[Synthesis and structure-activity relationships of novel 14 beta-side chain taxol derivatives]

In order to develop new generation of taxol-like anticancer agents with fewer side effects, improved activity, superior pharmacological properties and broad antitumor spectrum, along with structure-activity relationship study, a series of new taxol derivatives are to be synthesized starting from sinenxan A--a biosynthetic taxane. Eight new 14 beta-side chain taxol derivatives with 4-OH and 4-Ac were synthesized in 5 and 6 steps from semisynthetic taxoid intermediate 7, respectively. These included taxol derivatives modified at C-2 position with benzoate, m-Cl benzoate, valerate and phenylacetate. All target compounds together with two other 14 beta-side chain taxol derivatives were tested in a microtubule assembly assay, and in an in vitro cytotoxicity assay (KB, A2780, HCT-8 cell line). All compounds had no effect in the microtubule assembly assay at 10 mumol.L-1. Most of them showed marginal activity in the in vitro cytotoxicity. The structure-activity relationship was different from taxol derivatives. 2-Aliphatic ester displayed similar activity to 2-aromatic ester, which indicated that the aromatic group at C-2 position was not important for cytotoxicity. Comparing among themselves, 4-OH derivatives possessed stronger activity than 4-Ac.

[Differences in exercise blood pressure response between dipper and non-dipper elderly patients with essential hypertension]

We evaluated the circadian variation and exercise stress response patterns of blood pressure (BP) in elderly patients with essential hypertension. Ambulatory BP monitoring for 48 hours every 30 minutes, and treadmill exercise test using a Bruce protocol at PM 3 to 5 were performed in 49 untreated patients with hypertension. Mean daytime (awake), and night-time (sleeping) systolic BP (SBP) and diastolic BP (DBP) values were analyzed by reviewing the patients' diaries, and the nocturnal reduction rate (NRR) of SBP and DBP were calculated according to the following formula. NRR (%) = [(daytime mean-nighttime mean)/daytime mean] x 100. The patients were divided into two groups according to the presence (dipper, n = 25) or absence (non-dipper, n = 24) of a reduction in both SBP and DBP during the night by an average of more than 10% of the daytime BP. Mean values of SBP and DBP measured over 48 hours in the dipper and non-dipper groups were similar. Responses of SBP to dynamic exercise at 2 to 5 minutes in the non-dipper group were significantly smaller than those in the dipper group (p < 0.05). Non-dipper patients with hypertension responded to dynamic exercise stress with smaller increases in SBP than did those in the dipper group. The differences in BP responses to exercise may affect the circadian blood pressure profile in dipper and non-dipper elderly patients with essential hypertension.

Protein kinase C regulates Fas (CD95/APO-1) expression

Fas (CD95/APO-1) is a transmembrane protein of the TNF/neuron growth factor receptor family. Ligation of Fas by specific Abs or Fas ligand (FasL/CD95 ligand) induces rapid apoptotic cell death in a variety of cell types. Despite progress in understanding the death signals transduced from Fas, very little is known with regard to the mechanisms by which Fas expression is regulated. Using our previously established murine T cell hybridoma model A1.1, we show that specific protein kinase C (PKC) inhibitors could block activation-induced Fas expression and apoptosis. The activation of PKC with PMA or 1-oleoyl-2-acetyl-sn-glycerol could mimic the TCR signal by inducing the expression of Fas but not FasL. PKC-dependent Fas expression was also observed in several murine and human tumor cell lines. Since the inhibition of Ca2+ redistribution by an inhibitor of intracellular Ca2+ mobilization, 8-(diethylamino)-octyl-3,4,5-trimethoxybenzoate hydrochloride, inhibited TCR-induced FasL but not Fas, the expression of Fas appears to be independent of Ca2+ mobilization. Significantly, expression of the newly identified Fas-regulatory gene, TDAG51, was found to be dependent upon the activity of PKC. PKC activation only induced Fas expression in cells expressing wild-type TDAG51. Thus, Fas expression is likely mediated by PKC through TDAG51.

Induction of species-specific host accommodation in the hamster-to-rat xenotransplantation model

The combination of two immunosuppressants, leflunomide and cyclosporin A (CsA), completely inhibits immune xenoreactions in the hamster-to-Lewis rat xenotransplantation model. In addition, the control of acute xenograft rejection with this combination of immunosuppressants subdues early T-independent xenoreactivity and uncovers a late immune response that can be controlled by CsA alone. We attribute this acquired responsiveness to CsA to a modification in the recipient's humoral response to the xenograft, and refer to this change as host accommodation. Host accommodation can be induced in Lewis rats receiving hamster hearts by the combination of leflunomide and CsA. A 7-day treatment with leflunomide and CsA was able to convert xenoreactivity from one that was resistant to CsA treatment into one that was controlled by CsA. The presence of the hamster xenograft was critical for the induction of host accommodation since the immunosuppressive regimen, either alone or in combination with a transfusion with donor-specific spleen cells, was unable to modify the anti-hamster reactivity in Lewis rats. When accommodation was induced in the presence of hamster hearts, these accommodated rats were able to acutely reject third-party mouse hearts while under CsA therapy, thus indicating that the host accommodation is species specific. Finally, we demonstrate that host accommodation is associated with a loss in the ability to produce species-specific, T-independent xenoantibodies. These novel observations suggest that xenoreactive T-independent humoral responses can be deleted selectively without significant loss of other innate, Ag-specific T-independent humoral responses.

[Study on voltammetric behaviour of clozapine and its single-sweep oscillopolarography]

A sensitive reduction peak of clozapine is obtained by single-sweep oscillopolarography in 0.1 mol.L-1 H2SO4 solution. The peak potential is -0.95 V (vs. SCE). The peak current is directly proportional to the concentration of clozapine with a detection limit of 2.0 x 10(-8) mol.L-1. The voltammetric behaviour of clozapine and its mechanism of electrode reaction have been studied by linear-sweep and cyclic voltammetry and pulse polarography etc. The reduction process is irreversible with adsorptive characteristics. The number of electrons transferred n is 2. The electron transfer coefficient alpha is 0.62. Its behaviour obeys Langmuir adsorption isotherm. The adsorption coefficient beta is 1.91 x 10(6) L.mol-1. The energy of adsorption delta G0 = -35.83 kJ.mol-1. The method has been applied to the determination of clozepine in tablet and urine.

[Yishen huanshuai recipe retard progression of chronic renal failure]

OBJECTIVE

To investigate the effect of Yishen Huanshuai recipe (YSHSR) on the progression of chronic renal failure (CRF).

