Camostat, an oral trypsin inhibitor, reduces pancreatic fibrosis induced by repeated administration of a superoxide dismutase inhibitor in rats

BACKGROUND AND AIM

An oral trypsin inhibitor, camostat (CM), has a beneficial effect on chronic pancreatitis, but its mechanism is not yet fully understood. Recently, pancreatic stellate cells (PSC) have been reported to play an essential role in pancreatic fibrosis. An experimental model of pancreatic fibrosis induced by a superoxide dismutase (SOD) inhibitor (diethyldithiocarbamate [DDC]) was developed in rats. Thus, the effect of an oral trypsin inhibitor on pancreatic fibrosis and PSC was investigated.

METHODS

Pancreatic fibrosis was induced in rats using DDC (DDC rats). DDC + CM rats were administered DDC, and subsequently were fed a diet containing CM. Immunohistochemistry of the pancreas was performed with monoclonal anti-alpha-smooth muscle actin (alpha-SMA) antibody and anti-desmin antibody.

RESULTS

The DDC rats showed a significant increase in alpha-SMA-positive cells or desmin-positive cells compared with control rats. These significant increases in the fibrotic area improved after treatment with CM. The level of prolyl hydroxylase in the pancreas, which significantly increased as a result of DDC, decreased after treatment with CM.

CONCLUSION

Camostat has a beneficial effect on pancreatic fibrosis induced by the administration of a SOD inhibitor, which inhibits the proliferation and activation of PSC.

Restoration of connexin 43 by Bowman-Birk protease inhibitor in M5076 bearing mice

The present study was designed to investigate the effects of Bowman-Birk inhibitor (BBI) on up-regulation of connexin (Cx) expression to estimate BBI's tumor-suppressor effect in mice with M5076 ovarian sarcoma. The relative tumor weight (p<0.05, r(2)=0.301) and proliferating cell nuclear antigen (PCNA, p<0.01, r(2)=0.493) were negatively correlated with the doses of BBI. In contrast, the relative density of Cx43 was positively correlated with the doses of BBI (p<0.05, r(2)=0.351). Therefore, it suggests that the anti-carcinogenic effects of BBI induced negative growth control caused by the expression of Cx43 genes in mice with M5076 ovarian sarcoma.

Protective role of urinary trypsin inhibitor in acute lung injury induced by lipopolysaccharide

Urinary trypsin inhibitor (UTI), a serine protease inhibitor, has been widely used as a drug for patients with acute inflammatory disorders such as disseminated intravascular coagulation, shock, and pancreatitis. However, direct contribution of UTI to inflammatory diseases has not been established. The present study analyzed acute inflammatory lung injury induced by lipopolysaccharide (LPS) in UTI-deficient (-/-) mice and corresponding wild-type (WT) mice. UTI (-/-) and WT mice were treated intratracheally with vehicle or LPS (125 mug/kg). The cellular profile of bronchoalveolar lavage fluid, lung water content, histology, and expression of proinflammatory molecules in the lung were evaluated. After LPS challenge, both genotypes of mice revealed neutrophilic lung inflammation and pulmonary edema. UTI (-/-) mice, however, showed more prominent infiltration of inflammatory cells and edema than WT mice. After LPS challenge in both genotypes of mice, the lung levels of mRNA and/or protein expression of interleukin-1beta, macrophage inflammatory protein-1alpha, macrophage chemoattractant protein-1, keratinocyte chemoattractant, and intercellular adhesion molecule-1 (ICAM-1) were elevated in both groups, but to a greater extent in UTI (-/-) mice than in WT mice. These results suggest that UTI protects against acute lung injury induced by bacterial endotoxin, at least partly, through the inhibition of the enhanced local expression of proinflammatory cytokines, chemokines, and ICAM-1.

[Clinical study on effects of ulinastatin on patients with systemic inflammatory response syndrome]

OBJECTIVE

To evaluate the value of ulinastatin in hindering systemic inflammatory response syndrome (SIRS) to proceed to multiple organ dysfunction syndrome (MODS).

