Reversal of multidrug resistance by a novel quinoline derivative, MS-209

MS-209, a novel quinoline derivative, was examined for its reversing effect on multidrug-resistant tumor cells. MS-209 at 1-10 microM completely reversed resistance against vincristine (VCR) in vitro in multidrug-resistant variants of mouse leukemia P388 cells (VCR-resistant P388/VCR and Adriamycin (ADM)-resistant P388/ADM) and human leukemia K562 cells (VCR-resistant K562/VCR and ADM-resistant K562/ADM). MS-209 at 1-10 microM also completely reversed resistance against ADM in vitro in P388/VCR cells, K562/VCR cells, and K562/ADM cells. In ADM-resistant P388 (P388/ADM) cells, however, ADM resistance was only partially reversed at the MS-209 concentrations tested. MS-209 enhanced the chemotherapeutic effect of VCR in P388/VCR-bearing mice. When MS-209 was given p.o. at 80 mg/kg twice a day (total dose, 160 mg/kg per day) with 100 micrograms/kg VCR, a treated/control (T/C) value of 155% was obtained. MS-209 also enhanced the chemotherapeutic effect of ADM in P388/ADM-bearing mice. The most prominent effects were obtained when MS-209 was given with 2 mg/kg ADM, yielding T/C values of 150%-194% for the combined treatment at an MS-209 dose of 200-450 mg/kg. MS-209 inhibited [3H]-azidopine photolabeling of P-glycoprotein efficiently. Furthermore, the accumulation of ADM in K562/ADM cells was increased more efficiently by MS-209 than by verapamil. These results indicate that MS-209, like verapamil, directly interacts with P-glycoprotein and inhibits the active efflux of antitumor agents, thus overcoming multidrug resistance in vitro and in vivo.

Pathogenic significance of interleukin-6 in a patient with antiglomerular basement membrane antibody-induced glomerulonephritis with multinucleated giant cells

We report a patient with anti-glomerular basement membrane disease who developed renal failure associated with systemic manifestations, including acute-phase inflammatory reactions and plasmacytosis. Renal tissue obtained by an open surgical biopsy showed circumferential cellular crescents, multinucleated giant cells, and exudation of fibrin in all glomeruli. Immunofluorescence microscopy demonstrated deposition of immunoglobulin G, C3, and membrane attack complex along glomerular capillary walls. Multinucleated giant cells were suggested to be macrophage-monocyte lineage because they were CD68 positive. Bone marrow aspiration showed an increase of plasma cells. Immunostaining showed intensive expression of interleukin-6 (IL-6) in practically every part of the renal sites involving multinucleated cells, crescents, tubules, and infiltrating cells, suggesting that one of the sources of systemically elevated IL-6 was the kidney. Serum IL-6, anti-glomerular basement membrane antibody, and acute-phase proteins were markedly elevated, and returned dramatically to the normal level after corticosteroid therapy and plasmapheresis. We believe that IL-6 played an important role in the development of many symptoms in the present case.

Establishment and characteristics of a gastric cancer cell line (HuGC-OOHIRA) producing high levels of G-CSF, GM-CSF, and IL-6: the presence of autocrine growth control by G-CSF

We successfully established a human gastric cancer cell line, HuGC-OOHIRA, from the ascites of a 60-year-old patient with advanced gastric cancer (poorly differentiated adenocarcinoma) complicated by peritonitis carcinomatosa and leukocytosis of unknown origin. Morphologically, the cells were polygonal and adhered weakly to the culture flask. They tended to pile up upon reaching confluence. Chromosome analysis revealed that the cell line has two modes of chromosome number, namely near diploidy and tetraploidy. Double minutes (DMs) were present in abundance in each cell. The doubling time was 25-30 hr. The cell line was successfully transplanted into nude mice, and their peripheral leukocyte counts increased in proportion to the growth of the tumors. At 2 weeks after the transplantation, the serum rG-CSF level was elevated to 2,893 pg/ml. The concentration of human G-CSF in the culture supernatants was an extraordinary high level of 145,380 pg/ml/day. Secretion of GM-CSF and IL-6 was also detected. The intracellular localization of the G-CSF was identified for the first time by immunofluorescence. Moreover, Northern blot analysis detected G-CSF mRNA in this cell line. Anti-recombinant human G-CSF serum suppressed the propagation of HuGC-OOHIRA cell line. Therefore, it is likely that the autocrine growth loop by G-CSF is present in this cell line. This cell line would be very useful for understanding both the cellular and molecular basis for the production of various cytokines such as G-CSF as well as cytokine-dependent tumor proliferation.

