Saccharin mechanistic data and risk assessment: urine composition, enhanced cell proliferation, and tumor promotion

Sodium saccharin (NaSac) produces bladder tumors consistently in male rats only after lifetime exposure that begins at birth. NaSac is not metabolized and is negative in most genotoxicity tests. NaSac-induced cell damage and proliferation have been proposed as important factors in tumor promotion, and dose-response information demonstrating a threshold for these parameters is available. One theory proposes that high levels of NaSac, combined with protein in a high Na+, high pH environment found only in the male rat, form toxic microscopic crystals; therefore, NaSac-induced tumors may not be relevant to human carcinogenesis.

2,3,7,8-Tetrachlorodibenzo-p-dioxin mechanistic data and risk assessment: gene regulation, cytotoxicity, enhanced cell proliferation, and tumor promotion

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has been found to cause several tumor types in rodents, but TCDD has not been proven to cause cancer in humans, although there have been reported associations. TCDD does not bind to DNA, and indirect tests for DNA damage have been mostly negative. Tumorigenicity by TCDD in rodents has been linked to cellular necrosis, enhanced cell proliferation and tumor promotion. TCDD binds to the Ah receptor, which induces CYP1A1. This binding may be involved in tumorigenicity in rodents; however, additional TCDD-induced toxic changes appear to be required. Biopersistence and organ distribution may play an important role in TCDD dosage extrapolation to humans, but these have not been adequately determined.

Vinyl chloride mechanistic data and risk assessment: DNA reactivity and cross-species quantitative risk extrapolation

Vinyl chloride produced several tumor types among species. Angiosarcoma of the liver is found in all tested species, including humans with occupational exposures. Vinyl chloride is biotransformed by CYP2E1 to DNA-reactive chloroethylene oxide producing cyclic etheno adducts, which are mutagenic. The dose-response for angiosarcoma of the liver formation in rodents is supralinear, which is consistent with saturation of metabolic activation, and the tumor rate in humans at occupational exposure levels is similar to that for equivalent exposures in rodents.

Phenobarbital mechanistic data and risk assessment: enzyme induction, enhanced cell proliferation, and tumor promotion

Chronic exposure to high doses of phenobarbital (PB) causes hepatocellular adenomas in both mice and rats and hepatocellular carcinomas in some strains of mice. Long-term PB therapy has not been found to cause human tumors. PB is not DNA reactive, and most genotoxicity tests have yielded negative results. PB has been extensively studied as an epigenetic, rodent liver tumor promoter. At exposures causing rodent liver tumors, PB has measurable effects on hepatocytes: PB inhibits cell-to-cell communication; PB induces enzymes, including P450 cytochromes; PB stimulates proliferation and inhibits apoptosis of hepatocytes in neoplastic foci. Threshold exposures for some of these endpoints coincide with the threshold exposure for tumorigenesis.

N-nitrosodiethylamine mechanistic data and risk assessment: bioactivation, DNA-adduct formation, mutagenicity, and tumor initiation

N-Nitrosodiethylamine (NDEA) is DNA reactive after bioactivation and produces tumors in every animal species tested. Bioactivation is effected by several P450 isozymes including CYP2E1, which is ethanol inducible. Tumor formation in rat liver was proportional to O4-ethyldeoxythymidine formation in DNA, which was generally proportional to NDEA dose. At low doses in the 0.033-1.1 ppm range, the dose-response for esophageal tumor formation was sublinear, possibly due to DNA repair. Although no epidemiological studies have specifically evaluated NDEA, sufficient exposure levels would be expected to cause cancer in humans.

Carotid Dacron patch angioplasty: immediate and long-term results of a prospective series

The purpose of the present study was to determine the acute clinical results associated with the performance of Dacron patch angioplasty during carotid endarterectomy, and to define the incidence of residual and recurrent carotid stenoses in patched arteries. Some 115 consecutive patients (mean age 68.0 years) underwent 119 primary carotid endarterectomy procedures in which the arteriotomy was repaired with a Dacron patch. The patients underwent duplex/occulopneumoplethysmography evaluation at 6 months after surgery, and annually thereafter. There was one (0.8%) operative death and two (1.7%) perioperative strokes. There were no immediate postoperative carotid thromboses. There were no wound or patch infections acutely, or in long-term follow-up. Thirteen patients (11%) were lost to follow-up; hence 106 arteries in 102 patients were followed for 1-65 (mean 17.8) months, including 66 arteries (62%) that have undergone serial OPG/duplex evaluation. The incidence of residual stenoses (within 3 months) was 4.5%, and that of recurrent stenoses 4.8%. The results of the study show Dacron carotid patch angioplasty to be associated with excellent clinical results, with a relatively low incidence of residual/recurrent carotid stenoses.

Social and biological risk factors for mild and borderline impairment of language comprehension in a cohort of five-year-old children

Biological risk factors during intra-uterine life, delivery and the neonatal period, and measures of social adversity during pregnancy, were studied as predictors of a 'mildly impaired' (50 to 74) or 'borderline' (75 to 84) score on the Peabody Picture Vocabulary Test (PPVT) at aged five years in 3906 children. Biological risk factors in pregnancy were associated with neither PPVT outcome. Gestation of < 36 weeks, > 3 minutes to establishment of respiration and admission to intensive care were associated with a lower PPVT score indicating mild impairment, though only in the unadjusted analyses. A five minute Apgar score of < 5 and male sex were related to borderline scores, though only the latter remained significant after statistical allowance for possible confounding. In contrast, almost all measures of social adversity were related to both PPVT outcomes even after statistical adjustment for the influence of other factors.

Gastric emptying in acute overdose: a prospective randomised controlled trial

OBJECTIVE

To test the hypothesis that administration of activated charcoal is as efficacious and safe as the combination regimen of gastric emptying plus charcoal in adults after acute oral overdose.

DESIGN

Prospective randomised controlled trial, with subjects presenting on odd-numbered dates allocated to the emptied group (E), and those on even-numbered dates to the not-emptied group (NE).

SETTING

Princess Alexandra Hospital, Brisbane (a tertiary referral hospital), which serves an adult urban community, between 4 January 1988 and 11 June 1990.

SUBJECTS

Consecutive patients (13 years or older) who presented to the Emergency Department after ingesting an overdose of one or more compounds able to be adsorbed by activated charcoal.

INTERVENTIONS

All patients received charcoal by the oral or nasogastric route. Those in the E group also had gastric emptying by ipecac-induced emesis or gastric lavage.

OUTCOME MEASURES

Clinical course during the first six hours after treatment began, length of hospital stay, complications.

RESULTS

876 patients were eligible for the study. There were no significant differences between the E and NE groups in age and sex distribution, severity of the overdose or other characteristics, except the mean interval between presentation and administration of charcoal (91 min [SD, 52] for E group and 55 [SD, 41] for NE group; P = 0.0001). There were no significant differences between the E and NE groups in outcome, even when the groups were stratified for severity of the overdose or into subgroups that presented sooner or later than one hour after ingestion.