METHODS

Sixty patients were randomly divided into routine treatment group (n=30) and ulinastatin treatment group (n=30). Both groups were given routine treatment, while the patients of the ulinastatin treatment group were given ulinastatin (100 kU intravenously drip, once every 8 hours, and continued for 5 days) in addition. Additionally, 15 healthy persons were enrolled as normal control group. Temperature (T), heart rate (HR), respiration rate (RR) and white blood cell (WBC) count were observed everyday. The duration of SIRS, the number of organ dysfunction, and mortality were also compared. Serum C reactive protein(CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6(IL-6) and IL-10 levels were measured before treatment and 5 days after in ulinastatin treatment group, routine treatment group, and in normal control group at the time of health examination.

RESULTS

All of the SIRS markers were not different both in ulinastatin group and routine treatment group before treatment. T, RR, HR and WBC were reduced significantly after 3 days in ulinastatin groups(P<0.05 or P<0.01), but HR was not lowered significantly after 5 days and WBC after 7 days of treatment in regular treatment group (P<0.05 or P<0.01). All of the cytokines in ulinastatin treatment group and routine treatment group were higher than normal control group before treatment. Serum CRP, TNF-alpha and IL-6 levels were reduced significantly after 5 days of treatment in both ulinastatin treatment group and routine treatment group(P<0.01), but in ulinastatin treatment group the reduction was faster than routine treatment group(both P<0.01). IL-10 level was elevated significantly after treatment in ulinastatin treatment group(P<0.01), but it showed no significant change in routine treatment groups(P>0.05). The number of patients with duration of SIRS longer than 3 days were fewer and the incidence of MODS was lower in ulinastatin treatment group than those in routine treatment group(10.00% vs. 36.67%, P<0.05), and the fatality rate was reduced significantly with ulinastatin(3.33% vs. 20.00%, P<0.05).

CONCLUSION

Ulinastatin significantly improves the inflammatory symptom and signs of SIRS, such as T, HR, RR, and WBC, inhibits the production of inflammatory cytokines, and enhance the anti-inflammatory cytokines in the treatment of SIRS. It can effectively prevent SIRS to proceed to MODS.

[Effect of ulinastatin on human blood coagulation and platelet aggregation in orthopaedic surgery]

OBJECTIVE

To investigate the effect of ulinastatin (UTI) on human blood coagulation and platelet aggregation in orthopaedic surgery.

METHODS

Thirty ASA I-II patients without blood dyscrasia and blood coagulation obstacle were randomly divided into two groups: Group I (UTI group, n=15) in which patients received UTI 5000 U/kg, and Group II (control group, n=15) in which patients received NS 100 ml. PT, TT, APTT, IB, INR and PAG1, PAG5, and PAGM were measured at 3 points: pre-infusion (T0), 1 hour after the infusion (T1), and 2 hours after the infusion (T2).

RESULTS

Compared with the saline group, APTT and PT of UTI group were prolonged significantly than the baseline (before infusion). In Group I, after the infusion, APT, TT and PT were prolonged significantly than before the infusion.

CONCLUSION

UTI 5000 U/kg can ameliorate orthopaedic patients and blood coagulation status,which may reduce microthrombus syndrome in the operation and prevent venous thrombosis after the operation.

[Effect of ulinastatin on lung injury after dilute hydrochloric acid aspiration]

OBJECTIVE

To determine the effect of ulinastatin (UTI) on blocking the development of acute lung injury (ALI) induced by acid aspiration in the early period.

METHODS

The SD rats were randomly divided into 3 groups: control group (n = 10), injury group (n = 10), and UTI-treated group (n = 10). The rats in the control group were injected intrabronchialy saline while the other 2 groups were injected HCl. The UTI-treated group was injected UTI at 4 x 10(4) U/kg after acid instillation. Blood gas as well as wet/dry weight ratio (W/D) of the left lung was measured. The changes of IL-8 and TNF-alpha levels in the pulmonary tissues were determined by enzyme-linked immunosorbent assay.

RESULTS

The result of blood gas analysis in the UTI-treated group was much better than that in the injury group (P < 0.01). W/ D and IL-8, TNF-alpha levels were lower in the UTI-treated group than those in the injury group significantly (P < 0. 01), and there was no difference between the UTI-treated group and the control group in IL-8 and TNF-alpha levels (P > 0. 05).

CONCLUSION

UTI administration can lessen the development of ALI induced by acid aspiration in the early period.

