Human chorionic gonadotropin in gastric carcinoma. A useful marker for bone metastasis

Twenty patients with bone metastases from gastric carcinoma resected during the 13 years from 1974 through 1987 were investigated in relation to the serum and tissue carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). The incidence of bone metastases was 2.1% (20/933). The serum AFP, CEA and hCG positive rates were found to be 14.3, 42.9 and 69.2% for patients with bone metastases and 18.3, 19.4 and 14.1% for those without bone metastases, respectively. In addition, the tissue AFP, CEA and hCG positive rates were 11.1, 100 and 77.8% for such patients with bone metastases, and 8.0, 80.8 and 21.1% for those without bone metastases. Only the serum and tissue hCG positive rate was significantly higher for the patients with bone metastases than those without bone metastases. The bone metastatic lesions were investigated for tissue hCG in four cases, and found to be positive in all the four bone lesions. In four of the patients with metachronous bone metastases, serum hCG levels were elevated before or at the time when bone metastases were diagnosed. Furthermore, serum hCG levels fell in response to chemotherapy or tumor resection. On the contrary, the serum AFP or CEA levels did not correlate with the clinical course in patients with bone metastases. These results indicate that the measurement of the tissue and serum hCG in patients with gastric carcinomas could be of extreme value in the search for bone metastases and the serum hCG level could be a useful marker for the prediction of bone metastases in gastric carcinoma.

Gastric cancer heterogeneity

This study was carried out on 222 samples from 37 gastric carcinomas to assess the incidence of multiple stem lines in primary tumors and metastasis as reflected by multiple DNA stem lines and their relationship to epidermal growth factor (EGF) receptor expression, histologic grade, tumor size, and degree of wall infiltration. Fifteen primary tumors (40.5%) were homogeneously diploid/peridiploid whereas 22 (59.5%) were aneuploid. In the lymph node metastasis, seven patients (29.2%) had an homogeneous diploid/peridiploid pattern in all metastatic lymph nodes. On the other hand, 17 (70.8%) had at least one aneuploid peak in the lymph node metastasis. DNA content heterogeneity was seen in 12 (33%) of primary tumors whereas 14 (66.6%) of 21 patients had multiple cell clones in the metastasis. Therefore, 12 patients had a metastatic clone which was not observed in the primary tumor. DNA content heterogeneity was seen even in tumors with submucosal invasion suggesting that this phenomenon is also present at earlier stages. No correlation between the histologic grade and the DNA distribution was observed. Furthermore, histologic heterogeneity was independent of DNA content heterogeneity. The EGF receptor expression was observed in six of the 23 patients in whom this analysis was done. The EGF receptor expression was constant in all samples which were studied and even samples with a different DNA content and histologic grade were stables for the EGF receptor expression.

[Monoclonal antibody NCC-ST-439 in gastric cancer tissue]

An immunohistochemical study revealed that NCC-ST-439 positive tumor were detected in 33% of the 244 gastric carcinomas. The incidence of NCC-ST-439 immunoactivity in well differentiated adenocarcinomas (papillary and tubular adenocarcinoma) was significantly higher than in poorly differentiated adenocarcinomas (including signet-ring cell and mucinous adenocarcinoma). Moreover, NCC-ST-439 immunoreactive tumors showed more frequent vessel invasion and higher DNA content than non-reactive tumors. The recurrence rates of NCC-ST-439 immunoreactive tumors in the liver and lymph nodes were significantly higher than those of non-reactive tumors. Patients with NCC-ST-439 immunoreactive carcinoma had much worse prognosis than those with NCC-ST-439 non-reactive carcinoma. These results suggest that NCC-ST-439 antigen produced by tumor cells plays an important role in the invasive growth and vessel invasion and also serves as a biological marker of malignancy in patients with gastric cancer.

Epidermal growth factor receptor status and S-phase fractions in gastric carcinoma

The correlation with epidermal growth factor (EGF) receptor expression and clinicopathologic findings were studied in 242 gastric carcinomas. They were stained for EGF receptor by means of an immunohistochemical technique using a monoclonal antibody against the receptor. S-Phase fractions were measured by in vivo bromodeoxyuridine (BrdU) labeling and indirect immunohistochemical staining using anti-BrdU monoclonal antibody. In normal gastric epithelium, EGF receptor immunoreactivity could not be found. EGF receptor was found in 76 (31.4%) of 242 gastric carcinomas. Diffusely infiltrating types of carcinomas were more likely than localized tumors to be EGF receptor-positive. In addition, EGF receptor-positive tumors had significantly higher values of BrdU labeling indices than EGF receptor-negative tumors. The patients with EGF receptor-positive carcinomas also had a poorer prognosis than did negative cases. These results suggested that EGF receptor-positive tumors may have higher proliferative activity and local extension may progress more rapidly, and also seem to show that EGF receptor status may possibly be a useful prognostic marker for gastric carcinomas.

