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Giatromanolaki A, Sivridis E, Maltezos E, Koukourakis MI. Down-regulation of intestinal-type alkaline phosphatase in the tumor vasculature and stroma provides a strong basis for explaining amifostine selectivity. Semin Oncol 2002; 29:14-21. [PMID: 12577238 DOI: 10.1053/sonc.2002.37356] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Strong clinical and experimental evidence indicates that amifostine confers cytoprotection in normal, but not in tumor, tissues. However, the mechanism of such selective action is poorly understood. Intestinal-type alkaline phosphatase (IAP) is a major isoenzyme involved in the hydrolysis of amifostine (WR-2721) to its active thiol form WR-I065. Could differences in IAP expression between normal and malignant tissues account for amifostine's selectivity? Paraffin-embedded material from normal breast, lung, colon, and head and neck tissues, together with their malignant counterparts, were retrieved and stained immunohistochemically for human IAP (antibody 7324, Abcam, Cambridge, UK) and endothelial cell CD31 antigen. Normal tissues (epithelium, fibroblasts, and vessels) consistently displayed strong nuclear and cytoplasmic IAP reactivity. The vascular density (number of positive vessels per x 200 optical field), whether assessed in anti-IAP or anti-CD31 stained sections, was very similar, indicating a strong IAP content for the entire normal vasculature. Therefore, amifostine hydrolysis is ensured in normal tissues and may occur at both vascular and interstitial levels. By contrast, 60% of the tumors analyzed showed a loss of IAP expression in both epithelial cells and stroma, and only 10% to 15% of them demonstrated nuclear/cytoplasmic reactivity, which was confined to the epithelial cells. Similarly, the percentage of tumor vessels exhibiting some IAP reactivity was very low (6% to 17%). This dramatic loss of IAP expression from tumor stroma/vasculature may form a strong basis for explaining amifostine selectivity. In contrast, the abundance of IAP expression in normal tissues, stromal and vascular, ensures an intense hydrolysis of WR-2721 and rapid intracellular accumulation of WR-1065.
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677
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Vaupel P, Briest S, Höckel M. Hypoxia in breast cancer: pathogenesis, characterization and biological/therapeutic implications. Wien Med Wochenschr 2002; 152:334-42. [PMID: 12168517 DOI: 10.1046/j.1563-258x.2002.02032.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nearly 50% of locally advanced breast cancers exhibit hypoxic and/or anoxic tissue areas that are heterogeneously distributed within the tumour mass. Hypoxia is predominantly caused by structural and functional abnormalities of the newly formed tumour vessels arising from neovascularization, by a disturbed microcirculation, by enlarged diffusion distances, and by tumour-associated or therapy-induced anaemia. The extent of pretherapeutically measured hypoxic tissue areas is independent of clinical tumour size and stage, and histological type and grade. Anaemia can substantially worsen tumour O2 depletion. Hypoxia is known to directly or indirectly confer resistance to irradiation and some chemotherapeutic drugs leading to treatment failure. Sustained tumour hypoxia also gives rise to a more malignant phenotype (malignant progression). Due to this association between tumour hypoxia, malignant progression and treatment failure, tumour oxygenation has proven to be an independent, powerful prognostic factor for local control, overall and disease-free survival. Pretreatment assessment of tumour hypoxia is therefore needed to allow the selection of patients for more aggressive treatment within clinical trials or for individualization of therapy, and to identify patients who could benefit from hypoxiatargeting treatment measures. Due to a relatively high risk of relapse, patients with hypoxic tumours should undergo close surveillance. Anaemia in cancer patients should be prevented/corrected in order to improve radio-/chemosensitivity and thus to increase cancer cure rates.
