Changes in laboratory results for cancer patients treated with interleukin-2

The systemic administration of interleukin-2 (IL-2) can lead to significant antitumor responses in some patients with metastatic cancer in whom standard therapy has failed. A limitation of this immunotherapy is the toxicity associated with IL-2 infusion. To assess toxicity, we determined aspartate aminotransferase (AST; EC 2.6.1.1), alanine aminotransferase (ALT; EC 2.6.1.2), gamma-glutamyltransferase (GGT; EC 2.3.2.2), lactate dehydrogenase (LD; EC 1.1.1.27), alkaline phosphatase (ALP; EC 3.1.3.1), creatine kinase (CK; EC 2.7.3.2), total bilirubin (TBI), direct bilirubin (DBI), creatinine, urea nitrogen, and C-reactive protein in serum from 21 patients before and during five consecutive days of IL-2 treatment. Ten patients were followed for an additional five days after the end of IL-2 therapy. The IL-2 infusion caused liver toxicity and prerenal azotemia, as evidenced by significant increases (P less than 0.05) of all analytes except CK by day 1. There was a progressive increase in the results (except CK) for these tests until IL-2 treatment was stopped. Seven tests related to liver function (AST, ALT, GGT, LD, ALP, DBI, and TBI) showed increases, but the test results indicated significant improvement and moved toward the baseline value five days after the end of IL-2 therapy. Concentrations of creatinine and urea nitrogen in serum were normal three days after the cessation of IL-2 therapy.

Prevalence of thyroid abnormalities in patients with dermatitis herpetiformis and in control subjects with HLA-B8/-DR3

PURPOSE

The prevalence of thyroid dysfunction as measured by the presence of overt thyroid disease, abnormal results of thyroid function tests, or antithyroid antibodies was compared in patients with dermatitis herpetiformis (DH) and a normal control group who had the HLA-B8/-DR3 haplotype.

PATIENTS AND METHODS

The study population consisted of 56 patients with DH and 26 control subjects with the HLA-B8/-DR3 haplotype. All were examined for thyroid function abnormalities and thyroid autoantibodies.

RESULTS

Patients with DH had a statistically significant increase in the prevalence of abnormal thyroid function test results and autoantibodies: 32% versus 4% for controls (Z = 2.01, p less than 0.02). In patients with DH, hypothyroidism was the most common thyroid abnormality (12 of 56) followed by hyperthyroidism (four of 56). Two patients had normal thyroid function test results with thyroid autoantibodies. Risk factors for thyroid abnormalities in patients with DH were increasing age (chi 2 = 6.55, p less than 0.02, significant) and the presence of thyroid microsomal antibodies. The HLA-B8/-DR3 haplotype was not a risk factor for thyroid abnormalities.

CONCLUSION

The findings suggest that thyroid disease is independently associated with DH. Examination of patients with DH should include thyroid function tests along with assays for antithyroid antibodies.

Changes in brainstem and cortical auditory potentials during Qi-Gong meditation

"Qi Gong" (QG) is a meditation exercise known for thousands of years in China and has always been widely practiced. It has been claimed to have a variety of healing and other health benefits. To provide an understanding of the effect of QG on brain structures along the whole neural axis from the periphery to the cerebral cortex, we have monitored short-latency auditory brainstem evoked response, middle-latency response, and long-latency cortical auditory evoked potentials, before, during, and after QG. Our results showed that QG caused an enhancement of brainstem auditory evoked response with a concomitant depression of cortical responses. These observations may be related to the healing and other health benefits of QG.

High-frequency components in epileptiform EEG

We analyzed the spectral content of interictal and ictal EEG of rats treated with metrazol. Significant power was present in the EEG between 100 and 800 Hz ictally but not interictally. Since high-frequency activities appeared to accompany spiking episodes, a computer algorithm was developed to recognize rapid voltage fluctuations or high-frequency components in EEG. The algorithm turned out to be effective in the identification of seizure spikes. The significance of high frequencies in EEG spikes and the advantage of the spike selection algorithm are discussed.