CONCLUSIONS

Gastric emptying can be omitted from the treatment protocol for adults after acute oral overdose.

The influence of anesthetic method on infrainguinal bypass graft patency: a closer look

Although several studies have demonstrated a reduced incidence of postoperative deep venous thrombosis among patients who receive regional anesthesia, the influence of anesthetic method on early arterial bypass graft patency has not been well studied. The records of 78 consecutive patients undergoing elective femoro-popliteal (FP) or femoro-tibial (FT) bypass grafts, and who were randomized to receive general anesthesia and postoperative patient-controlled intravenous narcotic analgesia (GEN, n = 41), or epidural anesthesia and postoperative continuous epidural analgesia (EPI, n = 37), were retrospectively reviewed. The two groups were evenly matched with respect to demographic characteristics, risk factors, and vascular variables. There was one death in each group, yielding an operative mortality of 2.6 per cent, and leaving 76 patients available for further analysis. Graft occlusion occurred in 11 (14.5%) cases within the first 7 postoperative days, including 9 (22.5%) GEN and 2 (5.6%) EPI patients (P < 0.05). There were two (4.4%) FP occlusions, including two (8.7%) GEN and 0(0%) EPI cases; there were nine FT occlusions, including seven (41.2%) GEN and two (14.3%) EPI cases. Graft occlusion occurred in 11 (17.1%) of the 64 limb salvage cases, including nine (27.3%) GEN and two (6.5%) EPI cases (P < 0.05), and in seven (12.7%) of 55 greater saphenous vein grafts, including six (22.2%) GEN and 1 (3.6%) EPI cases (P < 0.05). By multivariate analysis, FT grafts, preoperative plasminogen activator inhibitor-1 (PAI-1) levels, and GEN were predictive of early graft occlusion (P < 0.05). Furthermore, the levels of circulating PAI-1 were higher 24 hours postoperatively among patients in the GEN group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Identity and pathogenesis of stomach tumors in Sprague-Dawley rats associated with the dietary administration of butachlor

Macroscopic stomach tumors induced in Sprague-Dawley rats during two chronic bioassays with the acetanilide herbicide butachlor at a dietary concentration of 3000 ppm, were evaluated histologically and immunohistochemically in order to determine their identity and pathogenesis. The tumors, which occurred primarily in female rats, were a heterogeneous series, including a few consisting wholly or partly of classic solid or anaplastic epithelium, but with the majority containing diffusely distributed primitive neoplastic cells. The latter had either the general appearance of undifferentiated epithelium or presented a more "mesenchyme-like" pattern where the cells were epithelioid, blastema-like, neuroendocrine-like or sarcoma-like with fascicular disposition. Gastric glandular profiles were also present, usually located near the periphery of the tumors, but in some cases extending into the diffuse tumor tissue. Most of the tumors displayed variable immunohistochemical reactivity for cytokeratin, vimentin and neuron-specific enolase but were negative for muscle-specific actin or desmin except in the stromal tracts. Detailed examination of all available gastric tissue revealed the presence of additional microscopic neoplasms and precursor hyperplastic lesions. All of these were typical gastric neuroendocrine cell lesions (gastric carcinoids) originating in the fundic mucosa but occasionally invading submucosally, and consisting of epithelial cells in organized clusters, rosettes or primitive tubules. The enterochromaffin-like (ECL) nature of these microscopic neoplasms and precursor lesions was substantiated by strong immunohistochemical reactivity for cytokeratin, neuron-specific enolase and chromogranin A, and a negative reaction for vimentin. One microscopic tumor showed a transition from differentiated neuroendocrine type in the fundic mucosa to a dispersed "mesenchyme-like" pattern in the submucosal extension. An additional finding in the butachlor-treated male and female rats was atrophy of the fundic mucosa involving, in particular, reduction in the numbers of parietal cells. This effect was dose-related, being most severe in the high-dose (3000 ppm) females. On the basis of their morphological characteristics, coupled with the continuity evident in the microscopic lesions, it is concluded that the macroscopic stomach tumors associated with the dietary administration of butachlor are poorly differentiated gastric carcinoids, in some cases admixed with a non-neuroendocrine epithelial element. Fundic ECL and stem cells are known to be under the trophic influence of gastrin, which is apparently responsible for the induction of the tumors associated with butachlor administration. Gastric tumor development involving gastrin is recognized as a secondary, hormonal mechanism of carcinogenesis, demonstrating a dose-threshold phenomenon.(ABSTRACT TRUNCATED AT 400 WORDS)

A study of the mechanism of butachlor-associated gastric neoplasms in Sprague-Dawley rats

Long term administration of butachlor to Sprague-Dawley rats in a previous bioassay, resulted in the induction of gastric neoplasms which occurred only in the highest dose group (3000 ppm in the diet), primarily in females and specifically in the fundic region. The tumors were a composite of highly undifferentiated enterochromaffin-like (ECL) cells and mucus producing cells with morphologic characteristics unlike those previously described in the rat stomach. Mucosal atrophy of marked intensity was a consistent feature of the gastric mucosa in animals from the highest dose group. An additional long term study was conducted in female Sprague-Dawley rats at dietary levels of 0, 100, 1000 and 3000 ppm to explore the mechanism(s) involved in the formation of these neoplasms. Cell proliferation was evaluated in both fundic and pyloric regions of the stomachs of rats at multiple time periods from 14 days to 26 months. Mucosal thickness was determined in the fundic region at the same time intervals as were used for cell proliferation studies. Gastric pH and gastric acid production were measured after approximately 21 months of exposure. Serum gastrin levels were analyzed at 14, 60, and 120 days and at 6, 18 and 20 months. Cholecystokinin (CCK)/gastrin receptor binding studies were conducted on samples of four tumors and pooled fundic mucosa from five animals in the control group. Cell proliferation was increased in both the neck and base regions of the fundic mucosa at nearly all time points measured from 14 days to 26 months. The magnitude of the changes in the base region were substantially greater than those in the neck region. Fundic mucosal thickness was decreased beginning at the 30-day time point and continued at all intervals, being less than one half that of controls at 20 and 26 months. Gastric pH in rats from the highest dose was elevated to nearly twice control levels at 21 months. Gastric acid secretion was dramatically decreased in animals from the 3000 ppm group and was moderately decreased in the 1000 ppm group at 21 months. Hypergastrinemia was observed at the 3000 ppm level only, beginning at 120 days with progression to extremely high levels by 18 months. CCK/gastrin receptor binding was demonstrated in all tumors studied, at levels comparable to or higher than that of the pooled control sample. All changes involved only the fundic region, the site of tumor formation. Tumors occurred only in animals from the 3000 ppm level, the only level at which hypergastrinemia occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