Protective effect of ulinastatin against ischemia-reperfusion injury in rat small bowel transplantation

INTRODUCTION

We aimed, to evaluate the protective effects of ulinastatin (UTI) against graft ischemia-reperfusion injury in rat small bowel transplantation (SBT).

METHODS

Thirty-six recipients of rat SBT were randomly divided into three groups: 1, normal control, the graft was implanted immediately after harvest; 2, grafts preserved for 4 hours; and 3, grafts preserved for 4 hours and UTI administered to the recipients intravenously (50000 U/kg/d). Variables included pathological score and content of Na+-K+-ATPase, xanthine oxidase (XOD), malondialdehyde (MDA) and glutathione (GSH) in the transplanted small intestine.

RESULTS

The cold preservation caused moderate injury to the graft which was manifested by pathological changes as well as elevated XOD and MDA and decreased Na+-K+-ATPase and GSH content. Application of UTI diminished these changes.

CONCLUSIONS

UTI may exert protective effects against the ischemia-reperfusion injury of transplanted small intestine thereby promoting structural and functional recovery of the graft.

[Correction of phagocyte functional activity in inflammatory focus in patients with deep phlegmons of the neck]

High clotting activity (CA) of monocytes, low level of macrophage CA, and increase of proteolytic activity (PA) of neutrophils in the inflammatory focus predominate in patients with deep phlegmons of the neck at the peak of inflammatory process. Blood monocytes retain their anticlotting potential and macrophages possess CA during resolution of the inflammatory process. The neutrophil PA in the blood and lavage fluid was lower during the resolution phase in comparison with the peak of inflammation. Differentiated correction of phagocyte PA and LA in the inflammatory focus, predicted by laboratory findings, reduced the incidence of mediastinitis and improved the disease outcomes.

[Protective effect of a protease inhibitor on acute lung injury after hepatic ischemia/reperfusion in the rat]

OBJECTIVE

To study the role of a protease inhibitor (ulinastatin) in protection of lung damage following hepatic ischemia/reperfusion in rat.

METHODS

Thirty-two healthy male SD rats were randomly divided into four groups (n=8 in each group). Group A was served as sham-injury control group, group B rats were subjected to 90 minutes hepatic ischemia, and group C rats underwent 120 minutes reperfusion after 90 minutes ischemia of the liver. Ulinastatin (UTI) was administered to animals in group D which were reperfused 120 minutes after 90 minutes of ischemia of the liver. In addition to plasma malondialdehyde (MDA), broncho-alveolar lavage fluid protein (BALFP) content, and lung dry-to-wet weight ratios (D/W) were respectively examined in each group. The concentration of myeloperoxidase (MPO) in lung tissue was also measured.

RESULTS

Compared to group A, plasma MDA, content of MPO in lung tissues and BALFP were significantly increased in both group B and group C, but they were much lower than those in group D. In addition, D/W was markedly decreased during hepatic ischemia and after 120 minutes reperfusion, while it was significantly increased in animals pretreated with UTI.

CONCLUSION

Acute lung injury after hepatic ischemia and reperfusion is mainly induced by the oxidant stress, and neutrophil infiltration in the lung tissues is responsible for the damage under these conditions. Proteases inhibitors such as UTI might have antioxidation effects which attenuate lung injury induced by trauma to remote organs.

Biological countermeasures in space radiation health

Exposure to the types of ionizing radiation encountered during space travel may cause a number of health-related problems, but the primary concern is related to the increased risk of cancer induction in astronauts. The major types of radiation considered to be of importance during space travel are protons and particles of high atomic number and high energy (HZE particles). It is now clear that biological countermeasures can be used to prevent or reduce the levels of biological consequences resulting from exposure to protons or HZE particles, including the induction of cancer, immunosuppression and neurological defects caused by these types of ionizing radiation. Research related to the dietary additions of agents to minimize the risks of developing health-related problems which can result from exposure to space radiations is reviewed.

