyzed. Best agreement (86%) was found for PR determination in breast cancer, and the lowest rate of concordance for ER determination in fibrocystic disease of the breast. Special attention was directed toward the heterogeneity of receptor distribution in the specimens examined. In all tissues investigated, ER and PR were located in the nuclei of cells in both paraffin and frozen sections. Staining intensity varied among different cell types and from cell to cell for a single cell type, as well as in tumorous and normal tissues. In breast cancer, randomly scattered single cell receptor positivity was distinguished from focal/clonal positivity. Paraffin-embedded lymph node metastases showed significantly weaker staining as compared with their respective primary tumors. In the normal ovary, the corpus luteum and the stromal layer of the outer cortex were revealed as highly receptive elements for progestins, whereas ER was barely demonstrable in the normal ovary. Benign serous and mucinous ovarian tumors showed opposite ER and PR distribution among the stromal and epithelial components. Of special interest were the highly significant changes in ER and PR content in the stromal and glandular cells of the different layers of the normal endometrium throughout the menstrual cycle.

8043501

Platelet-activating factor in human endometrium.

Platelet-activating factor (PAF) is a phospholipid actively produced by human endometrium and deeply involved in the processes of ovoimplantation and labor. We recently found that PAF represents a new autocrine growth factor for a human adenocarcinoma cell line, HEC-1A. Indeed, biologically active PAF is synthesized by HEC-1A cells, under progesterone control. In HEC-1A cells, PAF regulates intracellular calcium concentration ([Ca2+]), DNA synthesis and expression of early oncogenes. All these effects are blocked by the receptor antagonist L659,989. However, while nanomolar concentrations of PAF mobilize [Ca2+], only micromolar concentrations affect cell growth, suggesting heterogeneity of PAF receptors or signaling. Two distinct populations of PAF receptors are present in HEC-1A cells, which bind PAF in nanomolar and micromolar concentrations, respectively. Since HEC-1A cells are producing elevated concentrations of PAF and micromolar concentrations of the PAF antagonist L659,989 inhibit cell proliferation, an autocrine role for PAF is suggested in HEC-1A cells.

8043500

Different conversion metabolic rates of testosterone are associated to hormone-sensitive status and -response of human prostate cancer cells.

The main goal of the present work was to compare the ability of human prostate cancer (PCa) cells to metabolize testosterone (T) in living conditions. To this end we studied three different human PCa cell lines (LNCaP, DU145 and PC3) having different hormone-sensitive status and capability of response to androgens. We used an original approach which allows the evaluation of conversion metabolic rates in growing cells after administration of labeled steroid precursor (presently T), at physiological concentrations (1-10 nM). Analysis of both precursor degradation and formation of several products was carried out using reverse phase-high performance liquid chromatography (RP-HPLC) and "on line" radioactive detection. Comparison of the three human PCa cells revealed that their metabolic aptitude differed in many respects: (i) rates of precursor degradation, (ii) different products' formation, and (iii) extent of conjugate production. In detail, PC3 cells quickly degraded T and exhibited high formation rates of androstenedione (A-4-ene-Ad); both DU145 and LNCaP cells mostly retained high levels of unconverted T, with a limited production of A-4-ene-Ad and its 17-keto derivatives (if any). Either LNCaP or DU145 cells generated a relatively high amount of dihydrotestosterone (DHT). In contrast, neither DHT nor its main metabolites were detected in PC3 cells at both short and longer incubation times. As expected, T degradation and A-4-ene-Ad production were highly correlated (r = 0.97; P < 0.03); similarly, A-4-ene-Ad and DHT formation showed a negative, significant correlation. Negligible production of conjugates was noted in both PC3 and DU145 cells, whilst it was remarkable in LNCaP cells (ranging from 43 to 57%). Overall, our data indicate that human PCa cells degrade T quite differently, favoring alternatively reductive or oxidative patterns of androgen metabolism.

8043499

Androgen-dependent prostatic tumors: biosynthesis and possible actions of LHRH.

Testosterone (T) is the major exogenous stimulus for the growth of prostatic carcinoma. It is believed that the proliferative action of T may be mediated by locally expressed growth modulatory factors. Recent evidence from our laboratory suggests that a LHRH (or a LHRH-like) loop might be expressed in human prostatic tumor cells. To verify this hypothesis, we have studied whether a mRNA for LHRH is expressed in the human androgen-responsive prostatic cancer cell line LNCaP, using the reverse transcription-polymerase chain reaction technique in the presence of a pair of specific oligonucleotide primers. A cDNA band of the expected size was obtained from LNCaP cells; this band hybridized with a 32P-labeled LHRH oligonucleotide probe and its sequence showed a complete match with the reported sequence of the human placental LHRH cDNA. These observations indicate that the mRNA coding for LHRH is expressed in LNCaP cells and suggest that a LHRH (or a LHRH-like) peptide might be produced by these cells. To clarify the possible action of this peptide, LNCaP cells were grown in a steroid-free medium and treated with a LHRH antagonist. The treatment resulted in a significant increase of tumor cell growth. These data clearly indicate that the LHRH system expressed in LNCaP cells plays an inhibitory role on cell proliferation, and that this system seems to be regulated in a negative way by steroids. An EGF/TGF alpha autocrine stimulatory loop (peptides, receptors, intracellular signals) is also functional in these cells. Treatment of LNCaP cells grown in serum-free conditions (i.e. in the absence of exogenous growth factors) with a monoclonal antibody against the EGF receptor, or with immunoneutralizing antibodies against EGF or TGF alpha, resulted in a significant decrease of cell proliferation. T positively regulates this EGF/TGF alpha system by increasing the concentration of EGF binding sites. The present data indicate that an inhibitory LHRH (or LHRH-like) system is expressed in LNCaP cells and participates in the local mechanisms regulating tumor cell proliferation together with an EGF/TGF alpha stimulatory loop. Both systems appear to be modulated by T.

8043498

Studies on the human prostatic cancer cell line LNCaP.

The effects of androgens, antiandrogens, and other steroid hormones on growth of the human prostate cancer cell line LNCaP were studied. Despite the absence of receptors for progesterone and estradiol, the growth rate of the androgen responsive LNCaP-FGC cells increased when cultured in the presence of either estrogens or progestagens. In addition, most antiandrogens were also growth stimulators. This aberrant response was due to a threonine to alanine substitution at amino acid position 868 in the steroid binding domain of the androgen receptor (AR). Only the antiandrogen ICI 176,334 could block transcription and cell growth by the mutant receptor. By immunoprecipitation of the AR from LNCaP cells with the specific antibody F39.4.1 and Western blotting, three types of heat-shock proteins co-precipitated: hsp90, hsp70 and hsp56. This co-isolation could be prevented by pre-incubating the cells with androgens or with the antiandrogen hydroxyflutamide. Only the antiandrogen ICI 176,334 could block the effect of androgens on complex dissociation and prevent tight nuclear binding of the AR. Hydroxyflutamide could only inhibit tight nuclear binding of the wild-type AR. Therefore, in LNCaP cells the mutation in the steroid binding domain of the AR prevents a blockade of receptor function by most antiandrogens, but not by ICI 176,334, probably because of a different mechanism by which this compound blocks receptor function.

8043497

Steroid biochemistry and categorization of breast cyst fluid: relation to breast cancer risk.

Patients bearing macrocysts of the breast are at higher risk of later developing cancer. The fluid filling the cysts (breast cysts fluid, BCF) contains unusual amounts of steroid conjugates, first androgen and estrogen sulfates. Measuring BCF cations (K+,Na+) allows categorization of cysts into two major subsets (type I and type II) that are associated with a different degree and/or turnover of apocrine metaplastic cells in the lining epithelium. Type I cysts (high K+/Na+ ratio) accumulate hugh amounts of dehydroepiandrosterone sulfate, estrone sulfate, androstane-3 alpha,17 beta-diol glucuronide, androsterone glucuronide and contain more testosterone and dihydrotestosterone than type II. Conversely, type II cysts (low K+/Na+ ratio) contain more progesterone and pregnenolone. A cohort study was started in 1983 at the Cancer Prevention Center, Ravenna, Italy, with the aim of evaluating the relationships between the biochemistry of BCF and the incidence of breast cancer in women with gross cystic disease (GCD) of the breast. The bimodal distribution of the cationic pattern has been confirmed from data obtained in 798 patients aspirated. The risk of cyst relapse was significantly higher among women with type I cysts or with multiple cysts at presentation. Twelve incident cases of breast cancer have been diagnosed among women whose BCF was categorized. Eleven out of 12 cases had type I or multiple cysts. The cumulative incidence of breast cancer among patients bearing type I cysts was 2.5%. We conclude that women with GCD bearing type I cysts have an increased breast cancer risk when compared with the counterpart bearing type II cysts or the general population.

8043496

Estrogen receptors: new perspectives in breast cancer management.

The imbalance between proliferative and differentiative estrogenic effect, caused by quantitative and qualitative alteration of the estrogen receptor (ER) expression, may play a determinant role in mammary neoplastic transformation. Our studies demonstrate that ER levels are significantly higher in human mammary neoplastic tissues when compared to perineoplastic tissues and that increased ER expression is associated with ER gene hypomethylation. During progressive multifactorial carcinogenesis, ER overexpression may represent an early step in neoplastic transformation. In fact, high levels of ER represent good markers of differentiation and can predict the likelihood of benefiting from anti-estrogen therapy. Nevertheless, about 35% of ER-positive breast cancers are resistant to endocrine therapy and 10% of ER-negative tumors behave as hormone-sensitive tumors. Recent studies on ER mRNA variants, which naturally occur in human breast tumors, demonstrated mutations, deletions and alternative splicings, yielding deletions of exons 3, 4, 5 and 7. ER variants exhibited altered functions or changed the responsiveness to hormonal therapy. Analysis of these variants could be a useful parameter to better predict tumor responsiveness to anti-estrogen therapy. Recently, a regain of hormonal responsiveness by ER-negative breast cancer cells has been reported following ER gene transfection. However, estradiol treatment inhibits rather than stimulates cell growth as well as the metastatic and invasive potential of the ER gene transduced cells. Transfer of the ER gene may be considered as a new therapeutic approach in the management of hormone-independent breast cancer.

