Immunohistochemical expression of vascular endothelial growth factor can predict response to 5-fluorouracil and cisplatin in patients with gastric adenocarcinoma

The combination of 5-fluorouracil (5-FU) and cisplatin is used most commonly for gastric carcinoma. Recent studies have indicated that vascular endothelial growth factor (VEGF) is related to drug delivery through angiogenesis and vascular permeability. In this study, we evaluated the efficacy and toxicity of continuous infusion of 5-FU and low dose cisplatin infusion as first-line treatment in patients with unresectable gastric adenocarcinoma. We also examined the relationship between chemotherapy response and immunohistochemical expression of VEGF in the biopsy samples of gastric primary. All 30 patients enrolled in this study were assessable for response, adverse reactions, and VEGF expression. The regimen consisted of 5-FU (350 mg/m2/day every day by continuous venous infusion) and low dose cisplatin (7 mg/m2/day by drip infusion over 1 h on days 1-5 every week). This treatment was repeated weekly for 3 consecutive weeks. Four weeks after the second cycle, mesurable lesions were estimated for response. An overall response rate was 46.7% (14/30). Patients with intestinal histologic type (10/12) and good performance status ([PS], 13/18) showed good response rate (83.3%, and 72.2%, respectively) compared to patients with diffuse histologic type (4/18) and poor PS [(1/12) 22.2%, and 8. 3%, respectively]. The response rate of VEGF-positive cases and VEGF-negative cases was 75% (12/16), and 16.7% (2/14), respectively. Multivarite analysis revealed that VEGF-positive and good PS had a significant impact on chemotherapy response in this treatment. The most common garde 3 or higher toxicities were myelosuppression (30%) and diarrhea (13.3%). Continuous infusion of 5-FU and low dose cisplatin infusion is an effective treatment for patients with unresectable gastric carcinoma, and VEGF expression may be a useful predictor of chemotherapy response in this regimen.

Identification of cDNAs encoding alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSDase)

To elucidate the molecular basis underlying quinolinate metabolism, the cDNA encoding ACMSDase was cloned.

Tryptophan-niacin metabolism in liver cirrhosis rat caused by carbon tetrachloride

We investigated the change of tryptophan-niacin metabolism induced by carbon tetrachloride (CCl4) in rats with liver cirrhosis. The rats were injected with CCl4 (0.5 or 1 mL of 50% olive oil solution/kg body weight) twice a week for 1 or 2 mo and given phenobarbital water simultaneously. The urinary excretions of nicotinamide (Nam) and its metabolites were assayed. As the result, the urinary excretion of Nam, N1-methyl-4-pyridone-3-carboxamide (4-Py), Nam + N1-methylnicotinamide (MNA) + N1-methyl-2-pyridone-5-carboxamide (2-Py) + 4-Py was lower in the CCl4-treated groups than in the non-treated group (control) regardless of the experimental period (1 mo and 2 mo) or dosing amount of CCl4 (0.5 and 1 mL). Moreover, we investigated which pathway of tryptophan-niacin metabolism was affected in CCl4-treated rat. As the result, the possibility that the MNA-->4-Py reaction is inhibited by CCl4 treatment was suggested in this experiment.

[Acute myelocytic leukemia and plasmacytoma secondary to chemotherapy and radiotherapy in a long-term survivor of small cell lung cancer]

A 68-year-old man was given a diagnosis of lung cancer of the right upper lobe (small cell carcinoma, T 4 N 2 M 0, stage IIIB) in February 1991. The tumor diminished after chemotherapy and radiotherapy. In February 1992, a partial resection of the lower lobe of the right lung was performed because of the appearance of a metastatic tumor. In September 1994, squamous cell carcinoma developed in the lower part of the esophagus, but disappeared after radiotherapy. In February 1998, a diagnosis of myelodysplastic syndrome was made. Two months later, the patient had an attack of acute myelocytic leukemia and died of cardiac tamponade. An autopsy determined that both the lung cancer and esophageal cancer had disappeared. Acute myelocytic leukemia and plasmacytoma of lymph nodes in the irradiated area were confirmed. These were regarded as secondary malignancies induced by chemotherapy and radiotherapy.

