The avoidance of small intestine injury in gynecologic cancer

The evolution of systematized operative staging and radical surgical procedures in the management of gynecologic cancer has increased the complexities of integrating radiation therapy. High dose irradiation to large treatment volumes has been associated with an increased incidence of small intestine injury. This complication is morbid and often fatal. Although predisposing factors have been extensively studied, there has been a paucity of reports evaluating preventative measures. Between 1975 and 1980, 140 patients with gynecologic cancer were treated at the Valley Presbyterian Hospital in the Division of Radiation Therapy. Twenty-six patients with cervix cancer received definitive irradiation and seven received adjunct irradiation. Seventy-two with corpus cancer received adjunct irradiation, seven received definitive irradiation and three palliative irradiation. Eleven patients with ovarian cancer received adjunct irradiation and 15 palliative irradiation. Eight-five patients were at potential risk for small intestine injury and had treatment planning small intestine X rays. Fixation was observed in 7/39 (18%) without prior pelvic surgery and 30/46 (65%) with prior pelvic surgery. Information from the small intestine X rays were used in 41 patients to make 60 treatment modifications. Twenty-five of 140 (17%) had a reduction of total dose, 26/140 (18%) had exclusion of the small intestine by shrinking fields, or patient positioning and 13/140 (9%) had displacement of the small intestine by distention of the bladder. No patient developed small intestine injury. The disease free survival for cervix cancer was 27/33 (82%), corpus cancer 68/79 (86%) and ovarian cancer 5/11 (45%). Pelvic failure was observed in 19/123 patients who received definitive or adjunct irradiation. One patient with corpus cancer and three patients with ovarian cancer might have benefited from the use of a larger treatment volume or a higher total dose.

Tolerance of T-cell clones is associated with membrane antigen changes

It is possible to regulate the activity of human influenza virus specific helper T-cell clones either by high concentrations of antigen or by anti-idiotypic suppressor T cells. In the absence of accessory cells, the appropriate peptide antigen recognized by the clones induces specific unresponsiveness. This phenomenon, however, is not the result of cytolysis as responsiveness to IL-2 remained unaltered. This suggests that high-dose immunological tolerance need not involve suppressor T cells, and that peptide antigens can interact directly with the T-cell surface. As recent reports suggest that the T-cell surface antigen T3 is involved in the triggering of T lymphocytes and possibly in antigen recognition we have investigated the expression of T3 and other cell surface antigens following the induction of T-cell tolerance. We report here that when a T-cell clone is exposed to a tolerizing concentration of the appropriate peptide antigen, surface T3 antigen is lost in a dose-dependent manner. As loss of surface T3 induced by anti-T3 antibody also results in unresponsiveness to antigen, we conclude that T3 is involved in the process of T-cell triggering by antigen.

Induction of tolerance in influenza virus-immune T lymphocyte clones with synthetic peptides of influenza hemagglutinin

Antigen-specific human T cell clones specific for defined peptides of influenza A hemagglutinin were found to be rendered unresponsive by incubation with moderately high concentrations of antigen. This was the case whether the synthetic peptide antigen was present for the duration of the culture or the cloned T cells were preincubated with antigen for 3-18 h at 37 degrees C, before stimulation with T-depleted irradiated sheep erythrocyte non-rosette-forming lymphocytes (E-) pulsed with the optimal dose of peptide. Tolerance could not be overcome by culture with various numbers of E- cells and antigen. The induction of unresponsiveness was antigen specific, since it depended upon incubation with the appropriate peptide recognized by that clone. In addition, the tolerant T cells remained unresponsive to stimulation with the specific peptide for at least 7 d after induction even though maintained in culture in the presence of T cell growth factor. This state of antigen-specific unresponsiveness is akin to immunological tolerance. Furthermore, the experiments reported here demonstrate that the helper T cell clone can be inhibited by the relevant peptide in the absence of any suppressor cells or their precursors. This suggests that antigen-induced unresponsiveness need not always depend on the presence of suppressor T cells. The induction of tolerance in T cell clones does not result in early T cell death, since cells that no longer proliferate in response to the specific antigen and accessory cells still proliferate in response to T cell growth factor.

Radiation therapy in bulky seminoma

Between 1969 and 1980, 17 patients with bulky retroperitoneal seminoma and 1 patient with bulky mediastinal seminoma were treated with radiation therapy. One patient had resection of gross retroperitoneal disease, and 1 patient had resection of gross mediastinal disease. Fifteen patients received adjuvant irradiation to the mediastinum and paraclavicular lymph nodes, and 1 patient received adjuvant chemotherapy. At last follow-up, 17 of 18 patients (94%) remain free of disease. No patient has sustained treatment-related morbidity or mortality.

