Effects of the somatostatin analog lanreotide on the circulating levels of chromogranin-A, prostate-specific antigen, and insulin-like growth factor-1 in advanced prostate cancer patients

BACKGROUND

The concept that neuroendocrine cells detected within prostate adenocarcinoma produce paracrine factors, that may exert a proliferative effect on exocrine prostate tumor cells, provides a rationale for the use of somatostatin analogs with the aim to counteract or delay the tumor progression. This study was designed to provide preliminary information on the effect of the administration of a long-acting somatostatin analog, lanreotide, on plasma levels of chromogranin A (CgA). Secondary aims were the evaluation of changes in circulating prostate-specific antigen (PSA) and insulin-like growth factor-1 (IGF-1).

METHODS

Lanreotide (Ipstyl 30 mg; Ipsen, Milan, Italy) was administered intramuscularly every 14 days for 2 months to nine heavily pretreated prostate cancer patients with hormone refractory disease. All patients had, at baseline conditions, CgA values above the normal range. Androgen deprivation was maintained during the study period, while other concomitant antineoplastic treatments were not allowed. Serum PSA levels and plasma CgA and IGF-1 values were measured every week.

RESULTS

Lanreotide treatment was very well tolerated and no patient experienced major toxicity. Plasma CgA values at baseline: mean 109 U/liter, standard deviation +/- 85 decreased significantly after treatment as follows: 42 U/liter, +/- 17.8; 27.2 U/liter +/- 13.6; 31.4 U/liter, +/- 17.8 and 27.6 U/liter, +/- 17.0; after 7, 14, 21, and 28 days, respectively (P < 0.01, Friedman ANOVA). Serum PSA did not change. Baseline IGF-1 was found to be above the detection limit in four cases, all of them showing a decrease after lanreotide.

CONCLUSIONS

Lanreotide administration to prostate cancer patients induces a decrease in plasma CgA and IGF-1 levels, without any influence on serum PSA values. Prostate 47:205-211, 2001.

A FYVE-finger-containing protein, Rabip4, is a Rab4 effector involved in early endosomal traffic

The small GTPase Rab4 is implicated in endocytosis in all cell types, but also plays a specific role in some regulated processes. To better understand the role of Rab4 in regulation of vesicular trafficking, we searched for an effector(s) that specifically recognizes its GTP-bound form. We cloned a ubiquitous 69-kDa protein, Rabip4, that behaves as a Rab4 effector in the yeast two-hybrid system and in the mammalian cell. Rabip4 contains two coiled-coil domains and a FYVE-finger domain. When expressed in CHO cells, Rabip4 is present in early endosomes, because it is colocated with endogenous Early Endosome Antigen 1, although it is absent from Rab11-positive recycling endosomes and Rab-7 positive late endosomes. The coexpression of Rabip4 with active Rab4, but not with inactive Rab4, leads to an enlargement of early endosomes. It strongly increases the degree of colocalization of markers of sorting (Rab5) and recycling (Rab11) endosomes with Rab4. Furthermore, the expression of Rabip4 leads to the intracellular retention of a recycling molecule, the glucose transporter Glut 1. We propose that Rabip4, an effector of Rab4, controls early endosomal traffic possibly by activating a backward transport step from recycling to sorting endosomes.

[Pelvic ultrasound monitoring of lymphocele in patients treated with radical prostatectomy]

Pelvic lymphoceles, occurred in patients undergone radical retropubic prostatectomy, are believed to increase the risk of deep venous thrombosis and so thromboembolic complications. The authors' aim is to evaluate the usefulness of pelvic ultrasonography in the diagnosis and in the possible early treatment of pelvic lymphoceles. Fifty-eight patients undergone radical prostatectomy and pelvic lymphadenectomy, between January '98 and December '99, underwent a pelvic ultrasonography in VII post-operative day. When a symptomatic or large (over 5 cm) lymphocele was found, it was treated with ultrasound (US) guided drainage. In the study, the following parameters were considered: lymphocele occurrence, size, location and treatment and thromboembolic complication. Statistical analysis was carried out with Fisher's exact test. Pelvic US showed a lymphocele in 23 out of 58 (40%) patients. Mean size was 5 cm. Deep venous thrombosis occurred in 4 patients, all with pelvic lymphoceles. No thromboembolic complications were recorded. In our experience, pelvic ultrasound has shown to be an easy e reliable tool for diagnosis and percutaneous treatment of pelvic lymphoceles.

[Efficiency of the extraction method with saline dextran in the pp65 antigenemia assay against human cytomegalovirus]

BACKGROUND

To prospectively evaluate the efficacy of the saline dextran extraction method in the human cytomegalovirus (CMV) pp65 antigenemia assay (Ag-pp65).

