Pharmacological evaluation of experimental isolated liver perfusion and hepatic artery infusion with 5-fluorouracil

The intention of this study was to estimate the pharmacological advantage of a clinically applicable method of isolated liver perfusion (ILP) over hepatic artery infusion (HAI) administering various doses of 5-fluorouracil (FUra). FUra concentrations were measured using high-performance liquid chromatography in liver tissue (pigs and rats), hepatic tumor tissue (rats), and in the systemic circulation (pigs) following ILP and HAI. Forty-two pigs and 36 rats were subjected to either ILP or HAI with 20, 40 or 80 mg of FUra/kg of body weight. ILP resulted in significantly increased FUra concentrations in the liver as compared with the results with HAI in rats and pigs. Median areas under the concentration-time curve in liver tissue were 122.7 mumol.g-1.min and 59.9 mumol.g-1.min (40-mg/kg dose-group) and 236.3 mumol.g-1.min and 45.1 mumol.g-1.min (80 mg/kg) for ILP and HAI, respectively in pigs (both P less than 0.05). Systemic plasma areas under the curve were significantly lower for ILP as compared with HAI in 40- and 80-mg/kg dose-groups with 2.2 mumol.ml-1.min and 9.2 mumol.ml-1.min (40 mg/kg; P less than 0.01) and 6.8 mumol.ml-1.min and 43.2 mumol.ml-1.min (80 mg/kg; P less than 0.01) for ILP- and HAI-treated pigs, respectively. In hepatic tumor tissue a dose-dependent increase of mean FUra concentration was found for ILP-treated rats (P less than 0.05). No significant differences were observed in median FUra concentrations in tumor tissue between ILP- and HAI-treated rats (0.66 mumol.g-1 and 0.63 mumol.g-1 for ILP- and HAI-treated groups with 80 mg/kg; P greater than 0.05). The mean FUra concentration tumor/liver ratio was 0.26. In order to clarify the metabolic fate of high-dose FUra, five rats were subjected to HAI with 150 mg of FUra/kg, and hepatic tumor extracts excised at t = 0 min, t = 5 min, and t = 15 min after infusion were analyzed using 19F nuclear magnetic resonance. Catabolite alpha-fluoro-beta-alanine appeared rapidly at t = 5 min and t = 15 min in liver tissue. Significant amounts of the presumed active nucleotides were not detected in tumor tissue. We conclude that ILP is a means to improve selectivity of administration of antitumor agents to the liver, as compared with HAI. The pharmacological advantage of ILP over HAI administering equivalent doses of FUra was not demonstrated in tumor tissue, because of a large differential between liver tissue extraction and tumor tissue extraction of FUra, which was influenced by the mode of administration.

High mitomycin C concentration in tumour tissue can be achieved by isolated liver perfusion in rats

To enable the treatment of hepatic metastasis with higher, theoretically more effective, doses of systemically toxic anticancer drugs, an isolated liver perfusion (ILP) technique was developed in WAG/Ola rats. First, in a toxicity study the maximally tolerated dose (MTD) of mitomycin C (MMC) was determined for a 25-min ILP and for hepatic artery infusion (HAI) after the administration of a bolus dose. The MTD in the ILP setting (4.8 mg/kg) was 4 times that using HAI (1.2 mg/kg). Subsequently, in a rat colorectal hepatic-metastasis model, concentrations of MMC in tumour, liver, plasma and perfusate were measured during a 25-min ILP to investigate the expected pharmacokinetic advantage of ILP. The mean plasma level determined after ILP (1.2 as well as 4.8 mg/kg MMC) was significantly lower (P less than 0.001) than that obtained following HAI. This may explain both the absence of severe systemic toxicity and the higher MTD in ILP-treated groups. No significant difference in mean tumour and liver tissue concentrations of MMC were found when the groups treated with 1.2 mg/kg drug via HAI vs ILP were compared. The mean MMC concentration in tumour tissue was significantly higher (almost 5 times; P less than 0.05) in rats treated by ILP with the MTD (4.8 mg/kg) than in those treated via HAI with the MTD (1.2 mg/kg). ILP of MMC can be safely performed using a dose 4 times higher than the MTD in the HAI setting, leading to an almost 5-fold concentration of MMC in hepatic metastasis. ILP of MMC may therefore represent a promising therapy for metastasis confined to the liver.