The product of the retinoblastoma susceptibility gene has properties of a cell cycle regulatory element

The retinoblastoma susceptibility gene product, Rb, is suspected to suppress cell growth. Rb is a 110-114 kd nuclear phosphoprotein. We have previously demonstrated that SV40 T antigen binds only to unphosphorylated Rb, and not pp112-114Rb, the family of phosphorylated Rb. Here we demonstrate the cell cycle-dependent phosphorylation of Rb. In G0/G1 cells, virtually all the Rb is unphosphorylated. In contrast, during S and G2, it is largely, if not exclusively, phosphorylated. Rb phosphorylation occurs at the G1/S boundary in several cell types tested. A 14 residue peptide, corresponding to the SV40 T domain required for transformation, is able to compete effectively with SV40 T for binding to p110Rb. We propose a model to explain how Rb may suppress cell growth by acting as a cell cycle regulatory element.

[Basic studies on oral administration of lentinan (I)--influence on lymphocyte subsets in peripheral venous blood]

The effect of oral administration of lentinan (LTN), a biological response modifier, in the control of systemic immune function was studied in 6-week old male Wistar-Imamichi SPF rats. In the LTN group, 1 mg LTN dissolved in 1 ml physiological saline was administration forcibly into the stomach twice weekly. Physiological saline alone was administered in a similar fashion to the control group. Blood samples were obtained prior to and after four and eight weeks of administration. White blood cells and lymphocyte counts were obtained and lymphocyte subsets were measured using monoclonal antibodies W3/13, W3/25 and 0 X 8 (Sera-Lab), and a laser flow cytometry system (Orthospectrum III, Orthodiagnostic System). The T cell ratio, helper/inducer T (Th) cell ratio, and suppressor/cytotoxic T (Ts) cell ratio were measured. The peripheral white blood cell count and lymphocyte count were not significantly different between the control and LTN groups. After four weeks of LTN administration, however, the LTN group showed a significantly higher T cell ratio, Th cell ratio and Th/Ts cell ratio than did the control group, and the Ts cell ratio was significantly lower. In the groups undergoing administration for eight weeks, no difference was noted in the lymphocyte subsets between the two groups. Oral administration of LTN apparently modulates the systemic immune function through T cell stimulation, especially Th cells, but continued administration may induce a tolerance to the effect of LTN.

IL-6/IFN-beta-2 as a circulating hormone. Induction by cytokine administration in humans

IL-6/IFN-beta 2 is a family of phosphoglycoproteins ranging in size from 19 to 30 kDa which elicits a broad range of physiologic and immune responses. Several cytokines, including TNF, have been shown to stimulate IL-6 production in cell culture. In this report, we describe the rapid induction of circulating biologically active IL-6 by the systemic administration of rTNF to patients with cancer. Low levels of IL-6 activity could be detected in the sera of patients as early as 5 min after rTNF infusion. IL-6 levels peaked approximately 2 to 3 h after rTNF bolus administration and were undetectable in most cases within 8 h. IL-6 was detected in two separate bioassays--the hybridoma B9 proliferation and the hepatocyte-stimulating factor assay. Maximum detectable levels of IL-6 ranged from 160 to 310 hybridoma growth factor units and 11-82 ng/ml in the hepatocyte-stimulating factor assay. IL-6 induction decreased after serial, daily doses of rTNF. Serial serum samples of patients receiving IL-2 or IFN-alpha were also assayed for IL-6 production. IL-2-treated but not IFN-alpha-treated patients generated low levels of IL-6 (range less than 20 to 95 hybridoma growth factor units/ml). Interestingly, in patients treated with IL-2, serum levels of TNF were detectable and peak TNF activity preceded measurable IL-6 levels. Serum levels of acute phase plasma proteins and of corticosteroid rose in response to rTNF administration. C-reactive protein increased (2.5 to 4.0-fold) within 8 h of rTNF administration and cortisol levels rose (10- to 20-fold) within 4 h after rTNF injection. We conclude that rTNF administration in man leads to the induction of circulating IL-6 which, due to its broad range of activities, may be an important physiologic signal regulating the immune response.