Fibrinolytic activity and bleeding after cardiac surgery with cardiopulmonary bypass and low-dose aprotinin therapy

Low-dose aprotinin inhibits hyperfibrinolysis in cardiac surgery. However, excessive postoperative bleeding and increased fibrinolysis may occur despite low dose-aprotinin administration. We investigated (i) whether fibrinolytic activity significantly rises under low-dose aprotinin administration, and (ii) whether this is associated with excessive postoperative bleeding (> or = 1000 ml/24 h). In a prospective single-blind trial, 120 consecutive patients were randomized to receive 280 mg aprotinin or no aprotinin before skin incision. D-dimer levels increased significantly to the end of surgery, reaching higher levels in the control group. The risk for excessive bleeding was lower in the aprotinin group (12 versus 37%, = 0.001). Fifteen minutes after heparin reversal, patients were at risk for excessive bleeding, when enhanced fibrinolysis was documented (aprotinin group, D-dimer > or = 1.0 micro g/ml, odds ratio = 9.1, = 0.047; control group, D-dimer > or = 3.0 micro g/ml, odds ratio = 4.6, = 0.014). Ninety-seven per cent of the aprotinin group and 81% of control group patients had no excessive bleeding when the D-dimer plasma level was below these values. We conclude that (i) fibrinolytic activity significantly rises under low-dose aprotinin administration, and (ii) plasma D-dimer levels at end of surgery may help to identify patients who are unlikely to develop excessive postoperative bleeding.

Neuroprotective effect of urinary trypsin inhibitor against focal cerebral ischemia-reperfusion injury in rats

BACKGROUND

Acute inflammatory reactions cause neuronal damage in cerebral ischemia-reperfusion. Urinary trypsin inhibitor (UTI), a serine protease inhibitor, is cytoprotective against ischemia-reperfusion injury in the liver, intestine, kidney, heart, and lung through its antiinflammatory activity. Neuroprotective action of UTI on transient global cerebral ischemia has been documented. This is the first study to determine whether UTI is neuroprotective against transient focal cerebral ischemia.

METHODS

Adult male Wistar rats were randomly assigned to the following treatment groups: 0.9% saline (control, n = 9); 100,000 U/kg UTI (n = 9); and 300,000 U/kg UTI (n = 9). Treatments were performed intravenously 10 min before right middle cerebral artery occlusion for 2 h and subsequent reperfusion. Ninety-six hours after the onset of reperfusion, the motor neurologic deficit and the cerebral infarct size were evaluated. Furthermore, immunohistochemical staining for myeloperoxidase and nitrotyrosine to count infiltrating neutrophils and nitrated cells, respectively, was performed on the brain sections.

RESULTS

Infarct volume in the 300,000 U/kg UTI group was smaller than in the 100,000 U/kg UTI and saline control groups (P < 0.05). Treatment with 300,000 U/kg UTI showed a trend to improve neurologic outcome but did not reach statistical significance (P = 0.0693). The significant decrease in neutrophil infiltration was observed in the ischemic hemisphere treated with 300,000 U/kg UTI compared with saline control (P < 0.05). Nitrotyrosine deposition in the ischemic hemisphere was significantly reduced in the 300,000 U/kg UTI group compared with saline control and 100,000 U/kg UTI groups (P < 0.05).

CONCLUSIONS

Intravenous pretreatment with 300,000 U/kg UTI reduces focal ischemia-reperfusion injury in the rat brain, potentially opening a novel therapeutic avenue for the treatment of cerebral ischemia.

[Our experience on the effect of complex treatment with gordox in patients with acute and chronic-recurrent pancreatitis]

AIMS

In this retrospective trial we assess how acute pancreatitis patients respond to nonoperative therapy; operative methods and results after surgery for acute and chronic-recurrent pancreatitis.

METHODS

We present 738 acute pancreatitis patients, treated from 1991 to 2001 in our clinic. In all cases we start a nonoperative therapy comprising losses replacement, analgesics (including narcotic ones), spasmolytics, antibiotics, protease inhibitors-Contrical or Gordox (only during 1997 and 1998) and/or somatostatine (Sandostatin), H2-blockers, naso-gastric tube. Monitoring of the main parameters as blood pressure and pulse rate, number of leukocytes, values of serum amylase, urea and creatinine is performed.