Induction of lymphokine-activated killer activity in rat splenocyte cultures: the importance of 2-mercaptoethanol and indomethacin

The role of 2-mercaptoethanol and indomethacin in the induction of lymphokine-activated killer (LAK) activity by interleukin-2 (IL-2) in rat splenocyte cultures was investigated. Spleens from 4-month-old male rats of five different strains were tested. Splenocytes were cultured for 3-5 days in the presence of IL-2 (1000 U/ml) and LAK activity was assessed by 4-h 51Cr release assays with P815 and YAC-1 cells as targets. LAK activity could be induced by IL-2 in splenocytes from all rat strains, but only when 2-mercaptoethanol was present in the culture medium. Optimal LAK activity was induced when the 2-mercaptoethanol concentration in splenocyte cultures was at least 5 microM. Different rat strains showed differences in levels of in vitro induction of LAK activity. In the presence of 2-mercaptoethanol the level of LAK activity induced by IL-2 was high in BN and Lewis rats, intermediate in Wistar and Wag rats, and low in DZB rats. In the absence of 2-mercaptoethanol no or minimal LAK activity was induced. Furthermore we observed that addition of 50 microns indomethacin to the culture medium in the presence of 2-mercaptoethanol augmented the induction of LAK activity to some extent. In the absence of 2-mercaptoethanol, addition of indomethacin resulted only in low levels or no induction of LAK activity. We conclude that for optimal induction of LAK activity by IL-2 in rat splenocyte cultures 2-mercaptoethanol is essential, while indomethacin can only marginally further improve this induction.

A comparative study of isolated liver perfusion versus hepatic artery infusion with mitomycin C in rats

Systemic toxicity is usually the dose-limiting factor in cancer chemotherapy. Regional chemotherapy is therefore an attractive strategy in the treatment of liver metastasis. Two ways of regional chemotherapy, hepatic artery infusion (HAI) and isolated liver perfusion (ILP), were compared investigating the difference in toxicity with tissue and biofluid concentrations of mitomycin C (MMC). In wistar derived WAG rats the maximally tolerated dose of mitomycin C via HAI was 1.2 mg kg-1. Body weight measurements after HAI with doses higher than 1.2 mg kg-1 suggest both an acute and delayed toxic effect of mitomycin C since the time weight curves were triphasic: a rapid weight loss, a steady state and a second fall in weight phase. These rats died due to systemic toxicity. ILP with 4.8 mg kg-1 was associated with no signs of systemic toxicity and only transient mild hepatotoxicity. ILP with 6.0 mg kg-1 was fatal mainly due to hepatic toxicity. The four times higher maximally tolerated dose in ILP resulted in a 4-5 times higher peak concentration of mitomycin C in liver tissue, while the plasma concentration remained significantly lower than in the HAI treated rats. In the tumour tissue a 500% higher concentration of mitomycin C was measured in the ILP with 4.8 mg kg-1 than in HAI with 1.2 mg kg-1 treated rats. We demonstrated that when mitomycin C was administered by ILP a 400% higher dose could be safely administered and resulted in a five times higher tumour tissue concentration. In view of the steep dose-response curve of this alkylating agent this opens new perspectives for the treatment of liver metastasis.

Electron microscopic observations on the accumulation of large granular lymphocytes (pit cells) and Kupffer cells in the liver of rats treated with continuous infusion of interleukin-2

Treatment schedules were investigated for in vivo induction of lymphokine-activated killer cells in the rat liver. Treatment of rats with continuous systemic or regional infusion of recombinant human interleukin-2 with a dose of 4 to 8 x 10(4) U/day during 7 days, resulted in an increase in number of large granular lymphocytes or pit cells in the liver up to 43 times normal. Kupffer cells, nongranular lymphocytes, monocytes and neutrophils also increased in number, but with a maximal fivefold increase this was much less pronounced than for large granular lymphocytes. Kupffer cells showed morphological signs of activation and were frequently seen in mitosis. Frequent mitoses were also observed for large granular lymphocytes, but not for other leukocytes. This indicates that the effect of interleukin-2 treatment on hepatic (sinusoidal) cells was primarily directed to large granular lymphocytes and Kupffer cells. The large granular lymphocyte accumulation occurred mainly intrasinusoidally, but they were also frequently observed in the space of Disse where they are not found in control rats. This may be explained partly by the observed damage or gaps in the endothelial lining. The intrasinusoidal large granular lymphocytes adhered to the endothelium and to Kupffer cells. Higher responses, for all cell types, were found when interleukin-2 was administered regionally, that is, through the hepatic artery rather than through the systemic route (jugular vein), although the differences were not statistically significant. Doses below 4 x 10(4) U/day did not result in significant increases of large granular lymphocytes in the liver.

[Sacrococcygeal chordoma. A case report]

The authors describe the diagnosis of a rare neoplasm, a sacrococcygeal chordoma, which was suspected in view of compressive symptoms and diagnosed with the aid of endoscopic and x-ray methods (barium enema and CT). Diagnosis was confirmed at surgery.