IL-6/IFN-beta-2 as a circulating hormone. Induction by cytokine administration in humans

IL-6/IFN-beta 2 is a family of phosphoglycoproteins ranging in size from 19 to 30 kDa which elicits a broad range of physiologic and immune responses. Several cytokines, including TNF, have been shown to stimulate IL-6 production in cell culture. In this report, we describe the rapid induction of circulating biologically active IL-6 by the systemic administration of rTNF to patients with cancer. Low levels of IL-6 activity could be detected in the sera of patients as early as 5 min after rTNF infusion. IL-6 levels peaked approximately 2 to 3 h after rTNF bolus administration and were undetectable in most cases within 8 h. IL-6 was detected in two separate bioassays--the hybridoma B9 proliferation and the hepatocyte-stimulating factor assay. Maximum detectable levels of IL-6 ranged from 160 to 310 hybridoma growth factor units and 11-82 ng/ml in the hepatocyte-stimulating factor assay. IL-6 induction decreased after serial, daily doses of rTNF. Serial serum samples of patients receiving IL-2 or IFN-alpha were also assayed for IL-6 production. IL-2-treated but not IFN-alpha-treated patients generated low levels of IL-6 (range less than 20 to 95 hybridoma growth factor units/ml). Interestingly, in patients treated with IL-2, serum levels of TNF were detectable and peak TNF activity preceded measurable IL-6 levels. Serum levels of acute phase plasma proteins and of corticosteroid rose in response to rTNF administration. C-reactive protein increased (2.5 to 4.0-fold) within 8 h of rTNF administration and cortisol levels rose (10- to 20-fold) within 4 h after rTNF injection. We conclude that rTNF administration in man leads to the induction of circulating IL-6 which, due to its broad range of activities, may be an important physiologic signal regulating the immune response.

A clinical controlled trial of endoscopic sclerotherapy for repeated esophageal variceal bleeding

Thirty-seven patients with postnecrotic cirrhosis of the liver and 13 patients with primary hepatoma were proven to have repeated bleeding from ruptured esophageal varices. Clinically controlled trials were performed by assigning patients to either sclerotherapy or control arms (25 patients each). Combined intra-variceal and para-variceal injection before an upper endoscopic examination was performed in the sclerotherapy group. In all 25 sclerotherapy cases (100%) hemostasis was successful, which was a statistically significant success rate compared to the control group (52.0%) (p less than 0.01). In the sclerotherapy group 20% (5/25 cases) developed rebleeding, which was less than the 48.0% (7 cases of continuous bleeding and 5 cases of rebleeding) of the control group (p less than 0.05). Four cases (16.0%) in the sclerotherapy group died of erosive gastritis with massive bleeding, compared to 8 fatalities (32.0%) in the control group, because of uncontrolled esophageal variceal bleeding. Endoscopic sclerotherapy is a very effective method for arresting bleeding esophageal varices, and for decreasing the rebleeding rate.

SV40 large T antigen binds preferentially to an underphosphorylated member of the retinoblastoma susceptibility gene product family

Extracts of monkey cells (CV-1P) synthesizing SV40 large T antigen (T) were immunoprecipitated with monoclonal antibodies to T or p110-114Rb, the product of the retinoblastoma susceptibility gene (Rb). While a family of p110-114Rb proteins can be detected in anti-Rb immunoprecipitates, only one member of this family, p110Rb, was found in anti-T precipitates of these extracts. Identical results were obtained with extracts of CV-1P cells which had been previously mixed in vitro with highly purified T. The p110-114Rb family is composed of two sets--p110Rb, an un- or under-phosphorylated species, and pp112-114Rb, a group of overtly phosphorylated proteins. Thus, T bound preferentially to the un- or underphosphorylated member of the family. In addition, T failed to alter the relative abundances of these species. These results suggest a model in which the growth suppression function of Rb is down modulated either by phosphorylation or T antigen binding.

Evaluation of a radioimmunoassay of urinary cortisol without extraction

We evaluated the Kallestad "Quanticoat" cortisol RIA for direct (no extraction) measurement of urinary free cortisol, which requires no solvent extraction. An analytical-recovery study showed a linear regression of y (measured) = 0.65x (added) + 37.5 micrograms/L (Sy.x = 21.4 micrograms/L, r = 0.978, n = 48). Recovery appeared to vary with the urine used and with the concentrations of cortisol added. Within- and between-run CVs were less than or equal to 4.1% and less than or equal to 3.8%, respectively. Cross reactivities were low, except for prednisolone (20.5%). This no-extraction method gave higher values for urinary free cortisol than did either an RIA method involving extraction or an HPLC method. A comparison study with the HPLC (x) and with the method involving extraction (x') gave the following Deming-debiased regression equations: y = 1.60x + 68.8 (Sy.x = 34.4, n = 29) and y = 1.33x' + 0.69 (Sy.x = 40.3, n = 66), respectively. We conclude that the no-extraction method may give misleading results for patients' diagnosis or management if this cross reactivity is not taken into account.