MATERIAL AND METHODS

In a 2 months period we studied all the blood samples from immunodepressed patients. The extraction of leukocytes polymorphonuclear (LPMN) was obtained with a 6% dextran solution in 0.9% saline. The total leukocytes population was counted and the percentage of LPMN obtained was established. Simultaneously the LPMN were cultivated into the MRC-5 cell line by the shell vial method (SVC).

RESULTS

The 144 blood samples studied were divided in three groups depending of the positivity in the pp65-AG and/or in the SVC. The patients with both assays positive presented the lower overall leukocyte and LPMN counting, with a difference statistically significance with the pp65-Ag negative. No statistically difference was observed in the overall count of leukocytes in the pp65-Ag negative group. The overall percentage of LPMN obtained was 87%. The median value of pp65-Ag positive samples was 48/100,000 LPMN, this value would be 51/100,000 LPMN with the application of the real percentage of LPMN obtained (p > 0.05).

CONCLUSIONS

The saline dextran extraction method presented a high efficacy in the majority of blood samples studied. The immunological status and the presence of a CMV infection or disease in the patient were the principal factors that influence the extraction method. In general there is no need to adjust the pp65-Ag value obtained with this method to the real one.

Usefulness of pp65 antigenemia and viremia in the follow-up of renal transplant recipients with cytomegalovirus disease treated with ganciclovir

We prospectively evaluated the usefulness of the pp65 antigenemia assay (AGA) and viremia (isolation) in the follow-up of 15 renal transplant recipients with a cytomegalovirus disease treated with ganciclovir. The AGA was performed with the extraction of PMNL with saline dextran, and the viremia detected by the inoculation of them in the MRC-5 cell line (shell-vial). Sixty-nine blood samples were studied, and 55 (79.7%) positive AGA and 42 (60.8%) positive viremia detected. The AGA needed a median of 9 days to negativize, and the viremia only 4 days. In eight patients (53%) the AGA and viremia were negative simultaneously. In seven patients (47%) the viremia was negative before the AGA (median 10.7 days). In this group, three patients (43%) presented a paradoxal rising of the AGA values after the negativization of the viremia. For the follow-up of renal transplant recipients treated with ganciclovir, the viremia was the most useful method of control. The viremia was negative before the AGA in many patients, demonstrating the therapeutic efficacy of ganciclovir.

Circulating neuroendocrine markers in patients with prostate carcinoma

BACKGROUND

Circulating neuroendocrine markers were measured in patients with prostate carcinoma (PC), prostatic intraepithelial neoplasia (PIN), and benign prostatic hypertrophy (BPH) with the goal to: 1) evaluate the differences in the expression of these markers in patients with benign, premalignant, and primary or metastatic PC; 2) evaluate their prognostic significance; 3) compare values in patients with hormone-naive and hormone-refractory disease; and 4) assess changes after androgen deprivation or chemotherapy.

METHODS

Serum neuron specific enolase (NSE) (immunoradiometric assay) and plasma chromogranin A (CgA) (enzyme-linked immunoadsorbent assay) were evaluated in 141 patients with BPH, 54 patients with PIN, and 159 patients with PC; 119 patients were bearing hormone-naive disease and 40 were bearing hormone-refractory disease. CgA was monitored in 31 patients submitted to androgen deprivation and in 24 patients receiving chemotherapy.

RESULTS

Supranormal CgA was observed more frequently in patients with American Urologic Association (AUA) Stage D2 disease (45.5%) compared with those with Stage D1 disease (33.3%), Stage C disease (16.7%), Stage A/B disease (18.8%), PIN (25.9%), and BPH (17.0%) (P < 0.02). Supranormal NSE did not change in any of the patient subgroups. Elevated CgA was observed in 36.0% of patients with metastases who had hormone-naive disease and in 45.0% of patients with hormone-refractory disease (P value not significant). Supranormal NSE and CgA values were predictors for poor prognosis in patients with hormone-refractory disease. Elevated baseline CgA values decreased > 50% in 1 of 12 patients who received luteinizing hormone-releasing hormone analogs and in 2 of 12 patients who underwent chemotherapy.

CONCLUSIONS

CgA appears to reflect the neuroendocrine activity of PC better than NSE. Elevated CgA values correlate with poor prognosis and are scarcely influenced by either endocrine therapy or chemotherapy.

[Evaluation of different clinical samples and cell lines in the isolation of enterovirus in pediatric patients]

BACKGROUND

To evaluate prospectively the efficacy of different clinical samples and cellular lines in the isolation of Enteroviruses from pediatric patients.

METHODS

In the period july-1997 to july-1999 we analyze the samples of 102 pediatric patients (< 2 years old) with an unknown febrile etiology syndrome. After the process of decontamination the samples were inoculated in the MRC-5, Hep-2 and Vero cell lines by the shell-vial assay. After 2-3 days of incubation the monolayers were stained by a monoclonal antibody against VP1; then the strains were identified as Poliovirus, ECHO-virus or Coxsacke by specific antibodies.