Chemically synthesized peptides of hepatitis B surface antigen duplicate the d/y specificities and induce subtype-specific antibodies in chimpanzees

Synthetic peptides, predicted from the nucleotide sequence of the S gene of hepatitis B virus were analyzed in terms of the established specificities of the hepatitis B surface antigen. The analysis indicated that the group-specific alpha antigen is composed of at least three nonoverlapping sequences and that a relatively hydrophilic region of the surface antigen protein, spanning amino acid residues 110-137, specifies the major d and y subtype system. The d/y subtype appears to depend on changes in one or more variable amino acids at positions 127, 131, and 134 of the hepatitis B surface antigen protein. Peptide 49 (consisting of amino acid sequences of the y subtype for the region 110-137), coupled to a carrier protein and mixed with an adjuvant, stimulated a brisk anti-y response in chimpanzees, the relevant model of human response to hepatitis B virus immunization and infection. Experimental challenge with homologous hepatitis B virus resulted in a pattern of partial protection. The results offer promise for the application of chemically synthesized peptides as vaccines in the prophylaxis of hepatitis B virus disease.

Antibodies that react with predetermined sites on proteins

Contrary to previous predictions, relatively short synthetic peptides that mimic part of a protein sequence are routinely capable of eliciting an antiserum that reacts with the partially mimicked protein. Peptides capable of eliciting protein-reactive serums are frequently represented in the primary sequence of a protein, can be characterized by a set of simple chemical rules, and are confined neither to immunodominant regions of intact proteins nor to the amino or carboxyl terminals. As such, synthetic peptide immunogens are valuable for eliciting reagents with predetermined specificity that can be used for basic research. In addition, some synthetic peptides are capable of mimicking regions of virus proteins and eliciting immune responses in animals that are protective against the viral agents. Such peptides may thus serve as the basis for safe, chemically defined synthetic vaccines.

Clinical experience with malignant pheochromocytomas

In a 30 year period at Vanderbilt University Hospital, the affiliated Nashville General Hospital and the Nashville Veterans Administration Hospital, 64 patients with pheochromocytoma have been observed. In eight of these, the tumor proved to be malignant. Retrospective review of biologic characteristics of pheochromocytomas in this series included clinical, diagnostic imaging, chemical and histopathologic data. Aside from presence of distant metastases, none of these features had predictive value in indicating the biologic malignant nature of the primary tumor. One patient has been cured by radical surgical resection for 16 years. Three others have died with metastatic tumor and three patients are alive with metastatic tumor.

Immunogenic structure of the influenza virus hemagglutinin

We chemically synthesized 20 peptides corresponding to 75% of the HA1 molecule of the influenza virus. Antibodies to the majority (18) of these peptides were capable of reacting with the hemagglutinin molecule. These 18 peptides are not confined to the known antigenic determinants of the hemagglutinin molecule, but rather are scattered throughout its three-dimensional structure. In contrast, antibody raised to intact hemagglutinin did not react with any of the 20 peptides. Taken together these results suggest that the immunogenicity of an intact protein molecule is not the sum of the immunogenicity of its pieces.

Lung cancer: retreatment of local recurrence after definitive irradiation

Aggressive radiation therapy for the management of inoperable lung cancer has increased tumor control and survival. However, approximately 20% of patients continue to experience local recurrence as the sole manifestation of treatment failure. Seven hundred thirty-four patients were initially treated by radiation therapy for inoperable lung cancer, for recurrence after resection, or as adjunct postoperative therapy. Twenty-nine patients were referred for retreatment of cancer that recurred within the original treatment field. Following retreatment, 14 of 29 patients (48%) had a favorable subjective response, and 20 of 27 patients (74%) a favorable objective response. A favorable response was observed for all cell types and over a wide range of retreatment dosages. Symptomatic radiation pneumonitis developed in one patient, rib sclerosis and fracture developed in another. Th median survival after onset of retreatment was five months with a range of one month to 54 months. The clinically determined mechanisms of death were persistent intrathoracic disease in 14 of 25 patients (56%), intrathoracic disease and distant metastasis in 7 of 25 (28%), distant metastasis in 3 of 25 (12%), and unknown in 1 of 25 (4%).

Differentiated function in cultured epithelia derived from thick ascending limbs

Medullary thick ascending limbs were dissected from rabbit kidney and cultured on thin collagen membranes. The collagen membranes were supported by a special device that limited the exposed surface area to a disk 1 mm in diameter. The cells usually proliferated to form a confluent epithelial monolayer covering the collagen membrane within 8-10 days. Transepithelial voltage was measured between bridges immersed in the solutions bathing the bottom of the collagen membrane and the apical (upper) surface of the epithelium. The voltage typically was oriented positive toward the apical surface and persisted for a few weeks. Furosemide but not amiloride reduced the voltage reversibly. Both the orientation of the voltage and its reduction by furosemide are characteristic of thick ascending limbs. Therefore, the observed voltage supports the identification of the epithelial cells in culture and is evidence of differentiated function.