METHODS

Forty-six patients with CRF were divided into two groups: group A (self-controlled group, n = 18), whose treatment was subdivided into two stages. During the first stage, the patients treated with low protein diet and controlling blood pressure, while in the second stage, YSHSR was given. Group B(n = 28), whose treatment plan was similar with that of group A in second stage. The rate of progression of CRF was estimated by slope of the creatinine reciporcal (dl/mg) with time (month).

RESULTS

Mean slope of the creatinine reciprocal with time from the group A during the first stage was -0.0104 +/- 0.0021, while during the second stage, it was -0.0034 +/- 0.0018. There was significant difference between them (P < 0.05). Mean slope from the group B was -0.0047 +/- 0.0020. There was also significant difference between that from the group B and that from the group A during the first stage (P < 0.05).

CONCLUSIONS

Low protein and controlling blood pressure plus YSHSR therapy could markedly retard the rate of progression of CRF.

Progressive decline in the ability of calmodulin isolated from aged brain to activate the plasma membrane Ca-ATPase

To identify possible relationships between the loss of calcium homeostasis in brain associated with aging and alterations in the function of key calcium regulatory proteins, we have purified calmodulin (CaM) from the brains of Fischer 344 rats of different ages and have assessed age-related alterations in (i) the secondary and tertiary structure of CaM and (ii) the ability of CaM to activate one of its target proteins, the plasma membrane (PM) Ca-ATPase. There is a progressive, age-dependent reduction in the ability of CaM to activate the PM-Ca-ATPase, which correlates with the oxidative modification of multiple methionines to their corresponding methionine sulfoxides. No other detectable age-related posttranslational modifications occur in the primary sequence of CaM, suggesting that the reduced ability of CaM to activate the PM-Ca-ATPase is the result of methionine oxidation. Corresponding age-related changes in the secondary and tertiary structure of CaM occur, resulting in alterations in the relative mobility of CaM on polyacrylamide gels, differences in the intrinsic fluorescence intensity and solvent accessibility of Tyr99 and Tyr138, and a reduction in the average alpha-helical content of CaM at 20 degreesC. Shifts in the calcium- and CaM-dependent activation of the PM-Ca-ATPase are observed for CaM isolated from senescent brain, which respectively requires larger concentrations of either calcium or CaM to activate the PM-Ca-ATPase. The observation that the oxidative modification of CaM during normal biological aging results in a reduced calcium sensitivity of the PM-Ca-ATPase, a lower affinity between CaM and the PM-Ca-ATPase, and the reduction in the maximal velocity of the PM-Ca-ATPase is consistent with earlier results that indicate the calcium handling capacity of a range of tissues including brain, heart, and erythrocytes isolated from aged animals declines, resulting in both longer calcium transients and elevated basal levels of intracellular calcium. Thus, the oxidative modification of selected methionines in CaM may explain aspects of the loss of calcium homeostasis associated with the aging process.

Prolongation of cardiac graft survival with anti-CD4Ig plus hCTLA4Ig in primates

BACKGROUND

The aim of this study was to determine whether the use of combined immunotherapy with a brief course of humanized anti-CD4Ig and hCTLA4Ig would prolong heterotopic cardiac allograft survival in primates (rhesus monkeys). This model was based on work in "high responder" rats where a brief course of depletive anti-CD4mAb plus hCTLA4Ig was successful in inducing transplantation tolerance.

METHODS

Heterotopic cardiac transplants were performed in rhesus recipients. Donor/recipient pairs between groups were confirmed to be reactive prior to transplantation by MLR matching. Humanized anti-CD4Ig, a recently developed anti-CD4mAb, was given at a dose of 20 mg/kg i.v. on days -3, -2, -1, and 0. hCTLA4Ig was administered at 6 mg/kg/dose i.v. on days 0 and 2 for the first recipient and days 0, 2, 4, and 6 for the second recipient. No further immunosuppression was administered. The treated (n = 2) or untreated (n = 5) recipients were followed for graft function by daily palpitation.

RESULTS

Treatment with anti-CD4Ig plus hCTLA4Ig resulted in a significant prolongation of heart graft survival (42 days for the first recipient and 52 days for the second recipient) compared to untreated recipients (7 days x 4, 11 days x 1). FACS analysis demonstrated CD4 depletion of anti-CD4 treated animals to <2% on posttransplant day 1. The CD4+ T cells gradually repopulated to 50-70% pretransplant levels just prior to rejection. No adverse responses (fever, tachypnea, tachycardia, infections) were observed.

CONCLUSIONS

These are the first results demonstrating that a brief course of combined specific induction immunotherapy with humanized anti-CD4Ig plus hCTLA4Ig, in the absence of adjuvant posttransplant immunosuppression, was well tolerated and resulted in marked prolongation of cardiac allograft survival in primates.

Somatotropin-dependent decrease in fatty acid synthase mRNA abundance in 3T3-F442A adipocytes is the result of a decrease in both gene transcription and mRNA stability

Somatotropin (ST) markedly decreases lipogenesis, fatty acid synthase (FAS) enzyme activity and mRNA abundance in pig adipocytes. The present study was conducted to determine whether the decrease in FAS mRNA in 3T3-F442A adipocytes was the result of a decrease in transcription of the FAS gene and/or a change in FAS mRNA stability. Insulin increased the abundance of FAS mRNA 2-13-fold and fatty acid synthesis 3-7-fold. Somatotropin decreased the stimulatory effect of insulin on the abundance of FAS mRNA and lipogenesis by 40-70% and 20-60% respectively. Subsequent run-on analyses demonstrated that the decrease observed in FAS mRNA in response to ST was associated with an 82% decrease in transcription; ST significantly shortened the half-life of FAS mRNA from 35 to 11 h. To corroborate the run-on analyses, cells were stably transfected with a pFAS-CAT5 (in which CAT stands for chloramphenicol acetyltransferase) reporter construct that contained 2195 bp of the 5' flanking region of the rat FAS gene. Insulin treatment increased FAS-CAT activity 4.7-fold. When ST was added to the insulin-containing medium there was an approx. 60% reduction in FAS-CAT activity. In summary, our results indicate that ST decreases FAS mRNA levels and that this is the result of a marked decrease in both transcription of the FAS gene and stability of the FAS mRNA.

[A preliminary study on alternation of generations of Cordyceps sinensis (Berkey) Sacc]

The insect pathogeny of parasitic hepialus by Cordyceps sinensis is, reported in this paper. The infestation of hepialus larvae by Cordyceps sinensis, growth and reproduction of hypha body in the hemolymph of host larvae, growth of stroma, maturity of hymenium and the abjection and germination of ascospores were observed.