Cloning, nucleotide sequence, and expression in Escherichia coli of the gene for poly(3-hydroxybutyrate) depolymerase from Alcaligenes faecalis

The extracellular poly(3-hydroxybutyrate) depolymerase gene from Alcaligenes faecalis T1 was cloned into Escherichia coli DH1 by using the plasmid pUC8. An A. faecalis T1 genomic library was prepared in E. coli from a partial Sau3AI digest and screened with antibody against the depolymerase. Of the 29 antibody-positive clones, 1 (pDP14), containing about 4 kilobase pairs of A. faecalis T1 DNA, caused expression of a high level of depolymerase activity in E. coli. The enzyme purified from E. coli was not significantly different from the depolymerase of A. faecalis in molecular weight, immunological properties, peptide map, specific activity, or substrate specificity. Most of the expressed enzyme was found to be localized in the periplasmic space of E. coli, although about 10% of the total activity was found in the culture medium. Results of a deletion experiment with pDP14 showed that a large SalI fragment of about 2 kilobase pairs was responsible for expression of the enzyme in E. coli. The nucleotide sequence of the large SalI fragment has been determined. Comparison of the deduced amino terminus with that obtained from sequence analysis of the purified protein indicated that poly(3-hydroxybutyrate) depolymerase exists as a 488-amino-acid precursor with a signal peptide of 27 amino acids.

Selective covalent binding of the active sulfate ester of the carcinogen 5-(hydroxymethyl)chrysene to the adenine residue of calf thymus DNA

5-(Hydroxymethyl)chrysene (5-HCR) sulfate, an active metabolite of the carcinogen 5-HCR, bound significantly in a covalent manner to the purine bases of calf thymus DNA through its 5-methylene carbon with loss of a sulfate anion when incubated at pH 7.4 and 37 degrees C. From the DNA were isolated two purine base adducts by high-pressure liquid chromatography, and they were identified as N6-[(chrysen-5-yl)methyl]adenine and N2-[(chrysen-5-yl)methyl]guanine with the corresponding synthetic specimens. The purine base adducts, appearing in the ratio 1 to 27 for guanine to adenine in the chromatogram, accounted for about 60% of the total covalent binding of 5-HCR sulfate to the DNA. 5-HCR sulfate also reacted specifically with the exocyclic amino groups of the purine bases of 2'-deoxyadenosine 5'-phosphate and 2'-deoxyguanosine 5'-phosphate at much lower rates than did with those of calf thymus DNA. Denaturing the DNA by heating followed by rapid cooling, covalent binding of 5-HCR sulfate to it markedly decreased with the increasing ratio of N2-guanine to N6-adenine adducts (1:3.6). These results strongly suggest that secondary structure of DNA has an influence on the covalent binding of 5-HCR sulfate and that intercalation of the sulfate ester into DNA base pairs plays an important role in its preferential binding to N6 of the adenine residue of native DNA.

[Human epidermal growth factor (h-EGF) in gastric carcinomas]

Two hundred and twenty one gastric carcinomas were immunohistochemically stained for h-EGF and we examined the correlation between h-EGF immunoreactivities and histologic findings. Regarding macroscopic and histologic types, incidence of h-EGF immunoreactivities in infiltrating type and in poorly differentiated type was significantly higher than those in localized type and in differentiated type, respectively. In addition, h-EGF producing carcinomas showed high positive rate in prognostic serosal involvement and scirrhous type in stroma. Prognosis in patients with h-EGF producing tumors was poorer than that in those with h-EGF non-producing tumors, especially in stages II and III. These results suggest that h-EGF immunoreactivities serves as a biological marker of high malignancy.

