Ionizing radiation induces O6-alkylguanine-DNA-alkyltransferase mRNA and activity in mouse tissues

The effect of exposure to whole-body gamma-irradiation or fast electrons on O6-alkylguanine-DNA-alkyltransferase (ATase) activity and mRNA abundance has been examined in mice. In response to gamma-radiation, hepatic ATase activity was significantly raised in BDF1 mice 24 h post-irradiation, reaching a maximum of 2- to 3-fold at 36 h and beginning to decrease by 48-60 h. A small but consistently higher level of induction was achieved when mice were exposed using a low dose rate (0.015 Gy/min) compared to a high dose rate (0.5 Gy/min). ATase activity was also induced approximately 2-fold 48 h post-irradiation in brain, kidney, lung and spleen, with a greater induction again observed in response to the lower dose rate. In response to fast electrons from a linear accelerator hepatic ATase activity was also induced 2- to 3-fold 48 h post-irradiation in BDF1, BALB/c, C57Bl and DBA2 strains. Induction of ATase activity in livers of BDF1 mice was observed 48 h after a total single dose of 5 Gy gamma-radiation (2-fold), increasing to a slightly higher level at 15 Gy, but no induction was observed at doses of 2 Gy and below. Although a maximum 2- to 3-fold induction of ATase activity was observed, mRNA levels were induced 3- to 4-fold by 48 h after a dose of 15 Gy. Furthermore, significant increases in mRNA levels were detected at low doses (1-2 Gy) at which there was no apparent increase in ATase activity. This suggests that ionizing radiation increases ATase levels by a process involving transcriptional upregulation but that strong post-transcriptional and/or translational controls operate to limit induction of enzyme activity to 2- to 3-fold. This is the first report of an in vivo induction of ATase by ionizing radiation in a species other than the rat.

Protein kinase C down-regulation, and not transient activation, correlates with melanocyte growth

The nontumorigenic, immortal line of murine melanocytes, Mel-ab, requires the continual presence of biologically active phorbol esters for growth (R.E. Wilson et al., Cancer Res., 49:711-716, 1989). Comparable treatments of B16 murine melanoma cells result in partial inhibition of cell proliferation. The role of protein kinase C (PKC) in the modulation of growth of cells from these two melanocytic cell lines has been investigated. Significant levels of PKC were present in quiescent Mel-ab cells as determined by Western blotting, whereas no immunoreactive protein was detected in cell extracts from either proliferating Mel-ab or B16.F1 cells. Phosphorylation of a Mr 80,000 protein, which by one- and two-dimensional gel analysis comigrated with the known Mr 80,000 protein substrate of PKC in fibroblasts, was induced in 12-O-tetradecanoylphorbol-13-acetate-stimulated quiescent Mel-ab cells but not in proliferating Mel-ab cells or B16.F1 melanoma cells. Direct measurement of PKC activity in these cells demonstrated a 10-fold greater level of activity in quiescent Mel-ab cells (262 +/- 50 pmol/min/mg SD) compared with growing cells (22.8 +/- 11.8 pmol/min/mg SD). An intermediate level of activity was detected in proliferating B16.F1 melanoma cells (148.5 +/- 20.4 pmol/min/mg SD). The subcellular distribution of PKC was dependent upon the growth state of the cells such that quiescent Mel-ab cells displayed a higher level of activity in the cytosol, whereas growing Mel-ab cells displayed greater activity in the particulate fraction. Like many other transformed lines, B16.F1 melanoma cells constitutively expressed the majority of enzyme activity in the particulate fraction. Measurement of [3H]phorbol ester binding in intact cells paralleled the PKC activation data such that quiescent Mel-ab cells displayed binding of 1612 +/- 147 cpm/10(6) cells, whereas proliferating Mel-ab and B16.F1 melanoma cells displayed binding of 652 +/- 28 and 947 +/- 81 cpm/10(6) cells, respectively. Membrane-permeant diacylglycerol analogues, which activated but did not down-regulate PKC, were devoid of growth-stimulating effects on melanocytes, even in the presence of the specific diacylglycerol kinase inhibitor, R59022. Together, these data show that PKC down-regulation, and not activation, correlates with the growth of melanocytes in culture.

Comparative acute nephrotoxicity of salicylic acid, 2,3-dihydroxybenzoic acid, and 2,5-dihydroxybenzoic acid in young and middle aged Fischer 344 rats

Experimental evidence suggests that the oxidative metabolites 2,3- and 2,5-dihydroxybenzoic acid (DIOH) may be responsible for the nephrotoxicity of salicylic acid (SAL). In the present study, enzymuria in conjunction with glucose (GLU) and protein (PRO) excretion were used as endpoints to compare the relative nephrotoxicity of SAL with 2,3- and 2,5-DIOH. In addition, the effect of age on enzymuria and GLU and PRO excretion following treatment with SAL or 2,3- and 2,5-DIOH was investigated because the elderly are at greater risk for SAL-induced nephrotoxicity. Three and 12-month male Fischer 344 rats were administered either no treatment, vehicle, SAL, 2,3-DIOH, or 2,5-DIOH at 500 mg/kg p.o. in 5 ml/kg corn oil/DMSO (5:1). Effects of these treatments on functional integrity of renal tissue was assessed from 0--72 h after dosing by measurement of urinary creatinine, GLU, and PRO, as well as excretion of proximal and distal tubular renal enzymes. Enzymes measured as indicators of proximal tubular damage were N-acetyl-beta-glucosaminidase (NAG), gamma glutamyltransferase (GGT), alanine aminotransferase (ALT), and alkaline phosphatase (AP), while urinary lactate dehydrogenase (LD) and aspartate aminotransferase (AST) were measured as indicators of distal tubular damage. In comparison to 3-month vehicle-treated rats, 2,3- and 2,5-DIOH caused a significant increase between 0-8 h in excretion of urinary GLU and activities of AST, NAG, and LD, with peak effects occurring between 4-8 h. Toxic effects of either metabolite were not evident beyond 24 h, and toxicity of 2,5-DIOH was significantly greater in comparison to 2,3-DIOH. SAL treatment resulted in similar effects on enzymuria as well as GLU and PRO excretion, but peak effects did not occur until 16-24 h, and often persisted until 72 h after dosing. Maximal enzymuria in response to SAL treatment was significantly greater in 12- vs. 3-month rats for AST, NAG, and LD. In response to 2,3-DIOH treatment, the maximal response was significantly greater in 12- vs. 3-month rats for LD and AST, and for NAG in response to 2,5-DIOH treatment. The results of this study suggest that both 2,3- and 2,5-DIOH are nephrotoxic metabolites of SAL, but implicate 2,5-DIOH as the more potent nephrotoxic metabolite. The relative lack of an age effect for 2,3- and 2,5-DIOH vs. SAL supports the hypothesis [2] that age-related differences in biotransformation of SAL, and not increased tissue sensitivity to 2,3- or 2,5-DIOH, contribute to the age-related increase in susceptibility to SAL-induced nephrotoxicity.

