[True aneurysm of the ascending aorta in HIV disease]

A 31-year-old male who presented with a true aneurysm of the ascending aorta had for 5 years been seropositive for HIV-1 following intravenous drug abuse. Elective aneurysmectomy was refused. Controls by computerized tomography and echocardiography gave evidence of a progressive dilatation during the following 8 months. In February 1992 a further increase of the aneurysm with severe thoracic pain necessitated an emergency graft implantation. Histopathology of the resected aorta revealed a granulomatous giant cell mesaortitis. The postoperative course was uneventful and the patient remained free of cardiovascular symptoms, but died 25 months later due to multiple HIV-associated opportunistic infections. The differential diagnosis (Marfan's syndrome, vasculitis due to tuberculosis, syphilis and other infectious agents, rheumatological diseases, HIV-associated vasculitis) and the etiopathological considerations are discussed.

Phase II trial of docetaxel in patients with platinum-refractory advanced ovarian cancer

PURPOSE

This phase II study was conducted to evaluate the efficacy and toxicity of docetaxel in the treatment of patients with platinum-refractory ovarian cancer.

PATIENTS AND METHODS

Twenty-five patients with platinum-refractory advanced ovarian cancer were treated. Twenty of the patients had failed to respond to platinum-based front-line chemotherapy and five had failed to respond to platinum-based therapy repeated at relapse. One patient had received prior pelvic radiation therapy. Patients were required to have bidimensionally measurable disease. Docetaxel was administered at a dose of 100 mg/m2 intravenously (i.v.) over 1 hour every 21 days. Twenty patients received no corticosteroid premedication and five received premedication with corticosteroids and antihistamines.

RESULTS

Eight of 23 assessable patients (35%) had a partial response (PR; 95% confidence interval, 16% to 57%). The median response duration was 5 months. Hospitalization for toxicity, predominantly neutropenic fever, occurred in 12 patients (48%) and 16% of courses. Anemia was common in the study population. Nonhematologic toxicities included alopecia, rash, fluid retention, diarrhea, peripheral neuropathy, and hypersensitivity reactions.

CONCLUSION

Docetaxel demonstrates significant activity in patients with platinum-refractory advanced ovarian cancer. Routine premedication is recommended. Further investigations of this agent in ovarian cancer, including combinations with other active agents, appear indicated.

Fluorescence spectroscopic studies on the identification and quantification of 7H-dibenzo[c,g]carbazole and dibenz[a,j]acridine metabolites

Fluorescence spectroscopic techniques were developed and employed in the identification and quantitation of the metabolites of the carcinogenic pollutants 7H-dibenzo[c,g]carbazole (DBC) and dibenz[a,j]acridine (DBA) after HPLC separation. Metabolites formed in vitro with 3-methylcholanthrene (3-MC)-induced Sprague-Dawley rat liver microsomal preparations were used as the model for this research. The fluorescence spectra of the three major DBC metabolites matched those of the synthetic standards, 1-OH-, 3-OH- and 5-OH-DBC, respectively. Similarly, the fluorescence spectra of the four major DBA metabolites matched those of the synthetic standards, 1,2-diol-, 3,4-diol-, 5,6-diol- and 5,6-epoxide-DBA, respectively. Synchronous fluorescence spectroscopy (SFS) has been especially helpful for the identification of these metabolites since it produces a single peak for each compound. Regression equations of the SFS peak areas versus concentrations of the synthetic standards were used to calculate quantities of the microsomal metabolites from the SFS peak areas of the metabolites. These values were comparable with those quantities calculated from radioactivity measurements. The use of HPLC combined with SFS is a convenient and sensitive non-radiometric method which can be used to identify and quantify DBC and DBA metabolites.