8043495

Aromatase gene expression in adipose tissue: relationship to breast cancer.

Recent studies have established that concentration gradients of aromatase expression occur within the breast, with the highest levels of expression occurring in sites proximal to a tumor. These variations in aromatase expression correlate with regional differences in the relative proportions of the histologic components of breast adipose tissue, in particular adipocytes and stromal cells, since regions containing the highest numbers of stromal cells are the sites of elevated aromatase transcript levels. Although the initiating events are unknown, it is proposed that, once neoplastic cells start to replicate, tumor growth will be promoted by locally increased estrogen levels. In turn, growth factors produced by the tumor in response to locally increased estrogen levels may further increase aromatase expression in the surrounding adipose tissue. Thus a positive feed-back loop is established in which locally-produced estrogens and tumor-derived growth factors act by paracrine and autocrine mechanisms to sustain the growth and development of the tumor. Further support for this concept is obtained from the observation that aromatase expression in breast adipose is regulated by enhancer elements that appear to respond positively to growth factors, in contrast to expression in granulosa cells, which is inhibited by growth factors.

8043494

Effects of progestagens and Org OD14 in in vitro and in vivo tumor models.

Sex steroids, in particular estradiol (E2) and progesterone (P4), play, together with other hormones and growth factors, a role in the development of normal breast tissue. The effect of four progestagens (norethisterone, 3-ketodesogestrel, gestodene and P4) and Org OD14, a steroid with weak estrogenic, progestagenic and androgenic properties were studied on growth of breast tumor cells in vitro using two subclones of MCF-7 (H and A) and T47D (S and A) cells. In addition, we investigated the effects of 3-ketodesogestrel, gestodene and Org OD14 on the growth of 7,12-dimethylbenz(a)anthracene(DMBA)-induced mammary tumors in rats. In the in vitro assays with MCF-7 cells norethisterone, 3-ketodesogestrel and gestodene stimulated growth only at high doses (> or = 10(-7) M), whereas P4 had no effect. Gestodene was more potent than 3-ketodesogestrel and norethisterone. Org OD14, stimulated cell growth at a dose of 10(-8) M, while E2 is active at 10(-10) M. In T47D-A cells similar effects were found, but the subclone S did not respond to the progestagens and Org OD14. The two T47D subclones also reacted differently to progestagens during growth stimulation with E2. In T47D-S the progestagens and Org OD14 inhibited, while in T47D-A these compounds did not modulate the effect of E2. In the DMBA model we found that gestodene and 3-ketodesogestrel were able to inhibit tumor growth to the same extent. Surprisingly, Org OD14 was even more effective in the DMBA model using the therapeutic approach. Using the prophylaxic approach tumor development was delayed and tumor growth was strongly suppressed. The inhibitory effects of Org OD14 on tumor growth in the DMBA model may be attributed to its mixed hormonal profile. From these studies we conclude that different cell lines and even subclones thereof respond quite differently to steroids. Both in vitro and in vivo studies are required to judge whether synthetic steroids might be involved in an increased risk for the development of breast tumors.

8043493

Regulation of apoptosis in S49 cells.

Apoptosis, or programmed cell death, is a highly regulated physiological process by which individual cells die and are removed from a given population. This process, defined by both morphological and biochemical characteristics, has been extensively studied in the glucocorticoid-induced immature thymocyte model. In the present study we explore the effects of glucocorticoids on variants of the S49.1 thymocyte without (S49-NEO) or with (S49-bcl-2) the bcl-2 proto-oncogene. In S49-NEO cells dexamethasone induced a time- and dose-dependent loss of viability and increase in DNA internucleosomal fragmentation (a biochemical hallmark of apoptosis). Glucocorticoid treatment was also associated with an apoptotic morphology (cell shrinkage, chromatin condensation) and the effects of this steroid could be reversed by the glucocorticoid antagonist RU486. In contrast, S49-bcl-2 cells showed no change in viability, DNA fragmentation or apoptotic morphology. Interestingly, the apoptotic effects of glucocorticoid in S49-NEO cells were mimicked by the translation inhibitor cycloheximide and the zinc chelator 1,10-phenanthroline, suggesting that zinc and translational events are necessary to maintain the nonapoptotic state. Finally, nuclease activity was extracted from glucocorticoid-treated S49-NEO cells but not control cells. Together the results further define the effects of glucocorticoids on these cells and provide insight into the mechanisms controlling apoptosis.

8043492

How do breast cancers become hormone resistant?

We propose that the molecular heterogeneity of estrogen receptors (ER) in breast tumor cells characterized by the presence of mutant receptor forms, generates the cellular heterogeneity evident when progesterone receptor (PR) or DNA ploidy are analyzed in cell subpopulations. Furthermore, it is likely that cellular heterogeneity leads to the lack of uniformity in response to tamoxifen that we have described. We find that heterogeneity of PR distribution and DNA ploidy reflects the existence of mixed subpopulations of breast cancer cells that are substantially remodeled under the influence of tamoxifen. It appears likely that rather than being "resistant", different subsets of cells can be inhibited or stimulated by tamoxifen and their suppression or outgrowth alters the phenotype of the tumor. PR heterogeneity in solid tumors of patients may predict for such a mixed, and potentially dangerous, response to antiestrogen treatment. Similarly, the molecular heterogeneity resulting from the presence of two normal PR isotypes can lead to inappropriate responses to progesterone antagonists in certain genes or cell types. These agonist-like responses are due to cooperative interactions between the receptors and other transcription factors. As we learn more about the heterogeneity of PR, ER and other proteins in tumors, we may be able to recognize such lethal cell subpopulations, or combinations of regulatory factors. Specifically, with respect to tamoxifen, our data suggest that its use as a chemopreventant in women at high risk of developing breast cancer [Kiang, J. Natn. Cancer Inst. 83, 1991, 462-463] should be viewed with caution, since in the presence of tamoxifen subpopulations of cells may arise that are stimulated, rather than inhibited, by the drug.

8043491

Novel aromatase and 5 alpha-reductase inhibitors.

Inhibitors of aromatase and 5 alpha-reductase may be of use for the therapy of postmenopausal breast cancer and benign prostatic hyperplasia, respectively. FCE 27993 is a novel steroidal irreversible aromatase inhibitor structurally related to exemestane (FCE 24304). The compound was found to be a very potent competitive inhibitor of human placental aromatase, with a Ki of 7.2 nM (4.3 nM for exemestane). In preincubation studies with placental aromatase FCE 27993, like exemestane, was found to cause time-dependent inhibition with a higher rate of inactivation (t1/2 4.5 vs 15.1 min) and a similar Ki(inact) (56 vs 66 nM). The compound was found to have a very low binding affinity to the androgen receptor (RBA 0.09% of dihydrotestosterone) and, in contrast to exemestane, no androgenic activity up to 100 mg/kg/day s.c. in immature castrated rats. Among a series of novel 4-azasteroids with fluoro-substituted-17 beta-amidic side chains, three compounds, namely FCE 28260, FCE 28175 and FCE 27837, were identified as potent in vitro and in vivo inhibitors of prostatic 5 alpha-reductase. Their IC50 values were found to be 16, 38 and 51 nM for the inhibition of the human enzyme, and 15, 20 and 60 nM for the inhibition of the rat enzyme, respectively. When given orally for 7 days in castrated and testosterone (Silastic implants) supplemented rats, the new compounds were very effective in reducing prostate growth. At a dose of 0.3 mg/kg/day inhibitions of 42, 36 and 41% were caused by FCE 28260, FCE 28175 and FCE 27837, respectively.

8043490

Aromatase inhibitors in the treatment of breast cancer.

A number of inhibitors of estrogen synthesis are now becoming available which could be of value in the treatment of breast cancer. 4-Hydroxyandrostenedione (4-OHA), the first of these compounds to enter the clinic has been found to be effective in postmenopausal patients who have relapsed from tamoxifen. Thus, in studies of 240 patients, 26% patients experienced partial or complete response to treatment. An additional 25% patients had disease stabilization. 4-OHA is a potent selective, steroidal inhibitor which causes inactivation of aromatase in vitro. It is effective in reducing concentrations of ovarian estrogens in rats and of ovarian and peripheral estrogens in non-human primate species. The compound has been shown to lower serum estrogen levels in postmenopausal breast cancer patients. However, not all of these patients experienced disease remission, suggesting that their tumors were hormone insensitive rather than that the dose of 4-OHA was suboptimal. In trials of patients who had not received prior tamoxifen treatment, 4-OHA (250 mg i.m. every 2 weeks) was found to induce complete or partial tumor regression in 33% of patients. The response of patients was not significantly different from that observed in patients treated with tamoxifen (30 mg o.d) of 37%. No significant difference between treatments was observed for disease stabilization, the duration of response or median survival. Several other steroidal aromatase inhibitors have been studied, such as 7 alpha-substituted androstenedione derivatives. MDL 18962 [10-(2-propynyl)estr-4-ene-3,17-dione] and FCE 24304 (6-methylen-androsta-1,4-diene-3,17-dione) are currently in clinical trials. Non-steroidal inhibitors of cytochrome P-450 enzymes, such as imidazole and triazole derivatives have been developed which are highly selective for aromatase. Three triazoles which are very potent and selective inhibitors are vorazole (6-[(4-chlorophenyl)(1H-1,2,4-triazol-1-yl)-methyl]1-methyl-1H- benzotriazole R 76713, arimidex 2,2'[5-(1H-1,2,4-triazol-1-yl methyl)-1,3-phenylene]bis(2-methylpropiononitrile) (ZD1033) and letrozole 4-[1-(cyanophenyl)-1-(1,2,4-triazolyl)methyl]benzonitril (CGS 20267). These compounds reduce serum estradiol concentration to undetectable levels in breast cancer patients. These highly potent inhibitors provide the opportunity to determine whether a further degree of estrogen suppression will be important in producing greater clinical response.(ABSTRACT TRUNCATED AT 400 WORDS)

8043489

Design of novel antiestrogens.