Benzoyl peroxide: an integrated human safety assessment for carcinogenicity

Topical benzoyl peroxide has been used in the treatment of acne for over 30 years, with no reports of adverse effects that could be related to skin carcinogenesis. Two case-control epidemiological studies have found a lack of association between the specific use of benzoyl peroxide and skin cancer. In addition to these findings in humans, 23 carcinogenicity studies in rodents with benzoyl peroxide, including 16 employing topical application, have yielded negative results. An increase in skin carcinomas was reported in 1 study in which benzoyl peroxide in acetone was applied to the skin of SENCAR mice for a 1-year period; however, this study did not employ adequate control groups to fully understand the unusual findings, and the results were inconsistent with those of 6 other similar studies. While benzoyl peroxide is not a complete carcinogen in animals and has weak or no mutagenic potential, it has been found to be a tumor promoter in mouse skin using experimental two-stage models of carcinogenesis. Consistently positive results have been obtained in tumor promotion studies in which SENCAR mice were exposed to initiating doses of potent experimental carcinogens followed by promotion with benzoyl peroxide in acetone. Negative results have been obtained in similar studies with commercial formulations. However, the results of promotion studies with benzoyl peroxide do not carry significant weight for human safety assessment as evidenced by (i) the absence of demonstrated carcinogenicity in humans of a number of rodent tumor promoters despite long-term human exposure; (ii) the observation that tumor promotion in mouse skin occurs only under specific experimental conditions and predominantly in highly sensitive strains; (iii) clinical use scenarios markedly different from the conditions resulting in tumor promotion in mouse skin; and (iv) the significant physiological differences between mouse and human skin. Thus, to date, available scientific evidence does not allow the results of these rodent promotion studies to be meaningfully applied to human safety assessment. As such, significant scientific progress must be made before human safety estimations can be derived from rodent promotion data.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of studies related to tumorigenicity induced by hydroquinone

Hydroquinone (HQ) produced renal adenomas in male F344 rats, and these tumors appeared to arise from areas of spontaneous progressive nephropathy; the nephropathy itself has been found to be enhanced by HQ. Other neoplasms were not confirmed to be causally related to HQ among the reported bioassays. In the male F344 rat, HQ administered alone was not DNA reactive. HQ produced enhanced proliferation of renal tubular epithelium, presumably through toxicity involving glutathione conjugate formation. In the kidney, bone marrow, and other tissues, HQ may induce toxicity by redox cycling and lipid peroxidation. In bone marrow, HQ may produce microtubulin dysfunction, which is a plausible explanation for positive cytogenetic tests, the only consistently positive genotoxicity effect reported for HQ. Although HQ is a metabolic product of benzene, several lines of evidence suggest that the effects of HQ exposure are significantly different from those of benzene. Based upon the plausible mechanisms by which HQ may produce kidney tumors in male rats, we have concluded that occupational exposure levels of HQ are not predicted to be a cancer risk for humans.

Antiepileptic treatment and risk for hepatobiliary cancer and malignant lymphoma

The possible influence of phenobarbital and phenytoin treatment on cancer risk was investigated in a case-control study nested in a cohort of 8004 epileptic patients in Denmark. Information on anticonvulsive treatments was abstracted for 95% of 60 patients with cancers of the liver and biliary tract or malignant lymphoma and for 94% of 171 cancer-free control patients. Use of anticonvulsive drugs was correlated with angiographic procedures that used Thorotrast, a well-known human liver carcinogen. After exclusion of study subjects exposed to Thorotrast, no association was seen between treatment with phenobarbital and cancer of the liver (odds ratio, 1.0; 95% confidence interval, 0.1-8.0) or biliary tract (odds ratio, 0.8; 95% confidence interval, 0.1-4.2). Furthermore, a histopathological evaluation of slides from 7 of 9 liver cancer patients not treated with Thorotrast revealed that 3 of the 4 cases of hepatocellular carcinoma involved cirrhosis of the liver, which suggested an etiological role for alcohol or viral hepatitis. A possible link was observed between use of phenytoin and risk for non-Hodgkin's lymphoma (1.8; 0.5-6.6), with a rising trend in risk with increasing dose. Our results suggest that the increased risk for cancers of the liver and biliary tract among Danish epileptic patients is likely to be due to Thorotrast administration and factors associated with cirrhosis of the liver rather than to anticonvulsive treatment.

Correlation of relaxometry and histopathology: the transplantable human glioblastoma SF295 grown in athymic nude mice

Human glioblastomas of the brain are characterized by a wide range of proton relaxation rates in vitro (1/T1 and 1/T2) and heterogeneous appearance in magnetic resonance imaging. It was previously found that their 1/T1 values vary widely at magnetic field strengths much below imaging fields, even at the same water content. In the present study, we measure 1/T1 at different magnetic field strengths (NMRD profile) for a specific transplantable, human glioblastoma (SF295), grown subcutaneously in athymic nude mice, to search for histologic characteristics that might correlate with the variability of 1/T1 at low fields (1/T1L). Using a field-cycling relaxometer, NMRD profiles were obtained for 32 fresh, histologically characterized, tumor specimens, 7 to 24 days post implantation of cryopreserved SF295 fragments. Tumor volume, dry weight, and pH of specimens were determined, the extent of hemorrhage and necrosis rated, and specimen location within the tumor recorded. A statistically significant increase in the average 1/T1 was found with increasing level of necrosis at 0.0024 T and below, possibly reflecting progressive protein aggregation in samples with up to 40% necrosis. This correlation was not significant at imaging fields. Although pH was increased in central necrosis, neither pH, dry weight, sample location, nor fresh hemorrhage could explain the changes in 1/T1L. The variability of 1/T1L among SF295 samples is much reduced compared to that of fresh surgical specimens of human glioblastomas of the brain. The heterogeneous appearance of glioblastomas in MRI may have a histologic correlate which reflects molecular changes involved with induction of cell death and necrosis. Further investigations may identify the factors responsible for affecting 1/T1L (hypoxia, radiation, chemotherapy).

Sequence of the rat hypoxanthine guanine phosphoribosyl transferase (HPRT) transcriptional promoter region in wild-type and mutant rat liver epithelial cell lines

The hypoxanthine guanine phosphoribosyltransferase (HPRT) gene is mutated by a variety of genotoxic agents in adult rat liver (ARL) epithelial cell lines. By polymerase chain reaction (PCR) amplification and DNA sequencing of rat ARL cell HPRT gene sequences with mouse- and rat-specific oligonucleotides, a large portion of the rat HPRT transcriptional promoter region was sequenced. This region exhibits approximately 60% homology with the corresponding mouse sequence, contains a similar G/C-rich region at its 3' end, and contains a similar series of 6-nucleotide (nt) GGGCGG repeats. To determine if this region is a target for mutation by different genotoxins, HPRT-deficient ARL mutants induced by 2-acetylaminofluorene (AAF), N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), or 7,12-dimethyl-benz[a]anthracene (DMBA) were isolated and studied. A 1003-nt fragment of predominantly HPRT regulatory sequences was amplified by PCR using purified genomic DNA from 17 independent mutants and sequenced directly. None of the 17 mutants examined exhibited any alterations in the transcriptional regulatory region or the 5' untranslated region of HPRT exon 1 after direct sequencing analysis of PCR products. In addition, none of the 2-AAF-induced mutants exhibited differences in in vitro transcription rates as determined by nuclear run-on analysis. These data suggest that regulatory sequences of the HPRT gene are not a primary target for mutation by the genotoxins studied.