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678
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Coradini D, Pellizzaro C, Veneroni S, Ventura L, Daidone MG. Infiltrating ductal and lobular breast carcinomas are characterised by different interrelationships among markers related to angiogenesis and hormone dependence. Br J Cancer 2002; 87:1105-11. [PMID: 12402149 PMCID: PMC2376202 DOI: 10.1038/sj.bjc.6600556] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/02/2002] [Accepted: 07/11/2002] [Indexed: 11/17/2022] Open
Abstract
To obtain a more integrated understanding of the different breast cancer phenotypes and to investigate whether bio-molecular profiles can distinguish between specific histotypes, we explored the interrelations among several biologic variables indicative of, or related to, hormone dependence, proliferation and apoptosis control, and angiogenesis in ductal and lobular carcinomas, the most common histotypes. Oestrogen and progesterone receptors, tumour proliferative activity, the expression of cyclin A, p16(ink4A), p27(kip1), p21(waf1), p53, bcl-2, and levels of vascular endothelial growth factor and hypoxia-inducible factor-1alpha (HIF-1alpha) were evaluated in 190 in ductal and 67 lobular carcinomas. Our findings support the hypothesis that in ductal and lobular carcinomas are two distinct, partially phenotypically unrelated entities, the latter being characterised by the presence of features indicative of differentiation such as oestrogen receptors, low proliferation and lack of p53 expression and associated with low vascular endothelial growth factor content compared to angiogenesis in ductal carcinomas. Conversely, no significant difference was found between lobular carcinomas and in ductal carcinomas considering the frequency distribution of PgR-positive cases, cyclin-dependent kinase inhibitors acting at the G1/S boundary, bcl-2 and HIF-1alpha protein expression. Although both generally defined as hormone responsive, in ductal and lobular carcinomas are also characterised by biologic patterns in which proteins related to hormone responsiveness, cell-cycle control, apoptosis and angiogenesis were differently associated. This finding suggests the need to refine breast cancer characterisation in order to provide detailed information about individual tumours, or subsets of tumours, that will help in defining optimal treatment approaches.
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MESH Headings
- Apoptosis
- Biomarkers
- Breast Neoplasms/blood supply
- Breast Neoplasms/chemistry
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/blood supply
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/blood supply
- Carcinoma, Lobular/chemistry
- Carcinoma, Lobular/pathology
- Endothelial Growth Factors/analysis
- Female
- Humans
- Hypoxia-Inducible Factor 1, alpha Subunit
- Intercellular Signaling Peptides and Proteins/analysis
- Lymphokines/analysis
- Middle Aged
- Neoplasms, Hormone-Dependent/pathology
- Neovascularization, Pathologic/pathology
- Proto-Oncogene Proteins c-bcl-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Transcription Factors/analysis
- Tumor Suppressor Protein p53/analysis
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
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679
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Ran S, Downes A, Thorpe PE. Increased exposure of anionic phospholipids on the surface of tumor blood vessels. Cancer Res 2002; 62:6132-40. [PMID: 12414638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Anionic phospholipids are largely absent from the external leaflet of the plasma membrane of mammalian cells under normal conditions. Exposure of phosphatidylserine on the cell surface occurs during apoptosis, necrosis, cell injury, cell activation, and malignant transformation. In the present study, we determined whether anionic phospholipids become exposed on tumor vasculature. A monoclonal antibody, 9D2, which specifically recognizes anionic phospholipids, was injected into mice bearing a variety of orthotopic or ectopic tumors. Other mice received annexin V, a natural ligand that binds to anionic phospholipids. Both 9D2 and annexin V specifically localized to vascular endothelium in all of the tumors, and also to tumor cells in and around regions of necrosis. Between 15 and 40% of endothelial cells in tumor vessels were stained. No localization was detected on normal endothelium. Various factors and tumor-associated conditions known to be present in the tumor microenvironment were examined for their ability to cause exposure of anionic phospholipids in cultured endothelial cells, as judged by 9D2 and annexin V binding. Hypoxia/reoxygenation, acidity, thrombin, and inflammatory cytokines all induced exposure of anionic phospholipids. Hydrogen peroxide was also a strong inducer. Combined treatment with inflammatory cytokines and hypoxia/reoxygenation had greater than additive effects. Possibly, injury and activation of tumor endothelium by cytokines and reactive oxygen species induce exposure of anionic phospholipids, most likely phosphatidylserine. Anionic phospholipids on tumor vessels could potentially provide markers for tumor vessel targeting and imaging.
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680
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Aichinger U, Schulz-Wendtland R, Krämer S, Lell M, Bautz W. [Scar or recurrence--comparison of MRI and color-coded ultrasound with echo signal amplifiers]. ROFO-FORTSCHR RONTG 2002; 174:1395-401. [PMID: 12424666 DOI: 10.1055/s-2002-35348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE MRI is the most reliable method to differentiate scar and recurrent carcinoma of the breast after surgical treatment. This study compares MRI and color-coded ultrasound with and without echo signal amplifier (ESA). MATERIALS AND METHODS Forty-two patients with suspected recurrent tumors were enrolled in this prospective study, with 38 patients after breast conserving therapy and 4 after mastectomy. All patients had a clinical examination, mammography (n = 38), real time ultrasound (US), color-coded ultrasound without and with ESA (Levovist(R), Schering, Berlin), and dynamic MRI. The criteria used for duplex ultrasound were tumor vascularisation and flow pattern. The results were compared with histologic findings or the results of follow-up examinations for at least 12 months. RESULTS The detection of penetrating or central vessels proved to be an accurate sign of malignancy in duplex ultrasound. With the application of ESA, additional vessels were detected within the lesions, increasing the diagnostic accuracy (83 % with ESA versus 79 % without ESA). The sensitivity of color-coded ultrasound improved from 64 % to 86 % with echo signal amplifier. The specificity was 86 % without and 82 % with echo signal amplifier. MRI was found to have a sensitivity of 100 % and a specificity of 82 %. The same 5 lesions were false positive on MRI and color-coded US after Levovist(R). No lesion without signs of vascularity within or in its vicinity was malignant. CONCLUSION Color-coded ultrasound seems to be a promising method in the differentiation between scar and recurrence. Lesions with penetrating or central vessels have a high probability of being malignant, whereas lesions without any signs of vascularity inside or nearby have a high probability of being benign. Advantage of contrast-enhanced US is its ubiquitous availability.