RESULTS

576 responded to this therapy and recovered. The ones who worsened--162 acute pancreatitis patients--underwent surgery: necrectomy followed by postoperative prolonged local lavage in the area of pancreatic couch or laparostomy. This method contributes to a prolonged evacuation of biologically active substances and devitalized tissues. The average number of Ranson's Prognostic Criteria was 4.5. Furthermore, mortality is reduced to 19%. A mortality analysis is done. Surgery (cholecystectomy and bile duct exploration) is offered to patients who recovered from acute pancreatitis caused by cholelythiasis and/or choledocholythiasis.

CONCLUSIONS

The majority of patients respond to the nonoperative therapy. Despite the recent improvement in diagnostics and treatment of acute pancreatitis morbidity and mortality rates are still high.

Influence of a human protease inhibitor on surgical stress induced immunosuppression

BACKGROUND/AIM

Postoperative tissue injury and immunosuppression can occur after major surgery. In this study, we explore the potential benefits of administering a protease inhibitor to treat immunosuppression caused by surgical stress.

METHODS

Sixteen patients with esophageal cancer were preoperatively allocated at random into two equal groups. A urinary trypsin inhibitor, ulinastatin (UTI), was intravenously administered to the treatment (UTI) group at a dose of 150,000 U every 12 h from the start of surgery until postoperative day 5, whereas the control group received a placebo. One unit of UTI was defined as the amount of UTI necessary to inhibit the activity of 2 microg of bovine pancreatic trypsin by 50%. We measured the plasma levels of polymorphonuclear neutrophil elastase, interleukin 8, circulating T lymphocyte subsets, and mitogenic activity and in vitro production of tumor necrosis factor alpha in lipopolysaccharide-stimulated whole blood.

RESULTS

The postoperative serum value of polymorphonuclear neutrophil elastase was significantly lower in the UTI group, but the interleukin 8 concentrations did not significantly vary between the two groups. On the other hand, the severity of the postoperative immunosuppression was reduced in the UTI group, and immune functions, such as the numbers of T lymphocytes, the mitogenic activity of lymphocytes, and the level of tumor necrosis factor alpha production in whole blood, recovered significantly earlier in the UTI group.

CONCLUSION

These data suggest that a protease-modulating therapy may be a new strategy for the treatment of surgical stress induced immune dysfunction.

Development of tobacco smoke-induced lung tumors in mice fed Bowman-Birk protease inhibitor concentrate (BBIC)

Male strain A/J mice were exposed, 6h a day, 5 days a week for 5 months to a mixture of 89% cigarette sidestream and 11% cigarette mainstream smoke and then allowed to recover for another 4 months in air. The animals were fed Bowman-Birk protease inhibitor concentrate (BBIC) at a concentration of 1% in AIN-93G diet either during smoke exposure, following smoke exposure or during the entire 9 months. At the end of the experiment, the incidence and multiplicity of lung tumors were determined. In a positive control experiment, strain A/J mice were injected with 3-methylcholanthrene (MCA) and fed a diet containing 1% BBIC; these animals were killed 5 months later. It was found that in the animals treated with MCA, BBIC decreased lung tumor multiplicities, whereas in the smoke exposed mice, BBIC did not modulate lung tumor development.

Zeamatin, clotrimazole and nikkomycin Z in therapy of a Candida vaginitis model

OBJECTIVE

To study the interaction of antifungal drugs in topical therapy.

MATERIALS AND METHODS

Local therapy of Candida vaginitis with drugs alone and in combination was examined in a murine model. Zeamatin, a natural plant-derived antifungal protein, was tested alone and in combination with an azole, clotrimazole or nikkomycin Z, a chitin synthase inhibitor.

RESULTS

Whereas alone, zeamatin was ineffective, nikkomycin Z was effective only when dosed multiple times per day, and clotrimazole efficacy was variable when administered in experimental vehicles (unlike the complex and undefined commercial preparation), zeamatin enhanced the efficacy of either of the other two drugs when they were given in combination.

CONCLUSION

Drug interactions between novel drugs with unique mechanisms of action should be explored further, and may lead to more potent regimens.

Effect of a human urinary protease inhibitor (Ulinastatin) on respiratory function in pediatric patients undergoing cardiopulmonary bypass

BACKGROUND

We performed this prospective randomized study to determine the effect of a human urinary protease inhibitor (Ulinastatin) on respiratory function in pediatric patients undergoing cardiopulmonary bypass.