Sequential functional and morphological alterations during hepatocarcinogenesis induced in rats by feeding of a low dose of 2-acetylaminofluorene

The early cellular events in liver carcinogenesis were studied in Fischer-344 male rats that either were fed 200 ppm 2-acetylaminofluorene (AAF) for up to 10 wk or were fed the carcinogen for 8 wk followed by maintenance for an additional 24 wk. By 1 wk of exposure, AAF caused a reduction in the number of glutamine synthetase (GS)-positive centrilobular hepatocytes, an increase in DNA synthesizing hepatocytes in the central areas of the hepatic lobules, and a shift from multinucleated to mononucleated hepatocytes, although overt hepatocellular necrosis was not evident. By 3 wk, altered hepatocellular foci characterized by deficiencies in iron storage (IS-) and collagen production and by expression of gamma-glutamyl transferase (GGT+) and placental-type glutathione transferase (PGT+) activity appeared. Single PGT+ cells were also found. During continued exposure, foci increased in number, size, and total area with the increases escalating between 8 and 10 wk of exposure. Cessation of AAF exposure at 8 wk resulted in a slight decrease in the number of foci after a further 6 wk of maintenance, but with continued maintenance for another 6 and 12 wk, the number again increased. IS- characterized the majority of foci during carcinogen administration, whereas after cessation of exposure, GGT+ and PGT+ foci predominated. None of the foci were positive for GS. After AAF exposure for 10 wk, a few neoplasms developed and greater numbers occurred after maintenance for a further 24 wk of rats exposed for 8 wk. We conclude the following: (a) the low dose of AAF caused subtle alterations in function and proliferation of normal hepatocytes and converted hepatocytes into focus cells; (b) reduction of the GS+ area is a sensitive indicator of cytotoxicity of AAF; (c) the development of some foci at an early stage depends on a promoting action of AAF, which ceased when the carcinogen was withdrawn, allowing some foci to undergo reversion; (d) a strong linkage exists in expression of IS-, GGT+, and PGT+ in foci; (e) the carcinogenic process accelerates in the absence of any indication of increased cytotoxicity by AAF; and (f) under the conditions of this study, no GS+ foci, adenomas, and carcinomas were found, indicating that no carcinogen-induced expression of GS occurred in these lesions and that GS expression is not linked to other phenotypic abnormalities.

A retrospective study of risk factors of akathisia in terminally ill patients

Akathisia is a distressing disorder that manifests as a state of restlessness and motor agitation. We aim to highlight the problem of akathisia to the palliative care physician by identifying and quantifying risk factors in the terminally ill. A retrospective case-control study was utilized to investigate risk factors for akathisia. Medical records of cases (N = 100) and controls (N = 365) archived in a computerized database were downloaded and risk factors determined using conditional logistic regression analyses. Exposure to pharmacologically similar drugs, such as haloperidol [odds ratio (OR), 18.4; 95% confidence interval (CI), 8.2-41.4], prochlorperazine (OR, 8.1; 95% CI, 3.0-21.8), and promethazine (OR, 3.3; 95% CI, 1.3-8.0), conferred an increased risk. Other significant variables were exposure to morphine (OR, 5.3; 95% CI, 1.9-14.2), sodium valproate (OR, 2.5; 95% CI, 1.0-6.4), and sodium bicarbonate/tartrate (Ural) (OR, 4.2; 95% CI, 1.2-15.3). Highlighting factors that predispose patients to akathisia emphasizes that this syndrome should not be forgotten when treating the terminally ill. It is recommended that those drugs identified should be judicially used and carefully monitored.

The STL1 gene of Saccharomyces cerevisiae is predicted to encode a sugar transporter-like protein

A gene has been cloned from the yeast Saccharomyces cerevisiae which, on the basis of the deduced translation product, encodes a sugar transporter-like protein. This gene, STL1, was identified as an open reading frame (ORF) closely linked to the cinnamic-acid-resistance gene POF1 on chromosome IV. The putative translation product of STL1 (STL1) contains 536 amino acids, with a M(r) of 60,507. Hydropathy analysis of STL1 suggests that it contains the twelve transmembrane (TM) domains characteristic of a family of sugar transporters from S. cerevisiae and other organisms. STL1 displays greatest homology (28% identity) to the products of the yeast HXT2 (hexose transporter) and GAL2 (galactose transporter) genes. Disruption of STL1 had no detectable effect on yeast growth on glucose, galactose, mannose, maltose or glycerol as sole carbon source. The transport function of the gene product remains unknown at present.

Carotid endarterectomy in the very elderly: is it worthwhile?

BACKGROUND

Stroke continues to be the third leading cause of death in this country, its incidence and corresponding mortality rate increase with age, and in the majority of cases it results from arteriosclerosis of the carotid artery. Although recent studies have clearly shown the benefit of carotid endarterectomy in reducing the incidence of stroke, performance of this procedure in very elderly patients, the patient population for whom it should be most beneficial, has been challenged by some investigators on the basis of perceived increased operative risk.

METHODS

The records of all carotid endarterectomies (n = 63) performed during the last 12 years for all patients (n = 59) with a minimum age of 75 years were reviewed to define the short-term risk of operative mortality, stroke and other major complications, and the long-term outcome.

RESULTS

No (0%) operative deaths and three (4.8%) perioperative strokes occurred. Major cardiac complications occurred in five cases (7.9%). Follow-up, ranging from 1 to 122 months (mean, 27.4 months), was available for 54 patients (91.5%). Cumulative freedom from stroke was 92% at 2 years and 80% at 5 and 10 years of follow-up. Long-term survival rate was 80% at 5 years and 52% at 10 years, and stroke-free survival rate was 68% at 5 years and 42% at 10 years of follow-up.

CONCLUSIONS

Carotid endarterectomy can be performed in very elderly patients with low operative risk and excellent long-term results.