N-alkylated nitrogen-in-the-ring sugars: conformational basis of inhibition of glycosidases and HIV-1 replication

The conformations of nitrogen-in-the-ring sugars and their N-alkyl derivatives were studied from 1H NMR analyses, mainly using 3J(H,H) coupling constants and quantitative NOE experiments. No significant difference was seen in the ring conformation of 1-deoxynojirimycin (1), N-methyl-1-deoxynojirimycin (2), and N-butyl-1-deoxynojirimycin (3). However, it was shown that the C6 OH group in 1 is predominantly equatorial to the piperidine ring, while that in 2 or 3 is predominantly axial, and its N-alkyl group is oriented equatorially. In the furanose analogues 1,4-dideoxy-1,4-imino-D-arabinitol (4) and its N-methyl (5) and N-butyl (6) derivatives, the five-membered ring conformation differed significantly by the presence or absence of the N-substituted group and the length of the N-alkyl chain. Compound 3 reduced its inhibitory effect on almost all glycosidases, resulting in an extremely specific inhibitor for processing alpha-glucosidase I since N-alkylation of 1 is known to enhance both the potency and specificity of this enzyme in vitro and in vivo. This preferred (C6 OH axial) conformation in 2 and 3 appears to be responsible for their strong alpha-glucosidase I activity. Compound 4 is a good inhibitor of intestinal alpha-glucohydrolases, alpha-glucosidase II, and Golgi alpha-mannosidases I and II, but its N-alkyl derivatives 5 and 6 markedly decreased inhibitory potential for all enzymes tested. In the case of 2,5-dideoxy-2,5-imino-D-mannitol (DMDP, 7), which is a potent beta-galactosidase inhibitor, its N-methyl (8) and N-butyl (9) derivatives completely lost potency toward beta-galactosidase as well. N-Alkylation of compounds 4 and 7, known well as potent yeast alpha-glucosidase inhibitors, resulted in a serious loss of inhibitory activity toward yeast alpha-glucohydrolases. Activity of these nine analogues against HIV-1 replication was determined, based on the inhibition of virus-induced cytopathogenicity in MT-4 and MOLT-4 cells. Compounds 2 and 3, which are better inhibitors of alpha-glucosidase I than 1, proved active with EC50 values of 69 and 49 micrograms/mL in MT-4 cells and 100 and 37 micrograms/mL in MOLT-4 cells, respectively, while none of the furanose analogues exhibited any inhibitory effects on HIV-1. The change in potency and specificity of bioactivity by N-alkylation of nitrogen-in-the-ring sugars appears to be correlated with their conformational change.

Chemoprevention by galanin against colon carcinogenesis induced by azoxymethane in Wistar rats

The effects of the neuropeptide galanin on the development of colon tumors induced by azoxymethane (AOM) and on the labeling index of colon epithelial cells were investigated in Wistar rats. Treatment with galanin significantly decreased the incidence of colon tumors at week 45. Galanin did not influence the histological appearance of the colon tumors, but it slightly increased the frequency of sub-mucosal adenocarcinomas. Furthermore, it significantly decreased the labeling index of colon mucosa during and after AOM treatment. These findings indicate that galanin inhibited the development of colon tumors and that this effect may be related to its suppression of colon-epithelial-cell proliferation.

A case of triple early gastric cancer in the remnant stomach

A 63-yr-old man, who had undergone distal gastrectomy and gastrojejunostomy (Billroth II method) 32 yr previously for duodenal ulcer, was admitted with suspected gastric remnant cancer. An upper gastrointestinal series and endoscopy revealed a protruding lesion at the stoma of the remnant stomach. Total gastrectomy with resection of the adjacent jejunum was performed. Histological examination demonstrated two well-differentiated adenocarcinomas (a mixed type I and IIc lesion with submucosal invasion and a type IIa lesion with intramucosal invasion) and a type IIc mucocellular carcinoma located in the mucosa. Gastritis cystica polyposa also was observed in the remnant stomach. The combination of three early gastric cancers and gastritis cystica polyposa suggests that the mucosa of the remnant stomach had a high malignant potential. The patient has survived without recurrence for 5 yr since the operation.

