Expression of the multidrug transporter, P-glycoprotein, in acute leukemia cells and correlation to clinical drug resistance

The overexpression of a cell-surface glycoprotein termed P-glycoprotein (P-gp) is frequently associated with multi-drug resistance (MDR) in cell lines in vitro. To evaluate the implications of P-gp expression in clinical drug resistance, the authors examined the expression of P-gp in leukemia cells from patients with acute myelogenous leukemia (AML) and those with acute lymphoblastic leukemia (ALL) at initial presentation and relapse, using immunoblotting with a monoclonal antibody against P-gp, C219. Nine of 17 patients with AML and four of 11 patients with ALL had P-gp-positive results at the initial presentation, and most P-gp-positive patients did not respond to chemotherapy. Four of seven patients at the relapsed stage and all three patients with preceding myelodysplastic syndrome had P-gp-positive results. The expression of P-gp and clinical refractoriness to chemotherapy were highly correlated. These data indicate that the expression of P-gp is closely related to clinical drug resistance in acute leukemia.

Expression of the multidrug transporter, P-glycoprotein, in acute leukemia cells and correlation to clinical drug resistance

The overexpression of a cell-surface glycoprotein termed P-glycoprotein (P-gp) is frequently associated with multi-drug resistance (MDR) in cell lines in vitro. To evaluate the implications of P-gp expression in clinical drug resistance, the authors examined the expression of P-gp in leukemia cells from patients with acute myelogenous leukemia (AML) and those with acute lymphoblastic leukemia (ALL) at initial presentation and relapse, using immunoblotting with a monoclonal antibody against P-gp, C219. Nine of 17 patients with AML and four of 11 patients with ALL had P-gp-positive results at the initial presentation, and most P-gp-positive patients did not respond to chemotherapy. Four of seven patients at the relapsed stage and all three patients with preceding myelodysplastic syndrome had P-gp-positive results. The expression of P-gp and clinical refractoriness to chemotherapy were highly correlated. These data indicate that the expression of P-gp is closely related to clinical drug resistance in acute leukemia.

Expression of the multidrug transporter, P-glycoprotein, in chronic myelogenous leukaemia cells in blast crisis

The overexpression of a cell-surface glycoprotein termed P-glycoprotein (P-gp) is frequently associated with multidrug resistance (MDR) in cell lines in vitro. To evaluate the implications of P-gp expression in clinical drug-resistance, we examined the expression of P-gp in fresh leukaemia cells from chronic myelogenous leukaemia (CML) patients in blast crisis. By using immunoblotting with a monoclonal antibody against P-gp, C219, we showed that leukaemia cells from three CML patients in blast crisis were P-gp negative at the stage when these patients were in complete remission, and that the cells showed high levels of P-gp expression at times when the same patients had relapsed and had not responded to chemotherapy. Six out of 11 patients (nine in the refractory state) were P-gp positive and they rarely responded to chemotherapy. These data suggest that the expression of P-gp is closely associated with drug-resistance in CML.

The prevalence of human T-cell leukemia virus type I infection in patients with hematologic and nonhematologic diseases in an adult T-cell leukemia-endemic area of Japan

In order to clarify the prevalence of human T-cell leukemia virus type I (HTLV-I) infection in the Kagoshima district, Japan, a highly endemic area for HTLV-I, antibodies for HTLV-I (anti-HTLV-I) were examined in the sera of 6167 from healthy residents and patients with various hematologic and nonhematologic diseases. In healthy residents, including blood donors, the prevalence of anti-HTLV-I was 11.9% (562/4741 persons). The prevalence increased with age, and was significantly higher in in females than in males (P less than 0.01). The prevalence of anti-HTLV-I in blood donors was 8.5%. In In hematologic diseases, the prevalence of anti-HTLV-I was 98.3% in ATL, 28.9% in lymphoproliferative disorders except ATL, and 10.6% in myeloproliferative disorders. In nonhematologic diseases, the prevalence of anti-HTLV-I was shown to be 29.5% in pulmonary tuberculosis, 25.8% in leprosy, 33.8% in chronic renal failure (CRF), 21.9% in autoimmune diseases, and 47.8% in strongyloidiasis. The various diseases except myeloproliferative disorders had significantly higher prevalence of anti-HTLV-I than healthy residents (P less than 0.01 or 0.05). For autoimmune diseases, the prevalence of anti-HTLV-I in patients with blood transfusion (55.6%) was higher than in those without blood transfusion (8.7%), and healthy residents. In hemodialysis patients with CRF who had received blood transfusions the prevalence of anti-HTLV-I increased with the number of blood transfusions. Therefore, HTLV-I transmission via blood transfusion would partially explain these high prevalence of anti-HTLV-I. However, the prevalence of anti-HTLV-I in hemodialysis patients with CRF was statistically higher than that in healthy residents, regardless of blood transfusion (P less than 0.01). Furthermore, hemodialysis patients showed significantly higher prevalence of anti-HTLV-I than healthy residents, even at a younger age. Patients with pulmonary tuberculosis and leprosy showed the same results as hemodialysis patients. These results suggest that possibility that HTLV-I infection has some relation not only to ATL but also to other diseases. Therefore, it seems very important to halt the spread of HTLV-I transmission as soon as possible.

