A novel trans-lymphatic drug delivery system: implantable gelatin sponge impregnated with PLGA-paclitaxel microspheres

A translymphatic drug delivery system which incorporates poly-lactide-co-glycolide-paclitaxel (PLGA-PTX) or PLGA-rhodamine microspheres into gelatin sponge matrix is described. The system combines the sustained release properties of PLGA-PTX with the structural advantages of gelatin matrix that can be implanted directly to the lymphatic site for both therapeutic and prophylactic purposes. The PLGA microspheres were prepared using spray drying technique. The particles were in the size range of 1-8 microm, suitable for intraperitoneal and intrapleural lymphatic targeting delivery. Scanning electron microscopy revealed the homogeneous distribution of PLGA microspheres in the porous sponge network. The release of PTX was mainly controlled by the degradation of the PLGA. Crosslinking gelatin using carbodiimide reduced the biodegradation of the sponge and thereby delayed the release of the PLGA in vitro. In vivo lymphatic delivery was assessed in both healthy rats and rats bearing orthotopic lung cancer. Intraperitoneal and intrapleural implantation of the sponge impregnated with PLGA microspheres resulted in spontaneous absorption of the particles in the lymphatic system. It is concluded that the system provides great potential for targeted delivery of therapeutic agent to the lymphatic system especially for the control of lymphatic metastasis in cancer.

Impact of lymph node metastasis on outcome after extrapleural pneumonectomy for malignant pleural mesothelioma

OBJECTIVES

Extrapleural pneumonectomy is a therapeutic option for selected patients with malignant pleural mesothelioma. The impact of lymph node metastasis on the site of recurrence and the role of mediastinoscopy in the selection of patients for extrapleural pneumonectomy, however, remain unclear.

METHODS

We reviewed 50 consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma in our institution between January 1993 and March 2005.

RESULTS

The median survival was 11 months, with a 3-year survival of 24%. Survival was significantly worse for patients with N2 disease than for those with no lymph node metastasis (median survival 10 months vs 29 months, respectively, P = .005). Patient sex, histologic cell type, stage, and N2 disease, but not mediastinoscopy, had significant impacts on survival according to univariate analysis. In a multivariate analysis, however, only the presence of N2 disease remained a significant predictor of poor outcome. The proportion of patients with N2 disease and the long-term survival was similar regardless of whether preoperative mediastinoscopy yielded a negative result. The initial site of recurrence was determined in 28 patients (locoregional in 10 and distant in 18). The presence of N2 disease had no impact on the site of recurrence. Adjuvant hemithoracic radiation therapy, however, significantly decreased the risk of locoregional recurrence.

CONCLUSIONS

The presence of N2 disease negatively affects the prognosis of patients with malignant pleural mesothelioma. Mediastinoscopy, however, seems to have a limited role in patient selection for extrapleural pneumonectomy. Adjuvant hemithoracic radiation therapy but not N2 disease affects the risk of locoregional recurrence.

Integrin-linked kinase inhibitor KP-392 demonstrates clinical benefits in an orthotopic human non-small cell lung cancer model

INTRODUCTION

The overexpression of integrin-linked kinase (ILK) has been implicated in the promotion of tumor invasion and metastasis. We studied the anticancer effects of KP-392, a potent selective inhibitor of ILK in the NCI-H460 cell line. In vitro, KP-392 inhibited ILK activity of H460 cells. In vivo, the effect of KP-392 was investigated in a metastatic H460 orthotopic lung cancer model.

METHODS

Intraperitoneal KP-392 (5 mg/day per animal) was administered both alone and in combination with cisplatin (5 mg/kg per week for 3 weeks). In group I, all treated animals were followed until death to assess therapeutic effect on survival. In group II, tumor growth and metastasis were evaluated by sacrificing one animal from each treatment when a control animal died.