Enhanced efficacy of bleomycin adsorbed on silica particles against lymph node metastasis in patients with esophageal cancer: a pilot study

BACKGROUND

Lymph node metastases occur very frequently and extensively in patients with esophageal cancer. The aim of this pilot study was to try the targeting chemotherapy for lymph node metastases by use of bleomycin adsorbed on silica particles (BLM-SI).

METHODS

BLM-SI or bleomycin solution (BLM-SOL) was injected into the submucosa of the esophageal wall by means of endoscopy 3 days before operation in 16 patients with middle thoracic esophageal cancer. The distribution of bleomycin in the regional lymph nodes and surrounding connective tissues was studied.

RESULTS

When BLM-SI was administered, bleomycin activity was found in both the regional lymph nodes and connective tissues, not only in the mediastinal region but also in the cervical and abdominal region. Bleomycin activity was significantly higher in all regions after BLM-SI administration than after BLM-SOL administration. Degenerative or necrotic changes were microscopically observed in 11 of 36 lymph nodes with metastatic foci. Bleomycin activity in the blood was significantly lower after BLM-SI was administered than after BLM-SOL. Serious systemic side effects except for fever were not observed in any patients.

CONCLUSIONS

These results indicate that BLM-SI could be a useful treatment modality for targeting lymph node metastasis of esophageal cancer without serious side effects.

Lymph node metastasis of early stage carcinoma of the esophagus and of the stomach

We undertook a comparative histologic study of early stage carcinoma of the esophagus and stomach, with tumor invasion limited to the submucosa. Here we analyze lymph node metastasis, lymphatic invasion, and vascular invasion. Our study is based on a retrospective review of 77 patients with early stage carcinoma of the esophagus and 192 patients with early stage carcinoma of the stomach treated during the period from 1973 through 1991. The incidence of lymph node metastasis and lymphatic invasion was significantly higher in intramucosal or submucosal esophageal cancer than in intramucosal or submucosal gastric cancer. However, there was no significant difference between intramucosal esophageal cancer and submucosal gastric cancer. The metastatic site of lymph nodes in esophageal cancer tended to be distant from the location of primary tumor compared with lymph nodes invaded by gastric cancer. Lymphatic invasion and vessel invasion between submucosal esophageal cancer and submucosal gastric cancer was statistically significant. From these results, we conclude that intraepithelial or intramucosal esophageal cancer is comparable to early stage carcinoma of the stomach, whereas submucosal esophageal cancer is actually an advanced lesion.

Chemoprevention by amiloride of experimental carcinogenesis in rat colon induced by azoxymethane

The effects of amiloride on the incidence and histology of colon tumors induced by azoxymethane, on the labeling index of the colon mucosa and on the activity of ornithine decarboxylase in the colon wall were investigated in Wistar rats. Rats received 10 weekly injections of 7.4 mg/kg body wt azoxymethane and s.c. injections of 5 or 7.5 mg/kg body wt amiloride in depot form every other day for 35 weeks. Prolonged administration of amiloride at a dose of 7.5 mg/kg, but not 5 mg/kg, significantly reduced the incidence of colon tumors at week 35. However, administration of amiloride had little or no significant influence on the histological types of colon tumors and cancers. Administration of amiloride at 7.5 mg/kg significantly decreased the labeling index of the colon mucosa and ornithine decarboxylase activity in the colon wall during and after administration of azoxymethane. These findings suggest that amiloride inhibits development of colon tumors. A possible mechanism of inhibition of colon carcinogenesis by amiloride is its suppression of proliferation of colon tumor cells.