QT dispersion in dipper- and nondipper-type hypertension

The aim of this study was to identify the relationship of QT dispersion on 12-lead electrocardiograms and left ventricular mass index on echocardiograms associated with the circadian rhythm of blood pressure (BP). Heart rate and BP were monitored every 30 min for 48 h in 62 patients with essential hypertension using an ambulatory BP monitoring device. The patients were divided into four groups according to gender and circadian BP pattern (nocturnal BP dipper or nondipper). The patients were classified as dippers if their daytime BP decreased by at least 10% during the night and all the other subjects were classified as nondippers. Age, body mass index, and 48-h mean BP were similar among the four groups. During the night-rest period, the systolic and diastolic BP were significantly decreased in dipper-type hypertensives. The maximum QTc interval and QTc dispersion were longer in nondippers than in dippers. Left ventricular mass index (LVMI) had a tendency to increase in nondippers. The nocturnal reduction of BP significantly correlated with QTc dispersion and LVMI. The QTc dispersion significantly correlated with LVMI and interventricular septum thickness.

Cost-effectiveness of screening for asymptomatic carotid stenosis

PURPOSE

The benefit of carotid endarterectomy for patients who are asymptomatic with > 60% carotid stenosis has been established by the Asymptomatic Carotid Atherosclerosis Study (ACAS). Which screening strategy is most appropriate is still unclear. This study assessed the cost-effectiveness of ultrasound screening for asymptomatic carotid stenosis.

METHODS

Cost-effectiveness analysis was performed with a Markov model and with data from ACAS and other studies.

RESULTS

For 60-year-old patients with a 5% prevalence of 60% to 99% asymptomatic stenosis, duplex ultrasound screening increased average quality-adjusted life years (QALY; 11.485 vs 11.473) and lifetime cost of care ($5500 vs $5012) under base-case assumptions. The incremental cost per QALY gained (cost-effectiveness ratio) was $39,495. Screening was cost-effective with the following conditions: disease prevalence was 4.5% or more, the specificity of the screening test (ultrasound) was 91% or more, the stroke rate of patients who were medically treated was 3.3% or more, the relative risk reduction of surgery was 37% or more, the stroke rate associated with surgery was 160% or less than that of the North American Symptomatic Carotid Endarterectomy Trial or ACAS perioperative complication rates, and the cost of ultrasound screening was $300 or less. A one-time screening, compared with a screening every 5 years, had more QALY (11.485 vs 11.482) and lower cost ($5500 vs $5790). Screening without arteriography, compared with screening with arteriographic verification, provided few additional QALYs (11.486 vs 11.485) at additional cost ($6896 vs $5500). The cost-effectiveness ratio was sensitive to assumptions about the stroke rate of patients who were asymptomatic and other variables.

CONCLUSIONS

Screening for asymptomatic carotid stenosis can be cost-effective when both screening and carotid endarterectomy are performed in centers of excellence.

Preparation of artificial ceroid/lipofuscin by UV-oxidation of subcellular organelles

Recent studies have consistently shown that, during oxidative damage, glycation, and other oxygen stress-related reactions, various biomolecules are converted into ceroid- and lipofuscin-like fluorescent pigments. In this study, artificial ceroid/lipofuscin was produced by exposing rat liver fractions to UV-light overnight. Thiobarbituric acid reactive substances (TBARS) were formed in increasing amounts during the early stages of the process, but decreased as the material was later converted into a polymeric structure with few remaining peroxides. In the transmission electron microscope the artificial pigment showed lamellar structures and was osmiophilic. By energy-dispersive X-ray analysis the material was found to contain Ca and Fe in the same way as natural ceroid/lipofuscin. Moreover, it exhibited ceroid/lipofuscin-like, greenish-yellowish autofluorescence when assayed by microfluorometry, with a fluorescence maximum consistently found at 430 nm when excited at 350 nm. Identical fluorescence maxima were found for each fraction of rat liver that was used as the origin of the pigments, i.e. nuclei, mitochondria, lysosomes and microsomes. Extracts with either chloroform-methanol, or sodium dodecylsulphate, showed identical complex fluorescence. When the pigments were extracted by chloroform-methanol, five fluorescent bands were obtained after thin-layer chromatographic separation. Fibroblasts were found to endocytose the material, a process that converted them into lipofuscin-loaded cells of an aged phenotype as observed by light and electron microscopy. Similar fluorescence emission spectra were obtained from cells grown at 40% O2, in order to stimulate endogenous lipofuscin-formation, and from cells exposed to artificial ceroid/lipofuscin. The described technique for creating artificial ceroid/lipofuscin is relatively easy to perform and should provide a useful new tool to study the possible influences of ceroid/lipofuscin on lysosomal and cellular functions.

Molecular dynamics simulation of unsaturated lipid bilayers at low hydration: parameterization and comparison with diffraction studies

A potential energy function for unsaturated hydrocarbons is proposed and is shown to agree well with experiment, using molecular dynamics simulations of a water/octene interface and a dioleoyl phosphatidylcholine (DOPC) bilayer. The simulation results verify most of the assumptions used in interpreting the DOPC experiments, but suggest a few that should be reconsidered. Comparisons with recent results of a simulation of a dipalmitoyl phosphatidylcholine (DPPC) lipid bilayer show that disorder is comparable, even though the temperature, hydration level, and surface area/lipid for DOPC are lower. These observations highlight the dramatic effects of unsaturation on bilayer structure.

[Circadian variation of blood pressure and heart rate in normotensive pre- and postmenopausal women]

The aim of this study was to assess the effect of menopause on circadian profile of blood pressure (BP) and heart rate (HR) in the normotensive pre- and postmenopausal women. Systolic BP (SBP), diagnostic BP (DBP) and HR were monitored every 30 min for 48 hrs using noninvasive ambulatory BP monitoring in 24 premenopausal and 40 postmenopausal women. Mean 48-hours, daytime (awake), and nighttime (sleeping) SBP, DBP and HR values were analyzed by reviewing the patients' diaries, and the nocturnal reduction rate (NRR) of SBP, DBP and HR were calculated according to the following formula. NRR (%9 = [(daytime mean-nighttime mean)/daytime mean] x 100. The study subjects were then divided into two groups according to the presence (dipper) or absence (nondipper) of a significant reduction in nocturnal BP (> 10%). Mean SBP, DBP and HR measured over 48 hours were similar between the premenopausal and the postmenopausal group. The NRR of DBP and HR in the postmenopausal group were significantly smaller than those in the premenopausal group (17.1 +/- 6.0% vs. 13.5 +/- 7.0%, 241.1 +/- 6.0% vs. 19.8 +/- 9.0%: p < 0.05). There tended to be higher prevalence of nondipper in the postmenopausal (37%) than in the premenopausal group (29%).