The physicochemical principle of "die and coin" complementarity proffered by Pauling and Delbruck and exemplified in Watson and Crick DNA was used to design new antineoplastic compounds. In search of an explanation for why certain molecules and not others are present in nature, biologically active small molecules were discovered to exhibit complementarity when inserted into cavities between base pairs in DNA. Ligands in the steroid/thyroid hormone/vitamin D family fit particularly well into the site 5'-dTdG-3'.5'-dCdA-3'. Degree of fit of various candidate compounds in the manner of a given hormone correlated with degree of hormonal activity. Hormone antagonists fit into the same site but in a different manner than the agonists. Computer graphics and energy calculations confirmed salient observations including the remarkable complementarity of estradiol and DNA. Using the above criteria, a new candidate antiestrogen, para-hydroxyphenyl-acetylamino-2,6-piperidinedione was successfully designed. Taken as a whole, these results coupled with recent independent findings raise the possibility that the mode of action of certain hormones and hormone antagonists may involve direct insertion into DNA mediated by classical protein receptors and other transcription factors.

8043488

Therapy of Cushing's syndrome with steroid biosynthesis inhibitors.

Several substances with different inhibitory effects on adrenal steroid biosynthesis were investigated in patients with Cushing's syndrome. It has been shown that trilostane, a 3 beta-hydroxysteroid-dehydrogenase inhibitor, is not potent enough to block cortisol biosynthesis in patients with hypercortisolism. Aminoglutethimide inhibits side chain cleavage of cortisol synthesis, but it has been demonstrated that the blocking effect on cortisol secretion is not strong enough to normalize urinary cortisol excretion in patients with Cushing's disease. For metyrapone, an inhibitor of adrenal 11 beta-hydroxylase, promising results were reported for the treatment of Cushing's syndrome. However, the drug has several side effects and depending on the definition of the desired reduction of cortisol secretion a true remission was only found in a minority of patients. The antifungal drug ketoconazole in vitro predominantly blocks 17,20-desmolase (IC50 1 microM) and to a lesser extent 17 alpha-hydroxylase (IC50 10 microM) and 11 beta-hydroxylase (IC50 15-40 microM). Therefore, ketoconazole in vivo most potently suppresses androgen secretion and only to a lesser extent cortisol biosynthesis. Several therapeutic trials with ketoconazole treatment in patients with pituitary Cushing's disease showed various remission rates between 30 and 90%. In contrast, in almost all patients with benign, primary adrenal Cushing's syndrome cortisol levels were normalized. In patients with ectopic ACTH syndrome ketoconazole was effective in about 50% of all reported cases, while cortisol hypersecretion due to adrenocortical carcinoma was only rarely inhibited by ketoconazole. The main side effect of ketoconazole treatment was liver toxicity which occurred in 12% of all treated patients. In contrast to ketoconazole, the narcotic drug etomidate shows a strong inhibitory effect on 11 beta-hydroxylase (IC50 0.03-0.15 microM) but only a weak inhibition of 17,20 desmolase (IC50 380 microM). This correlates with in vivo studies where even low, non-hypnotic doses of etomidate induced a pronounced fall in serum cortisol levels in normals and in patients with Cushing's syndrome. However, its clinical use is limited by its mandatory intravenous application and its sedative effects. In conclusion, ketoconazole remains the only available steroid-inhibitory drug for a therapeutic trial in patients with Cushing's syndrome who cannot be treated definitively by surgery.

8043486

Specific steroid response from a nonspecific DNA element.

A fundamental dilemma of steroid hormone regulation is how specific transcription is attained in vivo when several receptors recognize the same DNA sequence in vitro. We have identified an enhancer of the mouse sex-limited protein (Slp) gene that is activated by androgens but not by glucocorticoids in transfection. Induction requires a consensus hormone response element (HRE) and multiple auxiliary elements within 120 base pairs. Androgen specificity relies on a dual function to augment androgen but prevent glucocorticoid action from a site that both receptors can bind. The nonreceptor factors are the dominant force in transcriptional specificity, although HRE sequence variations can affect the stringency and magnitude of hormonal response. The effect of HRE variations suggests that receptor position is altered relative to the other factors. Thus protein interactions that elicit specific gene regulation are established by the array of DNA elements in a complex enhancer and can be modulated by subtle sequence differences that may influence precise protein contacts.

8043487

Cloning of ACTH-regulated genes in the adrenal cortex.

To search for genes that are induced by ACTH in adrenocortical cells, we screened adrenal cortex cDNA libraries by a differential hybridization method using cDNA probes representing mRNAs from cells with or without ACTH stimulation. Forty clones were identified as ACTH induced (yielding a frequency of about 1/2500 plaques screened), and two clones as ACTH repressed. The cDNAs isolated and sequenced include nuclear genes for microsomal steroidogenic enzymes and novel proteins of yet unidentified functions, and mitochondrial genes encoding subunits of oxidative phosphorylation enzymes. Northern blot analysis of RNA from cells stimulated with ACTH confirmed the induction of these genes by ACTH, yet revealed important differences in the relative responses of the respective mRNAs. The time courses showed the major increase in the initial 6 h; and a decline after 24-36 h. The enhancement of the levels of the mRNAs could be ascribed to transcriptional activation. Since the mitochondrial genome is transcribed as a single polycistronic unit, to account for the > 20-fold differences in the levels of the mitochondrial mRNAs it is necessary to invoke differential stabilities of these mRNAs. The synchronous increase in the expression of both the steroidogenic enzymes and the mitochondrial oxidative phosphorylation system subunits, provides evidence for coregulation of steroidogenic and energy producing capacities of adrenal cells to meet the metabolic needs of steroid hormone production. Suppression of beta-actin gene expression may be related to changes in actin polymerization during ACTH-dependent cytoskeletal reorganization.

8043484

[The beneficial effects of immunostimulating and antiviral therapy on ophthalmic zona].

A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulating treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed.

8043485

Comparative study on some systemic humoral and cellular immune markers in only HIV or HIV and hepatitis B infected children.

Three different groups of asymptomatic children, aged from 12 to 24 months (30 subjects per each group), i.e. controls, only HIV, or HIV/hepatitis B virus (HBV) double infected, were studied, as concerned the following systemic immune parameters: immunoglobulin (IgG, IgM, IgA, IgD) levels; absolute numbers of blood CD+4, CD+8, CD+16 and CD+19 cells; phytohaemagglutinin (PHA)-blast responsiveness of T lymphocytes; natural killer (NK) cell activity--as tested by means of cytotoxicity assays; per cent suppression of PHA-dependent T cell blastogenesis in the presence of concanavalin A (Con A) selected T suppressor (Ts) cells. On the other hand, in 15 ARC-shifting cases belonging to HIV, and HIV/HBV groups, respectively, a second serum sample was collected and searched comparatively with the corresponding first serum sample, as regarded: presence of total and anti-p24 HIV antibodies, patterns of Western Blot (WB), as well as amounts of free p24-HIV antigen. In asymptomatic double HIV/HBV infected subjects, some immune disorders occurred, at a more significant degree, as compared to only HIV-infected. Once the shift toward ARC being installed, in both infected groups a decrease of anti-p24 HIV antibody presence, disappearance of corresponding band in WB confirmation test, as well as presence of free p24 antigen in serum, were noticed. However, greater amounts of p24 antigen in HIV/HBV infected, as compared to only HIV infected patients, were found. Some considerations about diagnostic and predictive value of presented data are discussed.

8043483

[A seroprevalence study of the hepatitis C virus among multiply transfused patients].

A study was conducted on 61 polytransfused patients, 24 patients submitted to long lasting parenteral treatments, 116 blood donors and 132 controls. Immuno-enzymatic tests were used for detection of antibodies against hepatitis C virus (HCV). They were found in 56 (91.8%) out of the 61 polytransfused patients, in 5 (4.3%) of the donors, in 5 (20.8%) of the patients with multiple treatments and in 5 (3.7%) controls. The VHB markers were detected at variable rates in all investigated groups. The high rate of seropositivity indicates that hepatitis C is becoming an important public health problem in Romania.

8043482

[The immunochemical therapy of warts and growths due to the papillomavirus].

A complex immuno-chemical treatment (immuno-stimulation, blockage of virus replication, interferon induction) was applied to 23 patients with warts and vegetations with various localisations. Results confirmed the treatment efficiency.

8043481

[Membrane microviscosity in cell-virus systems].