[A case of Sjögren's syndrome complicated with cryoglobulinemia, nephrogenic diabetes insipidus, and renal tubular acidosis]

A 68-year-old woman had been complained of xerostomia since she was 30 years old. Further symptoms of polyuria, polyposia and insomnia had been developed since she was 35 years old. The biopsy material from a minor salivary gland demonstrated the infiltration of lymphocytes into mesenchyme which was compatible with Sjögren's syndrome. She admitted to our hospital because of myalgia in bilateral gastrocnemius and petechiae in both lower extremities in addition to the complaints described above. Complete blood cell counts on admission revealed hemoglobin 9.7 g/dl, platelet count 12.5 x 10(4)/microliters, and white blood cell count 3,300/microliters. Marked polyuria, polyposia (more than 5,000 ml/day, respectively) and low urine gravity (1.005) were observed, although the serum creatinine level showed normal value. Serologic examination showed that the elevation of total serum protein concentration (9.5 g/dl) with marked elevation of serum IgG level (6,190 mg/dl). Her immunoglobulins contained cryoglobulin (cryocrit 20%), and immunoelectrophoresis demonstrated the existence of IgG-kappa monoclonal protein. A positive anti-nuclear antibody at 1:320 dilution, a positive rheumatoid factor and a positive antibody to SS-A (Ro) were also observed. The serial studies of blood gas analysis could not demonstrated the presence of metabolic acidosis. Together with the result of elevated plasma antidiuretic hormone level and results of vasopressin test, Fishberg's concentrating test and the tests of the overload of NH4Cl or bicarbonate, she was diagnosed Sjögren's syndrome with both diabetes insipidus and subclinical renal tubular acidosis. She was initially medicated with prednisolone (40 mg/day, orally), then she was given six courses of intravenous cyclophosphamide (750 mg/body/month).(ABSTRACT TRUNCATED AT 250 WORDS)

Differential activities of 1-[(2-hydroxyethoxy)methyl]-6-(phenylthio)thymine derivatives against different human immunodeficiency virus type 1 mutant strains

A series of 23 1-[(2-hydroxyethoxy)methyl]-6-(phenylthio)thymine derivatives that were highly potent inhibitors of wild-type human immunodeficiency virus type 1 strain IIIB (HIV-1/IIIB) replication in CEM cells were evaluated against a panel of HIV-1 mutant strains containing the replacement of leucine by isoleucine at position 100 (100-Leu-->Ile), 103-Lys-->Asn, 106-Val-->Ala, 138-Glu-->Lys, 181-Tyr-->Cys, 181-Tyr-->Ile, or 188-Tyr-->His in their reverse transcriptase (RT). A different structure-antiviral activity relationship was found, depending on the nature of the mutated amino acid in the HIV-1 RT. The results show that 5-ethyl-1-ethoxymethyl-6-(3,5-dimethylbenzyl)uracil, 5-ethyl-1-ethoxymethyl-6-(3,5-dimethylphenylthio)uracil, and 5-ethyl-1-ethoxymethyl-6-(3,5-dimethylphenylthio)-2-thiouracil remain active against the majority of viruses containing single mutations which confer resistance to nonnucleoside RT inhibitors.

[Questionnaire survey on "The guidelines on diagnosis and treatment of asthma" edited by the Japanese Society of Allergology (1993)]

A questionnaire on the evaluation of "The Guidelines on Diagnosis and Management of Asthma" edited by the Japanese Society of Allergology in 1993 was sent to 586 physicians consisting of specialists authorized by the Japanese Society of Allergology and the board members of this Society, who treated patients with bronchial asthma. Of total 306 (52.2%) who responded, 177 (57.8%) answered the questions on adult asthma only, 65 (21.2%) on childhood asthma only and 52 (17.9%) on both adult and childhood asthma. In total, we had 229 respondents on adult asthma and 117 on childhood asthma. As a result, on drug therapy for chronic asthma, it was pointed out that the use of oral anti-allergics, oral steroids and inhaled beta-stimulants was excessive whereas the use of DSCG, inhaled steroids and long acting theophylline was slightly insufficient in both adults and children. On the management of acute episodes, the excessive use of beta-stimulants (inhaled, oral and injections) and the lack of the use of parenteral steroids and oxygen inhalation were pointed out in adults. The lack of oxygen inhalation also got a higher percent in children. Nevertheless, the guidelines were found to be highly regarded as a whole: "Very good" was 6.1% in adults (6.8% in children). "Appropriate" 38.0% (33.3%), "Almost appropriate" 52.0% (52.1%) and "Inappropriate" 3.9% (3.4%).