RESULTS

Both cisplatin and KP-392 significantly enhanced survival (37.8 +/- 3.7 and 34.9 +/- 5.2 days) compared with the control (30.2 +/- 3.6 days, p < 0.0001 and p = 0.0418, respectively), and the survival benefit from combination treatment was greater than that of either agent alone (45.8 +/- 3.9 days, p < 0.0001). Although KP-392 alone did not impact the incidence of metastasis, in combination with cisplatin a consistent trend of inhibition was seen for metastases in the kidney, bone, and the contralateral lung. KP-392 was well tolerated throughout the study. KP-392 demonstrated increased tumor necrosis and decreased nuclear phospho-protein kinase/Akt but did not change the levels of phospho-extracellular signal-regulated kinase 1/2.

CONCLUSIONS

ILK inhibitor does not enhance the toxicity of standard chemotherapy and may have a beneficial therapeutic effect in lung cancer.

Targeting colloidal particulates to thoracic lymph nodes

BACKGROUND

Thoracic lymphatics and lymph nodes can be affected by cancer and other diseases. Micro- or nanoparticulates are used as carriers for therapeutic agents. We investigated the lymphatic distribution after intrapleural administration of three different particulates.

METHODS

Various micro- and nanoparticles of charcoal, polystyrene and poly(lactide-co-glycolide) were administered into the pleural space of rats to study the lymphatic distribution of particles from the pleural cavity to the thoracic lymph nodes. Experimental animal models included healthy rats, rats following pneumonectomy and rats bearing orthotopic lung cancer to mimic relevant clinical scenarios and pathophysiology. Macroscopic examination, light microscopy, fluorescence microscopy complemented by transmission electron microscopy analysis of the lymphatic tissue allowed precise mapping and detection of the particulates in the thoracic lymphatic system.

RESULTS

We found that (1) the particles studied are cleared by the regional thoracic lymphatic system when placed in the pleural space; (2) the lymphatic uptake occurred as early as 3h after injection and is primarily through the parietal pleura; (3) the transport of particles to regional lymph nodes was consistently found in all three animal models; (4) particles of 0.7-2 microm in size give the best lymphatic distribution.

CONCLUSIONS

Regional thoracic lymphatics and lymph nodes can be accessed by colloidal particles injected into the pleural space.

Occurrence of the Perfect Stage of Powdery Mildew of Sugar Beets in Southern Montana in 2003

Wide spread powdery mildew infections on sugar beets were observed at the Southern Agricultural Experiment Station in Huntley, MT during September, 2003. Throughout the area, lower leaves were frequently heavily covered by the vegetative stage of the fungus with plants at the edge of the field having clearly visible abundant mature (black) and immature (brown) globose ascocarps on the leaf surfaces and stems. The fruiting structures had mostly branched appendages and were imbedded in the superficial mycelium. Their diameter ranged from 70 to 100 μm. Each ascocarp contained five to eight asci with one to four ascospores (mostly three) per ascus. Elliptical ascospores were hyaline and measured 20 to 25 μm long and 12 to 20 μm wide. On the basis of the descriptions given for isolates from Idaho and Colorado (1) and the usage of Erysiphe polygoni DC for powdery mildew on sugar beet in the United States, this isolate may be classified as E. polygoni DC. However, measurements taken show that ascocarps, asci, and ascospores also fall within the range of E. betae (Vanha) Weltz. as described by Weltzien (2). We strongly suggest that these species be compared by using rDNA analysis of the ITS region to determine whether they are separate species. If survival of the ascocarps and the viability and pathogenicity of the ascospores can be confirmed, epidemics of sugar beet powdery mildew could be understood as local and regional events that are not dependant on long distance dispersal of conidiospores. The occurrence of the perfect stage also could lead to the more frequent appearance of new races through genetic recombination. References: (1) J. J Gallian and L. E. Hanson. Plant Dis. 87:200, 2003. (2) H. C. Weltzien. Phytopathol. Z. 47:123, 1963.