Sonography of transjugular intrahepatic portosystemic shunts: detection of elevated portosystemic gradients and loss of shunt function

PURPOSE

To evaluate the role of ultrasound (US) in the detection of elevated portosystemic gradients and loss of shunt function in patients with a transjugular intrahepatic portosystemic shunt (TIPS).

MATERIALS AND METHODS

The authors' prospectively compared 151 Doppler hepatic sonograms with follow-up portal venograms in 64 patients with TIPS. Sonographic data from within the portal system, hepatic arteries, and three areas within the TIPS were collected. Statistical analysis of these parameters was used to establish the US criteria for shunt dysfunction.

RESULTS

Midshunt velocity thresholds of less than 50 and less than 60 cm/sec yielded sensitivities and specificities of 46% and 93%, and 57% and 89%, respectively, for the detection of portosystemic gradients exceeding 15 mm Hg. Use of a threshold midshunt velocity of less than 60 cm/sec or main portal vein velocity of less than 40 cm/sec raised the shunt dysfunction detection sensitivity to 86%, with a specificity of 54%.

CONCLUSION

Doppler US is an effective noninvasive screening tool for detecting elevated portosystemic gradients and evaluating the functional status of a TIPS. Midshunt velocities of less than 60 cm/sec or main portal vein velocities less than 40 cm/sec are a useful threshold for detecting shunt dysfunction.

Barium enema and colonoscopy: appropriateness of utilization in a Medicaid population

BACKGROUND

To assess the appropriateness of utilization patterns for the barium enema and colonoscopy in a Medicaid population.

METHODS

From 1987 to 1991, a Medicaid managed-care database in Philadelphia revealed claims for a total of 2357 outpatient barium enemas and 896 outpatient colonoscopic examinations. The database was reviewed to determine the primary diagnostic (ICD-9-CM) codes assigned to patients who underwent these procedures. These codes were used as a proxy for indications. Each of the diagnostic codes for barium enema and colonoscopy was then classified either as appropriate, inappropriate, equivocal, or miscoded based on current guidelines in the medical literature.

RESULTS

A total of 1962 claims (83%) for barium enema were classified as appropriate, 126 (5%) as inappropriate, 84 (4%) as equivocal, and 185 (8%) as miscoded, whereas 645 claims (72%) for colonoscopy were classified as appropriate, 176 (20%) as inappropriate, 65 (7%) as equivocal, and 10 (1%) as miscoded. Thus, significantly more colonoscopic examinations were rated as inappropriate (p < 0.001).

CONCLUSION

Our study suggests that more stringent criteria need to be used by physicians in ordering diagnostic examinations of the colon, particularly colonoscopy. Further investigation of the appropriateness of these procedures and the development and dissemination of guidelines seems warranted.

Induction of apoptosis in multi-drug resistant (MDR) human glioblastoma cells by SN-38, a metabolite of the camptothecin derivative CPT-11

The overexpression of the multidrug resistance (mdr1) gene and its product, P-glycoprotein (P-gp), is thought to limit the successful chemotherapy of human tumors. Recent studies demonstrate that SN-38, a metabolite of the camptothecin (CPT) derivative CPT-11, has antitumor effects on several tumors, but the mechanisms responsible for its cytotoxicity remain unclear. We therefore determined whether SN-38 has cytotoxic effects on MDR human glioblastoma GB-1 cells and non-MDR human glioblastoma U87-MG cells. Furthermore, we determined what role SN-38 plays in the induction of cytotoxicity in these tumor cells. In this study, we demonstrated that SN-38 had significantly stronger antitumor effects on GB-1 and U-87MG cells than did CPT (P < 0.01 and P < 0.05, respectively). In addition, findings obtained using a DNA fragmentation assay, Hoechst 33258 staining, in situ end-labeling and cell cycle analysis demonstrated that SN-38 induced apoptosis in these tumors. Our results suggest that SN-38 has a stronger antitumor effect on malignant glioma cells regardless of MDR expression than does CPT, and therefore can be considered a new chemotherapeutic agent potentially effective in the treatment of human primary or recurrent malignant gliomas resistant to chemotherapy.

Porcine somatotrophin differentially down-regulates expression of the GLUT4 and fatty acid synthase genes in pig adipose tissue

The present study was conducted to determine whether porcine somatotropin (pST) differentially regulates expression of the GLUT4 and fatty acid synthase (FAS) genes in pig adipose tissue. Three different experiments were conducted in which pigs were treated daily with different doses of pST for different time periods (7 or 14 d and from 60 to 90 kg of body wt). In these experiments, pST significantly and consistently decreased FAS mRNA levels (80%, 66% and 85%, respectively); however, GLUT4 mRNA was not affected by pST in two of the three experiments, and in the one showing an effect (Experiment 2), the decrease was less than observed for FAS (44%). Because of these results, we conducted subsequent experiments to see if the effects of pST on glucose metabolism in cultured pig adipose tissue (48 h) differed when glucose concentrations were changed from 1 to 5 mmol/L. These studies revealed that the antagonistic effect of pST on insulin action was more potent when glucose transport was saturated (5 mmol/L) than when glucose concentration limited glucose entry into the cell (1 mmol/L). In summary, these results suggest that the effects of pST on glucose transport in pig adipocytes are secondary to changes elicited by the hormone on intracellular glucose use for lipogenesis. When considered in the context of the decrease previously observed in glucose transport in pig adipocytes, the findings reported herein suggest that pST acts to decrease GLUT4 protein activity and/or distribution between the plasma membrane and the intracellular pool with little alteration in GLUT4 gene expression or total cell GLUT4 protein.