METHODS

Twenty-two children were included in this study. They were randomly allocated to 1 of the following groups; a control group (n=11) or a Ulinastatin group (n=11) in which patients received 5000 U/kg of Ulinastatin. Arterial blood samples were obtained before cardiopulmonary bypass (CPB), immediately after CPB, and 30 min after protamine administration, as well as 3 hours after and 18 hours after CPB, and Interleukin-8 and neutrophil elastase concentration were evaluated.

RESULTS

CPB time and aortic clamp time did not differ between the groups. Interleukin 8 and neutrophil elastase concentrations before CPB increased significantly immediately after CPB, these concentrations did not differ between the groups. However, neutrophil elastase concentrations of a Ulinastatin group were significantly lower than that of a control group at 30 min after protamine administration (a Ulinastatin group: 1011.3+/-539.1 mg/ml, a control group: 1619.7+/-595.7 mg/ml, p<0.05) and A-aDO2 of a Ulinastatin group was significantly lower than that of a control group at 2 hours after CPB (a Ulinastatin group: 67.1+/-70.6 mmHg, a control group: 169.2+/-116.3 g, p<0.05).

CONCLUSIONS

These results suggest that Ulinastatin suppresses the increase in neutrophil elastase and protects the respiratory function in pediatric patients undergoing cardiopulmonary bypass.

Intravenous ulinastatin therapy for Stevens-Johnson syndrome and toxic epidermal necrolysis in pediatric patients. Three case reports

BACKGROUND

More effective therapy is needed for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The clinical efficacy of intravenous ulinastatin therapy was investigated in 3 Japanese pediatric patients with SJS or TEN.

METHODS

Ulinastatin was given to 1 pediatric SJS patient and 2 pediatric TEN patients within 7 days (patient 1; SJS), 6 days (patient 2; TEN), or 4 days (patient 3; TEN) after the onset of the skin rash. Ulinastatin was administered intravenously at a dose of 7,500 U/kg/day (maximum dose: 300,000 U/day). No corticosteroids were given. After the skin lesions resolved, the ulinastatin dose was reduced to between 2,500 and 5,000 U/kg/day as maintenance therapy and then the drug was withdrawn.

RESULTS

Erythema, fatigue, and fever improved within 12-36 h of starting the ulinastatin infusion, and the skin lesions resolved completely after 4-7 days of ulinastatin therapy. None of the patients had cutaneous or ocular sequelae. No patient developed secondary infection or relapse and ulinastatin therapy caused no side effects.

CONCLUSION

Ulinastatin dramatically reduced the febrile period with no adverse effects and was very safe in this study. Ulinastatin appears to be a useful and effective therapy for controlling SJS and TEN without sequelae.

Soybean trypsin inhibitor confers protection against rotavirus infection in infant mice

OBJECTIVE

To study the effects of soybean trypsin inhibitor (TI) on glycine uptake, glutathione (GSH) levels and morphological changes of intestine in rotavirus (RV) infected infant mice.

METHODS

A total of 144 infant mice (7/8 days old) were divided in 3 groups (i.e. control, RV and RV + inhibitor). Infant mice were orally inoculated with the EB strain of RV and Trypsin protease inhibitor (TI) and 8 animals each were sacrificed on days 0,1,3,5,7 and 10 post infection (p.i). Glycine uptake (in vitro), GSH levels and histological changes were assessed in the jejunum, ileum and colon.

RESULTS

Glycine uptake and GSH levels were significantly reduced on days 3 and 5 p.i in jejunum and ileum of RV inoculated animals, compared to the controls. Glycine uptake and GSH levels were maintained as in controls in the RV + TI inoculated animals on days 3 and 5 p.i in jejunum and colon but not in ileum where lesser values were recorded. Histology showed vacuolar degeneration in ileum towards the apical portion whereas normal morphology was observed in jejunum, similar to controls. No histological changes were observed in colon in any of the groups. Electron microscopic study confirmed the viral infection.

CONCLUSION

Administration of Trypsin protease inhibitor along with RV reverted the effects of RV infection on amino acid uptake and GSH levels completely in the jejunum and partially in the ileum.