[A case of gastric carcinoma treated effectively with 5'-DFUR]

A 79-year-old male was admitted to our hospital for further examination on gastric carcinoma (1' type) in the cardia. The histology of biopsied tissue was moderately differentiated adenocarcinoma (tub2). The patient refused a gastrectomy and received three cycles of local injection therapy with OK-432 + Beriplast into the tumor. However, the tumor showed no decrease in size. Considering the quality of life, the patient was given out patient treatment with 5'-DFUR (Furtulon, 800 mg/day). Three months later, the patient showed a partial response (PR) on the basis of gastric X-ray and endoscopic findings. No adverse reactions to the drug were seen. The patient has been receiving the same drug since then, and has continued to show PR for 15 months. Biopsied tissues were checked immunohistochemically for expression of thymidine phosphorylase (TdRPase), and changes in tissue TdRPase level were examined by ELISA. The TdRPase level decreased with shrinking of the tumor. These results suggest that the shrinking of tumor following 5'-DFUR therapy is closely related to TdRPase.

Effects of various kinds of dietary amino acids on the hepatotoxic action of D-galactosamine in rats

The protective effects of various kinds of dietary amino acids against the hepatotoxic action of D-galactosamine (GalN) were examined. Male Wistar rats fed with 20% casein diets containing 10% or 5% amino acid for one week were injected with GalN (800 mg/kg body weight), and the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activities, the hepatic glycogen concentration, and the serum glucose-level were examined 20 hours after the injection. In the groups with the 10% amino acid diets, activities of AST, ALT, and LDH in serum of 10% L-glutamine (Gln), 10% L-asparagine (Asn), and 10% L-serine (Ser) groups were significantly lower than those of the control group, and in the groups with the 5% amino acid diets, those activities of 5% L-histidine (His), 5% L-tyrosine (Tyr), 5% L-lysine (Lys), and 5% L-glycine (Gly) groups were also lower than those of the control group. The concentration of liver glycogen of 10% Gln-, 10% Asn-, and 10% Ser- groups and those levels of 5% His-, 5% Tyr-, 5% Lys-, and 5% Gly-groups were also significantly higher than that of the control group. As a result, it was found that some kinds of dietary amino acid such as L-Ser, L-Asn, L-His, L-Lys, L-Tyr, and L-Gly, in addition to L-Gln were effective to protect the rats from GalN-induced injury.

Mucin histochemical analysis of minute gastric differentiated adenocarcinoma

Fifty-six surgically resected intramucosal differentiated adenocarcinomas (DA) of the stomach with a maximum diameter of less than 5 mm were analyzed by mucin histochemistry. Gastric type phenotypic expression was observed in 41.1% of cases, intestinal type in 28.6% and gastric-intestinal type in 28.6% of all cancers. Gastric type phenotypic expression was the most frequent. As the tumor diameter increased, the incidence of DA with gastric phenotype tended to decrease. Intestinal metaplasia of the cancer's surrounding mucosa was absent or slight in DA with gastric phenotype, but moderate to severe in DA with gastric-intestinal phenotype and intestinal phenotype. Morphologically and mucin histochemically, intestinal metaplasia surrounding DA with gastric phenotype was immature and incomplete compared with DA with gastric-intestinal phenotype or intestinal phenotype. It is suggested that a large amount of DA with gastric phenotype is histogenetically derived from the gastric gland proper without intestinal metaplasia. However, as the tumor grows and intestinal metaplasia progresses, intestinal type phenotypic expression appears and then DA with gastric phenotype changes into DA with gastric-intestinal phenotype or intestinal phenotype.

Effect of indigestible oligosaccharides on the hepatotoxic action of D-galactosamine in rats

The effects of dietary oligosaccharides on the hepatotoxic action of D-galactosamine (GalN) were investigated in this study. Male Wistar rats fed with 20% casein diets containing 10% oligosaccharide or D-galactose (Gal) for 2 weeks were injected with GalN (1,900 mg/kg of body weight), and the plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and the hepatic glycogen concentration were examined 20 hours after the injection. The plasma AST and ALT activities in experiment 1 for the Gal + neomycin (NEO) group were significantly lower than those for the control (C), NEO, raffinose (RAF) + NEO and galacto-oligosaccharide (GA-LO) + NEO groups. In experiment 2, these activities were significantly lower in the Gal, Gal + NEO and RAF groups than in the RAF + NEO group when the groups were treated with GalN. On the other hand, in respect of the hepatic glycogen concentration in experiment 1, that of the Gal + NEO group was higher than that of the C, NEO, RAF + NEO or GALO + NEO groups. In experiment 2, this parameter was significantly higher in the Gal, Gal + NEO and RAF groups than in the RAF + NEO group after the GalN treatment. As a result, it is suggested that the GalN-hepatitis-suppressive effects of indigestible oligosaccharides such as RAF or GALO is mediated by the action of intestinal bacteria.