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681
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682
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Yang WT, Tse GMK, Lam PKW, Metreweli C, Chang J. Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1227-1235. [PMID: 12418764 DOI: 10.7863/jum.2002.21.11.1227] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To record the correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. METHODS Women with palpable breast masses scheduled for excision biopsy were scanned with two- and three-dimensional color power Doppler sonography before and after the administration of a sonographic contrast agent. Vessel counts were performed on two- and three-dimensional sonographic images before and after contrast agent administration. All tumors were surgically removed and underwent immunohistochemical analysis for microvessel density assessment. The sonographic measure of tumor vascularity was correlated with microvessel density. RESULTS Pathologic examination showed 43 breast cancers and 14 benign breast masses. Higher microvessel density was noted in malignant than benign breast masses (P < .0005). Color power Doppler sonographic measurement of tumor vessel number showed a significant positive correlation with tumor size (P < .05) and progesterone receptor negativity (P < .05). A significant positive correlation was observed between microvessel density and the number of intratumoral blood vessels assessed by both two- and three-dimensional color power Doppler sonography (P < .05). Regression models showed three-dimensional color power Doppler sonography to have a significantly higher correlation with microvessel density when compared with two-dimensional color power Doppler sonography at baseline (P < .005). The administration of a sonographic contrast agent did not improve correlation with microvessel density. CONCLUSIONS A significant correlation was shown between color power Doppler sonographic measurement of tumor vascularity and microvessel density by immunohistochemical analysis. Further improvement in Doppler sonographic techniques to map capillary vessel flow should be explored to improve the current association with pathologic findings.
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683
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Dacic S, Kounelis S, Kouri E, Jones MW. Immunohistochemical profile of cystosarcoma phyllodes of the breast: a study of 23 cases. Breast J 2002; 8:376-81. [PMID: 12390361 DOI: 10.1046/j.1524-4741.2002.08608.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cystosarcoma phyllodes (CP) of the breast is a rare biphasic tumor composed of benign epithelium and a spindle cell stroma. Biologic behavior of CP cannot be predicted with certainty on the basis of morphologic criteria only. We studied immunohistochemical expression of basic fibroblastic growth factor (bFGF), urokinase, Ki67, p53 protein, and microvessel density in stromal and epithelial components of 14 low-grade CP (LCP) and 9 high-grade CP (HCP). bFGF was more often positive in LCP than in HCP. The stroma was positive for bFGF in 86% of LCP and 67% of HCP, and the epithelium was positive in 64% of LCP and 14% of HCP. Urokinase was positive in stromal cells of 86% of LCP and 93% of HCP. The epithelial positivity for urokinase in both groups resembled closely that of the stroma. p53 protein was more often positive in stromal cells of HCP (67%) than in LCP (50%). Ki67 was positive in the stroma of 43% of LCP and 89% of HCP and in the epithelium of 14% of LCP and 33% of HCP. There was no significant difference in microvessel density (MVD) in low- and high-grade lesions. Our study demonstrates that stromal Ki67 and p53 immunohistochemical positivity are more often associated with high-grade tumors. The positive immunostaining for bFGF, urokinase, Ki67, and p53 in stroma and epithelium of the majority of CP supports the existence of epithelial-stromal interactions and recognizes epithelium as an integral part of this tumor.