Isolation and 1H-NMR spectroscopic identification of poly(3-hydroxybutanoate) from prokaryotic and eukaryotic organisms. Determination of the absolute configuration (R) of the monomeric unit 3-hydroxybutanoic acid from Escherichia coli and spinach

Trace amounts of poly[(R)-3-hydroxybutanoate] were isolated from competent Escherichia coli, spinach, bovine serum albumin, beef heart mitochondria, and aortal tissues, all sources in which it is not accumulated as storage material. Its identity was in all cases proved by 1H-NMR spectroscopy. In some runs, the poly[(R)-3-hydroxybutanoate] isolated from competent E. coli also contained some 3-hydroxyvalerate, an observation confirmed by 1H-NMR spectroscopy and gas chromatography. The absolute configuration of the polymers isolated from E. coli and spinach was shown to be (all-R) by gas chromatography on chiral columns.

[Heart and AIDS]

Although pulmonary and central nervous symptoms prevail before death, autopsy often reveals marked myocardial alterations in AIDS patients. This discrepancy prompted us to systematically study cardiac alterations in 100 sequential autopsies of patients who died of AIDS. We appraised the results in relation to changes noted in other organ systems, and compared our data with the AIDS-associated cardiac alterations described in the literature. Cardiac lesions were present in more than 50% of our patients, predominantly in the myocardium (47%). 38 patients displayed signs of active myocarditis. The endocardium and epicardium were secondarily involved, although drug abuse (23 patients) was the most important risk factor for HIV infection, after homosexuality (44%). The prevailing opportunistic agents were identical to those generally seen in AIDS patients, i.e. toxoplasma, cytomegalovirus, mycobacteria and fungi, with the exception of Pneumocystis carinii. This microorganism spared the heart, although it was present in the lungs of 47 patients. Our results are in keeping with other published data. Toxoplasma, present in the myocardium of our patients more frequently than reported in other series, did not necessarily cause a concomitant myocarditis; Coxsackie viruses are deemed to be responsible for many cases of myocarditis in AIDS patients, perhaps even in cases in which we found toxoplasma pseudocysts to be present in the heart muscle. The study clearly shows that the heart is often the unrecognized target of AIDS-associated lesions, even in the initial phase of the AIDS outbreak (1981-1989). Thus, not every shortness of breath is necessarily of pulmonary origin.(ABSTRACT TRUNCATED AT 250 WORDS)

Intrinsic overexpression of two different mechanisms of resistance to chemotherapy (P-glycoprotein and GST-pi) in human endometrial carcinoma

Endometrial carcinoma is considered a tumor which does not respond well to chemotherapeutic treatment. Among the various mechanisms of resistance to chemotherapy which are under investigation, two of them (multidrug resistance, mediated by P-glycoprotein, and glutathione-S-transferase-pi [GST-pi] overexpression) are of great interest for gynecologic oncologists, because they involve several drugs commonly used in practice, among which Adriamycin and cisplatin are probably the most important ones. We have studied 23 human endometrial carcinomas of different histological varieties and 3 normal endometrial samples for the overexpression of both P-glycoprotein and GST-pi by means of immunohistochemistry. Both resistance markers were detectable in all tumor samples, and in normal endometrial tissue as well. The concomitant intrinsic overexpression of these two resistance mechanisms may in part explain why these tumors tend to be extremely resistant to chemotherapy.

A new gene coding for a differentiation antigen recognized by autologous cytolytic T lymphocytes on HLA-A2 melanomas

It has been reported previously that antitumor cytolytic T lymphocyte (CTL) clones can be isolated from blood lymphocytes of HLA-A2 melanoma patients, after stimulation in vitro with autologous tumor cells, and that some of these CTL clones lyse most HLA-A2 melanomas. A first antigen recognized by such CTL clones was previously shown to be encoded by the tyrosinase gene. We report here the identification of another gene that also directs the expression of an antigen recognized on most melanomas by CTL clones that are restricted by HLA-A2. The gene, designated Melan-A, is unrelated to any known gene. It is 18 kb long and comprises five exons. Like the tyrosinase gene, it is expressed in most melanoma tumor samples and, among normal cells, only in melanocytes.