Stability and heterogeneity of expression profiles in lung cancer specimens harvested following surgical resection

One of the major concerns in microarray profiling studies of clinical samples is the effect of tissue sampling and RNA extraction on data. We analyzed gene expression in lung cancer specimens that were serially harvested from tumor mass and snap-frozen at several intervals up to 120 minutes after surgical resection. Global gene expression was profiled on cDNA microarrays, and selected stress and hypoxia-activated genes were evaluated using real-time reverse transcription polymerase chain reaction (RT-PCR). Remarkably, similar gene expression profiles were obtained for the majority of samples regardless of the time that had elapsed between resection and freezing. Real-time RT-PCR studies showed significant heterogeneity in the expression levels of stress and hypoxia-activated genes in samples obtained from different areas of a tumor specimen at one time point after resection. The variations between multiple samplings were significantly greater than those of elapsed time between sampling/freezing. Overall samples snap-frozen within 30 to 60 minutes of surgical resection are acceptable for gene expression studies, thus making sampling and snap-freezing of tumor samples in a routine surgical pathology laboratory setting feasible. However, sampling and pooling from multiple sites of each tumor may be necessary for expression profiling studies to overcome the molecular heterogeneity present in tumor specimens.

Validating the prognostic value of marker genes derived from a non-small cell lung cancer microarray study

We previously reported that our cDNA microarray analysis of primary non-small cell lung carcinoma (NSCLC) could predict for patients at increased risk of cancer recurrence. From the result of this analysis, we selected 11 genes that were considered candidate prognostic marker genes and used the realtime reverse transcription polymerase chain reaction (RT-PCR) to investigate their expression in the same set of NSCLC cases used in the microarray study. Cluster analysis of the realtime RT-PCR data separated these patients into two groups with significantly different disease-free survivals (log-rank test, P < 0.017). In contrast, cluster analysis failed to confirm the prognostic significance of the realtime RT-PCR results for these 11 genes in a validation series of 92 NSCLC cases. In univariate analysis, hypoxia inducible factor 1alpha, Rho-GDP dissociation inhibitor (GDI) alpha (RhoGDI) and Citron/rho-interacting serine-threonine kinase 21 (Citron K21) were significant prognostic factors for disease-free survival in the entire cohort of 130 NSCLC patients, but none were significant in multivariate analysis. The results demonstrate that the prognostic significance of microarray (SAM) results can be partially validated using realtime RT-PCR, but secondary validation using larger and independent series of tumors is necessary to identify true prognostic marker genes.

Preoperative Assessment: An Anesthesiologist's Perspective

Advances in anesthesia and surgery have made it so that almost any patient with a resectable lung malignancy is now an operative candidate given a full understanding of the risks and after appropriate investigation. This situation necessitates a change in the paradigm that anesthesiologists use for preoperative assessment. Understanding and stratifying the perioperative risks allows the anesthesiologist to develop a systematic focused approach to these patients at the time of the initial contact and immediately before induction, which can be used to guide anesthetic management.

Expression of Chicken Ovalbumin Upstream Promoter-Transcription Factor II Enhances Invasiveness of Human Lung Carcinoma Cells

Chicken ovalbumin upstream promoter-transcription factor II (COUP-TFII) plays an essential role in angiogenesis and development. It is differentially expressed in tumor cell lines, but its role in carcinogenesis is largely unknown. We demonstrate here that noninvasive human lung cancer cells become invasive when COUP-TFII was expressed. The expression of extracellular matrix degrading proteinases, such as matrix metalloproteinase 2 and urokinase-type plasminogen activator, was up-regulated in these cells. This finding was confirmed by transduction of different human lung cancer cell lines with COUP-TFII protein and also by using antisense expression. We observed disorganization of actin filaments and focal adhesion kinase phosphorylation in COUP-TFII-transfected human lung cancer cells in addition to the increase in extracellular metalloproteinase activity. These results suggest that COUP-TFII may be considered as a new target for anticancer therapies.