The use of fluorescent probes for the appraisal of microviscosity properties of cell membranes, both inside the lipid double layer and/or near the double layer surface, are today an usual tool in cell biology. In the present paper an attempt was made to establish if there are significant changes in the mechanical properties of the host cell membranes.

8043479

[The pathomorphological aspects of arteriopathies associated with viral and microbial infections].

Presence of Mycoplasma, Chlamydia, Rickettsia burnetii, influenza type B, herpes and adenoviruses was detected by immunofluorescence in artery fragments collected from patients with arteriopathy. Pathohistological examination of the samples revealed inflammatory--lympho-histiocytic infiltration--and mostly dystrophic alterations. Arteriopathies were localised mostly at the pelvic limb level, especially on femoral artery. Their incidence was statistically significant.

8043480

Epidemiological, viral and serological studies concerning the evolution of some acute respiratory diseases between November 1992 and March 1993 in nine districts of the south-east area of Romania.

Viral and serological studies led to the conclusion that parainfluenza type 3 and influenza type A(H3N2) viruses were the most implicated in the etiology of acute respiratory diseases (ARD), viral pneumonia and clinical influenza in nine districts of the south-east area of Romania during the November 1992--March 1993 period. Epidemiological survey pointed on the 0-1 year group of age as the most affected by the above mentioned respiratory diseases.

8043477

[The mechanism of the antiherpetic action of an aqueous propolis extract. II. The action of the lectins of an aqueous propolis extract].

The report brings proofs of the presence of a lectin in the water propolis extract. It was detected in human fibroblast extracts previously treated with the propolis extract. Presence of the lectin was confirmed by polyacrylamide gel electrophoresis in the presence of SDS.

8043478

[The incidence of HBsAg in different population groups of Moldavia in 1991 compared to 1973].

AgHBs incidence in various population groups from the Iaşi region was relatively high in 1991, ranging from 3.8% in blood donors to 75.0% in patients with severe acute virus hepatitis. As compared to the incidence values recorded in 1973, 18 years ago, in the population of the same territory, some mutations were observed, the most important being the more then threefold reduction of the AgHBs incidence in blood donors. In subjects with liver diseases and in risk groups, the frequency of AgHBs carriers maintains at a high level.

8043476

Yellow fever outbreak in Ipetu-Ijesa: response after mass vaccination.

An outbreak of yellow fever in Ipetu-Ijesa, Nigeria, was confirmed by serological test and virus isolation. Serologically testing of subjects 12 weeks after an emergency mass vaccination following the outbreak showed a high degree of cross reactivity between yellow fever virus and seven other group B flaviviruses. There was no significant difference in the prevalence of neutralizing antibodies to yellow fever vaccine and wild virus among the vaccinated subjects. These findings are attributed to the probable hyperactivity and an all time exposure to yellow fever virus in circulation in the studied area.

8043475

Mathematical model for the AIDS epidemics evolution in Romania.

The individuals are distributed in 9 risk groups (adults and children), in which an HIV transmission way is predominant. Taking into account a simplified graph of the HIV infection evolution, kinetic equations for the number of individuals from each risk group--situated in various stages of HIV infection--are written. The approximative solutions of these equations give us: the characteristic exponents of the temporal evolutions of the main and secondary local epidemics; the ratios Ci/Bi and Di/Bi of asymptomatically contaminated and dead (as consequence of AIDS) versus symptomatically contaminated; the onset of local epidemics in various risk groups; the relative amplitude of the secondary local epidemics versus the main local ones.

8043474

[Moroxidine, an antiviral used for the treatment of zona (herpes zoster)].

Treatment with moroxidine, Romanian preparation with virustatic effects, was applied in 350 patients with different localisation herpes zoster lesions. Treatment had good effects, especially when it was applied early.

8043470

[The recent data on the viral origin of hairy leukoplakia of the oral cavity (OHL)].

Buccal hairy leukoplakia is associated with Epstein-Barr and HIV virus infections. The main symptom is the characteristic hairy lesion on side parts of the tongue without any other clinical signs. Histologically, there are hyperkeratosis, vacuolar degeneration, and presence of Candida, but no inflammatory infiltration. Antiviral drugs led to the regression of lesions, but there is a trend to relapse when treatment is interrupted.

8043468

[A library of procedures in LOTUS 1-2-3 for the rapid processing of laboratory data].

A series of MACROS have been drawn in order to eliminate the steps between the initial data and the final results. There are described more than 20 groups of MACROS for general mathematical operations and statistical works (t and chi-square tests, which are interpreted). Besides mentioning the input data, there are given details on reading the output results. The method described here can be used to easily develop this MACRO library, by adding new MACROS which should respond exactly to the specific data processing operations of each laboratory. Examples with data from the virology laboratory show using of these MACROS by any user, even those having a minimum knowledge about LOTUS 1-2-3 or about data processing.

8043466

Lymph node metastasis in medulloblastoma.

A 14-year-old boy was diagnosed as having a medulloblastoma in the posterior fossa. Radiation therapy was given and the patient made a good recovery. Three months later he presented with supraclavicular lymph node metastasis, in the absence of other foci of metastases. He was treated with 60Co and the metastasis decreased. Two months later a bone scan and bone marrow aspiration showed bone metastasis. He was started on chemotherapy. The different possible mechanisms of metastasis are discussed.

8043463

Psychosocial adjustment in long-term survivors of childhood medulloblastoma and ependymoma treated with craniospinal irradiation.

Improved prognosis for pediatric brain tumors has stimulated research into the quality of life of survivors. To assess cognitive function and psychosocial and family adjustment among this population, 18 long-term survivors of childhood medulloblastoma or posterior fossa ependymoma treated with surgical resection and craniospinal irradiation were interviewed and administered achievement tests and psychosocial questionnaires. A majority of parents reported significant difficulty caring for their child with a brain tumor, but no significant adverse effects upon the family. Academic achievement was significantly impaired in 12/18 subjects. Psychosocial adjustment was normal in 10/18 subjects. Although specific treatment variables (radiation dosage, chemotherapy, etc.) were not significantly related to these two outcome measures, impaired academic achievement was correlated with young age at diagnosis (p < 0.05) and impaired psychosocial adjustment was correlated with greater time since diagnosis (p < 0.05). Overall quality of life reported by these individuals appears to be acceptable but neuropsychological and psychosocial examination is clearly indicated as part of the follow-up program.

8043464

Staging and surveillance of children with central nervous system neoplasms: recommendations of the Neurology and Tumor Imaging Committees of the Children's Cancer Group.

Standardization of the baseline and surveillance evaluation of children with central nervous system (CNS) tumors could contribute to understanding tumor behavior, establishing prognoses, directing treatment, and interpreting multi-institutional cooperative study data. A tumor categorization schedule, based on recognized patterns of CNS tumor behavior involving 'aggressiveness' as assessed by the likelihood for neuraxis dissemination, relative time to progression and pattern of disease recurrence is presented. Included are the most common histologic subtypes of pediatric CNS neoplasms. No attempt has been made to include all histologic subtypes of pediatric CNS neoplasms. Using this categorization as a framework, recommendations are suggested for baseline evaluation at diagnosis and in surveillance.

8043462

Management of hydrocephalus in children with medulloblastoma: prognostic factors for shunting.

Patients with medulloblastoma frequently present with hydrocephalus. While not all patients with medulloblastoma will continue to suffer from hydrocephalus after tumor resection, there is a significant proportion who will require a permanent shunt. We have retrospectively reviewed a group of children with medulloblastoma not shunted preoperatively, and have identified several characteristics which are associated with a requirement for permanent shunt. We studied 42 patients and found that 17 patients (40%) required permanent shunts within 4 weeks of craniotomy. The shunted patients were younger (5.4 +/- 2.9 vs. 10.0 +/- 5.7 years; p < 0.01), had larger ventricles (p < 0.05), and had more extensive tumors (Chang's stage T3 and T4; p < 0.01). These variables were all independently significant. In addition, we found that the patients requiring postcraniotomy shunts had a much higher rate of morbidity including a postoperative pseudobulbar syndrome. Of interest, we found that none of our patients without the above characteristics required a shunt. In particular, we found that no patient older than 10 years required a shunt. Thus, we conclude that younger patients with moderate to severe preoperative hydrocephalus and extensive tumors may benefit from perioperative CSF diversion. Other patients not meeting the above criteria can probably be safely managed with perioperative corticosteroids alone.

8043461

Subependymal giant cell astrocytomas in children.

Between 1977 and 1991, at the Children's Hospital of Philadelphia, 10 patients, 5-16 years of age, were diagnosed as having subependymal giant cell astrocytomas. These patients accounted for 1.4% of all pediatric brain tumors seen during that time interval. One patient received a course of radiation therapy, which was ineffective in preventing tumor growth. All underwent surgical resections with the goal being maximal tumor debulking, if not complete resection. In 6 patients this was accomplished by the frontal transventricular route and, in the more recent patients, surgery was performed using a transcallosal approach. There were 2 perioperative deaths, and 2 other patients died later of causes unrelated to tumor progression. The remaining 6 patients remain alive and stable at a mean of 6.7 years of follow-up (range 1.8-12.4). None of these patients has received additional radiation therapy. Two patients have no other evidence of tuberous sclerosis. The use of modern radiographic and surgical techniques has made the treatment of this disease safer than in the past.

8043460

Quality of survival among children treated for brain stem glioma.