[A case of Guillain-Barré syndrome with ophthalmoplegia showing high titers of anti-GQ1b and -GD1b antibodies in the serum]

A 24-year-old housewife developed double vision, tingling sensation, and weakness in the legs following a flu-like illness. She then developed dysphagia and difficulty in standing. On admission her eyes were fixed in midline due to ophthalmoplegia. Doll's eye sign was negative. She had severe generalized muscle weakness and no sensory deficits. All tendon reflexes were lost. CSF protein was 58 mg/dl with cell count of 2/mm3. Antibodies to campylobacter jejuni, mycoplasma, EBV, and other microbes were negative. We treated her with plasmapheresis after which she showed rapid clinical recovery, although the ophthalmoplegia improved slightly later. Increased titer of IgG class antibodies to GD1b and to GQ1b, and of IgM antibody to GQ1b, were detected in the serum taken during the acute phase of the illness. In parallel with clinical amelioration, both the anti-GD1b and -GQ1b antibodies decreased in titer, or became negative. Since there is no common epitope to GD1b and GQ1b gangliosides, we speculated that the anti-GD1b and -GQ1b antibodies were induced independently by different antigens in this patient. Moreover, the presence of high titer IgM antibody to GQ1b possible indicates that this patient was at the relatively early stage of infection of unknown microbe, which then induced the IgG antibodies to GD1b and GQ1b by cross sensitization, which might correlate with the tetraplegia and the ophthalmoplegia, respectively.

[Two cases of acute massive pulmonary embolism diagnosed by pulmonary angiography with Swan-Ganz catheter]

We report two cases of acute massive pulmonary embolism diagnosed at the bedside by pulmonary angiography with Swan-Ganz catheter. In both cases the patients (women 48 and 49 years old) went into shock after surgery. Pulmonary angiography with Swan-Ganz catheter was done at the bedside to confirm the diagnosis. In both cases this revealed filling defects. Hemodynamics improved after-thrombolytic therapy. In general, pulmonary embolism can be definitively diagnosed by lung perfusion scan or pulmonary angiography. Pulmonary angiography with a Swan-Ganz catheter is useful in hospitals without complicated instruments, but is indicated only for unmovable and unstable patients with hemodynamic problems.

Diagnosis of catheter-related infections: the role of surveillance and targeted quantitative skin cultures

The results of quantitative skin cultures have been proposed as predictors of central venous catheter infection. We prospectively observed 132 patients for 3 months after catheter insertion. Specimens were obtained from all patients for routine surveillance quantitative skin cultures. Targeted quantitative skin cultures and quantitative catheter cultures were done at the time of removal of the central venous catheter. At a positivity level of > or = 10(3) colony-forming units per 24-cm2 area of skin around the insertion site, the surveillance and targeted quantitative skin cultures had specificities and negative predictive values that exceeded 90%. However, they had sensitivities of 18% and 75%, respectively, and they had positive predictive values of 25% and 100%, respectively. Unlike surveillance quantitative skin cultures, targeted quantitative skin cultures that are done when catheter infection is suspected are highly sensitive, specific, and predictive.

Flow cytometric analysis of DNA heterogeneity in superficial carcinoma of the esophagus

BACKGROUND

There are few studies of flow cytometric analysis for DNA heterogeneity of patients with superficial carcinoma of the esophagus limited to the epithelium or superficially invading the lamina propria or submucosa.

METHODS

Flow cytometric analysis of cellular DNA content was performed on superficial carcinomas of the esophagus using paraffin embedded blocks of the surgically resected specimens from 56 patients. To evaluate the intratumoral DNA heterogeneity, a total of 141 samples of the 56 tumors were analyzed, depending upon the tumor size.

RESULTS

One or two of the samples was available from 18 of 19 patients with tumors 2 cm or less in greatest dimension, whereas more than three of the samples were available from 22 of 37 patients with tumors 2.1 cm or greater in dimension (P < 0.003). Of 56 tumors, 40 (71.4%) exhibited DNA aneuploidy; DNA heterogeneity was found in 26 tumors (46.4%). The remaining 16 tumors exhibited DNA diploidy. Two of the five tumors that were limited to the epithelium had DNA heterogeneity. The mean dimension of the tumors with DNA heterogeneity was significantly greater (5.8 +/- 2.8 cm) than those exhibiting DNA diploidy (2.3 +/- 1.1 cm) and DNA aneuploidy without heterogeneity (2.9 +/- 2.4 cm). Recurrences after esophagectomy were detected in 6 of the 56 patients; the DNA ploidy pattern of these six patients exhibited DNA heterogeneity.