Increased expression of proliferating cell nuclear antigen in autoimmune hepatitis in a patient with raised serum concentration of CA19-9

A 52 year old woman had autoimmune hepatitis and an increased concentration of serum carbohydrate antigen 19-9 (CA19-9). The origin of the raised CA19-9 was studied using immunohistochemistry. Liver biopsy section showed chronic active hepatitis with large numbers of proliferated bile ductules. Immunohistochemical analysis revealed that the proliferated bile ductule cells were positive for proliferating cell nuclear antigen (PCNA) and for CA19-9. It is speculated that the raised serum CA19-9 concentration was derived from proliferated bile ductule cells and these cells, which are positive for PCNA, may be able to produce high concentrations of CA19-9.

Dietary linoleic acid alters alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD), a key enzyme of niacin synthesis from tryptophan, in the process of protein expression in rat liver

alpha-Amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD) [EC 4.1.1.45] is a key enzyme of niacin synthesis from tryptophan. In this study, we examined whether dietary linoleic acid alters the protein expression of ACMSD in rat liver. Antibody against rat liver ACMSD was prepared by injecting mice with the purified enzyme. With the use of this polyclonal antibody and analysis by two-dimensional electrophoresis, we studied the mechanism by which the level of liver ACMSD activity was varied in rats fed a linoleic acid diet. In the rats fed a dietary linoleic acid (L), ACMSD protein levels in the liver were strongly suppressed as compared with the rats fed a fat-free diet (FF). These results suggest that the expression level of ACMSD might be modulated by linoleic acid or their metabolites.

Antioxidant activity of ferulic acid beta-glucuronide in the LDL oxidation system

Antioxidant activity of ferulic acid beta-glucuronide, which is prepared from the plasma of feruloyl arabinose fed rats, in the CuSO4- induced LDL autoxidation system was studied. It has been found that absorbed ferulic acid occurred as the beta-glucuronide and that the antioxidant activity of ferulic acid beta-glucuronide, which has not only the hydrophobic ferulic acid moiety but also a hydrophilic sugar moiety, is stronger than ferulic acid in the LDL oxidation system.

[A case of recurrent advanced colon cancer treated with CPT-11 for second-line chemotherapy]

A 59-year old male patient had been operated on for sigmoid colon cancer in July, 1990. Operative findings were, P0, H0, S1, N (-), Stage I, and histological findings were ss, ly 2, v0, n (-). In July 1994, the CEA level elevated, and be was diagnoted as having para-aortic LN swelling and stenosis of anastomosis of colon. He was admitted for treatment of recurrent colon cancer. Initially, he was treated with continuous injection of 5-FU, low-dose CDDP and Leucovorin. His CEA level decreased and para-aortic LN diminished in size. But, in December 1995, the CEA level and para-aortic LN relapsed. 5-FU, CDDP and Leucovorin were administered, but the CEA level became more and more elevated. This regimen was not considered responsible for drug resistance. CPT-11 was administered at 60 mg/week 6 times, and 80 mg/week 3 times. The side effects disappeared, LN sightly diminished in size, and the CEA level decreased. Judging by the anticancer effect without severe side effect, we found CPT-11 a useful drug for second-line chemotherapy.

Change of tryptophan-niacin metabolism in D-galactosamine-induced liver injury in rat

The change of tryptophan-niacin metabolism in D-galactosamine (D-galN) injected rats was investigated. Rats fed with niacin-free diets containing 40% casein for 11 days were injected with D-galN (0.8 g/kg body weight). The urinary excretions of nicotinamide and its metabolites, and the activity of liver alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD) (EC 4.1.1.45), a key enzyme of tryptophan-niacin metabolism, were assayed. As the result, the urinary excretions of N1-methylnicotinamide (MNA), N1-methyl-2-pyridone-5-carboxamide (2-Py), N1-methyl-4-pyridone-3-carboxamide (4-Py) and their sum (nicotinamide+MNA+2-Py+4-Py) were higher in the D-galN-injected group than in the control group. Hepatic ACMSD activity in the D-galN-injected group was lower than that of the control group. These results suggest that the increase in urinary excretion of nicotinamide and its metabolites after the injection of D-galN is considered to be attributable to a decrease in liver ACMSD activity.