Modeling of lung cancer by an orthotopically growing H460SM variant cell line reveals novel candidate genes for systemic metastasis

Endobronchial implantation of NCI-H460 cells into the nude rat generates a primary lung tumor with mediastinal lymph node spread, but rarely systemic metastases. We isolated tumor cells from mediastinal nodes, orthotopically reimplanted the cells into nude rats and repeated this four times to derive a cell line, designated H460SM, that spontaneously metastasizes to bone, kidney, brain, soft tissue and contralateral lung. H460SM cells demonstrated higher invasive activity in vitro than parental NCI-H460 cells. Spectral karyotyping revealed a new inversion within 17q and loss of an extra normal copy of chromosome 14 present in parental NCI-H460 cells. Expression profiling of orthotopic primary tumors revealed differential expression of 360 genes. Of these, 173 were represented in the probe set of a 19.2K OCI cDNA microarray previously used to profile the gene expression of surgically resected lung cancer specimens. We have computationally validated clinical importance of these genes by using in silico analysis of 18 cases of pulmonary adenocarcinoma, which were split into two patient groups with markedly different clinical outcome. The model identifies additional novel candidate genes for the progression of lung cancer to systemic metastases and poor prognosis.

Early combined treatment with carboplatin and the MMP inhibitor, prinomastat, prolongs survival and reduces systemic metastasis in an aggressive orthotopic lung cancer model

We studied the synthetic matrix metalloproteinase inhibitor (MMPI) prinomastat (AG3340) in a well-established NCI-H460 orthotopic lung cancer model that exhibits highly predictable regional and systemic metastatic patterns. Both primary and metastatic tumors express the matrix metalloproteinases (MMP-2), MT1-MMP (MMP-14) and tissue inhibitor of metalloproteinases (TIMP-2). The anti-tumor activity of prinomastat was investigated both as a single agent and in combination therapy with carboplatin. Treatment with both carboplatin (at two dose levels) and prinomastat commenced when the primary lung cancer was approximately 200-300 mg in size and without gross or microscopic evidence of metastases. As single agents, prinomastat significantly reduced the incidence of kidney metastasis, but had no effect on metastatic frequency to other organs. As single agents neither drug enhanced length of survival over control animals, although microvessel counts in prinomastat-treated tumors were lower than in tumors from control animals (P<0.01). In combination prinomastat and the lower dose of carboplatin significantly enhanced survival over control animals, and over animals treated with carboplatin alone (P<0.05). Tolerance to this combination was assessed with body weight and serum biochemistries. At the higher carboplatin dose, toxicity became evident both as a single agent and in combination with prinomastat. Our results suggest that the administration of prinomastat in combination with standard cytotoxic chemotherapy during early stages of tumor growth and metastasis may prolong survival in non-small cell lung cancer (NSCLC) patients.

Predicting length of stay out of hospital following lung resection using preoperative health status measures

Studies evaluating predictors of operative outcome for lung resection have focused on physiological measures of cardiorespiratory impairment, but these have proved inadequate. This study evaluated the predictive abilities of six preoperative variables: the global quality of life (QL), social function (SF), and emotional function (EF) scales of the European Organization for the Research and Treatment of Cancer's (EORTC) QLQ-C30 questionnaire, 6-min walk distance (6MWD), forced expiratory volume (FEV1), and diffusion capacity (DLCO). Operative outcome was represented by the surrogate measure length of stay, out of hospital within the first 30 days (LOSOH). A single-centre prospective cohort study evaluating 70 subjects was conducted using multiple regression. LOSOH was bimodally distributed, therefore analysis was undertaken for the entire sample and for two separate groups (A and B). Group B (n = 4) experienced severe complications (LOSOH = 0-5 days) and was too small for statistical analysis. Group A (n = 66) suffered fewer and less severe complications (LOSOH = 14-26 days). For the entire sample, age was the sole predictor of LOSOH (R2 = 0.123, p = 0.003). In Group A, the strongest predictors of LOSOH were global QL score and 6MWD (R2 = 0.224, p < 0.001). LOSOH was inversely correlated with complications. While it remains difficult to predict severe complications in this population, within Group A, health status measures demonstrated a limited ability to predict LOSOH.