Treatment of primary hypercholesterolemia: fluvastatin versus bezafibrate

The effects of fluvastatin and bezafibrate on lipids, lipoproteins, and apoproteins (apo) were investigated in a multicenter randomized, double-blind, parallel-group study. After 8 weeks of strictly controlled (computer-based assessment) dietary stabilization, patients with primary hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] > or = 160 mg/dL; triglycerides < or = 300 mg/dL) were enrolled into a 6-week placebo phase. Altogether, 131 patients were randomized to receive either fluvastatin at 40 mg once daily (n = 64; mean age 53 years) or bezafibrate at 400 mg once daily (n = 67; mean age 52 years) for 12 weeks. Compliance with the diet was monitored (3-day food records) after 6 and 12 weeks. Fluvastatin led to significant reductions in LDL-C (-23%), total cholesterol (-17%), LDL-C/high-density lipoprotein cholesterol (HDL-C) (-24%) and apo B (-19%). Fluvastatin significantly increased LpA-I (+8%) and apo E (+20%). Bezafibrate produced significant reductions in LDL-C (-17%), total cholesterol (-13%), LDL-C/HDL-C (-24%), triglycerides (-28%), apo B (-15%), and LpA-I (-10%) and significantly increased HDL-C (+12%), apo A-I (+9%), apo A-II (+30%), apo E (+14%), and Lp(a) (+3%). No clinically notable increases in levels of liver enzymes or creatine phosphokinase were observed with either treatment. Both treatments were well tolerated. There was a low incidence of adverse events that tended to be mild and included headache, muscular pain, angina, and dyspepsia. The frequency of adverse events was similar in both treatment groups, and no significant differences in dietary behavior were observed. In conclusion, fluvastatin is a well tolerated 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor for the treatment of primary hypercholesterolemia. Effects of fluvastatin on LpA-I occur irrespective of changes in HDL-C.

P-glycoprotein, HER-2/neu, and mutant p53 expression in human gynecologic tumors

BACKGROUND

Overexpression of P-glycoprotein has been associated with a worse prognosis for some groups of patients not receiving chemotherapy. Recently, it has been demonstrated that in vitro both c-Ha-Ras overexpression and mutant p53 overexpression do activate the MDR1 gene (also known as PGY1) in murine NIH 3T3 cells. This direct connection between oncogenic activation, antioncogenic malfunctioning (presence of mutant instead of wild-type p53 protein), and MDR1 gene expression constitutes a fundamental conceptual model that could provide an explanation for the obscure prognostic role, in the absence of chemotherapy, of the MDR1 gene.

PURPOSE

Our goal was to test whether the relationship between MDR1 (P-glycoprotein) expression, oncogenic activation, and mutant p53 protein expression demonstrated in vitro is also reproducible in vivo for two groups of human gynecologic tumors.

METHODS

Fifty tumor specimens (31 mammary, 11 endometrial, and eight cervical) were analyzed. They had been obtained from previously untreated patients. Aliquots of these specimens had been frozen and stored at -70 degrees C since surgical collection or routinely fixed in formalin and embedded in paraffin. DNA was extracted from routinely fixed specimens for single-strand conformation polymorphism (SSCP) analysis. Immunohistochemical techniques were used on frozen material to determine: 1) P-glycoprotein expression using two different monoclonal antibodies (c219 and JSB1); 2) HER-2/neu (c-erb-B2; also known as ERBB2) expression using the NCL-CB11 monoclonal antibody; and 3) mutant p53 protein expression using the PAb 1801 monoclonal antibody. Polymerase chain reaction (PCR)-SSCP was used to confirm recognition of the mutated isoform of p53. Endometrial and cervical carcinomas were studied by both PCR-SSCP DNA analysis and immunohistochemical analysis. Only when there was full concordance between both methods were endometrial and cervical tumors considered to express mutant p53.