Effect of dietary L-glutamine on the hepatotoxic action of D-galactosamine in rats

The protective effect of dietary L-glutamine against the hepatotoxic action of D-galactosamine (GaIN) was investigated by model experiments with rats. Rats fed with 20% casein diets containing 10% free amino acids were injected with GaIN, and the serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase activities and the hepatic glycogen content were assayed 20 hours after the injection. These enzyme activities in the group fed with 10% L-glutamine diet for 8 days were lower than those in the groups fed with the control, 10% L-glutamic acid and 10% L-alanine diets for 8 days. The more prolonged the feeding period with the 10% L-glutamine diet was, the more the serum activity levels of such enzymes were decreased. Although neomycin also lowered these enzyme activities, its simultaneous ingestion with neomycin did not show any additive or synergistic effect. The hepatic glycogen content in the 10% glutamine group still remained high after the GaIN treatment. It is therefore assumed that the effectiveness of glutamine intake would have been mediated by glycogen metabolism rather than by uridine metabolism.

Purification and properties of alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD), key enzyme of niacin synthesis from tryptophan, from hog kidney

alpha-Amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD) (EC 4.1.1.45) was purified to a homogeneous state from hog kidney cytosol by ammonium sulfate fractionation, Butyl-Toyopearl 650, hydroxyapatite, DEAE-Sephadex, Toyopearl HW55, Superdex 200 and TSK-gel G3000SW chromatographies. The molecular weight of the enzyme was estimated to be 58,000 by TSK-gel G3000SW gel filtration. The optimum pH (constant concentration) was 7.5. The Km for alpha-amino-beta-carboxymuconate-epsilon-semialdehyde was 1.61 x 10(-5) M. The activity of purified enzyme was inhibited by some chemical modifying reagents such as monoiodoacetic acid and p-(chloromercuri) benzoic acid. A sulfhydryl group was deduced to exist in the active site of the enzyme.

Dietary wheat gluten alleviates the elevation of serum transaminase activities in D-galactosamine-injected rats

The effects of dietary protein on the elevation of activities of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in D-galactosamine-injected rats were investigated. The rats fed with experimental diets containing test protein sources for 2 weeks were injected with D-galactosamine (0.8 g.kg-1 body weight). The activities of AST and ALT in serum were assayed after 20 h. According to the results, these enzyme activities in the rats fed 40% casein diet were higher than those of 5, 10, or 20% casein groups. In the 40% gluten group, these enzyme activities were lower than in the 40% casein group. This difference was not considered to be caused by the deficit of L-lysine and L-threonine in gluten. The extent of the reduction of UTP and UDP-glucose in liver by D-galactosamine was almost the same in the 40% gluten and 40% casein groups. These results suggest that levels and quality of dietary protein affect the susceptibility of animals to the hepatotoxin D-galactosamine and dietary gluten was found to alleviate the elevation of serum transaminases in rats by the drug.

Effects of dietary gluten on the hepatotoxic action of galactosamine and/or endotoxin in rats

This study was done to clarify the effects of dietary wheat gluten on the hepatotoxic action of D-galactosamine (GalN) and endotoxin (Etx). Male Wistar rats fed a high casein or high gluten (supplemented with L-Lys and L-Thr) diet were injected with GalN or Etx, and the plasma glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, and lactase dehydrogenase activities were examined 20 h later. In rats fed the high gluten diet, these enzyme activities were lower than in the high casein group after injection of 800 mg/kg of GalN. But such a difference between the casein and gluten groups was not clear when they were treated with 400 mg/kg of GalN nor observed even after injection of Etx or Etx+GalN (400 mg/kg). Similarly these was no difference in the plasma concentrations of Etx, tumor necrosis factor-alpha, or interferon-gamma in the rats receiving an injection of 800 mg/kg of GalN between both dietary groups. These results suggest that dietary gluten affords protection against hepatic injury by a high dose of GalN but not by a low dose of GalN and/or Etx.

Effect of dietary linoleic acid on the tryptophan-niacin metabolism in streptozotocin diabetic rats

To make clear the mechanism of change of tryptophan-niacin metabolism in diabetic rats, we investigated the effect of dietary linoleic acid on the tryptophan-niacin metabolites and the activity of liver, alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD), a key enzyme of tryptophan-niacin metabolism, in streptozotocin diabetic rats. Moreover, we investigated the involvement of linoleic acid in the induction of hepatic ACMSD activity by streptozotocin diabetes. In diabetic rats, the sum of urinary excretion of nicotinamide, N1-methylnicotinamide (MNA), N1-methyl-2-pyridone-5-carboxamide (2-Py) and N1-methyl-4-pyridone-3-carboxamide (4-Py) was higher in the fat free diet group than in the linoleic acid group, that was accompanied by the increase of tryptophan intake and reduction of body weight in the fat free diet group. In diabetic rats, hepatic ACMSD activity was higher in the fat free diet group than in the linoleic acid group. The results indicated that the induction of hepatic ACMSD activity by diabetes was not due to removal of the suppressive effect of the linoleic acid on the enzyme. In the diabetic+insulin group, hepatic ACMSD activity was significantly lower than in the diabetic group.