Mechanisms of tolerance to rat heart allografts using posttransplant TLI. Changes in cytokine expression

Lewis rats were rendered tolerant to ACI heart allografts using a regimen of posttransplant total lymphoid irradiation (TLI), rabbit antithymocyte or antilymphocyte globulin (RATG or RALG), and a single donor blood transfusion. All three treatment modalities were required to induce tolerance. The mechanism of the maintenance of tolerance was investigated by comparing the secretion of cytokines in the MLR, and the expression of cytokine mRNA in the allografts of tolerant and nontolerant Lewis rats. Although, the 3H-thymidine incorporation and secretion of IL-2 was frequently comparable in the MLR from tolerant and nontolerant rats, the secretion of IFN-gamma was markedly reduced in the tolerant rats. This was reflected in a markedly reduced frequency of cells expressing IFN-gamma mRNA in the allografts of tolerant as compared with nontolerant hosts. The frequency of cells expressing IL-2 and IL-10 mRNA was also reduced, but no significant difference was observed for cells with IL-4 mRNA. Spleen cells from nontolerant rats rapidly rejected ACI allografts in irradiated adoptive hosts, but spleen cells from tolerant rats did not. Evaluation of the cytokine mRNA expression at early and late time points in the allografts of adoptive hosts showed a pattern similar to that of the primary hosts. Thus, the tolerant state was associated with a maintenance or elevation of IL-4 expression and a marked reduction of IFN-gamma expression. Previous reports have shown that TLI alone induced this shift in the early recovery phase after irradiation.

Involvement of interleukin-1 beta-converting enzyme in apoptosis of bFGF-deprived murine aortic endothelial cells

Apoptosis (programmed cell death) is an essential physiological process that is genetically regulated and contributes to the balance between cell growth, differentiation, and the maintenance of normal cells. Recent studies show that deprivation of growth factor induces apoptosis in endothelial cells. However, the molecular mechanisms regulating apoptosis remain unclear. In this study, we demonstrate that deprivation of basic fibroblast growth factor (bFGF) increased the expression of interleukin-1 beta-converting enzyme (ICE) protein, and subsequently induced apoptosis in murine aortic endothelial (MAE) cells. In contrast, the proteins of the tumor suppressor p53 and c-myc were undetected during apoptosis. This apoptosis was suppressed by the tetrapeptide ICE inhibitor, Ac-YVAD-CMK. Overexpression of murine ICE, in addition, induced apoptosis in MAE cells using gene transfer techniques. These results strongly suggest that ICE may mediate apoptosis in bFGF-deprived endothelial cells, and the suppression of ICE function could represent a novel approach for the protection of endothelial cells from damages.-Kondo, S., Kondo, Y., Yin, D., Barnett, G. H., Kaakaji, R., Peterson, J. W., Morimura, T., Kubo, H., Takeuchi, J., Barna, B. P. Involvement of interleukin-1 beta converting enzyme in apoptosis of bFGF-deprived murine aortic endothelial cells.

Decreased plasma membrane calcium transport activity in aging brain

We have assessed the functional properties of both calmodulin (CaM) and the plasma membrane Ca(2+)-ATPase in brains of young, middle aged, and old Fisher 344 rats. Under optimal conditions of saturating Ca2+ and ATP, the CaM-activated Ca(2+)-ATPase activity was decreased with increasing age, particularly when CaM isolated from the brains of aged rats was used to stimulate the enzyme. In the case of CaM, structural modifications within the primary sequence of the protein from aged brains were identified. We found that during normal biological aging approximately 6 methionine residues were modified to their corresonding sulfoxide per CaM, and no other amino acids were modified. Some aspects of the age-related decline in the effectiveness of CaM as an activator of Ca(2+)-ATPase could be simulated using a range of reactive oxygen species (including hydrogen peroxide and oxoperoxynitrite) and, in the latter case, the extent of oxidative modification of specific methionine residues was directly related to their surface accessibility. The pattern of oxidative modification of the methionines in the aged CaM was less straightforward, though both in vitro oxidation of CaM and aging within the brain markedly decreased the functional properties of this important Ca(2+)-regulating protein.

Cost analysis and the practicing radiologist/manager: an introduction to managerial accounting

Cost analysis is inherently one of the most tedious tasks falling on the shoulders of any manager. In today's world, whether in a service business such as radiology or medicine or in a product line such as car manufacturing, accurate cost analysis is critical to all aspects of management: marketing, competitive strategy, quality control, human resource management, accounting (financial), and operations management, to name but a few. This is a topic that we will explore with the intention of giving the radiologist/manager the understanding and the basic skills to use cost analysis efficiently, making sure that major financial decisions are being made with adequate cost information, and showing that cost accounting is really managerial accounting in that it pays little attention to the bottom line of financial statements but places much more emphasis on equipping managers with the information to determine budgets, prices, salaries, and incentives and influences capital budgeting decisions through an understanding of product profitability rather than firm profitability.

[Effects of recombinant human tumor necrosis factor on the development of ascitic tumor and expression of c-erbB2 in the nude mouse models of ovarian cancer]

OBJECTIVE

To investigate the effects of recombinant human tumor necrosis factor (rhTNF) on the growth of ascitic tumor and expression of c-erbB2 in the nude mouse models of ovarian cancer.

METHODS

By intraabdominal injection, rhTNF was delivered to the peritoneal cavity of nude mouse with ovarian cancer as well as control group, after 6 days treatment, tumor cell counting and expression of c-erbB2 were detected by indirect fluorescence flow cytometry.

RESULTS

There is a significant difference in tumor cell counting between the study group and control group (P < 0.01). Expression of c-erbB2 in study group was lower than that in control group.

CONCLUSION

rhTNF was demonstrated to have effects on both inhibition of ascitis tumor development and down regulation of c-erbB2 expression in nude mouse with ovarian cancer.

Oxidative modification of a carboxyl-terminal vicinal methionine in calmodulin by hydrogen peroxide inhibits calmodulin-dependent activation of the plasma membrane Ca-ATPase

In order to investigate the possibility that calmodulin (CaM) may be a principal target of reactive oxygen species (ROS) produced under conditions of oxidative stress, we have examined wheat germ CaM for the presence of highly reactive sites that correlate with the loss of function. Using reversed-phase HPLC and FAB mass spectrometry after proteolytic digestion, we have identified the sites of modification by hydrogen peroxide. We find that one of the vicinal methionines (i.e., Met146 or Met147) near the C-terminus of CaM is selectively oxidized. The ability of CaM to bind and to activate the plasma membrane (PM)-Ca-ATPase from erythrocytes was measured. There is a 30-fold decrease in the calcium affinity of oxidatively modified CaM. While there is a little change in the binding constant between the carboxyl-terminal domain of calcium-saturated CaM and a peptide homologous to the autoinhibitory sequence of the PM-Ca-ATPase, we find that there is a 9-fold reduction in the affinity of the amino-terminal domain of CaM with respect to the ability to bind target peptides. The extent of oxidative modification to one of the vicinal methionines near the carboxyl-terminal domain correlates with the loss of CaM-dependent activation of the PM-Ca-ATPase. The presence of oxidatively modified CaM prevents native CaM from activating the PM-Ca-ATPase, indicating that the oxidatively modified CaM binds to the autoinhibitory sequence on the Ca-ATPase in an altered nonproductive conformation. We suggest that the functional sensitivity of CaM to the oxidation of one of the C-terminal vicinal methionines permits CAM to serve a regulatory role in modulating cellular metabolism under conditions of oxidative stress. The predominant oxidation of a methionine near the carboxyl terminal of CaM is rationalized in terms of the enhanced solvent accessibility of these vicinal methionines.

Strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia detected by prostate needle biopsy

PURPOSE

We evaluated the strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia without concurrent carcinoma detected on prostate needle biopsy.

MATERIALS AND METHODS

Of 1,275 consecutive patients undergoing prostate needle biopsy 61 were identified with prostatic intraepithelial neoplasia but without concurrent prostate carcinoma. Of the 61 patients 53 had undergone repeat biopsy. The medical records, transrectal ultrasound, and operative and pathological reports of these patients were reviewed.

RESULTS

Repeat biopsy was done in 53 patients with prostatic intraepithelial neoplasia, yielding carcinoma in 15, prostatic intraepithelial neoplasia without carcinoma in 8 and benign tissue in 30. The yield of carcinoma from repeat biopsy of a prostatic intraepithelial neoplasia site was 8.3% (7 of 84 sites). A total of 18 sites of carcinoma was detected by repeat biopsy of a previous random biopsy site (8), a prostatic intraepithelial neoplasia site only (5), a transrectal ultrasound nodule (3), a palpable nodule and prostatic intraepithelial neoplasia site (1), and a transrectal ultrasound nodule and prostatic intraepithelial neoplasia site (1). Carcinoma was as frequently detected by repeat biopsy of a prostatic intraepithelial neoplasia site (6 patients) as by random repeat biopsy (6 patients).

CONCLUSIONS

Repeat prostate needle biopsy of patients with prostatic intraepithelial neoplasia should include random repeat biopsy and repeat biopsy of transrectal ultrasound abnormalities as well as previous sites of prostatic intraepithelial neoplasia.

Biochemical basis of lipofuscin, ceroid, and age pigment-like fluorophores

Serious studies of the formation mechanisms of age-related pigments and their possible cellular influence have been hampered for a long time by discrepancies and controversies over the definition, fluorescence emission, origin, and composition of these pigments. This review discusses several critical controversies in this field and lay special emphasis on the cellular and biochemical reactions related to the formation mechanisms of lipofuscin, ceroid, advanced glycation end-products (AGEs), and age pigment like fluorophores (APFs). Various amino compounds and their reaction with secondary aldehydic products of oxygen free radical-induced oxidation, particularly lipid peroxidation, are important sources of the fluorophores of ceroid/lipofuscin, which progressively accumulate as a result of phagocytosis and autophagocytosis of modified biomaterials within secondary lysosomes of postmitotic and other cells. Lipofuscin is the classical age pigment of postmitotic cells, while ceroid accumulates due to pathologic and experimental processes. There are good reasons to consider both ceroid and lipofuscin as materials of the same principal origin. The age-related intracellular fluorophores of retinal pigment epithelium (RPE) seems to represent a special class of lipofuscin, which partly contains derivatives of retinoids and carotenoids. Saccharide-originated fluorophores, principally AGEs formed during glycation/Maillard reactions, may be mainly responsible for the extracellular fluorescence of long-lived proteins, such as collagen, elastin, and lens crystalline. Although lipofuscin, ceroid, AGEs, and APFs can be produced from different types of biological materials due to different side reactions of essential biology, the crosslinking of carbonyl-amino compounds is recognized as a common process during their formation.

Evaluating health services: the importance of patients' preferences and quality of life

With limited resources available, we all would like to allocate health care dollars to do the most good. Clinical research tells us what outcomes to expect (in many cases) from the introduction of a health care program, a test, or a therapy. Even primitive cost analysis can assess the cost of such programs. The ability to place a value on health states is vital when assessing how patient outcomes influence the relative cost-effectiveness of medical procedures, therapies, and programs. Without a means to measure the value of a particular health state, one is left to compare apples with oranges and oranges with vacuum cleaners. In fact, comparisons of fruit and home appliances is relatively easy, because one can readily apply monetary values to apples, oranges, and vacuum cleaners and compare dollar amounts. How can one do the same for the outcomes of medical procedures and diagnostic tests? This is the challenge for health services and outcomes researchers throughout the world and, more urgently, the focus of policy makers, governments, and health insurers. The purpose of this paper is to describe quality-adjusted life-years (QALYs), a method that has successfully measured the outcomes of disparate health programs. We will introduce the QALY method, summarize the various methods of measuring and classifying health states, describe three methods that have been used to measure patients' preferences (utilities) for health states, and discuss the limitations of utility assessment and some controversies that result from the measurement and use of utilities and concerning health-related quality of life. Readers who are interested in general topics of radiology technology assessment and cost-effectiveness analysis should consult other review articles [1-4].

Tumor necrosis factor-alpha induces p53-dependent apoptosis in rat glioma cells

In this study, we demonstrated that tumor necrosis factor (TNF)-alpha inhibited the viability of rat glioma (C6) cells and induced apoptosis but did not affect the viability of rat newborn brain, mainly astroglial cells. The antitumor activity of TNF-alpha against C6 cells was partially inhibited by actinomycin D and cycloheximide, suggesting that it is possibly dependent upon new ribonucleic acid and protein synthesis. The results of immunoblotting assay demonstrated that TNF-alpha decreased the expression of mutant p53 protein but induced the expression of wild-type p53 in C6 cells during apoptosis. We suggest that TNF-alpha may activate the function of wild-type p53 protein by the suppression of mutant p53, at least indirectly, and induce p53-dependent apoptosis in glioma cells.

Hepatic enhancement during helical CT: a comparison of moderate rate uniphasic and biphasic contrast injection protocols

OBJECTIVE

The purpose of this study was to compare the degree and timing of peak hepatic enhancement, optimal scanning intervals, and optimal delay times of moderate-rate uniphasic and biphasic contrast material injection protocols for hepatic helical CT.