Frequent and specific mutations of the rat p53 gene in hepatocarcinomas induced by tamoxifen

Tamoxifen (TAM) is a triphenylethylene antiestrogen used for the treatment, and in clinical trials for the prevention, of breast cancer in women. In rats, TAM is a strong liver carcinogen which induces the formation of liver DNA adducts. The DNA of 24 hepatocarcinomas (HCCs) collected at necropsy from individual female Sprague-Dawley rats that were given 22.6 mg/kg TAM daily for 12 months was studied for the presence of mutations in exons 5-9 of the p53 gene by single-strand conformation polymorphism and DNA sequencing analysis. The sequences of introns 5-8 of the rat p53 gene were determined in order to design primers homologous to regions located in these introns. p53 mutations were found in 50% (12 of 24) of the HCCs. These mutations were all specifically clustered in two sites, codons 231 (exon 6-7) and 294 (exon 8). Nine HCCs contained a transition from adenine to guanine in the second base of codon 231 (CAC to CGC), which resulted in a histidine to arginine amino acid substitution; 4 HCCs contained a nonmiscoding transition from cytosine to thymidine in the third base of codon 294 (TGC to TGT; cysteine to cysteine). One HCC contained both mutations. The present report supports previous observations on the genotoxicity of TAM in rodents and raises concerns about its use as a chemopreventive agent against breast cancer in women.

Obstetrical outcomes of aboriginal pregnancies at a major urban hospital

While a number of previous papers have documented the poor general health of Australia's Aboriginal population, relatively few have considered the health of Aborigines living in Australia's urban centres. In this latter instance, Aborigines have access to conventional medical services and they live in a physical environment that does not differ greatly from that experienced by the lower-class white population. Of course, racial, familial and economic differences may continue to influence differentially the perceived accessibility of services to Aborigines and their non-Aboriginal neighbours. This paper compares the pregnancy outcomes of Aboriginal women and non-Aboriginal women living in a major urban centre in Australia. The data indicate that urban Aboriginal women have adverse pregnancy outcomes at one and a half to two times the rate experienced by the non-Aboriginal population. Much of the difference can be attributed to lifestyle variations in the groups being compared.

Comparison of DNA reactivity of the polyphenylethylene hormonal agents diethylstilbestrol, tamoxifen and toremifene in rat and hamster liver

The polyphenylethylene estrogenic drug diethylstilbestrol and a structural analogue tamoxifen have been found to be hepatocarcinogenic in female rats, whereas another analogue, toremifene, did not induce liver tumors. The 32P post-labelling technique for detection of DNA adducts was used to investigate the DNA reactivity of these three hormonal agents in the livers of female Sprague-Dawley rats and Syrian hamsters. Adducts were quantified using a radioanalytic imaging system in comparison with the standard Cerenkov assay. With administration of the chemicals at several doses by daily gavage to rats for 10 days and to hamsters for 7 days, tamoxifen was found to produce five adducts in rat liver and six adducts in hamster liver. The amounts of adducts were dose related from 10 to 90 mumol/kg per day in rats and from 17 to 160 mumol/kg per day in hamsters. The two methods of quantification yielded comparable results. Under these conditions, neither toremifene nor diethylstilbestrol produced adducts in rats and diethylstilbestrol produced none in hamsters. We conclude that tamoxifen is highly DNA reactive in the species studied and that this is likely to be involved in its strong carcinogenicity in rat liver.

Moderate hypothermia, with partial bypass and segmental sequential repair for thoracoabdominal aortic aneurysm

PURPOSE

Ischemic injury to the spinal cord, kidneys, and viscera occurs in a significant number of patients undergoing surgical repair of thoracoabdominal aortic aneurysms. Partial bypass has been used to perfuse the arterial system distal to the cross-clamp, but the primary determinant of ischemic morbidity remains the duration of aortic cross-clamping. Hypothermia may favorably affect outcome during these procedures, but moderate or deep hypothermia has traditionally required full cardiopulmonary bypass with cardiac arrest.

METHODS

In a series of patients undergoing thoracoabdominal (n = 14) or thoracic (n = 4) aneurysm repair, we used moderate hypothermia (30 degrees C) and partial bypass (aortofemoral or atriofemoral) while maintaining an intrinsic cardiac rhythm. Body temperature was controlled with a heat exchanger in the bypass circuit, which allowed for rapid cooling and rewarming. In addition to hypothermia and bypass, a segmental sequential surgical repair was used to minimize the duration of ischemia to any given vascular bed.

RESULTS

All patients survived the surgical procedure, and 16 patients survived until discharge from the hospital. None of the 18 patients had paraplegia or significant renal dysfunction. The only complication related to hypothermia was atrial fibrillation, which occurred in three patients and was amenable to therapeutic measures.

CONCLUSIONS

We conclude that moderate hypothermia, partial bypass, and segmental sequential repair may reduce ischemic injury. This combination of adjuncts was not associated with significant complications in this series of patients.

Cell culture assays for chemicals with tumor-promoting or tumor-inhibiting activity based on the modulation of intercellular communication

The ability of chemicals with tumor-promoting or tumor-inhibiting activity to modulate gap junctional intercellular communication is reviewed. The two most extensively used types of assays for screening tests are (1) metabolic cooperation assays involving exchange between cells of precursors of nucleic acid synthesis and (2) dye-transfer assays that measure exchange of fluorescent dye from loaded cells to adjacent cells. About 300 substances of different biological activities have been studied using various assays. For tumor promoters/epigenetic carcinogens, metabolic cooperation assays have a sensitivity of 62% and dye-transfer assays 60%. Thirty percent of DNA-reactive carcinogens also possess the ability to uncouple cells. The complete estimation of the predictive power of these assays could not be made because the majority of the substances studied for intercellular communication effects in vitro have not yet been studied for promoting activity in vivo. Both metabolic cooperation assays and dye transfer assays respond well to the following classes of substances: phorbol esters, organochlorine pesticides, polybrominated biphenyls, promoters for urinary bladder, some biological toxins, peroxisome proliferators, and some complex mixtures. Results of in vitro assays for such tumor promoters/nongenotoxic carcinogens, such as some bile acids, some peroxides, alkanes, some hormones, mineral dusts, ascorbic acid, okadaic acid, and benz(e)pyrene, do not correlate with the data of in vivo two-stage or complete carcinogenesis. Enhancement of intercellular communication was found for 18 chemicals. Among these, cAMP, retinoids, and carotenoids have demonstrated inhibition of carcinogenesis. We examine a number of factors that are important for routine screening, including the requirement for biotransformation for some agents to exert effects on gap junctions. We also discuss the mechanisms of tumor promoter and tumor inhibitor effects on gap junctional permeability, including influences of protein kinase activation, changes in proton and Ca2+ intracellular concentrations, and effects of oxy radical production.

Visceral lipid peroxidation occurs at reperfusion after supraceliac aortic cross-clamping

PURPOSE

Recently, we have reported that lipid peroxidation specific to oxygen free radical-mediated injury increased immediately after reperfusion of human liver allografts. However, in the human liver transplantation setting it was impossible to disassociate the contributions to lipid peroxidation caused by the warm and cold ischemic phases from those caused by reperfusion. Therefore we now have studied lipid peroxidation at reperfusion after supraceliac aortic cross-clamping in patients with normal livers.