Influence of soybean trypsin inhibitor on small bowel enzyme activities during rotavirus infection in malnourished infant mice

Rotavirus (RV) is considered to be one of the major causes of acute episodic diarrhoea throughout the world. This study was undertaken to investigate the effect of soybean trypsin inhibitor (TI) on brush-border enzymes during rotavirus infection in protein energy malnourished (PEM) infant mice. Animals were divided into 4 groups, namely controls, PEM, PEM+RV and PEM+RV+TI (n = 36 each). Group 1 and 2 animals were orally inoculated with 50 microl of normal saline each. Group 3 animals were orally inoculated with 50 microl of 100 ID50 dose of RV stock each. Group 4 animals were similarly inoculated with 0.6 mg TI/g body weight along with 50 microl of RV stock each. Animals were examined daily for diarrhoea and their body weight was recorded on alternate days postinoculation (dpi). Animals were killed by cervical dislocation after being given light chloroform anesthesia on 0, 1, 3, 5, 7 and 10 dpi. Small intestines were excised and homogenized in normal saline. Proteins, gammaglutamyl transpeptidase, alkaline phosphatase and disaccharidases were estimated in jejunum and ileum. Body weight was significantly reduced in PEM animals and with RV infection. Histologically, focal areas of vacuolar degeneration of lining epithelium were seen in RV-infected animals. Disaccharidases and other enzyme activities were decreased significantly in the PEM group compared to healthy controls and further depressed with RV infection in malnourished animals as compared to non-infected PEM. The enzyme activities were restored in animals receiving TI along with RV compared to the group receiving RV without TI. With the administration of soybean TI, the activities of disaccharidases, alkaline phosphatase, gammaglutamyl transpeptidase and intestinal architecture were restored showing a protective effect in PEM during RV infection.

[Intracellular disorders in the dog myocardium in low cardiac output syndrome caused by massive hemorrhage, approaches to correction]

It was shown on dog experiments that disorders in the phosphorylation-proteolysis-calcium transport system in the sarcoplasmatic reticulum of pathologically changed myocardium are an important component of cardiac activity depression in massive blood loss. Low cardiac output can be corrected by ammonium molibdate, phosphoprotein phosphatase inhibitor, and contrycal, proteolysis inhibitor.

Development of difluoromethyl-ornithine and Bowman-Birk inhibitor as chemopreventive agents by assessment of relevant biomarker modulation: some lessons learned

A major goal in the development of chemopreventive agents has been to develop markers that reflect the underlying process of carcinogenesis and which are modulatable by the agent under study. An important application of such markers will be to select cohorts that are at elevated risk for cancer development, which should allow use of smaller sample sizes in definitive phase III trials as well as shorter duration (and lower cost), without loss of statistical power. Susceptibility and surrogate end-point biomarkers are particularly important in this respect. Intermediate markers are probably best assessed in terms of proportionate rather than relative risk. The systematic development of difluoromethylornithine for use in chemoprevention against human cancer has involved pilot, phase IIa and IIb trials using participants with prior colonic polyps as the study group. A unique feature of the phase IIa study was the use of a dose de-escalation design which allowed selection of the lowest effective non-toxic dose of difluoromethylornithine. The phase IIb trial now in progress is using a combination of sulindac with difluoromethylornithine; the rationale for selection of markers for this study and for a randomized phase III registration trial is discussed. We also review the findings in phase I and IIa trials of Bowman-Birk inhibitor concentrate, in which patients with measurable oral leukoplakia are the study group.

Other novel agents: Rationale and current status as chemopreventive agents

Several novel targets are currently being evaluated both preclinically and clinically for the prevention of prostate cancer. Four divergent and novel approaches were discussed at the National Cancer Institute-sponsored workshop entitled, "New Clinical Strategies in Prostate Cancer Prevention." These interventions are further categorized into soy protein-based serine-protease inhibitors that reduce superoxide-induced DNA damage, and molecularly targeted approaches that are directed toward endothelin-1 expression/overexpression, peroxisome proliferator-activated receptor ligands, and insulinlike growth factors. Understanding each of these approaches has offered insights into the process of malignant transformation of prostatic epithelium, and further illustrates the difficulties of developing new agents in the treatment and prevention of prostate cancer. Close scrutiny of the clinical data emerging with these approaches, including validation of biologic endpoints, is required before large-scale prevention studies with these novel agents and targets can be considered.