In order to describe the status of long-term survivors of brain stem glioma, neuropsychological and behavioral measures were obtained a median of 2.5 (range 1.5-5.6) years after diagnosis from 16 survivors of 51 consecutively diagnosed children with brain stem glioma between 1983 and 1991. Among 11 children with dorsally exophytic tumors, 7 were treated with surgery alone (SRG) and 4 received conventionally fractionated local cranial radiation therapy (CFRT; 54-56 Gy) to the brain stem following surgery, 3 of these because of recurrent disease. Five others with diffusely infiltrative brain stem tumors received hyperfractionated radiation therapy (HFRT; 70.2 Gy) to the brain stem; 4 following biopsy or limited resection and 1 without prior surgery. IQs of children in the CFRT (mean 89, SD 24.4) and HFRT (mean 85, SD 12.7) groups were not significantly different. Children in the SRG group had significantly higher IQs (mean 100, SD 11.0) and fewer neurologic deficits than those who had received CFRT or HFRT. However, after statistically controlling for severity of neurologic deficits, treatment had no effect on IQ. The severity of residual neurologic deficits accounted for 42% of the variance in IQ scores; children with fewer neurologic problems scored higher. Additional studies are required to evaluate the potential neuropsychological benefits of equivalent total doses of HFRT compared to CFRT.

8043459

Hyperfractionated irradiation and concurrent cisplatin in brain stem tumors: a Pediatric Oncology Group pilot study (9139).

A phase I Pediatric Oncology Group Study was performed combining 7,020 cGy hyperfractionated irradiation (117 cGy twice daily separated by 6 h) with increasing concurrent doses of cisplatin given with the intent of radiosensitization as treatment for children with newly diagnosed brain stem tumors. Cisplatin was infused over 120 h on weeks 1, 3, and 5 during a 6-week radiotherapy course. The following cisplatin dose levels were studied: (1) 50 mg/m2/120 h, (2) 75 mg/m2/120 h and (3) 100 mg/m2/120 h. Sixteen of 17 children completed therapy. One child expired after 2 days of treatment secondary to massive intratumoral hemorrhage. At cisplatin dose level 3 (100 mg/m2/120 h), grade 2-4 myelosuppression was encountered in 3 of 5 evaluable patients. Otherwise, no other excessive toxicities, including renal and ototoxicity, were noted.

8043457

A comparison of the sensitivity of blood and bone marrow for the detection of minimal residual disease in chronic myeloid leukaemia.

We have sought to determine whether peripheral blood or bone marrow is more sensitive for assessment of minimal residual disease in chronic myeloid leukaemia (CML). Contemporaneous blood and marrow specimens were taken from 21 patients at various times after allogeneic bone marrow transplant (BMT) and from one patient in complete cytogenetic remission on alpha-interferon. Samples were analysed for evidence of BCR-ABL mRNA by RT-PCR: four were PCR negative and 19 PCR positive. Results with blood and marrow were concordant in all cases. BCR-ABL transcripts were quantified in PCR-positive samples using a competitive PCR titration assay. Results ranged from < 10 to 2 x 10(6) BCR-ABL transcripts/micrograms RNA. In all 19 cases a high degree of concordance in BCR-ABL levels with blood and marrow (r = 0.99) was found. We conclude that either tissue may be used for residual disease studies after BMT for CML.

8043456

Successful use of all-trans retinoic acid in acute promyelocytic leukaemia presenting during the second trimester of pregnancy.

The development of acute leukaemia in pregnancy is a rare event, with an estimated incidence of 0.9-1.2 cases per 100,000 per year and with the majority of cases occurring in the second and third trimesters. We report a case of acute promyelocytic leukaemia (APL) developing during the second trimester of pregnancy which was successfully treated with all-trans retinoic acid (ATRA) resulting in a complete morphological remission.

8043455

A randomized trial comparing vinblastine in slow infusion and by bolus i.v. injection in idiopathic thrombocytopenic purpura: a report on 42 patients.

Forty-two patients with ITP were randomly allocated to vinblastine slow infusion or bolus injection. 16/21 patients (76%) receiving slow infusion of vinblastine and 14/21 patients (67%) receiving a bolus injection of vinblastine had a response. There was no superiority of slow infusions of vinblastine over intravenous bolus injections, either when recently diagnosed and chronic ITP were analysed together or separately. In our opinion, intravenous bolus injections of vinblastine might be preferred, because they are easier to perform and have a better local tolerance.

8043454

Elevation of serum M-CSF concentrations during pregnancy and ovarian hyperstimulation.

Macrophage colony stimulating factor (CSF-1 or M-CSF) is involved in haemopoiesis and probably in mouse gestation. Sexual steroids induce its production by uterine glandular epithelial cells and its receptor (product of the protooncogene C-FMS) is expressed on placental trophoblastic cells. We measured M-CSF serum levels in 119 pregnant women and in eight women undergoing ovarian hyperstimulation for in vitro fertilization. M-CSF increased early (4-8 weeks) and progressively during gestation. Its rapid elevation during the course of ovarian hyperstimulation suggests that its synthesis is probably induced by sexual steroids. This locally produced M-CSF could play a role in human pregnancy and in the pathogenesis of thrombocytopenias observed during pregnancy.

8043453

Raised urinary calmodulin levels in idiopathic myelofibrosis: possible implications for the aetiology of fibrosis.

Platelet growth factors (e.g. PDGF and TGF-beta) are thought to be pathogenetically important in the stromal reaction characteristic of idiopathic myelofibrosis (IM). We have investigated a possible pathogenetic role for a further platelet mitogen, calmodulin. Platelets are rich in calmodulin, of which 30-40% is releasable with a time course that differs from alpha-granule proteins. In IM urinary calmodulin concentrations were 3-fold those of the normals controls. We suggest that an abnormal release of calmodulin may occur from platelets/megakaryocytes in patients with IM, and that calmodulin should be considered, along with other growth factors, in the pathogenesis of marrow fibrosis.

8043452

Aggressive natural killer cell leukaemia/lymphoma in two patients with lethal midline granuloma.

We report two patients with leukaemic proliferations of large granular lymphocytes. The immunophenotype study showed that the leukaemic cells were positive for CD2, CD38, CD56 and anti-HLA-DR monoclonal antibodies and negative for other T-cell (CD3, CD4, CD8) and B-cell markers (CD19, CD20 and surface immunoglobulins). The clinical course was acute and a diagnosis of aggressive natural killer cell leukaemia/lymphoma was made. No clonal rearrangements of either C beta T-cell receptor or JH immunoglobulin genes were found. Functional studies done in one patient demonstrated non-restricted cytotoxic activity after activation with IL-2. Lethal midline granuloma had been previously diagnosed in both patients. A possible relationship between this entity and the natural killer cell leukaemia is discussed.

8043451

Uncommon clinical presentation of a lymphocytic lymphoma of intermediate differentiation in a patient with systemic sclerosis.

The association of systemic sclerosis (SSc) and non-Hodgkin lymphoma is a rare event and its pathogenetic mechanism remains to be clarified. We describe a previously unreported association of SSc with a lymphocytic lymphoma of intermediate differentiation (IDL), involving the gastrointestinal tract, gallbladder and one salivary gland. Whereas the morphological, immunological and cytogenetic features were typical of IDL, the extensive extranodal involvement and the association with an autoimmune disorder were suggestive of two other lymphomas of mantle lineage: mucosa-associated lymphoid tissue (MALT) lymphoma and monocytoid B-cell lymphoma (MBCL).

8043450

alpha-Interferon in myelofibrosis: a case report.

A patient with advanced myeloid metaplasia was treated with alpha-interferon (29 months) with a remarkable response. He had anaemia, thrombocytopenia and hepatosplenomegaly with infarction. The initial bone marrow showed replacement with fibrosis with no evident haemopoietic cells. Post-therapy, the patient became asymptomatic, transfusion independent and had normal blood counts. The repeat bone marrow was 30% cellular with 1 + reticulin and no fibrosis. Treatment was well tolerated without appreciable side-effects. These results indicate that prolonged therapy with alpha-interferon can improve haemopoiesis and reverse marrow fibrosis.

8043449

Graft-derived anti-HPA-2b production after allogeneic bone-marrow transplantation.

We report on a male who received a bone-marrow allograft from his HLA identical sister for acute myelogenous leukaemia. After transplantation, the patient suffered from refractoriness to the transfusions of HLA-matched platelets and a strong platelet-specific antibody, anti-HPA-2b, of IgG1 subclass was demonstrated in the patient's serum. In the serum of the bone-marrow donor a weak IgG1 anti-HPA-2b was demonstrated. IgG allotyping of the patient and donor showed identical results. We could not determine the origin of the anti-HPA-2b, although we hypothesize that the anti-HPA-2b was produced by immunocompetent donor lymphocytes infused with the suspension of bone-marrow cells.

8043448

A successful pregnancy after bone marrow transplantation for severe aplastic anaemia with pre-transplant conditioning of total lymph-node irradiation and cyclophosphamide.

Pregnancy after bone marrow transplantation (BMT) for severe aplastic anaemia (SAA) is now an encouraging reality. We present a successful pregnancy, 4 years after BMT for SAA, in a woman being immunosuppressed before transplantation with cyclophosphamide and total lymph-node irradiation (TLI). No fetal complication was diagnosed.

8043447

Binding and uptake of exogenous isoferritins by cultured human erythroid precursor cells.