METHODS

Ethane, a noninvasive biomaker of lipid peroxidation, was measured in exhaled breath of patients before and during cross-clamping of the thoracic aorta and at sequential time intervals after visceral reperfusion.

RESULTS

Approximately a two-fold transient increase in the ethane level was observed at around 15 minutes after reperfusion in those patients whose aortas were cross-clamped for more than 18 minutes.

CONCLUSIONS

These results indicate that free radical-mediated lipid peroxidation occurs at reperfusion of warm ischemic viscera in the clinical setting of aortic repair. This observation supports the hypothesis that substantial lipid peroxidation occurs when tissues are subjected to cold or warm ischemia followed by reperfusion.

Single-stage repair of distal aortic arch and thoracoabdominal dissecting aneurysms using aortic tailoring and circulatory arrest

The adjuncts of profound hypothermic circulatory arrest and aortic tailoring are combined with standard graft replacement of the noncritical portions of the aorta. This combination permits single-stage replacement of the arch, thoracic, and abdominal aorta in patients with postdissection aneurysm. Reconstruction is begun with repair of the mid to distal aortic arch and Dacron graft replacement of the proximal descending thoracic aorta, usually under profound hypothermic circulatory arrest. The proximal graft is then cannulated and the patient partially warmed while the middle segment is "tailored." Aortic tailoring consists of longitudinal aortotomy and removal of the dissection membrane(s) from the distal third of the descending thoracic aorta to below the renal arteries. The aorta is then closed creating a single channel 2 to 3 cm in diameter and containing the origins of the important intercostal, lumbar, and visceral arteries. A Dacron graft is used to replace the infrarenal segment. Five patients have successfully undergone single-stage, total repair of the aorta including the arch, thoracic, and abdominal segments. All survival without paraplegia or significant visceral ischemia. Follow-up has not shown dilatation of the tailored segment. We believe that reduction in diameter of the tailored aortic segment and thus wall tension, growth of neointima on all luminal aortic surfaces, and active collagen deposition contribute to the success of this procedure.

Dose response of promotion by butylated hydroxyanisole in chemically initiated tumours of the rat forestomach

The antioxidant food preservative butylated hydroxyanisole (BHA) was tested in an initiation-promotion protocol in which male F344 rats (6 wk old), 27 per group, were gavaged with a single dose of 200 mg N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)/kg. After 3 wk on control diet, test diets containing 0, 60, 300, 1000, 3000, 6000 or 12,000 ppm BHA were fed until termination of the experiment at approximately 110 wk, at which time most animals had died with stomach tumours. MNNG caused a high incidence of tumours in the glandular stomach and forestomach of all groups. Administration of 12,000 and 6000 ppm BHA, but not 3000 ppm or lower doses, caused statistically significant increases in the time-related incidence of MNNG-induced forestomach tumours as analyzed by life table analysis. BHA had no effect on the incidence of tumours in the glandular stomach or oesophagus. Tumour incidences in other organs were not related to BHA dose. No increase in hyperplasia in the oesophagus was evident in the high-dose BHA-treated animals compared with the MNNG-only group. This study provides corroboration that BHA affects only forestomach tumorigenesis and that the dose for enhancement of tumorigenesis is at least 1500-fold greater than human exposure.

Interventive prophylaxis of liver cancer

About 30 agents have been shown to diminish liver cancer in experimental animals. For many of these, safety is well established, thus permitting intervention studies, and some agents are already being used in trials for anticarcinogenesis at other sites. An aspect that has received little attention and warrants further study is combination cancer prophylaxis.

Genotoxicity and carcinogenicity in rats and mice of 2-amino-3,6-dihydro-3-methyl-7H-imidazolo[4,5-f]quinolin-7- one: an intestinal bacterial metabolite of 2-amino-3-methyl-3H-imidazo[4,5-f]quinoline

BACKGROUND

Compounds formed on the surface of fried or grilled meat and fish may be associated with increased risk of colon cancer. Normal intestinal bacteria can convert one of these compounds, 2-amino-3-methyl-3H-imidazo[4,5-f]quinoline (IQ), to the 7-hydroxy metabolite, 2-amino-3,6-dihydro-3-methyl-7H-imidazolo[4,5-f]quinolin-7-o ne (7-OHIQ), a direct-acting mutagen.

PURPOSE

We studied the genotoxicity and carcinogenicity of 7-OHIQ to determine if it is responsible for the colon-specific activity of IQ.

METHODS

The effects of pure, synthetic 7-OHIQ on DNA were evaluated in the Ames Salmonella typhimurium TA98 test, with and without an induced rat liver S9 fraction, and in the Williams DNA repair test using freshly explanted rat hepatocytes. 7-OHIQ was also subjected to an in vivo bioassay for 21 months by long-term intrarectal infusion in male F344 rats, using IQ and N-nitrosomethylurea (NMU) given intrarectally as positive tumor-producing controls. The standard NIH-07 rodent diet was supplemented with 15% corn oil to maximize any effect of the infused materials on the colon. A parallel bioassay involved intraperitoneal injection of 7-OHIQ in newborn mice, followed by dietary administration from week 11 to week 67. Again, IQ and NMU were used as positive controls.

RESULTS

We confirmed that 7-OHIQ is a direct-acting mutagen in the Ames test, with added S9 liver fraction giving higher mutagenicity. 7-OHIQ was negative in the Williams test, whereas IQ was positive. 7-OHIQ did not induce colon cancer in rats, and in the newborn mouse test it produced only a low incidence of liver neoplasms.

CONCLUSIONS

7-OHIQ is not genotoxic, for to be so classified it must be definitely positive in both the Ames and Williams tests; moreover, it is not carcinogenic, in marked contrast to IQ and NMU.

Asbestos in the air of public buildings: a public health risk?

The Environmental Health and Safety Council of the American Health Foundation has examined current estimates of cancer risks associated with the presence of asbestos-containing materials (ACM) in public buildings. The Council finds that even complete removal of asbestos from all of these buildings will provide no measurable benefit to public health. The removal of nonfriable ACM only can be postulated to protect the public against a small hypothetical risk that cannot be measured epidemiologically. Moreover, examination of the assumptions used in the risk assessment calculations leads to the conclusion that these small calculated risks are likely to represent overestimates. In recent surveys, the measured asbestos levels in indoor air cast some doubt on whether occupant exposure to asbestos levels are contributed to significantly by ACM even when some of the material is friable or in bad condition. Furthermore, the models used for cancer risk estimates assume no threshold level for cancer and conclude that any exposure is carcinogenic. This may be unjustified in light of information on the mechanisms for some asbestos-caused disease. Based on the best available data, it is very unlikely that cancer will result from indoor asbestos exposure, especially where ACM is well maintained.