RESULTS

A statistically significant (P = .009; Fisher's exact test) association between HER-2/neu and MDR1 expression was found for the more aggressive form of inoperable, locally advanced mammary carcinoma. Expression of HER-2/neu or mutant p53 was similar in both tumor groups studied--mammary carcinoma with a low basal expression of P-glycoprotein compared with endometrial and cervical carcinomas with significantly (P = .0002; chi-square test) higher levels of expression.

CONCLUSIONS

The highly statistically significant coexpression of P-glycoprotein and HER-2/neu took place only in the subgroup of aggressive, locally advanced, inoperable mammary carcinomas, whereas no statistically significant association could be found for operable tumors. No association between mutant p53 expression and MDR1 activation was found in the human tumors analyzed.

Isolation, cloning, and sequencing of simian foamy viruses from chimpanzees (SFVcpz): high homology to human foamy virus (HFV)

Several independent isolates of simian foamy viruses (SFV) were recovered from chimpanzee B-cell lines. One isolate, designated SFVcpz, was molecularly cloned and sequenced. In addition, the genome of SFV type 6 (SFV-6), an independent chimpanzee foamy virus isolate, was partially cloned. The SFVcpz provirus is 13,246 base pairs (bp) long. It is flanked by long terminal repeats (LTRs) and encodes the genes gag, pol, env, the transcriptional transactivator taf, and a second 3' open reading frame (orf-2). DNA sequences of molecular clones derived from the pol, env, and orf-2 genes of SFV-6 are almost identical to those of SFVcpz. DNA and deduced protein sequences of SFVcpz show high homologies to human foamy virus (HFV), whereas both SFV-1 from a rhesus macaque and SFV-3 from an African green monkey are phylogenetically further distant viruses. Amino acid homologies between corresponding genes of SFVcpz and HFV range between 86% for the taf gene and 95% for the pol gene. Comparisons of taf and pol of SFVcpz with SFV-1 and SFV-3 show 40 and 78% homology, respectively. The SFVcpz LTR consists of 1760 bp and is in the same size range as the LTRs of SFV-1 and -3, but significantly larger than the known HFV LTR. These comparisons reveal that a region approximately 500 bp long is missing in the HFV LTR. We also isolated and sequenced an LTR of a wild-type HFV provirus which aligns with high homology to the SFVcpz LTR without major gaps. Based on sequence comparisons in this report, primate foamy viruses may be arranged into different clusters with SFVcpz and HFV forming one cluster and SFV-1 and SFV-3 as prototypes for two unique clusters.

Risk factors for systolic dysfunction and ventricular dilatation in hypertrophic cardiomyopathy

The history of an 18-year-old male with hypertrophic cardiomyopathy (HCM) and ventricular dilatation is presented and the literature on systolic dysfunction and ventricular dilatation in patients with HCM is statistically analyzed in search of risk factors. The patient was followed for 7 years when he developed recurrent ventricular fibrillation, left ventricular dilatation and low cardiac output. An automatic cardioverter-defibrillator was implanted but the patient died of electro-mechanical dissociation. In order to define risk factors for systolic dysfunction and ventricular dilatation in HCM, the literature data of 17 patients with this complication were compared to a group of 139 consecutive patients with HCM from our hospital. The risk factors identified were a more markedly increased septal (20.1 vs. 18.0 mm, P < 0.05) and posterior wall thickness (13.6 vs. 11.0 mm, P < 0.001) in the patients subsequently developing systolic dysfunction and ventricular dilatation, whereas age, sex and the ratio between septal and posterior wall thickness were not significantly different between the two groups. A severely increased ventricular mass appears to be a risk factor for the development of systolic dysfunction with ventricular dilatation in HCM. Prognosis is usually poor and the reported case showed fatal ventricular arrhythmia despite the implantation of an automatic cardioverter-defibrillator.