Correlation of changes in serum analytes and hepatic histopathology in rats exposed to carbon tetrachloride

Clinical pathology data can significantly contribute to the characterization of a disease process if suitable time points for sample collection are chosen and combined with the measurement of biochemical analytes that are sensitive and specific for damage to a potential target organ. Using a well-defined model for hepatotoxicity, we correlated histopathological lesions in the liver with changes in selected serum analytes. Groups of Fischer-344 rats were treated with carbon tetrachloride (280 mg/kg in corn oil) for 1, 2, 4, 6, 8 or 10 days. Subgroups were allowed to recover for 1, 5 or 8 days, at which time blood and liver specimens were collected. Histologically, necrosis was detected in livers from rats treated for 1 and 2 days and allowed to recover for 1 day. This was followed by generalized fatty change in animals treated for longer periods. The maximum severity of fatty change occurred 7-12 days (total experimental time). A sharp rise and fall (48 h) in cytosolic enzyme activities were seen in serum. This preceded gradual increases in all analytes measured which eventually peaked at 9-11 days (total experimental time). The pattern seen in biochemical analytes paralleled the development of marked fatty change. We discuss relationships between the histologic and biochemical findings and conclude that appropriate clinical biochemistry measurements in a toxicology experiment can provide valuable mechanistic information.

Evidence for oxidative damage to red blood cells in mice induced by arsine gas

In animals and human beings exposed to arsine gas (AsH3) a severe and fulminant lysis of erythrocytes occurs. Little is known about the effects of subchronic exposure on the hematopoietic system or about the mechanism of hemolysis produced by arsine gas. To examine these, we exposed male and female mice to 0.000, 0.025, 0.500 and 2.500 ppm arsine gas for 6 h a day, 5 days a week during a 90-day period. After 5, 15, and 90 days of exposure, blood was collected and routine hematologic profiles were performed to document the effects of arsine gas on peripheral blood. A moderate hemolytic anemia, indicated by decreases in erythrocyte counts, hematocrits, hemoglobin concentrations and increases in mean corpuscular hemoglobins and mean corpuscular hemoglobin concentrations, was seen in blood samples collected after 5 days of exposure. In blood collected after 15 and 90 days of exposure, the anemia was less severe but a greater increase in mean corpuscular volumes and absolute reticulocyte counts revealed an active regenerative response. Higher concentrations of methemoglobin in animals in the 2.500 ppm exposure group (measured after 90 days of exposure) indicated that the rate of oxidation of heme (ferrous to ferric) increased due to exposure to arsine gas. Additionally, the presence of Heinz bodies in blood smears stained with brilliant cresyl blue and decreases in reduced glutathione concentrations in red blood cells exposed to arsine gas in vitro provide evidence that the mechanism of hemolysis involves depletion of intracellular reduced glutathione resulting in an oxidation of sulfhydryl groups in hemoglobin and possibly red cell membranes.

Changes in growth characteristics and macromolecular synthesis on recovery from severe hypoxia

Chinese hamster ovary cells subjected to severe hypoxia stop growing. When oxygen was reintroduced growth resumed, but at a slower rate. The longer the hypoxic stress, the slower the recovery growth rate. Six hours of hypoxia caused very little decrease in growth rate while a 24 h period almost halved the rate. Short hypoxic periods resulted in almost no growth lag, while longer periods caused significant lag. Clonogenic survival was 60% after 12 h of hypoxia and rose slowly during recovery, reaching control levels after 60 h. Following 24 h of hypoxia, survival remained around 60% throughout recovery. The cell cycle distribution after hypoxia was similar to that of aerobic cultures. After 4-6 h of recovery, a subpopulation of cells entered S phase, and reached G2 by 12 h. During this time few G2-M cells divided. With longer recovery, cells much larger than aerobic cells emerged, containing greater than 4C DNA content and enhanced amounts of RNA. When these cells were isolated, they exhibited slightly slower growth kinetics, greatly lengthened lag time and decreased survival when compared to aerobic cells or the smaller cells. Most of the extra DNA and RNA was lost within one cell cycle.

Non-clastogenicity in mouse bone marrow of fructose/lysine and other sugar/amino acid browning products with in vitro genotoxicity

Heated sugar/amino acid reaction mixtures, known to contain products that are clastogenic and/or mutagenic to cells in vitro, were evaluated for clastogenic activity in mouse bone marrow using the erythrocyte micronucleus assay. Heated (i.e. browned) fructose/lysine reaction mixtures were also evaluated in the Salmonella his-reversion assay and the Chinese hamster ovary (CHO) cell chromosomal aberration assay to confirm and extend previous in vitro observations. Significant mutagenicity of fructose/lysine mixtures was observed in Salmonella typhimurium strains TA100, TA2637, TA98 and TA102, with greater activity in mixtures heated at pH 10 than at pH 7. S-9 decreased the activity in strains TA100, TA2637 and TA98, but increased the activity in strain TA102. Both pH 7 and pH 10 reaction mixtures of the fructose/lysine browning reaction were highly clastogenic in CHO cells. Heated mixtures of fructose and lysine, and of glucose or ribose with lysine, histidine, tryptophan or cysteine, did not increase the frequency of micronucleated erythrocytes in mice when administered by the oral route. This indicates the absence of chromosomal aberrations in erythrocyte precursor cells, and indicates that the genotoxic components of the browned mixtures are not absorbed and distributed to bone marrow cells in amounts sufficient to induce micronuclei when given orally. Because sugar/amino acid browning reactions occur commonly in heated foods, it is important to evaluate further the in vivo genotoxicity of browning products in cell populations other than bone marrow.

Drug resistance in Chinese hamster ovary cells during recovery from severe hypoxia

Chinese hamster ovary cells exposed to hypoxia developed an 80-fold resistance to a subsequent 1-hour exposure to doxorubicin (ADR) in air. Recovery in air before drug exposure resulted in loss of resistance. Cells exposed to hypoxia for 20 hours followed by a 15-hour recovery were still twofold to threefold more resistant than aerobic cells to a short pulse of ADR. A subpopulation of cells was generated that was at least twice as large as aerobic cells and contained greater than normal G2-M DNA content. This subpopulation showed no resistance to a continuous exposure to either ADR or methotrexate, nor was it more resistant to a pulse of ADR than the remaining cells with normal DNA content. Our data indicate that hypoxia can produce significant ADR resistance. However, conditions resulting in overproduced DNA did not cause significant additional resistance.