Alterations of nuclear pores in preneoplastic and neoplastic rat liver lesions induced by 2-acetylaminofluorene

The nuclear pore density and area were measured on freeze-fractured nuclei of ACI/N rat liver altered foci, adenomas and carcinomas induced by 2-acetylaminofluorene, and compared with those of normal hepatocytes. The pore density of nuclei from these preneoplastic and neoplastic lesions was significantly higher than that of hepatocytes, but there was no difference between lesions. The area of nuclear pores of the focus cells did not differ from normal hepatocytes, whereas the areas of pores of adenoma and carcinoma cells were increased. Moreover, the nuclear pore area of carcinomas was significantly greater than that of adenomas. These results suggest that some changes may occur in nuclear pores in the progress of tumorigenesis.

Calcium as a permissive factor but not an initiation factor in DNA synthesis induction in cultured rat hepatocytes by the peroxisome proliferator ciprofibrate

The non-genotoxic hepatocarcinogen and peroxisome proliferating agent, ciprofibrate, is a liver mitogen both in vivo and in cultured adult rat hepatocytes, but the mechanisms of its mitogenicity have not been elucidated. We previously observed that ciprofibrate rapidly increased hepatocyte free intracellular Ca2+ concentration ([Ca2+]i), suggesting that this effect may play a role in the initiation of DNA synthesis. In the present study, we have identified a relationship between Ca2+ and the stimulation of hepatocyte DNA synthesis by ciprofibrate. Exposure of cultured adult rat hepatocytes to ciprofibrate (200 microM) for 48 hr increased DNA synthesis by approximately 2-fold, and this response was attenuated in a Ca(2+)-deficient medium and by the Ca2+ channel blockers nicardipine and verapamil. To examine the relationship between the stimulation of hepatocyte DNA synthesis and increases in [Ca2+]i by ciprofibrate, the intracellular Ca2+ chelator 5,5'-dimethyl-1,2-bis(2-aminophenoxyethane)-N,N,N',N'-tetraacetic acid (dimethyl-BAPTA) was employed. Pretreatment of hepatocytes with dimethyl-BAPTA blocked ciprofibrate-induced [Ca2+]i increase, but did not block ciprofibrate-induced hepatocyte DNA synthesis. Dimethyl-BAPTA was only effective in reducing ciprofibrate-induced DNA synthesis when present during the latter 24 hr of a 48-hr culture period. These data suggest that the early mobilization of hepatocyte [Ca2+]i by ciprofibrate does not play an initiating role in the induction of hepatocyte DNA synthesis but rather may operate as a permissive factor for the entry of ciprofibrate-treated adult rat hepatocytes into S-phase.

Perinatal hypoxic-ischaemic brain injury: prediction of outcome

Twenty-six term babies with hypoxic-ischaemic brain injury were studied during the neonatal period to evaluate the prediction of outcome to at least one year of age by means of ultrasonography, CT scanning and Doppler ultrasound assessment of cerebral palsy blood flow velocity (CBFV). Adverse outcome was defined as the occurrence of cerebral palsy, developmental delay or death. At follow-up, 17 infants had an adverse outcome (seven died, 10 had disability); the remainder had no detectable impairment. Abnormalities on cranial ultrasound were not, but generalised decreased tissue density on CT scan was, associated with adverse outcome. Abnormal mean CBFV in the middle cerebral artery had no association with outcome, but abnormal mean CBFV in the anterior cerebral artery and a low resistance index in both arteries were significantly associated with adverse outcome. Such information may be used for appropriate counselling of parents of asphyxiated infants.

Multiple effects of morphine on facial scratching in monkeys

The medullary dorsal horn (MDH), the medullary homolog of the spinal dorsal horn, is a site where opioid-receptor agonists can act at opioid receptors to produce pronounced facial scratching, the behavioral correlate of pruritus. In the present study, after a 10-min baseline period, morphine (5.0 micrograms) was micro-injected into the MDH of monkeys. Behavior was videotaped and facial scratches were counted by two independent raters. Morphine greatly increased facial scratching behavior, which is consistent with previous findings where mu-opioid receptor agonists microinjected into the MDH have been to induce dose-dependent, naloxone-reversible facial scratching in monkeys. In the current research, intramuscular (IM) administration of the opioid-receptor antagonist, naloxone (0.5 mg/kg), reversed this MDH morphine-induced scratching. Additionally, IM morphine (1.0 mg/kg) produced a substantial reduction in facial scratching behavior. Scratching behavior continued at a high rate after injection of saline (0.1 mL/kg, IM). These findings support the hypothesis that morphine has both pruragenic and antipruragenic activity, depending on the site of action.

Non-linearity of neoplastic conversion induced in rat liver by low exposures to diethylnitrosamine

Neoplastic conversion induced in rat liver by diethylnitrosamine (DEN) was quantified by measuring preneoplastic and neoplastic lesions over a 34 week period in the beginning of which the carcinogen was given at three dose levels and two dose rates for the first 10 weeks, after which animals were maintained for 24 weeks with either no further exposure or were fed phenobarbital (PB) to promote neoplastic development of cells converted by DEN. DEN was injected s.c. in male F344 rats at weekly or biweekly intervals for total doses of 1, 2 or 4 mmol/kg body wt and then the rats were maintained on basal diet alone or diet containing 0.05% PB. At the end of exposure, DEN had produced a dose-related decrease in centrilobular glutamine synthetase-expressing (GS+) hepatocytes which is indicative of mild cytotoxicity. All doses induced foci that were gamma-glutamyltranspeptidase-positive and iron storage-deficient. The multiplicity of foci in the middle dose exceeded that in the low dose by about a factor of two and, in the high dose, was > 10-fold greater. A few GS+ foci were found in the high dose group only. At 34 weeks, neoplasms were present in the middle and high dose groups. Administration of PB after DEN increased the multiplicity of foci in all dose groups, most substantially in the low dose group. The effect of PB on liver neoplasm yield was marginal in the low non-carcinogenic dose, whereas it enhanced the multiplicity in the weakly carcinogenic middle dose by approximately 10-fold. Four principal findings were made: (i) even at the low doses used, a mild cytotoxic response not evidenced by morphological changes in conventional histopathology was manifested in the GS+ centrilobular subpopulation of hepatocytes; (ii) the dose response over a 4-fold dose range of DEN alone and when followed by PB was non-linear; (iii) the precursor role of foci in the evolution of liver neoplasms was evident and was most conspicuous in the case of GS+ foci; and (iv) a high level of foci induction was required for the evolution of neoplasms, even with PB promotion. The finding of non-linearity with increasing doses of DEN raises questions about the assumption that effects of carcinogens at high doses can be quantitatively extrapolated to low doses.

Preoperative spinal artery localization and its relationship to postoperative neurologic complications

PURPOSE

To evaluate the risk of spinal cord revascularization and ascertain the relationship between preoperative spinal arteriography and the frequency of postoperative neurologic injury and overall morbidity and mortality in patients who require surgical repair of thoracoabdominal aortic aneurysms.