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684
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Tricarico C, Pinzani P, Bianchi S, Paglierani M, Distante V, Pazzagli M, Bustin SA, Orlando C. Quantitative real-time reverse transcription polymerase chain reaction: normalization to rRNA or single housekeeping genes is inappropriate for human tissue biopsies. Anal Biochem 2002; 309:293-300. [PMID: 12413463 DOI: 10.1016/s0003-2697(02)00311-1] [Citation(s) in RCA: 425] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Careful normalization is essential when using quantitative reverse transcription polymerase chain reaction assays to compare mRNA levels between biopsies from different individuals or cells undergoing different treatment. Generally this involves the use of internal controls, such as mRNA specified by a housekeeping gene, ribosomal RNA (rRNA), or accurately quantitated total RNA. The aim of this study was to compare these methods and determine which one can provide the most accurate and biologically relevant quantitative results. Our results show significant variation in the expression levels of 10 commonly used housekeeping genes and 18S rRNA, both between individuals and between biopsies taken from the same patient. Furthermore, in 23 breast cancers samples mRNA and protein levels of a regulated gene, vascular endothelial growth factor (VEGF), correlated only when normalized to total RNA, as did microvessel density. Finally, mRNA levels of VEGF and the most popular housekeeping gene, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), were significantly correlated in the colon. Our results suggest that the use of internal standards comprising single housekeeping genes or rRNA is inappropriate for studies involving tissue biopsies.
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MESH Headings
- Biopsy
- Breast Neoplasms/blood supply
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/surgery
- Colonic Neoplasms/blood supply
- Colonic Neoplasms/genetics
- Colonic Neoplasms/metabolism
- Colonic Neoplasms/surgery
- Endothelial Growth Factors/chemistry
- Endothelial Growth Factors/genetics
- Endothelial Growth Factors/metabolism
- Female
- Gene Expression Regulation
- Glyceraldehyde-3-Phosphate Dehydrogenases/genetics
- Glyceraldehyde-3-Phosphate Dehydrogenases/metabolism
- Humans
- Immunohistochemistry
- Intercellular Signaling Peptides and Proteins/chemistry
- Intercellular Signaling Peptides and Proteins/genetics
- Intercellular Signaling Peptides and Proteins/metabolism
- Lymphokines/chemistry
- Lymphokines/genetics
- Lymphokines/metabolism
- Male
- Neovascularization, Pathologic/genetics
- RNA, Messenger/analysis
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/analysis
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- RNA, Ribosomal, 18S/analysis
- RNA, Ribosomal, 18S/genetics
- RNA, Ribosomal, 18S/metabolism
- Reference Standards
- Reproducibility of Results
- Reverse Transcriptase Polymerase Chain Reaction
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
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685
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Sartippour MR, Heber D, Ma J, Lu Q, Go VL, Nguyen M. Green tea and its catechins inhibit breast cancer xenografts. Nutr Cancer 2002; 40:149-56. [PMID: 11962250 DOI: 10.1207/s15327914nc402_11] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Investigators have shown that green tea may decrease the risk of cancer. It is widely accepted that the main active component of green tea is epigallocatechin-3-gallate (EGCG). In this study, we examined the effect of green tea on breast cancer growth and endothelial cells in in vitro assays and in animal models. Furthermore, we compared the potency of the different catechin components of green tea extract (GTE), including EGCG. Our data showed that mixed GTE and its individual catechin components were effective in inhibiting breast cancer and endothelial cell proliferation. In mouse experiments, GTE suppressed xenograft size and decreased the tumor vessel density. Our results demonstrated the value of all catechins and argued for the use of a mixed GTE as a botanical dietary supplement, rather than purified EGCG, in future clinical trials.
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686
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Maass N, Nagasaki K, Ziebart M, Mundhenke C, Jonat W. Expression and regulation of tumor suppressor gene maspin in breast cancer. Clin Breast Cancer 2002; 3:281-7. [PMID: 12425757 DOI: 10.3816/cbc.2002.n.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Maspin (mammary serpin) is an inhibitor of serine proteases with tumor suppressor activity in breast cancer. Maspin was originally identified by subtractive hybridization in normal breast epithelial cells, but its expression decreased during tumor progression. The loss of maspin gene expression with increasing malignancy is by transcriptional regulation. Maspin is known to be involved in invasion and metastasis, interact with the p53 tumor suppressor pathway, and act as an inhibitor of angiogenesis. The immunohistochemical analysis and reverse-transcription polymerase chain reaction of maspin in normal human breast tissue and breast carcinoma indicated a stepwise reduction of maspin expression during the progression from ductal carcinoma in situ to invasive carcinoma to lymph node metastasis. The lack of maspin expression in breast cancer seems to be associated with a short disease-free survival and supports maspin's function as an indicator for tumor aggressiveness and metastatic potential. New studies on the gene regulation of maspin provide evidence for promising potential of possible re-expression of maspin in tumor cells. The function of maspin as a tumor suppressor gene involved in tumor invasion, metastasis, and angiogenesis may not be limited to breast cancer.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/blood supply
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Gene Expression/genetics