Animal models for studying lung cancer and evaluating novel intervention strategies

The pathogenesis of lung cancer progression, invasion and metastasis remains undefined. Clinically relevant laboratory models of the disease could greatly facilitate its clarification. Model systems of lung cancer that accurately reflect different biologic properties and disease stages are necessary to ensure proper experimental design of studies aimed at increasing our understanding of the disease. Such models are also essential tools to accelerate development of new therapies for lung cancer. In this review we summarize the available lung cancer model systems in use today and define both their utility and limitations.

Novel candidate tumor marker genes for lung adenocarcinoma

Using the representational difference analysis (RDA) technique on pooled mRNA of five primary lung adenocarcinomas and their corresponding non-neoplastic lung tissues, we identified six genes that were putatively overexpressed in this type of lung cancer. Five corresponded to previously isolated genes, while one (Lc19) matched with the sequence of an unannotated EST. Real-time RT-PCR analyses of expression levels in a panel of 34 paired primary non-small cell lung cancer (NSCLC) and corresponding grossly normal appearing lung tissues confirmed the common overexpression of these genes in non-small cell lung cancer. Among these genes, overexpression of Lc19, hyaluronan binding protein 2 (HABP2) and crystalline-mu appeared more specific to adenocarcinoma, whereas ceruloplasmin, integrin alpha-11 and collagen type XI alpha 1 were overexpressed at high frequency among both adenocarcinoma and squamous cell carcinoma. These genes represent novel candidate tumor biomarker genes for NSCLC and its histological subtypes.

Preoperative assessment for pulmonary resection

Because of recent advances in anesthesia and surgery, almost any patient with a resectable lung malignancy is now an operative candidate, given a full understanding of the risks and provided he or she is investigated appropriately. This progress necessitates a change in the paradigm that one uses for preoperative assessment. Understanding and stratifying the perioperative risks allows the anesthesiologist to develop a systematic focused approach to these patients at the time of the initial contact and immediately before induction, which then can be used to guide anesthetic management (Fig. 7).

Validation of an orthotopic model of human lung cancer with regional and systemic metastases

BACKGROUND

We developed an orthotopic model of human lung cancer that exhibits highly predictable regional and systemic metastases. This study examines the response of the model when treated with conventional and experimental chemotherapy.

METHODS

NCI-H460 tumor fragments were implanted into the right caudal lung lobe of a nude rat. Treatment commenced 2 weeks later. We assessed response by comparing primary tumor and mediastinal lymph node weights, total body weight, and length of survival with untreated, tumor-bearing control animals. We also calculated the incidence of metastasis to kidney, bone, brain, and contralateral lung in treated versus untreated animals.

RESULTS

Mitomycin and cisplatin showed broad activity against primary and metastatic disease. The matrix metalloproteinase inhibitor batimastat, low-dose cisplatin, and mitomycin significantly prolonged survival. High-dose cisplatin caused renal toxicity that shortened survival. Brain metastases did not respond to mitomycin, consistent with its poor blood-brain barrier penetration.

CONCLUSIONS

Responses were similar to NCI-H460 in vitro data and consistent with clinical experience for these drugs. Drug-related toxicities similar to those seen in clinical practice were detected.