CONCLUSION

The incidence of DNA heterogeneity increases as tumor size increases and is associated with an increased risk of tumor recurrence after esophagectomy in patients with superficial carcinoma of the esophagus.

"Pseudo" hypertrophic neuropathy of childhood

A 9 year old boy had chronic progressive motor-sensory neuropathy that started in early infancy. He had enlarged nerves and pes cavus deformity. Motor conduction studies showed very dispersed, polyphasic compound muscle action potentials with conduction velocities around 2 m/s. A sural nerve biopsy showed severe loss of myelinated fibres. Two months of treatment with corticosteroids restored muscle power. During this time the enlarged nerves became normal and electrophysiological recovery was achieved. Chronically acquired neuropathy in infancy is strikingly similar to genetically determined neuropathy.

[IgE production and gene expression of interleukin-4 and interferon-gamma by peripheral mononuclear cells in asthmatic children]

In asthmatic children without he egg allergy, spontaneous IgE production of PBMC showed 1.27 +/- 0.28 IU/ml (Mean +/- SE) and IgE production of Dermatophagoides farinae (Df) stimulated PBMC after which IFN-gamma decreased to 0.89 +/- 0.23 IU/ml (Mean +/- SE) (p < 0.001). IgE production of Ovalbumin (OVA) stimulated PBMC after which IFN-gamma showed no decrease. In asthmatic children with hen egg allergy, IgE production of OVA stimulated PBMC and IFN-gamma decreased to 1.0 +/- 0.52 IU/ml (Mean +/- SE). In spontaneous IgE production it was 1.61 +/- 0.91 IU/ml. (p < 0.05). IL-4 mRNA was expressed in spontaneous PBMC in asthmatic children, but not in healthy non atopic children. The expression of IL-4 mRNA was suppressed in Df stimulated PBMC followed by IFN-gamma in asthmatic children. In asthmatic children, IFN-gamma mRNA were expressed in Df stimulated PBMC after which IFN-gamma. And simultaneously IgE production in Df stimulated PBMC were suppressed by addition of IFN-gamma.

Expression of desmoglein-I cell-adhesion molecule in primary tumors and metastatic lymph-nodes of esophageal cancer

The expression of desmoglein I (DGI) in both primary turners and metastatic lymph node of esophageal carcinoma was studied immunohistochemically in 102 patients using an anti-DGI monoclonal antibody. Normal squamous epithelial cells strongly expressed DGI at their cell-cell boundaries. DGI expression in the tumors was divided into DGI (++), DGI (+), DGI (-) according to the staining intensity. DGI (+) or DG (-) tumors had lymph node metastases more frequently than DGI (++) tumors (p<0.01). DGI expression was the same or of less intensity, than in the primary tumor in 128 (85%) out of 151 metastatic lymph nodes. These results indicate that reduction or loss of DGI expression may promote lymph node metastases.

Lymph node metastasis and the recurrence of esophageal carcinoma with emphasis on lymphadenectomy in the neck and superior mediastinum

A series of 335 patients with squamous cell carcinoma of the thoracic esophagus undergoing resection and reconstruction via a right thoracotomy and laparotomy with cervical anastomosis between 1973 and 1990, were reviewed. Prior to 1982, the removal of lymph nodes was limited to the nodes in the mediastinum below the tracheal bifurcation and upper abdomen (142 patients). Nodal metastases were found in 89 of these patients at operation. The upper abdominal nodes were the most frequent sites of metastasis (47.2%). None of the 38 patients with positive nodes sampled from the neck and superior mediastinum survived for more than 45 months. In the 50 patients with recurrences, 30 were in the neck and/or superior mediastinum. During or after 1983, the superior mediastinal nodes, particularly the bilateral recurrent nerve nodal chains, were routinely removed (193 patients). Nodal metastasis was proven in 131 of the 193 patients, in whom 87 (45.1%) had metastasis in the neck and superior mediastinum. Eleven of these 87 patients survived for 45 months or more. In the 61 patients with recurrences, 20 were in the neck and/or superior mediastinum. These data suggest that recurrent nerve nodal chains should be removed to improve survival in patients with esophageal carcinoma.