- Gene Expression Regulation, Neoplastic/genetics
- Genes, Tumor Suppressor/physiology
- Humans
- Immunohistochemistry
- In Vitro Techniques
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Metastasis
- Neovascularization, Pathologic/genetics
- Pancreatic Neoplasms/genetics
- Promoter Regions, Genetic/genetics
- Protein Biosynthesis
- Proteins/genetics
- Proteins/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Serpins/biosynthesis
- Serpins/genetics
- Serpins/metabolism
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687
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Watanabe O, Haga S, Shimizu T, Imamura H, Kinoshita J, Utada Y, Okabe T, Kimura K, Hirano A, Kajiwara T, Aiba M. Experience of intravenous digital subtraction angiography (IV-DSA) in evaluation of neoadjuvant chemotherapy for advanced breast cancer. Int J Clin Oncol 2002; 7:322-5. [PMID: 12402068 DOI: 10.1007/s101470200048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravenous digital subtraction angiography (IV-DSA) was performed before and after neoadjuvant chemotherapy (NACT) in five patients with locally advanced breast cancer, and the efficacy of NACT was evaluated on the basis of the results of IV-DSA and histopathological examination. Following NACT, the maximum density of tumor enhancement (MAX) in the IV-DSA image decreased by 61.6% in case 1, 50% in case 2, 58.1% in case 3, 90.8% in case 4, and 97.2% in case 5. In all five patients, the efficacy of chemotherapy was rated as a partial response in terms of tumor size, while histological efficacy was rated as slightly effective in cases 1-4 and moderately effective in case 5. The pathological efficacy of NACT was highest in case 5, which showed the greatest decrease in MAX. These results indicate that variations in MAX reflect clinical efficacy, and, to some extent, also permit prediction of pathological efficacy.
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688
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Skarpathiotakis M, Yaffe MJ, Bloomquist AK, Rico D, Muller S, Rick A, Jeunehomme F. Development of contrast digital mammography. Med Phys 2002; 29:2419-26. [PMID: 12408316 DOI: 10.1118/1.1510128] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Development of breast tumors is often accompanied by angiogenesis--the formation of new blood vessels. It is possible to image the effects of this process by tracking the uptake and washout of contrast agents in the vicinity of a lesion. In this article, a method for carrying out contrast subtraction mammography on a full-field digital mammography unit is described. Spectral measurements and modeling were performed to optimize the choice of x-ray target, kilovoltage and x-ray beam filtration for contrast digital mammography (CDM) on an available digital mammography system. Phantom studies were carried out to determine the sensitivity of CDM to iodine. Detection of iodine area densities of 0.3 mg/cm2 is possible for a circular object with a radius of 1.3 mm, which allows detection of uptake levels in the breast typically seen with cancer and some benign breast conditions. It was found that with a molybdenum anode x-ray tube, copper filtration could be used to effectively shape the x-ray spectrum to maximize the proportion of x rays with energies above the k edge of iodine. Simple logarithmic subtraction was found to be adequate in suppressing background signals dependent on the x-ray beam intensity and background thickness of the breast. The total x-ray dose from the procedure ranges between 1 and 3 mGy, similar to that from a conventional single view film mammogram. A clinical pilot study is currently being carried out to evaluate this technique.
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689
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Mankoff DA, Dunnwald LK, Gralow JR, Ellis GK, Schubert EK, Charlop AW, Tseng J, Rinn KJ, Livingston RB. [Tc-99m]-sestamibi uptake and washout in locally advanced breast cancer are correlated with tumor blood flow. Nucl Med Biol 2002; 29:719-27. [PMID: 12381452 DOI: 10.1016/s0969-8051(02)00333-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the influence of breast tumor blood flow on MIBI kinetics, we compared MIBI uptake and washout to [O-15]-water PET estimates of blood flow in patients with locally advanced breast cancer. METHODS Prior to therapy, 37 patients underwent MIBI and [O-15]-water PET imaging; 22/37 also had MIBI washout analysis. Twenty-five patients underwent serial imaging over the course of chemotherapy. RESULTS MIBI uptake and blood flow had a significant positive correlation pre-therapy. The change in MIBI uptake over the course of therapy also correlated with the change in blood flow. The half-time of MIBI washout inversely correlated with blood flow, indicating faster MIBI washout with higher blood flow. CONCLUSIONS Blood flow strongly influences early MIBI uptake and can be a factor affecting the rate of MIBI washout in breast tumors. We present a model of MIBI kinetics in tumors which forms a hypothesis for further mechanistic studies of MIBI uptake and washout in breast cancer.
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690
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Abstract
Therapy directed against specific biologic targets has long been used in the treatment of breast cancer; the estrogen receptor is a validated prognostic and therapeutic target, and antiestrogen therapy has been used effectively for decades. Recently, scientific progress and increased comprehension of mechanisms of breast cancer pathogenesis have led to the proliferation of both potential molecular targets and new therapeutic agents. The success of traztuzumab (Herceptin, Genentech, South San Francisco, CA), an anti-HER2 antibody, has spurred the development of other biologically directed therapeutics. In this overview, I discuss three targets relevant to breast cancer (the epidermal growth factor receptor family, angiogenesis, and NF-kappa B), and therapeutic approaches directed against these targets are discussed.