Correlation of DNA ploidy and proliferative activity in human gastric cancer

Analysis of DNA ploidy patterns was performed on 129 cases of primary gastric cancer and the results were correlated with histologic findings and in vivo bromodeoxyuridine (BrdU) labeling. Forty-nine cases were diploid (38%) and 80 cases were aneuploid (62%). There was no correlation between DNA ploidy and histologic type. In aneuploid tumors, incidence of lymphatic invasion, lymph node metastasis, and rate of advanced cases were significantly higher than those in diploid tumors. During the follow-up period of 5 to 10 years, 23 of 40 patients (55%) with aneuploid tumors died of disease within 3 to 120 months. Only 13 of 36 patients (36%) with diploid tumors died of disease. The BrdU labeling indices (BrdU LI) ranged from 2.8% to 26.7%, with a mean of 10.4%. There was no correlation between BrdU LI and histologic type or stage. The mean BrdU LI of early cancers was 8.1%. The mean BrdU LI of advanced cancers was 11.9%. The BrdU LI of cancers with lymphatic invasion or lymph node metastasis was higher than those without them. The mean BrdU LI of diploid cancers was 6.0%. The mean BrdU LI of aneuploid cancers was 11.9%. There was a good correlation between BrdU LI and DNA ploidy patterns. These results indicate that DNA ploidy patterns and BrdU LI may possibly be useful prognostic markers for gastric cancers.

[Correlation of epidermal growth factor receptor status and clinical outcome in gastric carcinoma]

Analysis of epidermal growth factor receptor (EGFR) was performed on 242 primary gastric carcinomas and the results correlated with histologic findings and S-phase fractions measured by bromodeoxyuridine (BrdU) labeling. They were stained for EGFR by means of an indirect immunoperoxidase technique using a monoclonal antibody against the receptor. Seventy-six of these cancer tissues exhibited EGFR reactivities. All the cancer cell membranes were stained and sometimes the stroma were stained. These EGFR status were then compared on the basis of pathologic findings including macroscopic type, depth of invasion, differentiation type, vascular invasion and lymph node metastasis. Staining for EGFR in Borrmann's 3 or 4 type was significantly stronger than those in other macroscopic types. The staining for EGFR was closely related to the poorly differentiated type and frequent serosal involvement. BrdU labeling index was studied in 25 cases. These values were from 2.3% to 18.6%, with a mean of 10.4%. The mean BrdU labeling index of EGFR positive cases was 12.2%, of negative cases 7.6%, respectively. There was a good correlation between BrdU labeling index and EGFR status. In addition, There was a signifiCANT 8P less than 0.05) correlation between the presence of the EGFR and poor prognosis. However, EGFR status was not significantly correlated with the lymph node metastasis, vessel invasion and size of the tumors. These results indicate that demonstration of EGFR status may be useful in prognosis and this receptor may be a suitable target for therapy.

The occurrence of acute lymphoblastic leukemia shortly after the cessation of human growth hormone therapy

We encountered a case of a 21-year-old man who had developed acute lymphoblastic leukemia (ALL) shortly after the cessation of approximately six years' human growth hormone treatment for pituitary dwarfism. The patient had also been treated with thyroid preparations and methylandrostanolone, a kind of anabolic steroid. Factors relating to the onset of ALL in this case are discussed.

DNA ploidy pattern and tumour spread in gastric cancer

The DNA ploidy pattern of gastric cancer was studied in 58 patients to investigate the heterogeneity between primary tumour and metastases. In both primary tumours and lymph node metastases, diploid patterns accounted for 33 per cent, whereas all liver metastases were aneuploid. The percentage of polyploid cells was higher in the liver metastases than in primary tumours and lymph node metastases. When the heterogeneity of DNA ploidy pattern between primary tumour and metastasis was evaluated, diploid tumours had a significantly lower rate of lymph node metastasis heterogeneity than aneuploid tumours. When the DNA ploidy pattern and survival were evaluated, the patients who had a diploid pattern in both primary tumour and metastasis had a significantly higher survival rate than the patients who had an aneuploid pattern in the primary tumour and metastasis (57 per cent versus 26 per cent at 5 years). These data suggest that cell heterogeneity is a common phenomenon in gastric cancer, and this may be important in the evolution of the disease. Furthermore, the role of the DNA ploidy pattern as a prognostic factor is emphasized.