MATERIALS AND METHODS

Fifty patients scheduled for surgical repair of a thoracoabdominal aortic aneurysm underwent spinal arteriography. All patients were divided into a positive spinal artery group (in which the spinal artery was identified) or negative spinal artery group (in which the spinal artery was not identified) and further divided based on extent of disease.

RESULTS

The complication rate of spinal arteriography was 4.6%; no patient had a permanent neurologic injury. No significant difference existed between the positive and negative spinal artery groups in occurrence of neurologic injury (P = .88) or combined morbidity and mortality (P = 51).

CONCLUSION

Patients who require spinal cord revascularization do not have greater frequency of neurologic injury or overall morbidity and mortality than those without this requirement. Spinal arteriography enables definitive spinal cord revascularization and thereby reduces the risk of neurologic injury.

Birthweight below the tenth percentile: the relative and attributable risks of maternal tobacco consumption and other factors

Analysis of 7776 singleton births defined a cohort of babies with birthweight below the 10th percentile after adjusting for gestational age and sex. The relative risk of a baby being small for gestational age in respect to a number of factors, such as parental anthropometry, demographic factors, behavior patterns (tobacco, cannabis, alcohol, and caffeine consumption), maternal pathology, and fetal abnormality, was calculated. The highest relative risks are associated with severe antepartum hemorrhage, severe pre-eclampsia, and severe fetal abnormality. As these are relatively rare events, a more accurate calculation of overall risk to the population as opposed to the individual can be obtained by studying the percent attributable risk of each of the factors. This demonstrates that maternal tobacco consumption is the major environmental risk factor in our population.

Major difference in the hepatocarcinogenicity and DNA adduct forming ability between toremifene and tamoxifen in female Crl:CD(BR) rats

The hepatoproliferative effects of 2 antiestrogens, tamoxifen and toremifene, were compared in a sequential 15-month study in which 2 doses of each compound were administered by daily gavage to female Sprague-Dawley rats for up to 12 months. The doses were 11.3 and 22.6 mg/kg for tamoxifen and 12 and 24 mg/kg for toremifene. There were scheduled sacrifices at 3, 6, 12, and 15 months, the latter including a 3-month recovery period from the 12th through the 14th month. In the chronic toxicity study, tamoxifen at 22.6 mg/kg produced 100% incidence of hepatocellular carcinoma at the 12- and 15-month sacrifice intervals and 67% and 71% incidences at the 11.3-mg/kg dose. Sequential observations showed an increased incidence of glutathione S-transferase-positive foci of hepatocellular alteration by 3 months with tamoxifen in the absence of hepatotoxicity, with the first liver carcinoma appearing by 6 months of treatment. Unscheduled deaths occurring beyond 7.5 months in the tamoxifen treated groups were due in almost all cases to liver cancer. In striking contrast, toremifene did not produce any hepatoproliferative effects at 12- and 24-mg/kg dose levels, nor in a pilot study at 48 mg/kg. The 24-mg/kg dose of toremifene exerted an inhibiting effect on foci of hepatocellular alteration in rat liver detectable by glutathione S-transferase immunohistochemistry at 3 months and by conventional histology at 12 months. An antiproliferative effect was also evident in mammary gland and anterior pituitary where both toremifene and tamoxifen suppressed tumor incidence in comparison to the control group. The ability of these drugs to modify rat liver DNA after p.o. administration was investigated using the 32P-postlabeling assay. Administration of tamoxifen at 45 mg/kg for 7 days produced liver DNA nucleoside modifications represented by 7 spots on the autoradiogram. Unlike tamoxifen, toremifene did not produce any modified bases in rat liver DNA detectable by the 32P-postlabeling technique. The dose levels of tamoxifen that are strongly hepatocarcinogenic in the rat are compared with doses used in humans in various applications. Taking internal drug exposure into account, we conclude that the margin of safety for use of tamoxifen as an endocrine prophylactic agent for healthy, but breast cancer prone, women is questionable.

Dose response effects of 2-acetylaminofluorene on DNA damage, cytotoxicity, cell proliferation and neoplastic conversion in rat liver

This study measured the effect of precise doses of 2-acetylaminofluorene (AAF) in inducing DNA damage, functional changes and neoplastic conversion in rat liver. Groups of male F344 rats at 9 weeks of age were exposed to cumulative doses of 0.5 or 2.0 mmol AAF per kg body weight given by gavage daily 5 days per week over an 8-week period and maintained with no further exposure for up to 8 weeks. Administration of AAF resulted in the formation of N-deoxyguanosin-(8-yl)-2-aminofluorene in liver DNA in relationship to dose. In centrilobular hepatocytes the zone of glutamine synthetase-expressing cells was reduced by exposure. By 8 weeks, but not at 4 weeks, the higher of the two doses of AAF provoked an increase in cell proliferation measured by immunohistochemical incorporation of bromodeoxyuridine. Altered hepatocellular foci expressing the placental form of glutathione transferase were induced by the high dose of AAF at 4 weeks, but not at the low dose. At 8 weeks the incidence of foci at the high dose was 79 times that induced by the low dose. These foci were highly proliferative. In animals exposed to AAF for 8 weeks and maintained for 4 weeks with no exposure, DNA adducts decreased by 80% and cell proliferation subsided by 80%, although the glutamine synthetase zone remained diminished. After discontinuation of AAF, the number of foci diminished by 50% and their proliferation subsided by 80% at 4 weeks, indicating a phenotypic reversion of many foci. With this protocol of administration of precise doses of AAF, we have established non-linearity of effects and a lack of correlation between DNA adduct formation and induction of cellular lesions. We suggest that doses in the range of those reported can be used to study the contribution of epigenetic and genotoxic effects in carcinogenesis and to study threshold events.

The histopathology of kidney changes in rats and monkeys following intravenous administration of massive doses of FCE 26184, human basic fibroblast growth factor

Intravenous administration of human basic fibroblast growth factor up to 100 micrograms/kg/day to Sprague-Dawley rats caused changes in the kidneys that included enlargement, vacuolation, and karyomegaly of podocytes in glomeruli, dilatation and cast formation in tubules, thickening of the media in the lobular arteries, and hyperplasia of the epithelium of the papilla and collecting ducts. In cynomolgus monkeys there was hyperplasia of the parietal epithelium of Bowman's capsule in the glomeruli, tubular dilatation, and minimal arteriopathy. These changes were only seen at 100 micrograms/kg/day. The development and eventual recovery over time were investigated in a sequence of sacrifices. In monkeys the first changes were seen after 7 days of treatment, but in rats only after 16 days. In both species the changes had partially resolved after 30 days of recovery and were considered to return to normal after 60 days without treatment. The morphological changes were accompanied by functional alterations that included proteinuria and raised blood urea. Changes that occurred in other tissues including bone, red blood cells, adrenals, ovaries, liver, gall bladder, spleen, mesenteric lymph nodes, thymus, aorta, salivary glands, and injection site are not described in this paper.