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691
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Lee AHS. The relationship of vascularity of the primary tumour to lymph node metastases and to distant haematogenous spread in carcinoma of the breast. Histopathology 2002; 41:366-8. [PMID: 12383222 DOI: 10.1046/j.1365-2559.2002.15102.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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692
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Miller KD. Issues and challenges for antiangiogenic therapies. Breast Cancer Res Treat 2002; 75 Suppl 1:S45-50; discussion S57-8. [PMID: 12353823 DOI: 10.1023/a:1020317917759] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Angiogenesis is defined as the growth and proliferation of blood vessels from the existing vasculature, allowing a developing tissue to obtain the nutrients necessary to maintain growth. This fundamental mechanism underlies the processes of reproduction, development and repair and occurs in both normal and tumor tissues. Since this process is confined to rapidly growing tissues, and is quiescent in normal tissues, it was hypothesized by Folkman that any therapeutic intervention that inhibited angiogenesis would be relatively specific to tumors, sparing normal tissue. The mechanisms by which tumors induce angiogenesis are complex. Tumors rapidly outgrow the capacity of the vasculature in their host tissue to provide nutrition and oxygenation, and are inherently hypoxic. In response to hypoxia, they produce a number of potent protein-mediators that stimulate the growth of new blood vessels. These angiogenic factors are not specific to tumors - they are produced by all tissues in response to hypoxia. Many of the mechanisms have been elucidated at a molecular level, and a number of ligands, receptors and signal-transduction pathways defined. Many of these represent potential targets for the development of novel therapeutic agents. Several drug candidates that target angiogenic mechanisms are currently being evaluated in breast cancer. The ultimate goal of all such development is to improve disease outcome, and to augment currently available therapies. However, the evaluation of these drug candidates in clinical studies is complex and requires a fundamental re-appraisal of conventional clinical trial methodology and the application of advanced bioscientific technology to facilitate understanding of the complex pharmacology that they may produce.
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693
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Zitzmann S, Ehemann V, Schwab M. Arginine-glycine-aspartic acid (RGD)-peptide binds to both tumor and tumor-endothelial cells in vivo. Cancer Res 2002; 62:5139-43. [PMID: 12234975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Targeting tumor cells or tumor vasculature by peptides is a promising strategy for delivering cytotoxic drugs for cancer therapy. The identification of efficient targeting peptides depends on the availability of informative methods for determining cellular binding specificities. Here, we have used fluorescence-activated cell-sorting (FACS) analysis in combination with an isopentane freezing method to show targeted binding of the Arg-Gly-Asp (RGD)-4C-peptide labeled with FITC, not only to endothelial cells but also to tumor cells in human breast cancer xenografts grown in nude mice. Nontumorous cells showed only background binding. This study suggests, that the RGD-4C-peptide can target tumor endothelial cells as well as tumor cells. Consequently, it should be possible to design a combination therapy approach against both targets.
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694
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Martin TA, Mansel RE, Jiang WG. Antagonistic effect of NK4 on HGF/SF induced changes in the transendothelial resistance (TER) and paracellular permeability of human vascular endothelial cells. J Cell Physiol 2002; 192:268-75. [PMID: 12124772 DOI: 10.1002/jcp.10133] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocyte growth factor/scatter factor (HGF/SF) is a multi-function cytokine that has been shown to regulate the expression of cell adhesion molecules in human endothelial cells. It is also a key cytokine in the development and progression of cancer, particularly during metastasis. NK4 is a variant of HGF/SF that has already been shown to be antagonistic to HGF/SF. This study shows that HGF/SF decreased transendothelial resistance (TER) and increased paracellular permeability in human vascular endothelial cells can that such effects can be inhibited by addition of the NK4 variant. In addition, HGF/SF-stimulated invasion of endothelium by breast cancer cells was inhibited by the addition of NK4. Western blotting revealed that HGF/SF decreased the protein level, and increased tyrosine phosphorylation of ZO-1, but did not cause a change in level of occludin or claudin-1, both molecules involved in tight junction function. RT-PCR revealed that addition of HGF/SF caused no change in signal for claudin-5 or junctional adhesion molecule (JAM), but there was a decrease in the signal for claudin-1. NK4 was able to prevent the decrease in levels of ZO-1 protein by HGF/SF.