Isolation of naturally processed peptides recognized by cytolytic T lymphocytes (CTL) on human melanoma cells in association with HLA-A2.1

Cytolytic T lymphocyte (CTL) clones have previously been derived from peripheral blood of melanoma patient SK29(AV). They lyse autologous melanoma cells but not autologous Epstein-Barr virus (EBV)-transformed B lymphocytes. Immunoselection experiments indicate that these CTL clones recognize 4 different antigens (Aa, Ab, B, C) in association with a single HLA restriction element, HLA-A2.1. While the expression of antigens B and C appears to be confined to SK29-melanoma cells, antigens Aa and Ab are shared by a high proportion of allogeneic HLA-A2-positive melanoma lines. HLA-A2.1 and total HLA class I molecules have now been purified from SK29-melanoma cells using affinity chromatography and associated peptides have been eluted. Peptide pools eluted from HLA-A2.1 and total class I were separated by reversed phase high performance liquid chromatography (HPLC). Individual HPLC fractions were tested for their ability to sensitize target cells for recognition by SK29-CTL clones. The presence of antigens Aa, Ab, B and C was detected in distinct HPLC fractions that were identical for both peptide pools. As target for detection of peptide antigens in HPLC fractions, the use of the HLA-A2.1-positive antigen processing mutant cell line CEM x 721.174.T2 (T2), pre-incubated with anti-HLA-A2 monoclonal antibody (MAb) MA2.1, was shown to be essential. Single-peak target-sensitizing activity was found for antigens Ab and B, whereas multi-peak sensitizing activity was reproducibly detected for antigens Aa and C. We reason that at least some of these melanoma peptide antigens might occur in biochemically distinct isoforms.

[Obesity in the elderly and very elderly--prognostic significance and practical conclusions]

Epidemiological work on the age-dependency of the relation between overweight and mortality confirms an opinion which is traditional among physicians and has it roots in a mixture of biological understanding and common sense. The data base can be summarized in three points: 1) Up to the age of 60-65 years, overweight is combined with decreased life expectancy. The excess mortality is found mainly in the cardiovascular area and can be explained by the well-known risk factors of atherosclerosis. In the Framingham-study, overweight per se is a risk factor for this group of diagnoses. 2) In the age group 65-74 years, the relation between overweight and excess mortality vanishes gradually; the right arm of the U- or J-curve levels off. The optimal BMI moves to the right, and the right arm of the curve is shortened. 3) In high age, from 75-80 years on, overweight coincides with improved prognosis. The geriatric literature is in agreement in the sense that overweight is no problem in high age.

High-intensity chemotherapy with peripheral blood progenitor cell support

In a series of clinical studies at Memorial Sloan-Kettering Cancer Center, we have used hematopoietic growth factors and peripheral blood-derived hematopoietic progenitor cells to facilitate delivery of multiple courses of high-dose chemotherapy at abbreviated treatment intervals. In these studies, we have demonstrated the feasibility of cross-over regimens involving induction chemotherapy with high-dose cyclophosphamide, supported by granulocyte colony-stimulating factor and followed by multiple peripheral blood leukapheresis to harvest progenitor cells. These cells are then used as rescue for the consolidation component of treatment, which, in the earlier-generation studies, consisted of a single course of high-dose carboplatin/etoposide/cyclophosphamide chemotherapy. In subsequent studies, patients received either four courses of high-dose carboplatin or carboplatin/cyclophosphamide or tandem courses of thiotepa. In all cases, the planned interval between treatments was 14 days, and the achieved median was approximately 16 days. These studies show that the administration of high-intensity regimens that deliver multiple courses of very high-dose chemotherapy at relatively brief intervals is feasible. Our current research focuses on exploiting these findings to devise disease-specific regimens for breast and ovarian cancer.