Production of interleukin-6 in vitro parallels development of cytotoxic T lymphocytes from murine thymocytes

In an attempt to provide information useful for improving tumor immunotherapy, we examined the lymphokine requirements for generation of cytotoxic T lymphocytes (CTL) from C57BL/6 murine thymocytes. Our previous work indicated that interleukin-6 (IL-6) is involved in the maturation of CTL in vitro. Using a standard chromium 51 release assay and P815 mastocytoma tumor cells as targets, we found that after 66 hours of in vitro culture, a much greater CTL response was generated in the presence of interleukin-2 (IL-2) plus IL-6 (70.5% +/- 10.6%) compared with that generated in the presence of IL-2 only (25.2% +/- 1.0%). After 72 hours of culture, however, this difference was no longer significant, with cultures incubated with both IL-2 and IL-6 yielding 70.6% +/- 1.8% lysis versus 64.5% +/- 3.4% for cultures incubated with IL-2 only. To attempt to understand this difference, we examined the production of IL-6 in thymocyte cultures using a cell line, PC-6, that proliferates in the presence of IL-6. We found that the CTL response generated from unfractionated murine thymocytes in the presence of concanavalin A plus IL-2 correlated with production of IL-6 by cells within the thymic population. These data suggest that the generation of a CTL response in the absence of added IL-6 is due to the production of this ubiquitous lymphokine by thymocytes on in vitro culture. We present this as further evidence that IL-6 is necessary for the development of functional CTL from murine thymocytes and may therefore play a role in the development of effective tumor immunotherapy.

Ibuprofen causes reduced toxic effects of interleukin 2 administration in patients with metastatic cancer

Metastatic cancer was treated with interleukin 2 and lymphokine-activated killer cells with the addition of the cyclooxygenase inhibitor ibuprofen in an attempt to reduce side effects in 13 patients (eight male and five female). Twenty-six patients treated with only interleukin 2 and lymphokine-activated killer cells formed the control group. After interleukin 2 administration, a significantly increased number of lymphokine-activated killer cells were transfused in ibuprofen-treated patients. Cytotoxic effects were not significantly different in the treated and untreated groups. With regard to cell phenotype, both groups of patients manifested significant activation of the immune system as measured by T10 and OK1a. Symptom scores were dramatically reduced in patients treated with ibuprofen. Temperature above 37 degrees C were rare. Ibuprofen did not significantly alter rate of response in this immunotherapy trial (38% vs 42%). Ibuprofen is now routinely used in all of our current immunotherapy trials.

Enhanced synthesis of specific proteins, RNA, and DNA caused by hypoxia and reoxygenation

When Chinese Hamster ovary cells were exposed to severe hypoxia they responded with an enhanced synthesis rate of a small group of specific proteins, which we have termed the oxygen regulated proteins (ORPs). The five major ORPs had molecular weights of 33, 80, 100, 150, and 260 kD. ORP260 was the first ORP to be synthesized at enhanced rates after the induction of hypoxia, reaching its maximal synthesis rate after only a few hours. The other ORPs responded slower, but were being synthesized at maximal rates by 8 hr of hypoxia. Upon reoxygenation, the synthesis rates of the ORPs declined rapidly with ORP260 again responding most rapidly. They all reached control levels by 12 hr of recovery. The induction of enhanced synthesis of these proteins required a very severe degree of hypoxia. They were not seen at oxygen levels higher than 0.03%. While enhanced synthesis of the ORPs was turned on and off quickly with induction of, and recovery from hypoxia, the proteins were not degraded at high rates once synthesized. All five major ORPs have apparent half-lives in excess of 24 hr. When cells were exposed to hypoxia for 20 hr and then allowed to recover for 15 hr, a population of cells was generated that had, on average, at least twice the cell volume as aerobic control cells. These large cells also contained greater than 4C DNA content as well as enhanced amounts of RNA.

c-AMP-induced c-fos expression in cells of melanocyte origin

The expression of the c-fos gene in murine cells of melanocyte origin in response to cAMP-elevating agents has been examined. Accumulation of c-fos mRNA at a high level as a consequence of these treatments precedes both proliferative and cytodifferentiative changes in non-tumorigenic or tumorigenic cell lines.

Induction of tumorigenicity and lack of in vitro growth requirement for 12-O-tetradecanoylphorbol-13-acetate by transfection of murine melanocytes with v-Ha-ras

A nontumorigenic line of murine melanocytes, Mel-ab, has been transfected with the v-Ha-ras gene under transcriptional control of the Moloney murine leukemia virus long terminal repeat. Transfectants produced rapidly growing undifferentiated melanomas in recipient mice. The inhibition of melanin production in transformed cells, observable both in vitro and in vivo, suggests that ras may affect melanocyte cytodifferentiation. Mel-ab cells require the continual presence of 12-O-tetradecanoylphorbol-13-acetate, or other activators of protein kinase C, for in vitro growth. Transfectants expressing v-Ha-ras no longer manifested this requirement and were actually growth inhibited by the addition of protein kinase C activators. These results are consistent with the notion that ras acts via the protein kinase C pathway in conferring autonomous growth on Mel-ab cells.

Effect of timing of lymphokine presentation on generation of cytotoxic T lymphocytes

Encouraging results of clinical trials with interleukin 2 therapy for advanced malignant neoplasms have led to efforts to reduce the toxicity and improve the efficacy of tumor immunotherapy. To begin to achieve this goal, we studied the lymphokine requirements for in vitro generation of polyclonal cytotoxic T lymphocytes (CTL) from C57BL/6 murine thymocytes. We found that both interleukin 2 and interleukin 6 are required for optimal generation of CTL from murine thymocytes. Timing studies show that neither lymphokine alone in culture will produce maximum CTL levels during the first 84 hours of culture. In addition, we found that thymocytes cultured with concanavalin A are unresponsive unless either interleukin 2 or interleukin 6 is present from the onset of culture.

A new regimen of interleukin 2 and lymphokine-activated killer cells. Efficacy without significant toxicity

Adoptive immunotherapy with high-dose interleukin 2 and lymphokine-activated killer (LAK) cells has proved to be successful in the treatment of some patients with metastatic cancer, but not without a significant degree of associated toxic effects. The primary goal of this study was to substantially reduce the toxicity of this complex and expensive treatment, while maintaining or improving efficacy. To this end, 29 patients were treated with LAK cells in conjunction with a low-dose regimen of interleukin 2 and a prolonged period of administration following LAK cell infusion. This protocol resulted in a considerable reduction in toxicity, as compared with that described in previous studies, without compromising the efficacy. This study offers further confirmation that adoptive immunotherapy of metastatic cancer can be clinically beneficial to patients for whom no other effective therapy is presently available.

Polyoma middle T abrogates TPA requirement of murine melanocytes and induces malignant melanoma

We have transfected the polyoma middle T oncogene into an immortal murine melanocyte cell line, Mel-ab. This highly pigmented line is phorbol ester (TPA) dependent for in vitro growth, suggesting activation and/or down regulation of Protein Kinase C (PKC) is essential for mitogenesis. Moreover, cells of this line do not form tumours when injected subcutaneously into immunocompetent or immunoincompetent mice. Here we show that PyMT alone is sufficient to produce TPA-independence and transformation to the tumourigenic state in transfected Mel-ab cells. Western blot analysis shows that middle T overcomes the TPA requirement by a mechanism independent of PKC down regulation though this does appear to occur when Mel-ab cells are grown continuously in TPA. These results suggest that PyMT is not exerting its transforming effect by PKC down regulation, but conceivably at some later stage of second messenger signalling, possibly through PyMT-c-src protein kinase activity.