Evaluation of a radioimmunoassay of urinary cortisol without extraction

We evaluated the Kallestad "Quanticoat" cortisol RIA for direct (no extraction) measurement of urinary free cortisol, which requires no solvent extraction. An analytical-recovery study showed a linear regression of y (measured) = 0.65x (added) + 37.5 micrograms/L (Sy.x = 21.4 micrograms/L, r = 0.978, n = 48). Recovery appeared to vary with the urine used and with the concentrations of cortisol added. Within- and between-run CVs were less than or equal to 4.1% and less than or equal to 3.8%, respectively. Cross reactivities were low, except for prednisolone (20.5%). This no-extraction method gave higher values for urinary free cortisol than did either an RIA method involving extraction or an HPLC method. A comparison study with the HPLC (x) and with the method involving extraction (x') gave the following Deming-debiased regression equations: y = 1.60x + 68.8 (Sy.x = 34.4, n = 29) and y = 1.33x' + 0.69 (Sy.x = 40.3, n = 66), respectively. We conclude that the no-extraction method may give misleading results for patients' diagnosis or management if this cross reactivity is not taken into account.

Enzyme abnormalities of patients with acquired immunodeficiency syndrome

We determined the enzyme activities of glucose-6-phosphate isomerase, alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase in serum from 23 normal controls, 27 anti-HIV seropositive individuals confirmed by Western blot, and 53 patients with acquired immunodeficiency syndrome (AIDS). There is a significant difference for all four enzyme activities among controls, HIV seropositive individuals, and patients with AIDS, the enzyme activities showing a progressive increase as the disease progresses. Evidently these enzyme measurements may be adjunctive biochemical markers for progression of AIDS.

Enzyme abnormalities of patients with acquired immunodeficiency syndrome

We determined the enzyme activities of glucose-6-phosphate isomerase, alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase in serum from 23 normal controls, 27 anti-HIV seropositive individuals confirmed by Western blot, and 53 patients with acquired immunodeficiency syndrome (AIDS). There is a significant difference for all four enzyme activities among controls, HIV seropositive individuals, and patients with AIDS, the enzyme activities showing a progressive increase as the disease progresses. Evidently these enzyme measurements may be adjunctive biochemical markers for progression of AIDS.

Nutritional status of patients with acquired immunodeficiency syndrome

Nutritional status may be an important factor in the prognosis of morbidity and mortality. We assessed the nutritional status of individuals seropositive for human immunodeficiency virus (HIV) (as confirmed by Western blot) and of patients with AIDS, by determining the concentration in serum of total protein, albumin, prealbumin (transthyretin), and retinol-binding protein. HIV-seropositive individuals showed no significant difference from normal volunteers in values for prealbumin, albumin, and retinol-binding protein. Patients with AIDS showed significantly smaller prealbumin and albumin concentrations than did normal and HIV-positive individuals. There was no significant difference in the concentration of retinol-binding protein among the three groups. The concentration of total serum protein was significantly greater in HIV-positive individuals and in patients with AIDS than in normal individuals. Thus, the nutritional status of patients with AIDS may be a factor for morbidity and mortality.

Synthetic magainin analogues with improved antimicrobial activity

Based on modifications to enhance the alpha-helical structure of the broad spectrum antibiotic magainin 2, a series of analogues have been synthesized which display an increase up to two orders of magnitude in antimicrobial activity and, in the most favorable case, no appreciable increase in hemolytic activity over magainin 1 at the concentrations tested.

SV40 large tumor antigen forms a specific complex with the product of the retinoblastoma susceptibility gene

Monkey cells synthesizing SV40 large T antigen were lysed and the extracts immunoprecipitated with either monoclonal anti-T antibody or monoclonal antibody to p110-114, the product of the retinoblastoma susceptibility gene (Rb). T and p110-114 coprecipitated in each case, implying that the proteins are complexed with each other. Substitution and internal deletion mutants of T that contain structural alterations in a ten residue, transformation-controlling domain failed to complex with p110-114. In contrast, T mutants bearing structural changes outside of this domain bound to p110-114. These results are consistent with a model for transformation by SV40 which, at least in part, involves T/p110-114 complex formation and the perturbation of Rb protein and/or T function.