MATERIALS AND METHODS

One hundred fifty patients were randomized into three injection protocols, receiving 42.3 g iodine (150 ml iothalamate meglumine) delivered using 3 ml/sec uniphasic, 2 ml/sec uniphasic, or biphasic (3 ml/sec [50 ml], 1 ml/sec [100 ml]) technique. Statistically fitted aortic and hepatic enhancement curves were generated from dynamic incremental CT data for each patient. Protocols were compared by maximum hepatic enhancement, and contrast enhancement indices were modeled for a 38-sec helical acquisition.

RESULTS

The 3 ml/sec and 2 ml/sec uniphasic protocols produced higher peak hepatic enhancement (64 +/- 15 H and 62 +/- 15 H [mean +/- 1 SD]) than the 3 ml/sec biphasic protocol (52 +/- 10 H; p < .001). Contrast enhancement indices for the 3 ml/sec uniphasic and 2 ml/sec uniphasic protocols (385 +/- 398 H/sec and 397 +/- 412 H/sec) were significantly greater than the index for the 3 ml/sec biphasic protocol (123 +/- 194 H/sec; p < .0001) at a 50-H threshold. Optimal scan delay times were 50 +/- 8, 75 +/- 7, and 119 +/- 8 sec, respectively, for the 3 ml/sec uniphasic, 2 ml/sec uniphasic, and 3 ml/sec biphasic techniques.

CONCLUSION

The moderate-rate uniphasic injections studied provided greater hepatic enhancement throughout the helical acquisition without requiring the prohibitively long delay time necessitated by the moderate-rate biphasic injection. These findings differ from prior results that showed that a uniphasic injection may provide comparable levels of hepatic enhancement when compared with a high-flow-rate biphasic injection.

Tissue-specific effects of anti-CD4 therapy in induction of allograft unresponsiveness in high and low responder rats

In these experiments, we studied the role of anti-CD4 (Ox38) monoclonal antibody in the prevention of heart and/or kidney allograft rejection in low (ACI) and high (Lewis) responder rats. In low responder ACI rats, donor-specific tolerance for heart and kidney allografts (individually or in combination) was achieved by pretransplant anti-CD4 therapy. In high responder Lewis rats, anti-CD4 therapy alone (or combined with anti-CD8 (Ox8), thymectomy or total lymphoid irradiation) did not prevent first-set rejection of heart allografts. This difference was correlated with a more profound and longer lasting CD4+ cell depletion in the low responder strain. Anti-CD4 treatment, however, produced tolerance of kidney transplants in high responder rats. Additionally, anti-CD4 treatment induced tolerance to heart (as well as kidney) allografts in Lewis recipients of combined kidney and heart allografts from ACI. The effects of anti-CD4 treatment thus depend upon the recipient responder status as well as the organs transplanted and the order of transplantation.

Induction of tolerance to heart allografts in high responder rats by combining anti-CD4 with CTLA4Ig

It has been difficult to induce donor-specific transplantation tolerance in high responder Lewis rats. Results presented below demonstrate that amounts of pretransplant anti-CD4 sufficient to allow allograft tolerance in low responder strains (5 mg/kg x 4 days) did not prevent the acute rejection of ACI heart allografts in high responder Lewis recipients. Higher doses of pretransplant anti-CD4 (10 mg/kg, 15 mg/kg, and 20 mg/kg) given alone could delay but not prevent allograft rejection. Pretransplant anti-CD4 combined with anti-CD8, thymectomy, and total lymphoid irradiation all failed to produce tolerance to ACI heart allografts. However, a regimen of anti-CD4 combined with CTLA4Ig allowed indefinite survival of ACI heart allografts (mean survival time, > 100 day). Second-donor matched heart grafts were permanently accepted, and third-party heart grafts were permanently accepted, and third-party heart allografts were rejected by the tolerant recipients. These results suggest a new combination therapeutic strategy for clinical transplantation.

Induction of tolerance to heart allografts in high responder rats by combining anti-CD4 with CTLA4Ig

It has been difficult to induce donor-specific transplantation tolerance in high responder Lewis rats. Results presented below demonstrate that amounts of pretransplant anti-CD4 sufficient to allow allograft tolerance in low responder strains (5 mg/kg x 4 days) did not prevent the acute rejection of ACI heart allografts in high responder Lewis recipients. Higher doses of pretransplant anti-CD4 (10 mg/kg, 15 mg/kg, and 20 mg/kg) given alone could delay but not prevent allograft rejection. Pretransplant anti-CD4 combined with anti-CD8, thymectomy, and total lymphoid irradiation all failed to produce tolerance to ACI heart allografts. However, a regimen of anti-CD4 combined with CTLA4Ig allowed indefinite survival of ACI heart allografts (mean survival time, &gt; 100 day). Second-donor matched heart grafts were permanently accepted, and third-party heart grafts were permanently accepted, and third-party heart allografts were rejected by the tolerant recipients. These results suggest a new combination therapeutic strategy for clinical transplantation.

Test-tube simulated lipofuscinogenesis. Effect of oxidative stress on autophagocytotic degradation

Cysteine-stimulated oxidation of a rat liver lysosomal-mitochondrial fraction (LMF) was studied. The process would simulate oxidative stress-related events during the degradation of autophagocytosed material within secondary lysosomes, which may contribute to the formation of lipofuscin or age pigment. Millimolar concentration of cysteine was needed to stimulate LMF lipid peroxidation, measured as thiobarbituric acid reactive substances (TBARS). The amount of endogenous LMF iron was 545 micrograms/l and was enough to initiate peroxidation, probably through the reduction of ferric to ferrous iron by cysteine with induction of Fenton chemistry. Peroxidation could be completely inhibited by the addition of the iron chelator desferal or the antioxidant BHT. A substantial amount of the formed TBARS was associated with trichloroacetic acid (TCA) precipitable proteins. Elevated protein carbonyls was observed 1-2 h after the increase of TBARS. The tryptophan-tyrosine related protein autofluorescence (280/335 nm) decreased sharply during the first few hours of incubation. In contrast, a lipofuscin-type autofluorescence (345/430 nm) appeared only after a few days, suggesting that the latter fluorophore is not an immediate product of protein oxidation. The sequential formation of TBARS, protein carbonyls and lipofuscin-type autofluorescence as well as their dependence on iron and reducing agent add further support to the concept that lipofuscin forms in secondary lysosomes as a result of iron-catalyzed oxidative reactions involving autophagocytosed materials.