Membrane-bound anti-CD3 monoclonal antibodies trigger cytolytic T-lymphocyte-mediated tumor lysis

Cytolytic T lymphocytes (CTLs) are an efficient immune mechanism for the destruction of foreign or pathogenic cells. Attempts to use CTLs in human cancer therapy have focused on the cell-surface molecules that regulate CTL function. An important molecule in CTL function is the CD3 antigen. Biochemical characterization has suggested that the CD3 antigen may function as a "trigger" for T-lymphocyte activation. To investigate this possibility, we used monoclonal antibody (MAb) to the CD3 antigen to trigger activation of long-term CTL lines. The anti-CD3 MAb was able to trigger killing of a variety of human and mouse tumor cell lines; however, not all tumor cells were lysed by the CTL. The susceptibility of the tumor cells to CTL-mediated lysis appeared to correlate with the binding of the anti-CD3 MAb to the tumor cell surface. The requirement for surface binding of the MAb was tested by covalently cross-linking the anti-CD3 MAb to the tumor cell membrane. Membrane-bound anti-CD3 MAb triggered high levels of CTL-mediated tumor cell killing. Similar results were obtained when anti-CD3 MAb was cross-linked to phosphatidylethanolamine and inserted into the cell membrane. These results indicate that the attachment of anti-CD3 MAb to the tumor cell surface provides a powerful new approach to the in vitro activation of human killer T cells and the in vivo treatment of human cancer.

Comparison of CT and MRI brain tumor imaging using a canine glioma model

A canine gliosarcoma model was used to study the effectiveness of magnetic resonance imaging (MRI) with gadolinium contrast enhancement in defining the histologic margins of brain tumors. The effectiveness of this technique was compared to conventional computed tomography (CT) using iodinated contrast enhancement. Cultured canine gliosarcoma cells were injected into the left hemisphere of adult mongrel dogs. The dogs developed brain tumors and progressive clinical signs. Serial MRI with and without gadolinium diethylene triamine penta-acetic acid was compared to serial CT with and without sodium iothalamate obtained on the same days. After the final scans, animals were sacrificed; the brains were removed and processed for routine histopathologic study. All tumors were visualized with contrast-enhanced MRI which proved most sensitive. Gadolinium di-ethylene triamine penta-acetic acid caused bright enhancement of tumors in a distribution that consistently corresponded to areas of pathologically proved tumor infiltration. Gross and microscopic autopsy findings correlated better with MRI than with CT which tended to produce poorer resolution and underrepresent the size of viable tumor. Gadolinium-enhanced MRI is more accurate than unenhanced MRI, unenhanced CT, or enhanced CT in defining the histologic margins of tumors.

Adoptive immunotherapy of human cancer using low-dose recombinant interleukin 2 and lymphokine-activated killer cells

The adoptive transfer of recombinant-methionyl human interleukin 2 (rIL-2)-activated autologous peripheral blood mononuclear lymphokine-activated killer (LAK) cells to cancer patients is being evaluated as an alternative to conventional cancer therapy. We have independently developed an alternative regimen to previously reported adoptive immunotherapy protocols using rIL-2 and LAK cells which features the prolonged administration of low-dose rIL-2 (30,000 units/kg) and an automated, entirely enclosed system of peripheral blood cell procurement, culture, harvest, and reinfusion of activated cells. The cell culture system was tested with a murine tumor model in which LAK cells generated in plastic culture bags were reinfused into tumor-bearing mice. Tumor regression was as effective with cells activated in the bags as in conventional culture flasks. Twenty-eight cancer patients were treated for 5 consecutive days with low-dose rIL-2, followed by leukapheresis, infusion of LAK cells, and prolonged IL-2 administration. At least 50% tumor regression was observed in 46% of all patients treated. These data imply that human peripheral blood mononuclear cells retain fully their capacity for rIL-2-induced activation and effector cell function under this alternative approach, and further, that a low-dose rIL-2 regimen with markedly reduced toxicities can be as effective as high-dose rIL-2 regimens if low-dose rIL-2 is given for a prolonged period of time following LAK cell infusion.

Surgical therapy of localized abdominal non-Hodgkin's lymphomas

Non-Hodgkin's lymphomas may involve a variety of abdominal organs, including the liver, spleen, gastrointestinal tract, and retroperitoneum. The number of organs potentially involved and the noncontiguous mode of spread make non-Hodgkin's lymphoma a difficult tumor to evaluate at the time of laparotomy. To clarify the surgical management of patients with this tumor, we retrospectively reviewed the medical records of 202 patients with histologically proven abdominal lymphomas. Within this group, 36 patients underwent laparotomy before they had chemotherapy or radiation therapy. Ten patients were explored to establish a histologic diagnosis of lymphoma. The remaining 26 patients underwent laparotomy because of presumed benign disease. Twenty patients were found to have localized disease at laparotomy. Patients with localized disease demonstrated significantly better survival than patients with extranodal and nodal involvement (p less than 0.05). Four patients with local resection received no adjuvant therapy and were free of disease a median of 50 months after surgery.

Recommendations for the surgical management of advanced breast cancer

By judicious selection of patients and operative procedures, the surgeon has an opportunity to improve the quality of life and to enhance disease-free survival in specific patient sub-groups, despite the fact that the local breast cancer may be advanced and untreated.

Application of microencapsulation for toxicology studies. II. Toxicity of microencapsulated trichloroethylene in Fischer 344 rats

Gelatin-sorbitol microcapsules containing 44.1% trichloroethylene (TCE) were prepared and mixed in NIH-07 rodent meal diet and provided at microcapsule concentrations of 0 (untreated control group), 1.25, 2.5, 5.0, or 10% (equivalent to 0, 0.55, 1.10, 2.21, or 4.41% TCE, respectively) to groups of 10 male F344 rats for 14 days. An additional control group received diets containing 5% empty capsules. For comparisons, TCE dissolved in corn oil was administered by gavage to different groups of 10 male rats for 14 consecutive days at dose levels adjusted to correspond to those in the feed study. Treatment-related deaths occurred only in the highest dose group of the gavage study. Body weight gain and feed consumption were reduced in high-dose groups of both the feed and gavage studies. There was no measurable loss of TCE in feed sampled from the cages during the study. Dose-related increases in organ (liver and kidney) weight/body weight ratios, individual cell necrosis in the liver, and hepatic microsomal NADPH cytochrome c reductase and peroxisomal palmitoyl-CoA oxidase and catalase activities were found in both the dosed-fed and gavage groups. Induction of cytochrome P-450 occurred only in the dosed-feed study. There were no significant compound-related pathologic lesions observed in the kidneys, the only other organ examined microscopically. Differences in lethality, cytochrome P-450 levels, and induction of microsomal or peroxisomal enzyme activities were attributed to differences in the method of dosing (gavage versus dosed-feed). The demonstration of no significant loss of TCE from the feed and of similar toxic effects produced by microencapsulated TCE via feed and TCE in corn oil via gavage indicate that microencapsulation can provide an excellent alternative exposure route for studying the oral toxicological properties of volatile chemicals, such as TCE, in rats.