Coronary collateral development after acute myocardial infarction

In 31 patients without a history of preinfarction angina, coronary collateral circulation to the completely obstructed coronary artery was evaluated by coronary angiography during a convalescent period of their first myocardial infarction. Collateral visualization (collateral index) was found to be significantly greater in patients with involvement of the right coronary artery (2.1 +/- 1.1, SD) than in those with obstruction of the left anterior descending coronary artery (1.2 +/- 1.0, p less than 0.05). The time interval from the onset of symptoms of acute myocardial infarction to angiographic evaluation did not affect the extent of collateral visualization or the degree of coronary artery disease. These findings indicate that the collateral vessels develop after acute myocardial infarction regardless of the extent of coronary artery disease and accomplish the proliferative process within one month. It is also suggested that the collateral visualization is dependent on the size of perfusion territory of the infarct-related coronary artery.

[Malignancy in gastric carcinoma, with special reference to the DNA ploidy and proliferative activity]

Analysis of DNA ploidy patterns was performed on 129 primary gastric cancers and the results correlated with histologic findings and in vivo bromodeoxyuridine (BrdU) labeling. Forty-nine cases were diploid (38%) and 80 cases were aneuploid. There was no correlation between DNA ploidy and histologic type. In aneuploid cancers, incidence of lymphatic invasion, lymph node metastasis and rate of advanced cases were significantly higher than those in diploid tumors. During the follow-up period of 5-10 years, 23 of the 40 patients (55%) with aneuploid tumors died of disease within 3-120 months. Only 13 of the 36 patients (36%) with diploid tumors died of disease. The BrdU labeling indices (BrdU LI) were from 2.8% to 26.7%, with a mean of 10.4%. There was no correlation between BrdU LI and histologic type or stage. The mean BrdU LI of early cancers was 8.1%, of advanced cancers, 11.9%. BrdU LI of cancers with lymphatic invasion or lymph node metastasis was higher than those without them. The mean BrdU LI of diploid cancer was 6.0%, of aneuploid cancers, 11.9%. There was a good correlation between BrdU labeling indices and DNA ploidy patterns. These results indicate that determination of DNA ploidy patterns and growth fractions by BrdU labeling may be useful in the conjecture of prognosis of the patient and in the selection of patients from various modalities.

DNA ploidy in early gastric cancer and its relationship to prognosis

The relationship between DNA ploidy and clinical prognosis was determined in 65 patients who underwent gastroectomy for early gastric cancer. Of the 65 patients, 16 had intramucosal and 49 submucosal tumours. Five-year survival rates were 100 and 79.6% for patients with intramucosal and submucosal tumours respectively. Diploid tumours were observed more frequently among the patients with intramucosal neoplasms. Among the patients with submucosal invasion, the presence of polyploid cells (greater than or equal to 6c) in less than 10% of the malignant population was associated with a superior survival at 5 years, than those with greater than or equal to 10% of polyploid cells (92.1% vs. 36.3%). When the macroscopic type and the ploidy status were evaluated together, patients who had greater than or equal to 10% of cells with DNA greater than or equal to 6 c and a protruding type of tumour, had a 5 year survival rate of only 12.5%. Finally when factors such as the level of wall invasion, percentage of polyploid cells, type of histogram, and macroscopic type were evaluated by multiple regression analysis, macroscopic type and percentage of polyploid cells were the only significant prognostic factors. On the basis of these findings, the DNA ploidy pattern and the macroscopic type may be useful markers of patients who will develop recurrence.

Effect of limited tryptic modification of a bacterial poly(3-hydroxybutyrate) depolymerase on its catalytic activity

The extracellular poly(3-hydroxybutyrate) depolymerase of Alcaligenes faecalis T1, which hydrolyzes both hydrophobic poly(3-hydroxybutyrate) and water-soluble oligomers of D(-)-3-hydroxybutyrate, lost its hydrolyzing activity toward the hydrophobic substrate on mile trypsin treatment, but retained its activity toward water-soluble oligomers. The molecular mass of the trypsin-treated enzyme was 44 kDa, as estimated by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, which was 6 kDa smaller than that of the native enzyme (50 kDa). The trypsin-treated enzyme seemed to be less hydrophobic than the native one, because it was rather weakly adsorbed to a hydrophobic butyl-Toyopearl column compared with the native enzyme, and showed no ability to bind to poly(3-hydroxybutyrate), to which the native enzyme tightly bound. These results suggest that, in addition to a catalytic site, the enzyme has a hydrophobic site, which is not essential for the hydrolysis of water-soluble oligomers, but is necessary for the hydrolysis of hydrophobic substrates, and this hydrophobic site is removed from the enzyme by the action of trypsin.