RESULTS

96 clinical samples were studied (45 pharyngeal swabs, 28 feces, 13 cerebrospinal fluid, 5 bloods, 4 urines and one bronchoalveolar lavage). Enteroviruses were isolated in 48 patients (47%), corresponding to 60 clinical samples (62.5%). The enteroviruses were isolated in 75.5% of pharyngeal swabs, 71.4% of feces, 30.7% of cerebrospinal fluid, one blood (20%) and the bronchoalveolar lavage. 28 patients presented simultaneously both pharyngeal and rectal swabs; in this group the use of both samples permitted the isolation of Enteroviruses in 26 cases (92.8%). Of 60 Enteroviruses, 59 (98.3%) were isolated in the MRC-5 cell line, 23 (38.3%) in the Hep-2, and 14 (23.3%) in the Vero; the MRC-5 demonstrated a significant difference in the isolation of Enteroviruses compared with the other cell lines. The Enteroviruses were identified as 30 (50%) ECHO-virus, 15 (25%) as Poliovirus vaccine, 12 (20%) could not to be identified and in 3 cases (5%) no growth of virus was detected in the culture. The MRC-5 cell line was significatively superior to the other in the isolation of the different Enteroviruses.

CONCLUSIONS

To obtain the maximum diagnostic efficacy in front a patient with a possible infection by Enteroviruses, is necessary to use different clinical samples, specially the more related to the infection focci (cerebrospinal fluid or blood). The MRC-5 cell line has been the most efficace in the isolation of Enteroviruses independently of the type of clinical sample or the viral genus. The shell-vial assay is a good method for the isolation and identification of Enteroviruses isolated from clinical samples.

Peracetic Acid and Chlorine Dioxide for Postharvest Control of Monilinia laxa in Stone Fruits

The effects of different concentrations of peracetic acid (PAA; 62.5, 125, 250, 500, and 1,000 μg/ml)and chlorine dioxide (ClO₂; 12.5, 25, 50, 100, and 200 μg/ml) on germination of Monilinia laxa conidia were tested. Conidia germination was related to the concentration of chemical product used, as well as duration of treatment. Complete inhibition of germination was observed with PAA at 500 μg/ml after 5 min of contact with conidia and with ClO₂ at 50 μg/ml after 1 min of contact with conidia. The results of in vitro tests were confirmed by inoculation of fruits with treated conidia. The PAA treatment also was effective 1 h after pathogen inoculation but only on plums, for which a 1,000 μg/ml treatment significantly reduced decay incidence by 50%. In a semi-commercial test, pathogen conidia dipped for 20 min in PAA at 250 μg/ml or ClO₂ at 10 μg/ml or for 5 min in PAA at 250 μg/ml were completely inhibited, and no brown rot was observed in inoculated wounded nectarines and plums.

Changes in free and free-to-total prostate specific antigen after androgen deprivation or chemotherapy in patients with advanced prostate cancer

PURPOSE

To provide preliminary data on whether the diagnostic role of serum prostate specific antigen (PSA) in assessing the response to treatment is improved by concomitant free PSA evaluation both markers were evaluated in 42 patients with advanced prostate cancer who received hormonal therapy and 57 with hormone refractory disease who received chemotherapy.

MATERIALS AND METHODS

PSA was assessed at baseline and every 3 months during treatment. Free PSA was assessed in stored serum samples obtained at baseline and at maximum PSA decrease. Free PSA was not measurable in 17 patients who received androgen deprivation (40.5%) and 2 who received chemotherapy (3.5%) because it was less than 1.5 ng./ml.

RESULTS

Of the 21 patients with greater than 50% PSA decrease after hormonal therapy free-to-total PSA increased in 12 (57.2%) and decreased in 9 (42.9%). Of the 20 patients with PSA response after chemotherapy free-to-total PSA increased in 18 (90.0%) and decreased in 2 (10.0%). Free-to-total PSA increased in 12 of the 20 patients (60.0%) with PSA stabilization after chemotherapy. Patients with an increase in free-to-total PSA after chemotherapy had greater survival compared to those with a decrease or no change (19.8 versus 15.5 months, respectively, p <0.03).

CONCLUSIONS

These data suggest that an effective cytotoxic regimen mainly affects the protein bound PSA fraction. The absence of a clear predominant pattern of free-to-total PSA in patients with PSA response to hormonal therapy and the high percentage of hormone sensitive patients in whom free PSA was not assessable at maximum PSA decrease suggest that free PSA evaluation is less useful in prostate cancer patients undergoing androgen deprivation.