Monoclonal antibody-mediated modulation of parathyroid hormone secretion by dispersed parathyroid cells

Available data suggest that ionized calcium may interact with a cell surface "sensor" or "receptor" to produce changes in one or more intracellular second messengers that ultimately regulate the release of parathyroid hormone (PTH). Recently, we developed a series of monoclonal antibodies directed toward specialized differentiation antigens expressed on endocrine cells. Since many of these monoclonal antibodies displayed exquisite specificity for cell surface molecules on the parathyroid cell, we used these reagents as probes to investigate signal recognition/transduction mechanisms associated with abnormal calcium-regulated PTH secretion. Depending on their binding site on the respective target antigen molecules, these monoclonal antibodies either stimulated or inhibited hormone secretion. Thus, defects in membrane-associated structures may contribute to deranged calcium-regulated PTH secretion in abnormal parathyroid cells.

Splenic enlargement and hyperfunction as indications for splenectomy in chronic leukemia

The chronic leukemias are associated with significant morbidity from splenic enlargement and hyperfunction. Although some patients with chronic leukemia benefit from splenectomy, the indications for operation are unclear. To identify those patients who benefit most from splenectomy, nine patients with chronic lymphocytic leukemia (CLL) and eight patients with chronic granulocytic leukemia (CGL) who had splenectomy to palliate the symptoms of massive splenic bulk or to improve the hematologic sequelae of splenic hyperfunction were studied. Splenectomy for bulk symptoms provided good palliation of symptoms, but the duration of the benefit was limited by the stage of the disease. Five of eight patients with CGL with bulk symptoms died within 6 months of operation. Splenectomy for hyperfunction was limited to a short-term hematologic response. In three of four patients with CLL who were Coombs positive, the presence of autoantibodies correlated with a recurrent transfusion requirement within 3 months of splenectomy. Thus, the benefit of splenectomy for bulk symptoms must be weighed against the risk of surgery and the patient's limited life expectancy. The benefit of splenectomy for treatment of splenic hyperfunction depends on the stimulus to hyperfunction and may not be beneficial for patients with refractory autoimmune anemias.

Local recurrence and the deep resection margin in carcinoma of the breast

Deep resection margin of carcinoma of the breast is an important determinant of the extent of surgical resection as well as the use of adjunctive therapy. To investigate the relationship between deep resection margin and local recurrence, we retrospectively reviewed 105 consecutive female patients with clinical or pathologic Stage II infiltrating ductal carcinoma of the breast. All patients underwent a modified radical mastectomy with the removal of an intact pectoral fascia. The deep margin of resection was determined by histopathologic examination. Detailed follow-up information was obtained for 100 patients. In this study group, the distance from the tumor margin to the pectoral fascia did not correlate with local recurrence. Seventy-seven patients had deep margins of 1 centimeter or less; eight patients had a local recurrence. Recurrence in this group did not correlate with the distance from the deep margin (p = 0.92). The adjunctive administration of radiation therapy or chemotherapy did not appear to influence the frequency of local recurrences. These data suggest a deep margin consisting of an intact pectoral fascia may be adequate to prevent local recurrence in patients with infiltrating carcinoma of the breast.

Inhibition of rat colon tumor isograft growth with dequalinium chloride

In searching for a new approach to the systemic treatment of colorectal carcinoma, we have observed that certain lipophilic cationic compounds are accumulated and retained for a significantly longer period in the mitochondria of living carcinoma cells than in normal cells or sarcoma cells. We report the in vivo therapeutic effect of one of these compounds, dequalinium chloride, on the W163 rat colon carcinoma isograft, which grows rapidly in Wistar/Furth rats after primary tumor implantation, and which recurs rapidly after primary tumor resection. In the primary transplant model, tumors were implanted, and daily dequalinium chloride treatments were begun the following day in doses ranging from 1 to 10 mg/kg. In the recurrence model, isografts were implanted, allowed to grow for one week, and then all gross tumor was resected. Dequalinium chloride was administered in varying daily doses starting the day after resection. In both models, tumor was removed on day 11 after implantation or resection. At sublethal doses, dequalinium chloride significantly inhibited primary tumor growth to 60% that of controls and recurrent tumor growth to 50% that of controls. We propose that this unique biologic approach of targeting carcinoma mitochondria with lipophilic cationic compounds may provide a major new opportunity for treating colorectal carcinoma.

Doxorubicin chemotherapy in the treatment of soft-tissue sarcoma. Combined results of two randomized trials

In 1978, there were initiated two independent randomized, prospective trials of adjuvant doxorubicin hydrochloride (Adriamycin) following primary therapy for soft-tissue sarcoma. The virtual identity of these two protocols permits their combination for analysis. A total of 75 patients (42 men, 33 women) with soft-tissue sarcoma (stages IIB to IVA) were randomized, after receiving optimal regional therapy, to receive either doxorubicin hydrochloride (450 mg/m2) (37 patients) or observation (38 patients). Follow-up has ranged from 16 to 80 months (median, 49 months). Twenty-five patients (33%) died, and two patients receiving doxorubicin developed cardiotoxicity. No significant differences in local control, metastasis-free survival, disease-free survival, and overall survival were observed for the two treatment arms. Despite temporary prolongation of disease-free survival with doxorubicin in some subgroups, we conclude that there is no advantage to the use of adjuvant doxorubicin in the treatment of soft-tissue sarcoma.

Complete nucleotide sequence of the Escherichia coli ptr gene encoding protease III

The nucleotide sequence of a 3120 bp region of the E. coli chromosome that includes the entire ptr gene has been determined. The proposed coding region for Protease III is 2889 nucleotides long, which would encode a protein consisting of 962 amino acids with a calculated molecular mass of 107,719 daltons. The predicted primary structure of the protein includes a 23-residue signal sequence, cleavage of which would give rise to a mature protein of molecular mass 105,124 daltons. At its 3' end, the ptr gene overlaps the start of the recB coding sequence by 8 bases, suggesting that these genes may form part of an operon.

Surgical oncology in university departments of surgery in the United States

Data on surgical oncology and multidisciplinary cancer program activity were obtained from 124 of 126 university surgery departments in the United States. Most of these institutions have American College of Surgeons-approved cancer programs (84%) as well as divisions of medical (95%), radiation (94%), pediatric (76%), and gynecologic (79%) oncology. Only 47 departments (38%) have formal divisions of surgical oncology. There are no major staffing or activity differences in surgical departments with or without such divisions, but multidisciplinary cancer program activity is greater in those institutions with a surgical oncology focus. Peer-reviewed cancer research grants are more frequent in departments of surgery with a surgical oncology division (68% vs 47%). The activities of the existing 47 divisions of surgical oncology are mainly operative, with breast cancer, melanoma, and soft-tissue sarcomas being the major clinical responsibilities. Chemotherapy is also frequent (81%). Cancer education for undergraduate and postgraduate surgical trainees is a major responsibility of most divisions, but only a small proportion (28%) have postresidency surgical oncology training programs. In contrast to the growth of some oncologic specialties, the establishment of surgical oncology within university departments has been slow, and the manpower needs appear modest.