The interaction of extracellular human isoferritins with normal erythroid precursors developing in a two-phase liquid culture was studied. Cells at the stage of polychromatic normoblasts exhibited substantial specific binding of radioiodinated placental isoferritins. Considerably more acidic isoferritin was bound than basic isoferritin. The binding of ferritin was significantly higher at 37 degrees C than at 4 degrees C. All of the 125I-acidic isoferritin bound at 4 degrees C, but only part of that bound at 37 degrees C, could be dislodged by the addition of 500-fold excess of non-labelled acidic isoferritin. Acidic isoferritin displaced radio-iodinated acidic isoferritin from the erythroid cells more efficiently than intermediate or basic isoferritins. Kinetic analysis suggests a dissociation constant (Kd) of 3.9 x 10(-8) M for acidic ferritin and 3.7 x 10(-7) M for basic isoferritin. The average number of binding sites for acidic isoferritin was 1.3 x 10(5) per cell. The results point to specific binding and receptor-mediated internalization for predominantly acidic isoferritin by developing human erythroid cells.

8043446

Erythrocyte deformability has no influence on the rate of erythrophagocytosis in vitro by autologous human monocytes/macrophages.

Erythrocytes with decreased deformability are known to be rapidly removed from the circulation by splenic macrophages. The exact mechanism is, however, not well understood. We have analysed the phagocytosis of less-deformable erythrocytes by macrophages in vitro. Human monocytes/macrophages were isolated from peripheral blood and cultured for a total time of 6 h at 37 degrees C with 5% CO2. Autologous erythrocytes of the rhesus positive donor were rigidified by heat treatment (47 degrees C for 1 h). The change in erythrocyte deformability was assessed with a filter aspiration technique; the membrane elastic modulus was found to be increased about 2.5-fold. For controls, untreated erythrocytes and erythrocytes incubated with anti-RhD-antibodies were prepared. The rate of phagocytosis during 2 h at 37 degrees C and 5% CO2 was 0.74 +/- 0.59 (erythrocytes per monocyte/macrophage) for controls, 3.58 +/- 2.72 for anti-RhD-loaded erythrocytes and 0.82 +/- 0.74 for heat-treated erythrocytes, respectively. We conclude that decreased erythrocytes deformability does not cause an increased rate of phagocytosis by monocytes/macrophages compared to normally deformable erythrocytes in our in vitro model. This suggests that the preferential removal of rigid cells in vivo is probably not a specific process, but is due to the increased splenic transit time of rigid erythrocytes and hence longer interaction time between erythrocytes and phagocytes.

8043445

Avascular necrosis of bone after allogeneic bone marrow transplantation: clinical findings, incidence and risk factors.

In the present study we describe the incidence, clinical course, and management of avascular necrosis of bone following allogeneic bone marrow transplantation, and identify risk factors related to its development. All patients developing avascular necrosis of bone after allogeneic bone marrow transplantation between January 1974 and September 1992 were included in the analysis and were studied using the Hôpital Saint Louis Bone Marrow Transplant Database and hospital records. 27/727 allogeneic transplant recipients developed avascular necrosis leading to an 8.1% incidence at 5 years, by product limit estimate, ranging from 5% to 11.2%. Symptoms developed 119-1747 d (median 398 d) after transplantation. In these 27 patients a total of 52 joints were affected (mean 1.92 per patient, range 1-7). The hip joint was most often affected (69% of patients). All patients had joint pain that led to diagnosis by means of standard radiographs with or without the help of technetium-99 scans and/or magnetic resonance imaging. All but three patients received steroid therapy for acute graft-versus-host disease. Among 10 factors tested, three were shown to be significantly linked to an increased risk for developing avascular necrosis by multivariate analysis: male gender (relative risk (RR) 4.72, P = 0.002), age older than 16 (RR = 3.87, P = 0.004), and acute graft-versus-host disease requiring steroid therapy (RR = 6.30, P = 0.0002). 10 patients (37%) required joint replacement within 19 months (range 2-42) following diagnosis of avascular necrosis. In conclusion, avascular necrosis of bone is a frequent late complication of allogeneic bone marrow transplantation causing significant morbidity and requiring replacement surgery in one-third of affected patients. In this 18-year single-centre survey, older age, male gender and steroid therapy given for acute graft-versus-host disease were shown to independently increase the risk of avascular necrosis of bone.

8043444

In situ hybridization for the detection of cytomegalovirus in blood or bone marrow leucocytes after allogeneic bone marrow transplantation.

We report a study of CMV detection by a nonradioactive in situ hybridization (ISH) technique using a biotinylated CMV-DNA probe. The method was applied to blood and bone marrow cells and its results were compared with those of other currently used techniques. First, we analysed peripheral leucocytes on blood donors, and, after comparison with PCR, we obtained 75% sensitivity and 87% specificity rates. We then studied four BMT recipients during the first 105 d post-transplant. A positive signal was detected as a predominantly nuclear staining. The detection of an ISH-positive signal occurred at least 8 d before CMV isolation from viral culture. The number of positive cells was variable according to the patients' clinical evolution, showing a dramatic increase of labelled cells in viraemic patients and then a decrease until complete disappearance of labelled cells when an efficient anti-viral treatment was initiated. This study suggests that the detection of CMV-DNA by ISH performed on peripheral leucocytes is a valuable tool for the early diagnosis of CMV infection and could lead to the initiation of optimal ganciclovir treatment.

8043443

Molecular defects in CRM+ factor VII deficiencies: modelling of missense mutations in the catalytic domain of FVII.

The molecular defects causing CRM+ factor VII deficiency were investigated in seven unrelated subjects and several members of their families. Four missense mutations located in the catalytic domain of factor VII were found. The previously reported 304Arg-->Gln substitution was present in the homozygous and heterozygous forms, with different polymorphic haplotypes, thus demonstrating that it is recurrent and frequent in the Italian population. The 310Cys-->Phe substitution was found in the homozygous form and in the compound heterozygous condition with the nonsense mutation 356Trp-->stop. Two missense mutations, 298Met-->Ile and 342Gly-->Arg, were found in the homozygous and in the heterozygous condition respectively. Molecular heterogeneity was further increased by finding of the 353Arg-->Gln polymorphism in the doubly heterozygous condition with the 304 and 342 mutations. Plausible explanations for loss of FVII function were found by inspecting a model of the serine protease domain of factor VIIa. Inefficient activation of the catalytic site is predicted for 298Met-->Ile. 342Gly-->Arg would directly distort the geometry of the 'oxyanion hole' preventing formation of a substrate enzyme intermediate. 310Cys-->Phe is predicted to have an adverse effect on tissue factor interaction. These mutations point to important regions of the factor VII molecule.

8043442

A novel haemophilia B defect due to partial duplication of the factor IX gene.

A patient with mild FIX deficiency was found to have partial duplication of the 3' region of the gene, giving, in addition to the a normal gene, another piece of DNA containing exons 5', 6', 7' and 8' and the intervening sequences. Cloning and sequencing of the junction region revealed that crossover occurred at nt 31927 in the 3' untranslated region of one chromosome/chromatid and nt 10640 in intron 4 of the other. No homology or topoisomerase specific sequences were observed in the crossover region. PCR and sequencing of illegitimate FIX transcripts from the patient's lymphocytes showed at least three different species of mRNAs. Translation of two of these 'novel' mRNAs should result in truncated proteins. Possibilities for the splicing of the mature mRNA are offered to explain the translation of a normal-size FIX protein, which was the only product demonstrated on Western blot analysis.

8043441

A comparative study of partial primary structures of the catalytic region of mammalian protein C.

Protein C (PROC) is a plasma vitamin K-dependent zymogen of a serine protease which regulates blood-clotting cascade through proteolytic inactivation of the non-enzymatic cofactors of blood coagulation, Va and VIIIa. We characterized the partial nucleotide and amino acid sequences for the catalytic domain of PROC in six mammalian species, rhesus monkey, dog, cat, goat, horse and mouse, and compared these sequences with known ones from humans, the bovine and rat. By using a pair of primers based on the nucleotide sequences from human and bovine PROC cDNA, the PROC gene fragments were enzymatically amplified from their genomic DNAs and were sequenced by the dideoxy-termination method. The cloned PROC gDNA encoded a part of the heavy chain of PROC including the lesions of active site residues corresponding to human PROC Asp-257 and Ser-360. Comparison of the sequences from these species revealed that there was a high degree of homology at the nucleotide and amino acid levels; from 69% to 96% of the amino acids in the catalytic region were identical among the nine species including humans, the bovine and rat. The locations of five Cys residues as well as the putative carbohydrate attachment sites were evolutionally conserved. All the amino acids recognized in the human abnormal PROC variants were conserved across species, suggesting their functional importance, and a comparison of the conserved residues among PROC from multiple species will provide considerable information in the investigations of PROC functions.

8043440

The role of lipids in the detection of lupus anticoagulant by the dilute Russell Viper venom test: are platelets or reagents containing hexagonal HII phases necessary?

Liposomes prepared from rabbit brain extracts (RBE) and individual pure lipids (high phosphatidyl serine content, HIPS) were compared with frozen-thawed platelets (PLTS) in the dilute Russell Viper venom time (dRVVt). While all three preparations demonstrated sensitivity to lupus anticoagulant (LA) the highest detection rate was seen with RBE. For confirmation of LA, high concentration RBE achieved the most efficient correction of the defect. Electron microscopy and particle sizing showed RBE to be small, discrete liposomes, whereas HIPS and PLTS were aggregates of larger diameter particles. Low-angle X-ray diffraction showed no evidence of hexagonal HII phase. There appears to be no specific requirement either for platelets or for reagents containing hexagonal HII phases in the dRVVt. The dRVVt can be optimized by incorporating a simple dilute rabbit brain lipid mixture for detection of LA and a concentrated mixture as a correcting reagent.

8043439

The empty sack syndrome: a platelet storage pool deficiency associated with empty dense granules.