CD4-positive suppressor cells block allotransplant rejection

Mechanisms of maintenance of transplantation tolerance induced in adult rats by depletive regimens of anti-CD4 before transplantation of vascularized heart allografts were studied. Despite the fact that there has been little evidence that tolerant lymphocytes could prevent allograft rejection after adoptive transfer, we demonstrated a suppressive role for lymphocytes from tolerant animals in vivo. These experiments analyzed the ability of lymphocytes from tolerant rats to protect passenger leukocyte-depleted Lewis heart grafts that had been "parked" in ACI rats (treated with pretransplant anti-CD4 and maintained for > 100 days) compared with their ability to protect transplantation of fresh Lewis heart grafts in naive ACI rats. Although parked Lewis heart grafts were rejected in unmanipulated ACI recipients, parked hearts (but not naive Lewis heart allografts), were permanently accepted by naive ACI rats when syngeneic tolerant spleen cells were adoptively transferred at the time of transplantation. Further, we demonstrated that the suppressor cells in the tolerant spleen cells were CD4+. These results suggest that CD4+ spleen cells from tolerant rats inhibit allograft recognition and may maintain allograft tolerance by blocking the indirect pathway of allorecognition.

CD4-positive suppressor cells block allotransplant rejection

Mechanisms of maintenance of transplantation tolerance induced in adult rats by depletive regimens of anti-CD4 before transplantation of vascularized heart allografts were studied. Despite the fact that there has been little evidence that tolerant lymphocytes could prevent allograft rejection after adoptive transfer, we demonstrated a suppressive role for lymphocytes from tolerant animals in vivo. These experiments analyzed the ability of lymphocytes from tolerant rats to protect passenger leukocyte-depleted Lewis heart grafts that had been "parked" in ACI rats (treated with pretransplant anti-CD4 and maintained for &gt; 100 days) compared with their ability to protect transplantation of fresh Lewis heart grafts in naive ACI rats. Although parked Lewis heart grafts were rejected in unmanipulated ACI recipients, parked hearts (but not naive Lewis heart allografts), were permanently accepted by naive ACI rats when syngeneic tolerant spleen cells were adoptively transferred at the time of transplantation. Further, we demonstrated that the suppressor cells in the tolerant spleen cells were CD4+. These results suggest that CD4+ spleen cells from tolerant rats inhibit allograft recognition and may maintain allograft tolerance by blocking the indirect pathway of allorecognition.

Combination therapy with cisplatin and nifedipine inducing apoptosis in multidrug-resistant human glioblastoma cells

The authors found that multidrug-resistant human glioblastoma GB-1 cells demonstrated significantly more resistance to cisplatin than did nondrug-resistant human glioblastoma U87-MG cells (p < 0.1). They therefore attempted to determine whether calcium channel blockers enhance the antitumor activity of cisplatin against GB-1 cells. Nifedipine, a dihydropyridine calcium channel blocker, significantly enhanced the antitumor effect of cisplatin on GB-1 cells (p < 0.05). In the absence of normal extracellular Ca++, nifedipine enhanced the cytotoxicity of cisplatin. In addition, the antitumor activity of combined cisplatin and nifedipine was inhibited both by actinomycin D and cycloheximide, suggesting that such activity is dependent upon new RNA and protein synthesis. Surprisingly, DNA fragmentation assay demonstrated that synergism between cisplatin and nifedipine resulted in apoptosis (programmed cell death) at a relatively low concentration of cisplatin, which when tested alone did not induce apoptosis. In addition, it was demonstrated that nuclei from GB-1 cells lacked a Ca(++)-dependent endonuclease that degrades chromatin into nucleosomes and that calcium ionophore A 23187 did not decrease the viability of GB-1 cells. The above findings suggest the hypothesis that the noncytotoxic agent nifedipine synergistically enhances the antitumor effect of cisplatin on multidrug-resistant GB-1 cells lacking Ca(++)-dependent endonuclease, and subsequently induces apoptosis via its interaction with an as yet uncharacterized functional site other than the calcium channel on GB-1 cells.

Cost-effectiveness of MR angiography in cases of limb-threatening peripheral vascular disease

PURPOSE

To evaluate the cost-effectiveness of magnetic resonance (MR) angiography in the preoperative planning of treatment in patients with limb-threatening peripheral vascular disease (PVD).

MATERIALS AND METHODS

A decision model was developed to study the effects of MR angiography on the outcome and cost of treatment. The authors calculated the incremental cost per quality-adjusted life-years gained (ie, cost-effectiveness ratio) when conventional angiography was replaced or supplemented with MR angiography. Previously reported data regarding the accuracies of MR and conventional angiography were used in the analysis.

RESULTS

The cost-effectiveness ratio of MR angiography ranged from negative (cost-reducing) values to $78,000. For the base case in which the sensitivity and specificity of MR angiography for the evaluation of inflow vessels were 92% and 88% and those of conventional angiography were 97% and 97%, respectively, the cost-effectiveness ratio was $25,895.

CONCLUSION

MR angiography may be a cost-effective alternative to conventional angiography in patients with limb-threatening PVD if its accuracy for the inflow evaluation reaches certain thresholds. Further prospective investigation is warranted.

Combination therapy with cisplatin and nifedipine induces apoptosis in cisplatin-sensitive and cisplatin-resistant human glioblastoma cells

We attempted to determine whether calcium channel blockers (CCBs) enhance the anti-tumour activity of cis-diamminedichloroplatinum (cisplatin) against both cisplatin-sensitive human glioblastoma U87 MG cells and cisplatin-resistant U87-MG-CR cells, the latter of which we developed for resistance to cisplatin. Nifedipine, a dihydropyridine class CCB, significantly enhanced the anti-tumour effect of cisplatin on these two cell types in vitro and in vivo. Our findings also indicated that, in the absence of normal extracellular Ca2+ nifedipine was capable of enhancing the cytotoxicity of cisplatin. In addition, this anti-tumour activity was partially inhibited by actinomycin D and cycloheximide, suggesting that it is possibly dependent upon new RNA and protein synthesis. Interestingly, ultrastructural analysis, DNA fragmentation assay and cell cycle analysis demonstrated that synergism between cisplatin and nifedipine results in apoptosis (programmed cell death) at a relatively low concentration of cisplatin, which when tested alone did not induce apoptosis. Furthermore, we demonstrated that nuclei from these cells lack a Ca(2+)-dependent endonuclease that degrade chromatin in the linker region between nucleosomes. In conclusion, our studies suggest that the non-cytotoxic agent nifedipine is able to synergistically enhance the anti-tumour effects of cisplatin on U87-MG and U87-MG-CR cells lacking a Ca(2+)-dependent endonuclease and subsequently to induce apoptosis via interaction of nifedipine with an as yet uncharacterised functional site other than a calcium channel on target cells.