Complete nucleotide sequence of the Escherichia coli recC gene and of the thyA-recC intergenic region

The nucleotide sequence of a 6,000 bp region of the E. coli chromosome that includes the 3' end of the coding region for the thyA gene and the entire recC gene has been determined. The proposed coding region for the RecC protein is 3369 nucleotides long, which would encode a polypeptide consisting of 1122 amino acids with a calculated molecular mass of 129 kDa. Mung bean nuclease mapping of a recC specific transcript produced in vivo indicates that transcription of recC is initiated 80 bp upstream of the translational start point. A weak promoter sequence situated 5' to the transcription initiation point has been identified. In the 1953 bp thyA-recC intergenic region there are three open reading frames that would code for polypeptides of molecular mass 30 kDa, 13.5 kDa and 12 kDa, respectively. Although the first and third of these open reading frames are preceded by possible ribosome binding sites, no obvious promoter sequences could be identified. Moreover, transcripts for these reading frames could not be detected.

Characterization of a new monoclonal antibody to a cell surface antigen on colorectal cancer and fetal gut tissues

Murine hybridoma were raised against the human colon carcinoma cell line CL-187. One clone was found to secrete a monoclonal antibody (ND-1) that recognizes a large external antigen (LEA) on human colon carcinoma cells. With indirect immunofluorescence on formaldehyde-fixed cells, more than 90% of the human colorectal carcinoma cell lines tested expressed LEA. Almost all of the 46 human noncolorectal and nonhuman cell lines tested did not express LEA, including cancer cell lines from other endodermally derived tissues. Staining of frozen sections from human colorectal tumors, noncolorectal tumors, normal adult, and normal fetal tissues showed expression of the antigen on colorectal cancer tissue, fetal colon, and fetal biliary epithelium. LEA can also be detected in the serum and ascites of colorectal cancer patients. Double indirect immunofluorescence with rabbit anti-carcinoembryonic antigen (CEA) antibody and ND-1 monoclonal antibody on a human colorectal carcinoma cell line showed that LEA is distinct from CEA. Physicochemical analysis of LEA showed that it has a large molecular weight, is resistant to extraction from the cell surface, and that sialic acid is an important component of the antigenic site. Because of the specificity for colorectal cancer tissue along with certain biochemical properties, LEA appears to be unique when compared with other tumor-associated antigens. Further research is needed to define the clinical usefulness of LEA in either the diagnosis or treatment of colorectal carcinoma.

Abdominal pain in neutropenic cancer patients

A review of 58 patients with malignancies (age range, 14-73 years), who required surgical consultation for acute abdominal pain in the setting of neutropenia (granulocyte count less than 1000/mm3) after chemotherapy was conducted. Ninety percent had fevers greater than 37.8 degrees C, 30% had diarrhea or melena, and 25% had diminished bowel sounds. Five of the 29 patients (17%) with localized pain had surgical intervention; 3 of 29 patients (10%) with generalized pain underwent operations (2 for x-ray findings). All eight of these surgically treated patients survived to leave the hospital. Eighteen of the 29 patients with generalized pain were believed to have a similar syndrome of diarrhea (occasionally heme positive) and diffuse abdominal tenderness (some with peritoneal signs and distension), which was termed "neutropenic enteropathy." Eleven of these 18 patients had their symptoms resolve with antibiotic therapy, aggressive fluid replacement, and a return of their granulocyte count to normal. The other seven died of pneumonia (two), unknown causes (one), and diffuse enterocolitis throughout the intestinal tract (four documented at autopsy). The overall 30-day mortality rate in this series was 34%. Several factors correlated significantly with mortality: hypotension at the onset of pain (80% mortality), bacteremia (63% mortality), and fungemia (100% mortality). Absolute leukocyte count and absolute platelet count did not correlate with mortality. This study reaffirms that patients with neutropenic enteropathy are best treated conservatively. Patients with surgically correctable disease were identified by specific focal findings on examination or x-ray.

Mutagenicity tests of lipid oxidation products in Salmonella typhimurium: monohydroperoxides and secondary oxidation products of methyl linoleate and methyl linolenate

Nine hydroperoxy and hydroperoxy-epidioxy oxidation products derived from either autoxidation (AO) or photosensitized oxidation (PO) of methyl linoleate (MLo) or methyl linolenate (MLn) were tested for mutagenic activity by the Salmonella typhimurium his+ reversion assay using strains TA100, TA98, TA102, TA97 and TA1537. All nine oxidation products, monohydroperoxides from AO-MLn (I) or from PO-MLn (II), dihydroperoxides from PO-MLo (III), AO-MLn (IV) or PO-MLn (V), hydroperoxy epidioxides from PO-MLo (VI), AO-MLn (VII) or PO-MLn (VIII) and hydroperoxy bis-epidioxides from PO-MLn (IX), were weakly mutagenic in strains TA97 and/or TA100. The hydroperoxy epidioxides (VI-IX) exhibited significantly greater activity in strain TA97 than did the monohydroperoxides (I, II) or the dihydroperoxides (III-V). In strain TA100, all of the oxidation products tested exhibited similar activity. No major differences between products derived from autoxidized and photooxidized MLn (I v. II, IV v. V, VII v. VIII) were obtained. Rat-liver S-9 reduced the toxicity of all oxidation products to the tester strains. The greatest mutant yields were usually obtained in the presence of S-9, but mutagenic potency was sometimes greater without S-9. The structural feature common to all of the mutagenic oxidation products was the presence of a hydroperoxy group, suggesting that this characteristic is responsible for the observed mutagenicity, either directly or through a common degradative pathway to reactive products of lower molecular weight.

Colorectal carcinoma in patients under age 40

Patients under the age of 40 with colorectal cancer (29 females, 18 males) were compared with similar patients in our general hospital population and analyzed for patterns of presentation, stage at diagnosis, degree of tumor differentiation, and survival. There was a higher incidence of poorly differentiated tumors in the young patients (21% vs. 8% in the general population). Colon cancer in young adults was in a more advanced stage at presentation. The survival rate for young patients was 23% vs. 61% for the general population (p = 0.02). Stage C patients treated for cure had a survival rate of 56% in the general population compared with 34% in young adults (p = 0.05). The degree of tumor differentiation did not affect survival in those young patients undergoing curative resections (41% for well-differentiated and 30% for poorly differentiated cancers, p = 0.09). The median survival time by stage was: Stage A and B (N = 3) 36 months, Stage C (N = 26) 32 months, and Stage D (N = 18) 15.8 months. The need for early recognition of colorectal cancer in young adults is emphasized by the greater incidence of advanced disease and the high failure rate.

Surgical considerations in gastric cancer

The American Joint Committee on Cancer staging system for gastric cancer is presented and its importance for defining prognosis and therapy is described. The report of the Gastrointestinal Tumor Study Group concerning adjuvant chemotherapy for gastric cancer is presented and the criteria for curative and noncurative resections are elucidated. The concepts of intraperitoneal chemotherapy, as an adjunct to aggressive surgical resection, is discussed.