Covalent binding of 4-nitrobenzyl mercaptan S-sulfate to the sulfhydryl groups of hepatic cytosolic proteins and bovine serum albumin with mixed disulfide bond formation

4-Nitrobenzyl [35S]mercaptan S-sulfonic acid ([35S]NBM S-sulfate), a new type of reactive metabolite of the thiol [35S]NBM in rat liver cytosol fortified with 3'-phosphoadenosine 5'-phosphosulfate, bound rapidly and covalently at pH 7.4 and 37 degrees C to the sulfhydryl groups of rat liver cytosolic proteins with formation of disulfide bonds. From the radioactive proteins was isolated and identified the sole amino acid adduct, S-([35S]NBM)cysteine, after their acid hydrolysis under the anaerobic conditions. Bovine serum albumin (BSA), a model protein with a single SH group, also reacted readily with radioactive NBM S-sulfate to form a disulfide bond in stoichiometric manner. S-([35S]NBM)-cysteine was also isolated and identified as the sole amino acid adduct from the well-washed, radioactive BSA after the same anaerobic acid hydrolysis. A normal hepatic level of GSH not only retarded the BSA-NBM adduct formation completely, but also detached the radioactivity from BSA by the reduction of the disulfide bond with formation of [35S]NBM and its disulfide. Of twenty-one amino acids examined at pH 7.4 and 37 degrees C, only cysteine reacted with NBM S-sulfate and afforded S-(NBM)cysteine with concomitant formations of S-sulfocysteine, cystine, NBM, and its disulfide.

Induction of islet B-cell regeneration in partially pancreatectomized rats by poly(ADP-ribose) synthetase inhibitors

In order to clarify the mechanism of the prevention of diabetes mellitus developing after subtotal pancreatectomy, we examined regenerative activities of islet B-cells in 90% pancreatectomized and poly (ADP-ribose) synthetase inhibitor-treated rats by using autoradiographic and stathmokinetic techniques. Thirty days after 90% pancreatectomy, islets of rats without 3-aminobenzamide treatment were decreased in number, small in size and had irregular contour. Degranulation of the B-cells and fibrotic degeneration were frequently encountered. On the contrary, islets of remaining pancreas in rats receiving 3-aminobenzamide were increased in number, and their diameters ranged from 0.3-0.6 mm, being about two fold larger than those of normal rats. The labeling index of 3H-thymidine autoradiography and the mitotic indices in islet B-cells were increased in a temporally correlated manner in the 3-aminobenzamide treated rats. The mitotic indices of the 3-aminobenzamide-treated group on the 5th, 7th, 10th and 15th days were significantly larger than those in the control group. These results indicate that poly (ADP-ribose) synthetase inhibitors can induce self-replication or regeneration of B-cells in partially pancreatectomized rats.

Supersensitivity of coronary arteries in variant angina to spasm induced by intracoronary acetylcholine

Acetylcholine (20 to 100 micrograms) was infused directly into coronary arteries in 10 patients with variant angina (group A), 13 subjects without coronary artery disease (group B) and 8 patients with significant organic coronary artery stenosis (greater than or equal to 50%) but without variant angina (group C) during coronary arteriography, to clarify the action of this agent on coronary arteries. Temporary pacing was performed at a demand heart rate of 40 beats/min while bradyarrhythmia developed. Coronary arteriography after administration of acetylcholine showed coronary vasoconstriction in all 10 patients (100%) of group A. Angina accompanied by electrocardiographic ischemic changes in 9 of 10 (90%, 7 ST-segment elevation and 2 depression) was provoked during this test. In the patients of group B, acetylcholine also induced vasoconstriction in 8 of 22 (36%) coronary arterial systems examined, chest pain in 3 (14%) and ST-segment deviation in none (0%). In the patients of group C, acetylcholine induced vasoconstriction in 3 of 9 (33%), chest pain in 2 (22%) and ST-segment depression in 1 (11%). No definite coronary artery dilation induced by acetylcholine was noted. Coronary vasoconstriction (p less than 0.05), electrocardiographic ischemic findings (p less than 0.01) and chest pain (p less than 0.01) were induced significantly more frequently in group A than in both groups B and group C. No significant difference was found between group B and group C. The coronary arteries in the patients with variant angina seem to be more susceptible to acetylcholine than those of patients without variant angina irrespective of the presence of significant atherosclerosis.