Two tyrosinase nonapeptides recognized on HLA-A2 melanomas by autologous cytolytic T lymphocytes

A number of cytolytic T lymphocyte (CTL) clones derived from several melanoma patients have been found to recognize a majority of melanomas from HLA-A2 patients. We have reported previously that two such CTL clones recognize a product of the tyrosinase gene that is presented by HLA-A2. Here we show that one of these CTL clones recognizes a peptide encoded by the first nine amino acids of the putative signal sequence of tyrosinase. The other CTL clone recognizes a different tyrosinase peptide corresponding to amino acids 368-376. Both peptides contain consensus motifs of HLA-A2 binding peptides.

The beagle dog as a predictor of gastrointestinal findings in humans caused by the prostacyclin analogue taprostene

Beagle dogs were exposed orally to the prostacyclin analogue taprostene for four weeks. Dose levels of 200-3000 micrograms/kg body weight/day were used. Specific activity of taprostene on the digestive system compared to other species is reported. It is characterized by hypermotility of the gastrointestinal tract resulting in intestinal invagination in some animals. Gastrointestinal symptoms occurred also after intravenous administration indicating a systemic stimulating effect on smooth muscles. Concerning reversible gastrointestinal side effects in humans after intravenous infusion of prostacyclin the results of this subacute toxicity study indicated that the dog is an adequate and sensitive species for preclinical testing of prostacyclins.

Aprotinin does not decrease early graft patency after coronary artery bypass grafting despite reducing postoperative bleeding and use of donated blood

Forty-five male patients with planned coronary artery bypass operation were randomized in a double blind fashion to receive either 6 million kallikrein inactivator units of aprotinin (high-dose group), 2 million kallikrein inactivator units of aprotinin (low-dose group), or placebo (control group). Postoperative bleeding was significantly decreased in both aprotinin groups in comparison to that in the control group (590 ml [290 to 1800 ml] high-dose group and 650 ml [280 to 1900 ml] low-dose group versus 920 ml (350 to 2700 ml) control group, p < 0.001). There was no difference between the two aprotinin groups. The need for postoperative blood transfusion was significantly lower in the aprotinin groups (1.46 [0 to 4] blood units high-dose group and 1.65 [0 to 5] blood units low-dose group versus 2.43 [0 to 7] blood units control group, p < 0.05). All patients underwent coronary angiography between the seventh and twelfth postoperative day. No difference was found among the three groups in patency of vein grafts-93.8% in the high-dose group, 94.5% in the low-dose groups, and 93.3% in the control group. Therefore, aprotinin significantly reduced postoperative bleeding and transfusion requirement after coronary artery bypass grafting without influencing early graft patency.

Distinctive acceptor-end structure and other determinants of Escherichia coli tRNAPro identity

The previously uncharacterized determinants of the specificity of tRNAPro for aminoacylation (tRNAPro identity) were defined by a computer comparison of all Escherichia coli tRNA sequences and tested by a functional analysis of amber suppressor tRNAs in vivo. We determined the amino acid specificity of tRNA by sequencing a suppressed protein and the aminoacylation efficiency of tRNA by examining the steady-state level of aminoacyl-tRNA. On substituting nucleotides derived from the acceptor end and variable pocket of tRNAPro for the corresponding nucleotides in a tRNAPhe gene, the identity of the resulting tRNA changed substantially but incompletely to that of tRNAPro. The redesigned tRNAPhe was weakly active and aminoacyl-tRNA was not detected. Ethyl methanesulfonate mutagenesis of the redesigned tRNAPhe gene produced a mutant with a wobble pair in place of a base pair in the end of the acceptor-stem helix of the transcribed tRNA. This mutant exhibited both a tRNAPro identity and substantial aminoacyl-tRNA. The results speak for the importance of a distinctive conformation in the acceptor-stem helix of tRNAPro for aminoacylation by the prolyl-tRNA synthetase. The anticodon also contributes to tRNAPro identity but is not necessary in vivo.