Clinical study on the pathophysiology and treatment of PPI-resistant ulcers

We studied the gastric acidity, gastric emptying, and proton pump inhibitor (PPI) plasma levels in 10 patients with PPI-resistant ulcers. The pH3 holding-time ratio was low in nine of these patients, with an average ratio of only 39%. PPI plasma levels in those patients were also much lower than in those with nonresistant ulcers. Gastric emptying, determined by the acetaminophen method, was reduced in all 10 patients. Therefore, PPI-resistant ulcers appear to result from insufficient inhibition of gastric acidity, with reduced gastric emptying interfering with the absorption of PPIs. In patients with mild reductions in gastric emptying, PPI plasma levels increased after a change from single-unit enteric-coated tablets (omeprazole) to multiunit enteric-coated granules in capsules (lansoprazole). This change in formulation markedly inhibited gastric acidity and led to rapid healing. In patients with moderate reductions in gastric emptying, doubling the dose of lansoprazole was effective. In patients with severely reduced gastric emptying, there appeared to be a limit to the effectiveness of oral administration of PPIs. Changing the formulation and doubling the dose to compensate for reduced gastric emptying are effective approaches in the treatment of patients with PPI-resistant ulcers.

[Mucin histochemical study of differentiated adenocarcinoma of stomach]

The mucin phenotypic expression of gastric differentiated adenocarcinoma was investigated by mucin histochemical method. Seventy-nine advanced gastric carcinomas, which showed histologically differentiated type (well and moderately differentiated type) in the mucosa, were classified into four types; gastric type (30.4%), intestinal type (19.0%), combined type with both gastric and intestinal phenotype (45.6%) and lack of mucin type (5.1%). Moreover, differentiated adenocarcinoma of gastric type were subclassified into foveolar (F) type (37.5%), pyloric gland (P) type (37.5%) and mixed (M) type with foveolar and pyloric type (25.0%). Both gastric type and intestinal type differentiated adenocarcinoma were apt to change to undifferentiated type in the invasive lesion below the submucosa. On the contrary, carcinoma of combined type changed to undifferentiated type with significantly lower incidence than the former two type. F-type differentiated adenocarcinoma tended to develop scirrhous or non-solid type infiltration and carcinoma of P-type showed medullary or solid growth with significantly higher incidence than the other type. Mucin phenotypic expressions of differentiated adenocarcinoma had much to do with the mode of growth and infiltration of cancer in the gastric wall below the submucosal layer.

[Psychosocial features of the patients with home oxygen therapy]

Home oxygen therapy (HOT) has released patients with chronic respiratory failure (CRF) from hospitalization for the rest of their lives, and has brought some relief from their physical restriction due to CRF. However, some new psychosocial problems have arisen from this home care treatment. Research has been performed on 85 patients in our hospital by: (1) comprehensive psychosomatic questionnaire for patients with long-term oxygen therapy, (2) CMI, (3) SRQ-D (depression), (4) MAS and Questionnaire C of JMHW-CRF research group. The results of (1) indicated some problems in the majority of patients. Also in SRQ-D, about half of the patients showed a depressive state. In MAS, more than a few patients revealed a high anxiety level concretely, recognized psychosocial problems with loss of desire for treatment pessimism recording their prognosis, in addition to loss of QOL. All the above and an understanding by the staff of the psychosocial situation of patients and a grasp of their mental state are extremely important in the long-term care of HOT patients.

[Psychological approach to chronic respiratory failure]

Patients with chronic respiratory diseases, particularly chronic respiratory failure, are seriously handicapped mentally and physically as compared with those with diseases of other medical fields. This is because their disorders relate to breathing, which is the basic physical function directly associated with sustaining life. The authors have attempted a psychosomatic approach for patients with chronic respiratory disorders. Clinical science in this field of medicine in Japan is far behind that of other advanced nations. In the Comprehensive Emphysema Inventory, it was clearly reported that in many cases, psychological stress is involved in the onset of dyspnea. In SRQ-D or MAS, moreover, decreased motivation for treatment, anxiety regarding prognosis, and conflict were notable in psychosomatic tests. Patients on home oxygen therapy (HOT) appear to have problems in family relations and in the daily-living environment, even though HOT provides both mental and physical benefits. It was also noted that holistic or comprehensive care designed for improvement of not only physical condition, but also psychosocial aspects and quality of life, is essential to achieve good results in the respiratory rehabilitation of patients affected by chronic respiratory failure.