Lymphocyte subpopulations of peripheral blood in tsutsugamushi disease

We examined lymphocyte subpopulations in the peripheral blood and serum concentrations of immunoglobulin (Ig) in 8 patients with tsutsugamushi disease. In 7 of the 8 cases, there was a 4-fold or greater increase in IgG and IgM antibody titers between the initial and convalescent serum specimens. In one case, there was no increase, but IgM antibodies were detected with diagnostically significant antibody titers. The percentages of CD8- and CD2-positive lymphocytes measured before treatment were found to be significantly higher than during the recovery stage of patients with tsutsugamushi disease. The CD4/CD8 ratio in the peripheral blood calculated before treatment was significantly lower than that during the recovery stage. Serum concentrations of IgG and IgM in patients during the recovery stage were significantly higher than pretreatment levels, respectively.

[A molecular basis for multidrug resistance and reversal of the resistance]

Multidrug-resistance is frequently characterized by enhanced drug efflux resulting from a membrane glycoprotein of 170,000 daltons (P-glycoprotein). Analysis of cloned cDNAs for the human MDR 1 gene, whose product is the P-glycoprotein, indicates that P-glycoprotein is an energy-dependent drug-efflux system for cytotoxic hydrophobic anticancer drugs. We have demonstrated that a photoanalog of a reversing agent, SDB-ethylenediamine, specifically binds to P-glycoprotein. The binding site on P-glycoprotein seems to be identical with that of anticancer agents and other reversing agents. On the other hand, the radioactive photoactive dihydropyridine calcium channel blocker, [3H] azidopine, photolabels P-glycoprotein in membrane vesicles from multidrug-resistant cells. This photolabeling is almost completely inhibited by excess dihydropyridine analogs that reverse or lower drug-resistance. In contrast, the labeling is not significantly inhibited by analogs that do not reverse resistance. These results suggest that it may be possible to quickly screen for dihydropyridine analogs that reverse multidrug resistance by measuring the inhibition of [3H] azidopine labeling of P-glycoprotein.

Adult T-cell leukemia with leukemia cell infiltration into the gastrointestinal tract

Five cases of untreated adult T-cell leukemia (ATL) with leukemia cell infiltration into the gastrointestinal (GI) tract were reported. X-ray findings of the GI tract showed diffuse abnormal mucosal patterns throughout the GI tract in all five patients. Endoscopic findings corresponded well with the x-ray findings. Pathologic examination of biopsied specimens from all five patients revealed diffuse and extensive leukemic infiltration into the stomach and/or the large intestine.

Functions encoded by the yeast plasmid pSB3 isolated from Zygosaccharomyces rouxii IFO 1730 (formerly Saccharomyces bisporus var. mellis)

Functions encoded by the yeast plasmid pSB3 were analysed in Saccharomyces cerevisiae and Zygosaccharomyces rouxii. The autonomously replicating sequence (ARS) and partitioning mechanisms of pSB3 worked as satisfactorily in Z. rouxii ME3 as in the native host Z. rouxii IFO 1730 (formerly Saccharomyces bisporus var. mellis). The ARS in Z. rouxii ME3 was located within a 168 bp BanII-HindIII fragment spanning part of the inverted repeat (IR) and a unique region contiguous to it. The FLP enzyme (responsible for the intramolecular recombination at IRs) of pSB3 was functional in Z. rouxii ME3. In spite of the similarity of the putative recognition site for the FLP enzyme in pSB3 and pSR1, the FLP enzyme of pSB3 did not recognize the recombination site of pSR1, and the FLP enzyme of pSR1 did not use the recombination site of pSB3. Three transcripts of 3.4, 1.8 and 1.1 kb from pSB3 in Z. rouxii ME3 were identified by Northern blotting; they encompassed the A, B and C genes, respectively. pSB3 contained a region from which no poly(A)-containing RNA was transcribed.