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695
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Pan Q, Kleer CG, van Golen KL, Irani J, Bottema KM, Bias C, De Carvalho M, Mesri EA, Robins DM, Dick RD, Brewer GJ, Merajver SD. Copper deficiency induced by tetrathiomolybdate suppresses tumor growth and angiogenesis. Cancer Res 2002; 62:4854-9. [PMID: 12208730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Copper plays an essential role in promoting angiogenesis. Tumors that become angiogenic acquire the ability to enter a phase of rapid growth and exhibit increased metastatic potential, the major cause of morbidity in cancer patients. We report that copper deficiency induced by tetrathiomolybdate (TM) significantly impairs tumor growth and angiogenesis in two animal models of breast cancer: an inflammatory breast cancer xenograft in nude mice and Her2/neu cancer-prone transgenic mice. In vitro, TM decreases the production of five proangiogenic mediators: (a) vascular endothelial growth factor; (b) fibroblast growth factor 2/basic fibroblast growth factor; (c) interleukin (IL)-1alpha; (d) IL-6; and (e) IL-8. In addition, TM inhibits vessel network formation and suppresses nuclear factor (NF)kappaB levels and transcriptional activity. Our study suggests that a major mechanism of the antiangiogenic effect of copper deficiency induced by TM is suppression of NFkappaB, contributing to a global inhibition of NFkappaB-mediated transcription of proangiogenic factors.
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MESH Headings
- Angiogenesis Inhibitors/pharmacology
- Animals
- Breast Neoplasms/blood supply
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Cell Division/drug effects
- Copper/deficiency
- Disease Models, Animal
- Female
- Genes, erbB-2
- Humans
- Mammary Neoplasms, Experimental/blood supply
- Mammary Neoplasms, Experimental/genetics
- Mammary Neoplasms, Experimental/pathology
- Mammary Neoplasms, Experimental/prevention & control
- Mice
- Mice, Nude
- Mice, Transgenic
- Molybdenum/pharmacology
- NF-kappa B/genetics
- NF-kappa B/metabolism
- Neovascularization, Pathologic/drug therapy
- Rats
- Rats, Sprague-Dawley
- Transcription, Genetic
- Xenograft Model Antitumor Assays
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696
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Reinikainen H, Pääkkö E, Suramo I, Päivänsalo M, Jauhiainen J, Rissanen T. Dynamics of contrast enhancement in MR imaging and power Doppler ultrasonography of solid breast lesions. Acta Radiol 2002; 43:492-500. [PMID: 12423460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
PURPOSE To evaluate the dynamics of contrast enhancement in solid breast lesions at contrast-enhanced MR imaging and power Doppler ultrasonography (US) and to compare the methods to histology and to each other. MATERIAL AND METHODS Forty breast lesions were prospectively examined with dynamic MR and power Doppler US. Time-signal intensity curves of enhancement were obtained for both methods. The shape of the curve was analyzed to be benign, indeterminate or malignant. The curves were also analyzed quantitatively by calculating the slope of the curve and the area under the curve (both methods), relative enhancement (MR), and time to peak (US). The lesions were divided into malignant lesions, fibroadenomas, and other benign lesions. The results were compared to histology. RESULTS In the subjective analysis of the MR curve in differentiating between benign and malignant lesions the accuracy was 90%. The MR curve also enabled differentiation between fibroadenomas and malignancies. The accuracy of the US curve was 38%. Quantitatively, statistically significant differences were found using all the MR variables, except between malignancies and fibroadenomas. Using the US variables, no significant difference was found between the groups. CONCLUSION The dynamics of contrast-enhanced MR were reliable in the differential diagnosis of solid breast lesions, but contrast-enhanced power Doppler US was of limited value.
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697
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Bogin L, Margalit R, Mispelter J, Degani H. Parametric imaging of tumor perfusion using flow- and permeability-limited tracers. J Magn Reson Imaging 2002; 16:289-99. [PMID: 12205585 DOI: 10.1002/jmri.10159] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To quantitatively evaluate the spatial distribution of flow- and permeability-limited perfusion in MCF7 human breast cancer tumors orthotopically implanted in CD1-NU mice. MATERIALS AND METHODS Flow-limited perfusion was derived from (2)H-MRI recorded before and after infusion of deuterated water. Permeability-limited perfusion was evaluated from GdDTPA-enhanced (1)H-MRI. RESULTS The dominant processes in tumor perfusion, namely blood flow and capillary permeability, were mapped in orthotopically implanted MCF7 human breast cancer tumors. The dynamic data were processed according to physiological models, yielding parametric maps of intravascular volume fraction, water perfusion rate, GdDTPA permeability rate constant, and extracellular volume fraction accessible to GdDTPA. The maps exhibited the heterogeneous distribution of each perfusion parameter. Most of the tumor tissue (> or =95%) was perfused with HDO, while GdDTPA was perfused in only about 50% of it. In most loci the perfusion rate was limited by capillary permeability to GdDTPA. CONCLUSION The results demonstrated the instructive value of tracers with different properties used in conjunction to achieve a deeper understanding of tumor perfusion capacity. This study offers tools for the accurate, noninvasive evaluation of drug delivery efficacy.