Surgical oncology

There has been a recent reassertion of the surgeon's role in cancer management. Traditionally, surgery has been the major modality of cancer treatment. In settings of clinical trials, surgeons had initially assumed a more passive status, contributing patients while chemotherapists and radiotherapists developed experimental protocols. Currently surgeons are taking an active role in planning and participating in such clinical studies. The American Joint Committee Staging System is being widely adopted, quality control of surgical procedures is improving, and innovative surgical operations are being devised. Surgical oncologists have spearheaded the concepts of multimodal treatment for their colleagues for a variety of cancers, most particularly cancers of the breast, head and neck, esophagus, lung, stomach, colorectum, and testicles, and sarcomas. The interaction of surgical treatment with radiation and chemotherapy is now more carefully planned, both for primary and metastatic tumors, and meaningful data are being derived from patient care. There is emphasis on treatment options, individualization of therapy, and restorative procedures at a variety of cancer sites. Constitutional aspects of cancer, such as nutrition, immune status, and metabolic aberrations, are given more attention, and there is a greater application of advances in cancer biology to the overall clinical care of patients.

Lymphoid abnormalities in rats with adjuvant-induced arthritis. I. Mitogen responsiveness and lymphokine synthesis

Lewis rats injected in the hind paw with Mycobacterium butyricum develop a severe polyarthritis which shares certain features in common with rheumatoid arthritis in man. Spleen and peripheral blood mononuclear cells from rats with this form of arthritic disease proliferate poorly in vitro in response to concanavalin A (con A), phytohaemagglutinin (PHA), and pokeweed mitogen (PWM). The splenic hyporesponsiveness appears within four days of M. butyricum injection (three to five days prior to the development of detectable arthritis), reaches a peak 16-22 days following injection, and persists for at least 40 days. Buffalo strain rats injected with M. butyricum do not develop arthritis, and their spleen cells respond normally to con A, PHA, and PWM. In response to lipopolysaccharide (LPS) the synthesis of interleukin 1 (IL-1) by spleen or peritoneal macrophages from arthritic Lewis rats equalled or exceeded that of macrophages from normal rats. In contrast splenic T cells from arthritic rats produced reduced amounts of interleukin 2 (IL-2; T cell growth factor) in response to stimulation with PHA or con A. Moreover, con-A-activated spleen cells from arthritic rats failed to bind IL-2 and to respond to this growth factor with increased 3H-TdR uptake as did normal spleen cells. In-vitro treatment of 'arthritic' cells with 10(-5) M indomethacin did not restore to normal their reduced mitogen responsiveness, and spleen cells from normal and arthritic rats were equally sensitive to the inhibitory effects of prostaglandin E2 on con-A-induced proliferative responses. These results indicate that peripheral lymphoid function is compromised in rats with adjuvant-induced arthritis and that this functional deficit is mediated by aberrant synthesis of and response to IL-2 by T cells of arthritic animals.

The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons

The 1982 survey documented changes in the management of carcinoma of the breast in this country. If one compares the current survey results with the results of the 1978 survey, an inescapable conclusion is that there is a changing understanding of carcinoma of the breast and a willingness to apply new knowledge to clinical practice. These results also show the potential of the hospital Tumor Registry when records are systematically aggregated and data from different points compared. Future applications of this survey procedure and further analyses of these data may be used to document progress in the control of cancer. While useful for these purposes, it should be noted that these data are not intended, nor suited, for assessing the superiority of given treatments. They may not reflect the outcome that would result from a clinical trial. Comparisons made herein often involve patients who differed in many respects other than that on which the comparison was focused. However, within these constraints, the data may be useful for clinicians and scientists interested in the dynamic state of the treatment of carcinoma of the breast in large numbers of hospitals in the United States.

Effects of specific active immunization on tumor recurrence following primary tumor resection in WF rats with 1,2-dimethylhydrazine-induced bowel cancer

Primary gastrointestinal tumors were induced in male WF rats by 16 weekly sc injections of 1,2-dimethylhydrazine [(DMH) CAS: 540-73-8; 20 mg/kg/wk]. Twenty-four to 28 weeks after the start of DMH injections, all rats were surgically explored and gastrointestinal tumors were resected. Rats with no remaining microscopic disease after operation were immunized with one of four tumor isografts. The first isograft, DMH-W163, is a poorly differentiated mucinous adenocarcinoma explanted from a colon cancer in a DMH-treated animal. It has been shown to possess antigens that cross-react with other DMH-induced bowel adenocarcinoma isografts. The second isograft, DMH-W49, is a carcinosarcoma explanted from a DMH-treated primary colon cancer. It has intermediate antigenic cross-reactivity with other colon adenocarcinoma isografts in the WF model. The third isograft, DMH-W15, is a sarcoma explanted from a DMH-induced colon cancer that does not possess antigens cross-reactive with other DMH-induced colon adenocarcinomas. The fourth isograft, SPK, is a spontaneous (non-DMH-induced) renal cell carcinoma that is immunogenic but should not contain tissue-type-specific antigens cross-reacting with the bowel cancers. Immunized rats received three sc weekly injections of 1 X 10(3) irradiated cells. Concomitant control rats received no immunization after resection of the primary tumor. Within 24 weeks of primary tumor resection, 12 of 16 (75%) rats not immunized had tumor recurrence. Only 8 of 24 (34%) rats immunized with DMH-W163 had tumor recurrence (P less than .025 compared to controls). Fifty percent of animals (10/20) immunized with the carcinosarcoma DMH-W49 had a recurrence. Animals immunized with the non-cross-reacting DMH-W15 sarcoma isograft had a recurrence rate similar to that of controls (16/20, 75%). The rats immunized with SPK were not protected from recurrence. Twelve of 19 (63%) had a recurrence at or near the suture line within 24 weeks following primary tumor resection. These results confirm that adjuvant immunotherapy can decrease the rate of recurrence following primary tumor resection in this model. In addition, immunogens that possessed tissue-type-specific antigens were more effective in preventing tumor recurrence than those that did not.

Specific active immunotherapy with butanol-extracted, tumor-associated antigens incorporated into liposomes

With the use of whole tumor cell vaccines in a rat colon cancer minimal residual disease model, we have recently demonstrated that although tissue type-specific tumor immunogens protect against recurrence in the absence of histocompatibility differences, these immunogens offer no predictable tumor-specific protection in the presence of such differences. We have therefore begun to test whether syngeneic and allogeneic rat colon cancer tumor-associated antigens (TAAs), when incorporated into the bilayers of liposomes, could function as effective immunogens in immunotherapy and immunoprotection models. Male Wistar/Furth (W/Fu) rats were inoculated with 5 X 10(6) DMH-W163 colon cancer cells. All nonimmunized animals died of widespread metastases within 2 weeks of complete local tumor resection. In experimental groups, four methods of immunotherapy were used after resection: (1) irradiated whole tumor cells, (2) butanol-solubilized membrane extracts containing TAA only, (3) liposomes only, and (4) liposomes containing TAA. Only animals receiving TAA incorporated into liposomes had a significant increase in survival (p = 0.026). Thirty percent remain disease-free 6 months later. In additional experiments, Buffalo rats were challenged with 1 X 10(6) Buffalo rat colon adenocarcinoma cells after immunization by irradiated whole tumor cells or liposomes and butanol-extracted colon cancer TAAs. Only animals in the group immunized with TAA incorporated into liposomes were significantly protected from subsequent tumor isograft challenge. These data provide evidence of a way to present solubilized colon cancer-associated immunogens that may be applicable in a more clinically relevant, allogeneic setting.