[Studies on CA 125, CA 19-9, TPA and IAP as tumor markers in patients with ovarian cancer]

CA 125, CA 19-9, TPA and IAP were useful for diagnosis of ovarian cancer. CA 125 was localized immunohistochemically in the surface and cytoplasma of cancer cells of serous cystadenocarcinomas, clear cell carcinomas, endometrioid carcinomas and undifferentiated carcinomas and CA 19-9 localized in mucinous cystadenocarcinomas and endometrioid carcinomas. When the cut off value of CA 125 was set by 35 U/ml in the control group, the patients with serous cystadenocarcinoma showed positive in 81%, resulting by 1,766.5 U/ml as an average value. As for CA 19-9 having set by 37 U/ml as the cut off value, patients suffering from mucinous cystadenocarcinoma who revealed positive by 60%, were 194 U/ml in an average value. It is considered that measuring values of CA 125 and CA 19-9 are valuable not only to diagnose as ovarian cancers but also to evaluate their prognosis.

[Fundamental studies on arterial infusion chemotherapy for cervical cancer--with reference to the histological finding in infiltrating cancer and localization of the drugs in tissues]

Preoperative arterial infusion of peplomycin was carried out on 15 cases of Stage I or II cancer of the cervix, and the value of arterial infusion chemotherapy with peplomycin and its efficacy as a preoperative therapy in cervical cancer were evaluated by analysis of (1) histological changes, (2) localization of the drug in tissue, and (3) tissue concentration of the drug in the completely resected tissues, with the following results: The chief histological change was a regression of cancer nests accompanied by degeneration and necrosis of cancer cells. This change was clearer at the head of infiltrating cancers than at their superficial layer or center. Peplomycin was localized with high activity at the disintegrated part of cancer nests, i.e., its activity was closely correlated to the severity of histological change. Time-course changes in its localization suggested the vessel wall----stroma----cancer as the route of its transport. The tissue concentration of peplomycin was maintained high over a long time. Particularly in the portio vaginalis, the time course decline of the concentration was gentle. From the above findings, arterial infusion of peplomycin was considered to be an effective method of chemotherapy for cervical cancer, and worth being tried as a preoperative therapy too.

[A study on tumor marker of tissue-polypeptide-antigen (TPA) in gynecologic malignancies]

Tissue polypeptide-antigen (TPA), a tumor-associated antigen reported by Bjorklund et al., is a single chain polypeptide of approximately 22,000-45,000 molecular weight, which is being studied in various fields as a tumor marker. We determined the serum TPA level and tissue distribution of TPA in patients with gynecologic malignancies and healthy women. In healthy women, the serum TPA level was under 110 mu/l, without any relation to age or sex. In benign tumors, the mean serum TPA was 123.9 mu/l and it is comparable with that in healthy women. In cervical cancers, it was 212 mu/l and significantly higher than those in healthy women and in patients with benign tumors (p less than 0.01). In ovarian cancers, it was 414.7 mu/l, which showed significantly higher levels of serum TPA in ovarian cancers than those in healthy women and in patients with benign tumor, and it was also significantly higher than that in cervical cancers (p less than 0.001). As for the values after treatment, the serum TPA level clearly tended to fall in patients exhibiting good response, and tended to rise in those showing poor response. TPA was markedly localized in the cancer cells, but was almost entirely absent from the normal tissues of the cervix and endometrium.

[Experiences with intravenous drip infusion therapy of amikacin for severe infections in patients of hematological disorder]

Amikacin was studied for clinical effect in 7 patients with acute leukemia, 1 patient with chronic myelogenous leukemia-blastic crisis, 1 patient with malignant lymphoma and 1 patient with aplastic anemia, who were suffered from severe infection such as sepsis, pneumonia or subcutaneous abscess. Most of these patients had bleeding tendency, so amikacin was administered by intravenous drip infusion in a dose of 200 mg--400 mg for 1 hour. Total doses of amikacin were between 3.2 g and 12.6 g. These doses of amikacin gave good response to 3 patients with sepsis, 1 patient with subcutaneous abscess and 1 patient with pneumonia. We didn't observe any side effect most likely associated with amikacin. Therefore, intravenous drip administration of amikacin might be useful drug for management of severe infections in patients of hematological disorder, and seemed to be as safe as intramuscular administration.