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698
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Carriero A, Ambrossini R, Mattei PA, Angelucci D, Bonomo L. Magnetic resonance of the breast: correlation between enhancement patterns and microvessel density in malignant tumors. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2002; 21:83-7. [PMID: 12585660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The continuous growth of a solid tumor is contingent upon the induction and formation of new vascular structures (angiogenesis). Several studies have established a close correlation between the microvessel density (MVD) of a tumor and its growth capacity. Therefore, a non-invasive method to accurately assess tumor MVD in vivo would be clinically useful. We studied 20 consecutive patients (age range: from 39 to 78 yrs; average age: 58.9 yrs), with malignant breast neoplasms using dynamic MR examinations with a paramagnetic contrast agent and post-operative pathological evaluation. We found that the differences in dynamic MRI enhancement are a direct consequence of microvascular distribution within the neoplasm. This study did not yield a statistically significant correlation between high microcirculation neo-formation and high aggressiveness of the neoplasm, but did indicate that further studies with a larger study populations are necessary.
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699
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Schröder RJ, Bostanjoglo M, Hidajat N, Rademaker J, Röttgen R, Mäurer J, Felix R. [Analysis of vascularity in breast tumors--comparison of high frequency ultrasound and contrast-enhanced color harmonic imaging]. ROFO-FORTSCHR RONTG 2002; 174:1132-41. [PMID: 12221572 DOI: 10.1055/s-2002-33940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the ability of standard power Doppler and color harmonic imaging for visualising breast tumor vascularity using ultrasound probes of various frequencies, and to evaluate the influence on diagnostic accuracy using ultrasound contrast agent. MATERIALS AND METHODS Twenty patients (x = 43.6 +/- 11.7 years) with suspected malignancy of the breast underwent power Doppler to evaluate vascularity and to offer a differential diagnosis of the lesion. Two criteria were used for differential diagnosis: The quantitative extent of vascularity ("percentage vessel area", PVA) and the qualitative assessment of vascular architecture. The following power Doppler modes were compared in every patient: Plain and enhanced (Levovist(R)) 9 MHz and 12 MHz standard power mode and enhanced 9 MHz color harmonic imaging-(CHI). RESULTS The PVA increased from a mean of 2.2 +/- 2.9 % (9 MHz standard plain) via 4.8 +/- 4.1 % (12 MHz standard plain), 9.7 +/- 15.3 % (9 MHz standard enhanced), 17.4 +/- 20.0 % (9 MHz CHI enhanced) up to 19.4 +/- 14.8 % (12 MHz standard enhanced). The perceptibility of the vascular structure was best using the enhanced 12 MHz standard power mode, immediately followed by the enhanced 9 MHz CHI mode. The improved detection of vascular signal did not translate into improved diagnostic accuracy. The highest diagnostic accuracy (95 %) was obtained using the enhanced 9 MHz CHI mode (criterion "PVA") and the enhanced 9 MHz standard power mode (criterion "vascular structure"), whereas the 12 MHz probes delivered insufficient diagnostic accuracy and very low specificity. CONCLUSION Best quantitative and qualitative visualisation of the tumor vascularity was achieved using the enhanced 12 MHz standard power mode. Nevertheless, the highest diagnostic accuracy was obtained using enhanced 9 MHz standard power Doppler and enhanced 9 MHz color harmonic imaging. The visualisation of tumor vascularity and, partially, the diagnostic accuracy are improved significantly by color harmonic imaging without changing the probe frequently.
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700
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Furman-Haran E, Kelcz F, Degani H. Magnetic resonance imaging of breast cancer angiogenesis: a review. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2002; 21:47-54. [PMID: 12585654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The development and growth of solid tumors rely on a process known as perfusion which allows for the delivery and clearance of nutrients through their vasculature. The classical approach of studying tumor vasculature by histologic staining of endothelial cells provides a measure of microvessel density in areas of high vascularization (so-called "hot spots"). More advanced high-resolution, parametric, contrast-enhanced MRI techniques enable quantitative assessment of the vascular distribution and function over the entire tumor. Hence, MRI overcomes the intratumoral variation of the histological method. Clinical testing of the MRI approach, that evaluates the permeability and surface area of the tumor vasculature, demonstrates improved accuracy of breast cancer diagnosis.
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