The relationship of body temperatures to the efficacy of chemotherapy against systemic metastases from B16 melanoma

Potential synergy between physiologic levels of heat and chemotherapy was investigated in C57BL/6 mice bearing the B16 melanoma. Low levels of hyperthermia alone had no effect on the growth of the primary tumor but augmented the growth delay induced by cyclophosphamide. Although the addition of hyperthermia to chemotherapy and amputation increased the duration of survival and decreased the number of pulmonary metastases, heat did not increase the cure rate of animals with gross or microscopic pulmonary metastases. The incidence of local recurrence was decreased by hyperthermia in animals treated with chemotherapy and incomplete excision of the primary tumor.

The effect of 1,2-dimethylhydrazine (DMH) carcinogenesis on peripheral T cell subsets in the Wistar Furth rat

1,2-dimethylhydrazine (DMH)-induced colon cancer in Wistar/Furth (W/Fu) rats is analogous in many ways to human colorectal cancer. As part of our attempt to understand the immunobiology of these tumors, we have utilized the recently available monoclonal antibodies W3/25 and OX8 to monitor helper (Th) and suppressor (Ts) lymphocyte subpopulations. Normal untreated male W/Fu rats of less than 1 year of age were phenotyped (n = 43). The mean percentage of Th and Ts was 42 +/- 1 (mean +/- SEM) and 33 +/- 1, respectively. The mean Th/Ts ratio was 1.3 +/- 0.1. A Th/Ts equal to or greater than 1 is considered "normal" in the W/Fu rat. The DMH-treated rats (20 mg/kg/wk) were evaluated in initial experiments at various intervals after treatment. Rats studied 24 hours after a single DMH injection had no alterations in T cell subsets. Rats studied 28, 32, and 65 weeks after the start of 16 weekly DMH injections were found to have a decrease in the percentage of Th and a relative increase in Ts, with Th/Ts ratios of 0.6 +/- 0.2, 0.7 +/- 0.1, and 0.7 +/- 0.1, respectively (each P less than 0.01). In a separate experiment in which rats were studied after 4, 8, and 16 weeks of DMH injections, no alterations in T cell subsets were noted. Rats (n = 5) studied at 20 weeks after the start of DMH were found to have 41 +/- 3% Th and 36 +/- 2% Ts and a Th/Ts ratio of 1.2 +/- 0.1. Three of five rats were found to have adenocarcinomas. Four of five rats had Th/Ts less than 1. One rat with Th/Ts equal to 0.9 had metastatic disease. Rats studied at 25 weeks (n = 8) were found to have more advanced carcinomas (4/8) that were causing obstruction or bleeding in the animal. There was a significant decrease in Th and Ts in this group, with 24 +/- 3% and 26 +/- 3% respectively (P less than 0.001). The Th/Ts ratio for this group was 0.9 +/- 0.1 (P less than 0.01). In other experiments, rats were treated with DMH or placebo over a 16-week period and serially bled during and after treatment. No effect of DMH treatment on T cell subsets was noted. Repeated bleeding alone was noted to cause persistent alterations of T cell subpopulation.(ABSTRACT TRUNCATED AT 400 WORDS)

Identification of material with paternal HLA antigen immunoreactivity from purported circulating immune complexes in patients with gestational trophoblastic neoplasia

Circulating immune complex(es) (CIC) have been shown to rise progressively only when patients with hydatidiform molar pregnancy enter gonadotropin-documented remission. The CIC in 3 patients with gestational trophoblastic neoplasia (GTN)--1 with hydatidiform mole and 2 with choriocarcinoma--were characterized. Their clinical course was monitored by serial antigen-nonspecific polyethylene glycol (PEG) 6000-CIC assay and simultaneous human chorionic gonadotropin (HCG) assay from presentation until sustained gonadotropin-documented remission. As serial HCG progressively decreased to normal following surgical or chemotherapeutic reduction in tumor burden, PEG-CIC concurrently rose. Serum obtained at or near peak PEG-CIC levels was precipitated by 3.75% PEG 6000 and fractionated by column chromatography on Sephadex G-200 (exclusion limit, greater than 600,000 mol wt) in glycine-HCl and 1 M NaCl buffer at pH 2.8. None of the 5 elution fractions obtained from the 3 patients contained HCG or anti-HCG activity. However, in the hydatidiform molar patient, fractions 1 through 3 (mol wt greater than 67,000--and containing immunoglobulin) were shown to competitively inhibit complement-dependent antibody lysis on 1 of 4 paternal HLA haplotype (AW32) targets. In 2 of the 3 patients studied, low-molecular-weight fractions (not containing immunoglobulin) significantly inhibited reference anti-HLA binding of antisera directed against only 1 of 4 paternal HLA haplotypes. The immunospecificity of this inhibition was confirmed by criss-cross control assays in which elution fractions obtained from both of these patients were tested for inhibition of lymphocytolysis of both sets of paternal lymphocytes. None of these fractions were immunoreactive to maternal HLA haplotypes. Further analysis of serum from the hydatidiform molar patient revealed that no free complement-fixing antibody against paternal antigens could be found by conventional screening assays in unfractionated patient sera. Three of 4 paternal HLA antigens or non-complement-fixing anti-HLA immunoglobulin was detected in unfractionated pretreatment, treatment, and remission sera of the hydatidiform molar patient. Only in this patient's remission sera was unbound AW32 antigen or non-complement-fixing anti-AW32 antibody detected. These data demonstrate the successful characterization of at least 1 specific antigen fractionated from a tumor-associated immune complex. The implication that some patients with GTN may recognize and react to immunogenic paternal HLA antigens as part of their successful response to therapy for trophoblastic tumor is discussed.

Colon and rectal carcinoma in the west of Scotland. Symptoms, histologic characteristics, and outcome

Multiple clinical and pathologic factors have been analyzed retrospectively for a group of 456 patients with colon and rectal cancer treated in Glasgow over a span of 4 years. Sixty-five percent of these patients underwent curative resection, and another 16 percent had palliative resection. Obstruction and perforation (present in 19 and 5 percent, respectively) were associated with the highest operative mortality (17 percent for both) of any presenting symptom. However, when only patients who survived curative resection were considered, obstruction carried only a slightly lower 5 year survival than did other common symptoms, whereas perforation still led to only a 10 percent 5 year survival. Neither mucin production nor degree of differentiation influenced survival significantly. Adherence of the primary tumor to an adjacent organ was associated with a very poor prognosis (9 percent 5 year survival), but curative resection of the involved organs with the primary tumor increased the 5 year survival to 34 percent. Patterns of recurrence were noted to be markedly different for each primary site and for different stages. Dukes' stage was the most important overall determinant of prognosis.