Potential role of Rab4 in the regulation of subcellular localization of Glut4 in adipocytes

A role for Rab4 in the translocation of the glucose transporter Glut4 induced by insulin has been recently proposed. To study more directly the role of this small GTPase, freshly isolated adipocytes were transiently transfected with the cDNAs of both an epitope-tagged Glut4-myc and Rab4, a system which allows direct measurement of the concentration of Glut4 molecules at the cell surface. When cells were cotransfected with Glut4-myc and Rab4, the concentration of Glut4-myc at the cell surface decreased in parallel with the increased expression of Rab4, suggesting that Rab4 participates in the intracellular retention of Glut4. In parallel, the amount of Rab4 associated with the Glut4-containing vesicles increased. When Rab4 was moderately overexpressed, the number of Glut4-myc molecules recruited to the cell surface in response to insulin was similar to that observed in mock-transfected cells, and thus the insulin efficiency was increased. When Rab4 was expressed at a higher level, the amount of Glut4-myc present at the cell surface in response to insulin decreased. Since the overexpressed protein was predominantly cytosolic, this suggests that the cytosolic Rab4 might complex some factor(s) necessary for insulin action. This hypothesis was strengthened by the fact that Rab4 deltaCT, a Rab4 mutant lacking the geranylgeranylation sites, inhibited insulin-induced recruitement of Glut4-myc to the cell surface, even when moderately overexpressed. Rab3D was without effect on Glut4-myc subcellular distribution in basal or insulin-stimulated conditions. While two mutated proteins unable to bind GTP did not decrease the number of Glut4-myc molecules in basal or insulin-stimulated conditions at the plasma membrane, the behavior of a mutated Rab4 protein without GTPase activity was similar to that of the wild-type Rab4 protein, indicating that GTP binding but not its hydrolysis was required for the observed effects. Altogether, our results suggest that Rab4, but not Rab3D, participates in the molecular mechanism involved in the subcellular distribution of the Glut4 molecules both in basal and in insulin-stimulated conditions in adipocytes.

p53 protein expression as prognostic factor in patients undergoing radical prostatectomy for prostatic cancer

The authors give preliminary data on the evaluation of the p53 protein expression as prognostic factor in patients subjected to radical prostatectomy for prostatic cancer. p53 protein immunohistochemical nuclear staining was carried out on neoplastic tissue obtained from systematic sextant prostatic biopsies at the time of diagnosis. Out of 46 Patients 15 (32%) were p53 positive (p53+). No statistical correlation was observed between P53 staining, preoperative PSA and pathological Gleason Score, while the rate of patients with nodal involvement (pN+) was higher in the p53+ group than the P53- group with low statistical significance (p<0.03). The authors cannot yet evaluate Progression time and survival because the mean follow-up of the patients is still too short (30 months). The study is still in progress.

Oncogeni ed integrine nel carcinoma prostatico: Oncogenes and integrine in prostate cancer

We studied the c-ras oncogene and p53 oncosuppressorgene products (p21, p53) and also some integrine in prostatic cancer and BPH patients to evaluate a possible prognostic value. p21 was detected only in cancer tissue without any significant difference between different stages and grades of prostatic disease. p53 was more expressed in prostatic cancer than BPH, without any statistical difference. No correlation between p53 expression and different stages and grades was demonstrated. Fibronectin receptor (integrin) was significantly higher in cancer than BPH (P < 0,05). p53 expression, only in stage D patients, was related to a significant shorter progression time (P < 0,0001). Fibronectin receptor correlated with a significantly higher progression risk (Odds Ratio = 2,5).

Cervicobrachial neuralgia and low-back pain: psychological problems

The authors deal with the psychological and psychopathological implications connected with cervicobrachial neuralgia and low-back pain. In particular they propose a classification of the various pathologies pertaining to cervicobrachial neuralgia and low-back pain of nonneoplastic organic etiology. In the last part of the present paper the authors touch on the broader issues of patient handling and the role of psychiatric consultation.

[Identification and antibiotic-resistance of microbial strains isolated from urinary infections (author's transl)]

During the year 1977, 1491 urine samples were taken from patients living in the "Alta Valle del Tevere" (Umbria, Italy). The isolated microorganisms were examined and tested against 15 antibiotics. 535 samples (35.88%) were free from bacteria. Among the 1095 isolates, 52.42% were Gram-negative, 46.85% Gram-positive, and only 0.73% Fungi. The genera Citrobacter, Escherichia, Proteus, Pseudomonas, Enterobacter, Klebsiella, Staphylococcus and Enterococcus were identified. A high proportion of strains belonging to the genera Proteus and Pseudomonas were resistant to all the 15 antibiotics tested. However, although in a lower proportion, the multiple drug-resistance was present also in the strains of the genera Escherichia and Staphylococcus.