Two sisters with lifelong bleeding tendencies were examined to determine whether their condition was associated with a platelet defect. Their platelet aggregation in response to epinephrine and collagen was abnormal, and the secretion of serotonin and ATP was markedly reduced. The platelet contents of serotonin, ADP, and ATP were all diminished and the ATP:ADP ratio was increased. Direct enumeration by whole-mount and quinacrine-fluorescence techniques demonstrated that the platelets from both sisters had significantly fewer dense granules than controls. These characteristics are similar to an individual with Hermansky-Pudlak syndrome and are consistent with a platelet dense granule deficiency. In contrast, immunofluorescence studies using an antibody against the dense granule membrane protein granulophysin suggested that both sisters had numbers of granules within the normal range. Evaluation by immunoblotting and ELISA indicated the presence of normal levels of granulophysin in the platelets from both sisters; FACS analysis demonstrated the surface expression of granulophysin under conditions of selective dense granule release. These results are consistent with these sisters having a form of dense granule storage pool deficiency where the granular membranes are present but the granules have reduced contents. This observation represents a novel form of storage pool disease which we have termed the empty sack syndrome.

8043438

Assessment of therapeutic potential of interleukin 2 for myelodysplastic syndromes.

The therapeutic potential of interleukin 2 (IL-2) for myelodsplastic syndromes (MDS) was evaluated in vitro. IL-2-induced lymphokine-activated killer (LAK) cells were prepared from 38 MDS patients and 20 normal subjects. The cytotoxicity of LAK cells against K562 and Raji cell lines and MDS blasts was significantly reduced in high-risk MDS (refractory anaemia with excess blasts (RAEB), RAEB in transformation, and leukaemic transformation of MDS), but was relatively well-preserved in low-risk MDS (refractory anaemia (RA) and RA with ringed sideroblasts). Examination of the immunophenotypes of freshly-isolated lymphocytes showed that the percentage of CD4+ cells in low-risk MDS and the percentage of CD3+, CD4+ and CD8+ cell populations in high-risk MDS was significantly reduced compared with these populations in normal subjects. After cultivation with IL-2, these three cell populations were still reduced in the corresponding MDS groups and the percentage of CD3-CD56+ cells were significantly reduced in high-risk MDS. There was a positive correlation between the percentage of K562 cells lysed by MDS LAK cells and the percentage of CD3-CD56+ lymphocytes in MDS LAK cells. These aberrant lymphocyte subpopulations appeared to explain, at least in part, the reduced LAK cell cytotoxicity in MDS. These results present a possibility that IL-2 and LAK therapies are ineffective for most high-risk MDS patients, whereas they have potential value for low-risk MDS patients whose lymphocyte cytotoxicity is usually preserved.

8043437

N-desmethylclozapine: a clozapine metabolite that suppresses haemopoiesis.

Clozapine, a novel antipsychotic drug that is particularly effective in treatment-resistant schizophrenia, causes severe agranulocytosis of unknown aetiology in approximately 0.8% of U.S. patients. We evaluated potential toxic mechanisms of drug-induced agranulocytosis. Clozapine, the two major metabolites N-desmethylclozapine and N-oxide clozapine, and five other clozapine derivatives were screened for toxicity to normal haemopoietic precursors. For all compounds except N-des-methylclozapine, toxicity to CFU-GM, BFU-E and CFU-GEMM occurred at concentrations at least 10 times the normal serum levels reported in unaffected patients. In contrast, the LD50 for N-desmethylclozapine was 2.5 micrograms/ml for CFU-GM, 3.2 micrograms/ml for BFU-E, and 2.4 micrograms/ml for CFU-GEMM, only 3-6 times the normal serum concentration. Bone marrow from patients with acute clozapine-induced agranulocytosis was not more sensitive to clozapine or N-desmethylclozapine than bone marrow from normal donors. These studies suggest that N-desmethylclozapine, the major metabolite of clozapine, is itself toxic or is further metabolized to an unstable compound which is toxic to haemopoietic precursors of both myeloid and erythroid lineages.

8043436

Characterization and modulation of drug transport kinetics in K562 c1.6 daunorubicin-resistant cell line.

The effects of cyclosporin A (CSA) and cellular energy depletion on daunorubicin (DAU) transport kinetics were investigated in a human erythroid leukaemia cell line K562 c1.6 selected for resistance to daunorubicin. K562 c1.6/DAU resistant cells displayed high levels of P-glycoprotein and a high level of multidrug resistance against several antitumour drugs. The resistance factors of K562 c1.6/DAU cells to DAU, doxorubicin, vinblastine and etoposide were 106, 114, 85 and 13 respectively. A 1.6-fold decrease (P < 0.01, n = 8) in DAU accumulation and a 4-fold increase (P < 0.001, n = 8) in DAU efflux were shown in the resistant cells when compared to K562 c1.6 drug-sensitive parental cells. K562 c1.6/DAU cells were also shown to reach a DAU saturation level (SL) 8-fold faster (P < 0.001, n = 8) than the parental cells. Addition of CSA to the resistant cells led to a dose-dependent increase in cellular DAU retention, while no such effect was observed in the sensitive cells by the introduction of CSA. Resistance to the antitumour drugs could be reduced to various extents by CSA. The patterns of changes and modulations of DAU transport kinetics, as well as chemosensitivity in K562 c1.6/DAU cells were found to be similar to a vinblastine-resistant leukaemia cell line CEM/VLB100. However, K562 c1.6/DAU cells were more resistant to DAU, doxorubicin and etoposide than the CEM/VLB100 cells. An increase in DAU accumulation, intracellular SL and the time to reach 90% saturation level (SL90), and a decrease in DAU efflux in the resistant but not the sensitive cells were found in response to ATP depletion by sodium azide. These effects could be completely reversed by addition of glucose. Our results suggest that the presence of an energy-dependent effluxing mechanism responsible for the decreased drug accumulation and enhanced drug efflux may make a major contribution to the mechanism of resistance in K562 c1.6/DAU resistant cells.

8043434

Lack of restricted T-cell receptor beta-chain variable region (V beta) usage of reactive T-lymphocytes in Hodgkin's disease.

T-cell response against tumour-associated antigens is mediated by the TCR complex. To determine a possibly restricted TCR-V beta repertoire in reactive T-lymphocytes in Hodgkin's disease (HD), 20 cases (of which 10 were EBV-positive cases) were investigated using 14 monoclonal antibodies (MoAbs) recognizing 11 different TCR-V beta region family products and Northern blot analysis with cDNA probes specific for mRNA transcripts of 11 V beta families that were not detectable by MoAbs. Four V beta families (V beta 5, V beta 6, V beta 8, V beta 19) were investigated using both immunohistochemistry (IHC) with anti-V beta MoAbs and Northern blot analysis. Immunohistochemical and Northern blot findings were correlated with the detection of the Epstein-Barr virus (EBV) genome in Hodgkin's and Reed-Sternberg cells (H-RS). The non-neoplastic lymphocytes in HD were predominantly of T-phenotype (CD3+). Most of these cells were TCR-alpha beta+ (beta F1+) and only a few T-cells were reactive for TCR-delta 1 antibody (TCR-gamma delta+). In the majority of cases helper/inducer T-cells (CD4+) outnumbered suppressor/cytotoxic T-cells (CD8+). Labelling of these samples with the panel of 14 anti-V beta MoAbs showed that only a small percentage (0.2-5.5%) of beta F1+ lymphocytes were positive with each of these MoAbs. The proportion of these cells was comparable to that seen in normal tissues. Most TCR V beta+ cells were randomly distributed, but in virtually all cases occasional V beta+ cells pertaining to the various V beta families were seen in close contact to H-RS cells. Using total RNA extracted from malignant and normal tissues, no visible band was detected with the various V beta probes. As determined in the present study, the percentage of T-cells expressing a given V beta family must be > or = 10% to be detected with Northern blot. Thus, the percentage of V beta+ cells expressing V beta families which were explored only with Northern blot were within the same range as those of the 11 different TCR-V beta region families assessed with IHC, i.e. 1-10% of lymphoid cells. The results of the present study show that in HD there is no restricted T-cell V beta repertoire usage regardless of the detection of EBV. In addition, since the various V beta families are represented in T-cell subpopulations forming rosettes around H-RS cells, we conclude that the T-cells attracted by H-RS cells constitute a polyclonal population.

8043435

Decreased retinoblastoma protein expression in acute myeloblastic leukaemia is associated with the autonomous proliferation of clonogenic blasts.

We have previously shown that blasts from some patients with acute myeloblastic leukaemia (AML) grow autonomously in vitro and that this growth pattern is related to the production of autocrine growth factors including granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-1 beta. However, another potential mechanism of autonomous growth involves the deletion of growth inhibitory molecules. One such inhibitory protein is the product of the retinoblastoma (Rb) gene which is expressed in normal haemopoietic cells and functions in cell cycle control and as a transcriptional repressor. Deletion of the Rb gene has been reported in various types of malignancy. We have examined the expression of the Rb gene product in blasts from 39 patients with AML by Western analysis. Using an antibody, Rb (Ab-2) which recognizes the C-terminal region, 11/39 samples (28%) failed to express Rb protein. The results of the Western blot analysis were confirmed by flow cytometry using a second antibody, Rb (Ab-1), against residues 300-380 of the Rb protein. Samples from seven of the 11 Rb-negative cases were studied for the expression of Rb mRNA; Rb mRNA was absent in four and three cases were positive. Analysis of the growth characteristics of these cells showed that blasts from 24/39 cases (62%) had partially or totally autonomous growth in a blast cell colony assay. Of these 24 samples with autonomous growth, 10 (41%) were Rb protein negative; in contrast, of the 15 cases with non-autocrine growth only one was Rb protein negative (7%, P < 0.05). Also, in Rb positive blasts, suppression of Rb protein production using an antisense oligonucleotide significantly increased proliferation of clonogenic AML blasts, confirming that the Rb protein acts as a negative regulator of growth in AML blasts. Our data suggest that deletion of Rb protein expression is frequently found in AML and is associated with the acquisition of autocrine growth characteristics, possibly as the consequence of derepression of genes involved in growth control and cytokine production.