Prolactin receptor does not correlate with oestrogen and progesterone receptors in primary breast cancer and lacks prognostic significance. Ten year results of the Naples adjuvant (GUN) study

The correlation between prolactin (PRLR) and oestrogen (ER) or progesterone receptors (PgR) in breast cancer and a possible prognostic significance of PRLR at 10 year follow-up have been investigated in the Naples (GUN) adjuvant trial. A total of 308 pre- and post-menopausal patients with early breast cancer, who entered the trial from 1 February 1978 to 31 December 1983, received randomly Tamoxifen (TM), 30 mg per die for 2 years, or no therapy. PRLR status was known in 229 (74.3%) patients. Values of specific binding less than 1% were considered negative. PRLR was positive in 75/229 (32.8%). ER was assayed in 210/229 (91.7%) patients and PgR in 188/229 (82.1%). No significant correlation, by the Spearman test, was found between PRLR and ER or PgR, while ER status was highly interrelated with PgR status. By the Cox model no evidence of an independent prognostic role of PRLR on disease-free survival (DFS) was observed, nor an interaction between PRLR and adjuvant treatment with TM was found.

Steroid hormone receptor levels and adjuvant tamoxifen in early breast cancer. Ten year results of the Naples (GUN) Study

Ten year disease-free survival (DFS) results of the Naples randomized trial of adjuvant tamoxifen (TM), 30 mg per day for 2 years versus no therapy according to receptor levels, are reported. From Feb. 1, 1978, through Dec. 31, 1983, 308 pre- and postmenopausal patients with early breast cancer entered the trial. Estrogen receptor (ER) data were available on 239 (77.6%) patients, progesterone receptor (PgR) data on 194 (63.0%), and both receptor data on 181 (58.8%). ER and PgR were assayed by dextran-coated charcoal technique in a single laboratory. The effect of adjuvant TM was significantly related to ER and PgR concentration of the primary tumor. The greatest TM benefit on DFS was evident in patients with the highest levels of receptors. The interaction between the treatment effect and receptor concentration was found whether ER and PgR were considered separately or together.

Adjuvant therapy with tamoxifen in operable breast cancer. 10 year results of the Naples (GUN) study

Treatment with tamoxifen (TM), alone or in combination with cyclophosphamide, methotrexate, and fluorouracil (CMF), was used as an adjuvant to surgery in 433 patients with stage I, II, or III(T3a) breast cancer. Oestrogen receptors (ER) and progesterone (PgR) receptors were assayed in most cases. 308 premenopausal node-negative and postmenopausal node-negative or node-positive patients were randomised to receive TM, 30 mg daily for 2 years, or no further therapy. 125 premenopausal node-positive patients were randomised to receive either CMF for nine courses plus TM or CMF alone. After a median follow-up of 63 months TM significantly reduced the incidence of relapses and deaths compared with no therapy. A significant interaction between treatment effect and ER/PgR status was seen. Disease-free and overall survival were similar after treatment with CMF+ TM or CMF.

Calculated deposition of inhaled particles in the airway generations of normal subjects

Detailed regional deposition of inhaled particles in the human lung is calculated for individual airway generations. The calculations are based on Landahl's deposition model as applied to the morphometric lung model of Weibel. We consider primarily deposition patterns of iron oxide particles with diameters ranging between 1 and 10 micrometers, but we also calculate patterns of deposition for bis(2-ethylhexyl) sebacate particles with diameters as small as 0.2 micrometers. We obtain good agreement between predicted values and observed values for alveolar retention of inhaled iron oxide particles with 64 and 20% of total deposition predicted to occur in nonciliated airways for 2- and 5-micrometer particles, respectively. This is compared with 48 +/- 9 and 27 +/- 10% for the measured values. Calculated values for total lung deposition of small bis(2-ethylhexyl) sebacate particles agree well with experimental data. The calculations show a minimum in deposition occurring for particle diameters of 0.5 micrometers, which is in agreement with observations. A calculation of surface concentration of deposited 7.9-micrometer aerodynamic particles reveals a very large concentration occurring at airway generation four. This observation is considered in light of observations that bronchial carcinomas occur in this vicinity of the lung.

[Anthropometric state of nutrition in students of various elementary and secondary schools in Ancona]

An anthropometric assessment was made of the nutritional state of children from Ancona elementary and middle schools. It was found that the girls had more body fat than the boys, though the latter, too, displayed values above those reported in U.S. and Italian studies. The view is expressed that this excess fat requires counteraction through nutritional education. Diet and physical exercise are known to be important in the prevention of degenerative diseases of a metabolic nature. Such prevention must be undertaken as soon as possible.