Development and evaluation of an automated dye-binding assay for protein in cerebrospinal fluid

Addition of sodium dodecyl sulfate (SDS) to Coomassie Brilliant Blue reagent equalizes the binding variability of the dye to various proteins and markedly improves the accuracy of quantification of protein in cerebrospinal fluid. In the presence of SDS, the absorption spectrum and the absorption maximum are affected by reaction time and temperature, age of the dye preparation, and protein constituent. I automated this procedure, to optimize precision, enable use of a smaller sample, decrease hands-on time, maintain consistency in the time of reading, and avoid carryover. The results (y) compared well with those of the aca (x), with a Deming de-biased regression equation of y = 0.991x + 14.1 mg/L, Sy.x = 33.4 mg/L. The within-run and between-run precision (CV) was less than 2.5% and less than 4.5%, respectively. Commonly used antibiotics, flucytosine, or amphotericin B do not interfere. This automated procedure is fast and accurate and requires only 10 microL of sample.

Development and evaluation of an automated dye-binding assay for protein in cerebrospinal fluid

Addition of sodium dodecyl sulfate (SDS) to Coomassie Brilliant Blue reagent equalizes the binding variability of the dye to various proteins and markedly improves the accuracy of quantification of protein in cerebrospinal fluid. In the presence of SDS, the absorption spectrum and the absorption maximum are affected by reaction time and temperature, age of the dye preparation, and protein constituent. I automated this procedure, to optimize precision, enable use of a smaller sample, decrease hands-on time, maintain consistency in the time of reading, and avoid carryover. The results (y) compared well with those of the aca (x), with a Deming de-biased regression equation of y = 0.991x + 14.1 mg/L, Sy.x = 33.4 mg/L. The within-run and between-run precision (CV) was less than 2.5% and less than 4.5%, respectively. Commonly used antibiotics, flucytosine, or amphotericin B do not interfere. This automated procedure is fast and accurate and requires only 10 microL of sample.

An enzymatic method for 5-fluorocytosine

We developed an enzymatic method for determination of 5-fluorocytosine in serum, using creatine iminohydrolase (EC 3.5.4.21), the Cobas-Bio analyzer, and an extant ammonia method. Analytical recovery (y) of drug added to serum (x) was good, with y = 0.97x-0.7, Sy.x = 3.6, r = 0.997 (n = 65) over the range 6.25 to 150 mg/L. Comparison with an HPLC method (x) showed good agreement: y = 0.98x + 1.34, Sy.x = 3.7 (n = 37), as analyzed with the Deming debiased regression. Precision was good, CVs being less than 3% for within-run and less than 6% for between-run controls. Ammonia, amphotericin B, glucose, urea, and hemolysis do not interfere, but bilirubin shows analyte-dependent interference and lipemia interferes when triglycerides exceed 5 g/L. This assay is accurate, inexpensive, and easy to perform. It can be easily adapted for routine or emergency use.

An enzymatic method for 5-fluorocytosine

We developed an enzymatic method for determination of 5-fluorocytosine in serum, using creatine iminohydrolase (EC 3.5.4.21), the Cobas-Bio analyzer, and an extant ammonia method. Analytical recovery (y) of drug added to serum (x) was good, with y = 0.97x-0.7, Sy.x = 3.6, r = 0.997 (n = 65) over the range 6.25 to 150 mg/L. Comparison with an HPLC method (x) showed good agreement: y = 0.98x + 1.34, Sy.x = 3.7 (n = 37), as analyzed with the Deming debiased regression. Precision was good, CVs being less than 3% for within-run and less than 6% for between-run controls. Ammonia, amphotericin B, glucose, urea, and hemolysis do not interfere, but bilirubin shows analyte-dependent interference and lipemia interferes when triglycerides exceed 5 g/L. This assay is accurate, inexpensive, and easy to perform. It can be easily adapted for routine or emergency use.

Digital dermal patterns in breast cancer

Fingerprints of 570 breast cancer cases and the same number of matched controls were obtained from the population-based finger print file in Hawaii for studying the association between breast cancer and digital dermal patterns and ridge counts. The results showed that breast cancer patients had a significant excess of radial loops on the left hand. It was also found that the frequency of ulnar loops on the left hand was significantly elevated for premenopausal women with breast cancer, whereas an excess of radial loops on the left hand was observed for the postmenopausal women with breast cancer. No significant difference for the total and absolute ridge counts was found between breast cancer patients and controls.