The biology of some intraerythrocytic parasites of fishes, amphibia and reptiles

Fishes, amphibia and reptiles, the ectothermic vertebrates, are hosts for a variety of intraerythrocytic parasites including protists, prokaryotes, viruses and structures of uncertain status. These parasites may experience host temperature fluctuations, host reproductive strategies, population genetics, host habitat and migratory behaviour quite unlike those of endothermic hosts. Few blood infections of fishes, amphibia and reptiles have proven pathogenicity, in contrast to the many intraerythrocytic parasites of mammals and some birds which harm their hosts. Although not given the attention afforded to intraerythrocytic parasites of endotherms, those of ectotherms have been studied for more than a century. This review reports on the diversity, general biology and phylogeny of intraerythrocytic parasites of ectotherms. The existence of taxonomic confusion is emphasized and the main taxonomic features of most of the 23 better characterized genera, particularly the kinetoplastid and apicomplexan protists, are summarized. Transmission of protistan infections of aquatic ectotherms is also discussed. Leeches can transfer sporozoties or merozoites to the vertebrate host during feeding. Dormant sporozoites of Lankesterella may permit transmission of species of this genus between vertebrates by predation. The fish haemogregarine, Haemogregarina bigemina, probably has gnathiid isopods, rather than leeches, as its definitive hosts. Hepatozoon spp. in aquatic hosts, and Progarnia of caiman, may also use invertebrate hosts other than leeches. Protistan infections of terrestrial or semi-terrestrial hosts are transmitted by a variety of arthropods, or, in some cases, leeches, contaminated paratenic hosts, or sporocysts free in water. Transfer of protists between vertebrates by predation and congenitally may also occur. The biology of the host cells of these infections, the red blood cells of ectotherm vertebrates, is summarized and compared with that of mammalian erythrocytes. Erythropoiesis, the nature of the surface molecules (especially the possible existence of a major histocompatibility complex), the haemoglobins, and the shape and size of erythrocytes are discussed. The exoerythrocytic sites in which protists, prokaryotes, viruses and structures of uncertain status exist before erythrocyte entry are described. Tissue merogony, tissue cysts and invasion of the white cell series occur in a variety of protistan infections. Intraerythrocytic stages of protistan infections are also discussed, including modes of entry to erythrocytes, survival mechanisms, and multiplication. The impact of infection on host populations is difficult to assess, in part because there is no agreement in the literature on the criteria used to evaluate parasite-induced cost to the host. Almost all studies have been on haemogregarine and Plasmodium infections in, mainly, lizards, but also fishes and snakes. Some infections may be responsible for mortality in their hosts, but hosts themselves may be short-lived, or have a limited ability to recover from infection.

A study of smoking, p53 tumor suppressor gene alterations and non-small cell lung cancer

PURPOSE

The purpose of this study was to investigate the relationship between smoking and p53 tumor suppressor gene alterations, and their association with clinicopathologic features and prognosis in non-small cell lung cancer (NSCLC).

METHODS

For 111 of 119 stage I-III NSCLC patients that had been followed prospectively, tumor p53 protein accumulation was measured immunohistochemically (IHC). Staining was evaluated as a score (p53IHCS) combining intensity and percent distribution.

RESULTS

Forty-eight of 111 (43%) tumors had p53IHCS > 1. p53 IHC was associated with increasing tumor size (T) (p = 0.035), nodal status (N) (p = 0.091), stage (p = 0.054), and histology: squamous cell carcinoma (70%) and adenocarcinoma (27%) (p = 0.0002). In logistic regression analysis, p53 IHC was associated with squamous cell histology versus other histotypes [adjusted odds ratio (OR)5.90, 95% confidence interval (CI) 2.34-14.90]. p53 IHC was not associated with smoking variables. In multivariate proportional hazards analysis, p53IHCS and pack-years smoked (PY), both as continuous variables, were negative prognostic factors. The adjusted hazard ratios (HR) for the survival outcome recurrence for p53IHCS and PY were 1.20 (95% CI 1.02-1.40) and 1.03 (95% CI 1.01-1.04), and for death due to recurrent disease (DRD) were 1.35 (95% CI 1.11-1.64) and 1.03 (95% CI 1.01-1.04), respectively. Comparing the 75th percentile to the baseline 0, the adjusted HR for p53IHCS (5 vs. 0) was 4.5 and for PY (55 vs. 0) was 5.1 for the outcome DRD. Both variables demonstrated a dose-response relationship with survival.

CONCLUSIONS

PY and p53IHCS are significant, independent and important predictors of recurrence and DRD in stage I-III NSCLC.