8043433

Clonal history of a human follicular lymphoma as revealed in the immunoglobulin variable region genes.

The variable region genes used to encode the immunoglobulin expressed by tumour cells of a patient with follicular lymphoma have been identified and sequenced. Initially, a lymph node biopsy was analysed and revealed usage of VH and V kappa genes which had numerous substitutions as compared with the closest germ line genes. The pattern of mutations in VH was consistent with a role for positive selection by antigen. In addition, there was evidence in both VH and V kappa sequences for clonal heterogeneity. After 5 years, which included treatment with chemotherapy, the patient relapsed with tumour cells present in the blood. Analysis of the V-genes used by the emerging tumour revealed a single homogeneous sequence for both VH and VL, which, in each case, matched closely one of the sequences in the original lymph node biopsy. These results indicate that selection, possibly mediated by antigen, can operate on a cell destined to give rise to lymphoma, and that intraclonal variation can occur after the neoplastic event. However, in this case, late relapse in the blood is dominated by a single clone.

8043432

Regulation of transcription factors NF kappa B and AP-1 following tumour necrosis factor-alpha treatment of cells from chronic B cell leukaemia patients.

Malignant B lymphocytes from patients with B-chronic lymphocytic leukaemia (B-CLL) or hairy cell leukemia (HCL) are refractory in vitro to mitogenic stimulation by several agents which trigger proliferation of normal B cells. Tumour necrosis factor (TNF) is a growth factor for these malignant cells, although the proliferative response is usually small. TNF regulates some of its cellular responses via induction of the transcription factors NF kappa B and AP-1 (jun/fos). The induction of NF kappa B by TNF is mediated via a novel signalling pathway involving the generation of reactive oxidative intermediates. Induction of jun and fos proteins (polypeptide components of AP-1) are mediated via pathways involving protein kinase C and the protein kinase encoded by the raf proto-oncogene. Here we have used an electrophoretic mobility shift assay to show that TNF induced NF kappa B in malignant cells isolated from 3/3 HCL and 15/15 B-CLL patients. By contrast, phorbol myristate acetate (PMA), a direct activator of protein kinase C, failed to activate this transcription factor in 1/1 HCL and 5/5 B-CLL isolates. The induction of jun and fos proteins (as detected by Western blot analysis) showed greater heterogeneity. Nuclear jun was induced by TNF in 5/12 chronic B cell leukaemia isolates. PMA induced this protein in 4/5 samples. Nuclear fos was induced by TNF in only 2/12 isolates and by PMA in 2/5. The data suggest that the pathways for the activation of jun and fos by TNF are defective in some B-CLL and HCL cells and that these defects may be heterogeneous. The induction of AP-1 is crucial in securing the mitogenic response to TNF. It is therefore plausible that these lesions may contribute to the refractory nature of B-CLL and HCL cells to proliferative stimuli in vitro.

8043430

Immunodeficiency and IL-6 production by peripheral blood monocytes in multicentric Castleman's disease.

To study the pathogenesis of multicentric Castleman's disease (MCD), IL-6 producing cells and immune function were investigated in four MCD patients. The expression of IL-6 mRNA in one MCD lymph node was analysed by in situ hybridization. IL-6 mRNA expressing cells were scattered in the interfollicular areas and did not resemble plasma cells. Spontaneous IL-6 production was detected in the culture supernatants of peripheral blood mononuclear cells (PBMNC) from four patients. The IL-6 producing cells among the PBMNC were found to be monocytes by both in situ hybridization and immunohistochemistry. We evaluated immune function in four MCD patients. These studies show: (1) a negative PPD skin test in 3/4 patients, (2) decreased IL-2 production in 3/4 patients, (3) decreased T cell colony formation in 3/4 patients, (4) decreased NK activity and NK cell number in 2/4 patients, (5) increased soluble IL-2 receptor in 4/4 patients, and (6) decreased CD4/CD8 ratio in 3/4 patients. These results show that MCD resembles, in several ways, acquired immunodeficiency syndrome (AIDS).

8043431

Serum levels of major basic protein in patients with or without eosinophilia: measurement by enzyme-linked immunosorbent assay.

A bone marrow proteoglycan (BMPG) has been purified which consists of the same amino acid sequence as that of pro-MBP, and produced two anti-BMPG mAbs. Serum levels of major basic protein (MBP), a cationic protein rich in the eosinophil granule, were measured in patients with eosinophilia or allergic diseases by an enzyme-linked immunosorbent assay (ELISA) using these mAbs. The serum levels of MBP in patients with eosinophilia (n = 64) and in those with allergic diseases without eosinophilia (n = 32) were elevated significantly (P < 0.001 and P = 0.038, respectively). There was a weak positive correlation between the serum levels of MBP and the eosinophil counts in the patients with eosinophilia (r = 0.38). Among these patients, extremely high serum levels of MBP were found in those with hypereosinophilic syndrome (HES) and Kimura's disease. Serum levels of MBP decreased more slowly than the eosinophil counts in patients with eosinophilia when treated by glucocorticoids. We conclude that measurement of serum levels of MBP is useful in evaluating the total-body proliferation and infiltration of eosinophils more accurately than following-up the eosinophil counts alone.

8043429

Interleukin 2 interacts with myeloid growth factors in serum-free long-term bone marrow culture.

IL2 infusion may benefit patients with haematological malignancies by lowering the disease burden. However, conflicting data have been reported on IL2 effects on myelopoiesis, in vitro as well as in vivo. In the present study we investigated the ability of IL2 to act on committed and primitive bone marrow progenitor cells in defined serum-free (SF) culture conditions which avoid many technical biases such as interference by exogenous stimulating or inhibiting factors. Low doses of IL2 (0.1-1000 U/ml) were studied without or in combination with recombinant IL3, GM-CSF and erythropoietin, in SF long-term marrow culture (LTMC). We report data in favour of an inhibitory activity of IL2 limited to committed progenitors and excluding more primitive haemopoietic stem cells, as shown by an alteration of CFU-GM proliferation during the first 5 weeks of LTMC, decreasing with time, unaffected BFU-E and increased nucleated cell production. Beyond week 5, no difference was observed between IL2 supplemented cultures and the SF control cultures. In parallel, IL2 induced the adherence of fibroblastic cells and their progeny. In addition to the inhibitory effect, IL2 appeared to limit the stimulating effect on granulopoiesis and erythropoiesis of myeloid growth factors (GF) such as combination of IL3, GM-CSF and EPO. Indeed, in SF-LTMC conditions, IL2 inhibitory effect is effective on CFU-GM production throughout the 7 weeks of LTMC and on BFU-E during the first 2 weeks only. These data confirm the interaction of IL2 with other GFs in the complex interplay of the cytokine network.

8043427

Childhood Jessner's lymphocytic infiltrate of the skin.

We report a case of Jessner's lymphocytic infiltrate of the skin in an 11-year-old boy. This benign lymphocytic infiltrate was originally described in 1953, and classically occurs in middle-aged men. Its occurrence in children appears to be very rare, and there are only two other case reports in the literature.

8043426

Cutaneous manifestations of methylmalonic and propionic acidaemia: a description based on 38 cases.

Methylmalonic and propionic acidaemias are rare metabolic disorders with an autosomal recessive mode of inheritance. A number of aminoacidopathies may have cutaneous manifestations, but these are usually absent in methylmalonic and propionic acidaemia. We have studied 38 children with propionic and methylmalonic acidaemia in the last 10 years at the Hôpital Necker-Enfants Malades. Thirteen had cutaneous manifestations: acute superficial scalded skin and superficial desquamation, bilateral and periorificial dermatitis, psoriasiform eruptions, and alopecia. The relative uniformity of these manifestations (scalded skin and desquamation after metabolic decompensation, chronic bilateral and periorificial dermatitis) suggests that methylmalonic and propionic acidaemias should be included in the category of aminoacidopathies with cutaneous manifestations. All these patients were suffering from severe forms of these diseases, with no residual enzyme activity, and they were all subjected to a very severe natural protein-restricted diet. These cutaneous manifestations may therefore either be part of a complex multideficiency syndrome, or be due to the enzyme deficiency itself.

8043425

Quantification of erythema and pigmentation using a videomicroscope and a computer.

We report a method for quantitative analysis of erythema and pigmentation using a videomicroscope interfaced with a computer. The analysis was carried out by examining the brightness intensity of every picture element, composed of an image picked up from each band of red, green, and blue, and by deriving the quasi-absorbance value (absorbance index) from the mean brightness for each band. In assessments of UV-induced erythema and tanning, excellent linear correlations were found between the results obtained with our system and those with a narrow-band reflectance spectrometer. Moreover, the absorbance indices of haemoglobin and melanin solutions showed linear relationships with their concentrations in in vitro examination. As the monitored picture becomes out of focus if incorrect pressure is exerted on the skin, and as regions of interest can be chosen from a magnified image, this system offers excellent interobserver reproducibility, and is suitable for the evaluation of erythema or pigmented lesions which are too small or irregular to quantify by conventional methods such as colorimetry.