Organic solutes in fluid absorption by renal proximal convolutes tubules

Page 627: M. Burg, C. Patlak, N. Green, and D. Villey. “Organic solutes in fluid absorption by renal proximal convolutes tubules.” Page 628: the equation in the right column should read

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Sequence-specific antibodies show that maturation of Moloney leukemia virus envelope polyprotein involves removal of a COOH-terminal peptide

We followed maturation of the glycosylated envelope polyprotein Pr80env of a murine retrovirus by using antisera specific to subregions of the protein, including an antiserum directed against a synthetic peptide corresponding to the COOH-terminus of Pr80env. Shortly after synthesis and glycosylation, Pr80env is cleaved into two species, gp70 and Pr15E, that are found associated, perhaps through disulfide bonds, in infected cells. Pr15E is further cleaved at the time of virus maturation to form virus protein p15E. NH2-Terminal protein sequence analysis showed that Pr15E had an NH2 terminus in common with p15E. Pr15E, but not p15E, is precipitated by antibody against the COOH-terminal peptide; hence, p15E is missing a peptide at the COOH-terminus. Our data indicate that Pr15E is the predominant species in cells and p15E is the major species in virus.

Response of lymph node metastasis to sequential estrogen and radiation therapy in prostate carcinoma

Increasingly sophisticated diagnostic studies have shown a high incidence of tumor spread to the regional lymph nodes. The status of the lymph nodes has been evaluated by noninvasive diagnostic procedures such as lymphangiography and computerized axial tomography. The applicability of these procedures has been enhanced by the use of stringent criteria. Gross lymph node metastasis can be diagnosed with considerable confidence. Serial observations of lymphangiograms and computerized axial tomograms before and two months after the administration of estrogens provide an added dimension to the interpretation of lymph node metastasis. The nature and range of the response of lymph node metastasis were observed. Survival of patients with gross lymph node metastasis treated by sequential estrogen and radiation therapy was evaluated. A total of 11/18 (61 per cent) of patients remained free of symptoms, 8/11 (74 per cent) with a favorable lymph node metastasis responsive to estrogen therapy, and 3/7 (42 per cent) with lymph node metastasis refractory to estrogen therapy. Follow-up computerized axial tomograms of the lymph nodes done at one and two years after irradiation showed a persistent favorable response. Five patients are alive with disease, and 2 patients died of the disease.

Chemically synthesized peptides predicted from the nucleotide sequence of the hepatitis B virus genome elicit antibodies reactive with the native envelope protein of Dane particles

Thirteen peptides corresponding to amino acid sequences predicted from the nucleotide sequence of the hepatitis B surface antigen were synthesized chemically. The free or carrier-linked synthetic peptides were injected into rabbits, and 7 of the 13 elicited an antipeptide response. Antisera against four of the six soluble peptides longer than 10 amino acids were reactive with native antigen and specifically precipitated the 23,000- and 28,000-dalton forms from Dane particles. As the hepatitis molecule had not been chosen for study because of any structural feature suggesting unique opportunities for success, these results suggest that the strategy is general and should work for any protein as long as enough domains are studied. Peptides such as these could prove to be ideal vaccines.

Perineural metastases from squamous cell carcinoma of the face. Therapeutic considerations

Perineural metastasis from squamous cell carcinoma of the facial skin can cause disabling pain, paresis, soft tissue tumefaction bone destruction, impaired function and impaired vision. Two patients with perineural metastases were treated with palliative megavoltage irradiation and interstitial therapy. The meastases were controlled. Pain improved; cosmesis, function and vision were preserved.

Chemical synthesis of a polypeptide predicted from nucleotide sequence allows detection of a new retroviral gene product

We previously determined the nucleotide sequence of the 3' end of Moloney leukaemia virus and discovered the potential coding region for an unknown protein, R. We now show that this region does encode a protein. A pentadecapeptide of R was chemically synthesized and antibodies raised against it. Antisera to the synthetic peptide recognize the R protein and the env precursor polyprotein in infected cells. The strategy presented here should provide a general method for accessing proteins predicted by nucleotide sequences.

Expression of leukemogenic recombinant viruses associated with a recessive gene in HRS/J mice

HRS/J inbred mice carry a mutant autosomal recessive gene (hr), which in homozygotes coincides with susceptibility to spontaneous thymic leukemia. Unlike their heterozygote (hr/+) littermates, hr/hr homozygotes express high levels of xenotropic virus during the preleukemic period, and viruses with a broadened host range (termed polytropic viruses) can be isolated from their preleukemic and leukemic tissues. Because hr/hr and hr/+ mice are otherwise genetically identical, the virological differences between them support the role of polytropic viruses in the generation of thymic leukemia. In the present report we show that the HRS/J polytropic viruses are env gene recombinants with unique oligonucleotide and peptide maps. These polytropic viruses appear to arise by recombination between ecotropic virus and an unidentified genome related, but not identical to, the endogenous xenotropic viruses. Moreover, polytropic viruses not only accelerate leukemogenesis in HRS/J mice, but also induce thymic leukemia in the low leukemia strain CBA/J. By contrast, cloned ecotropic and xenotropic viruses have no leukemogenic action.

The syndrome of multisynostotic osteodysgenesis with long-bone fractures

Described here are two patients with a newly recognized syndrome of bone and cartilage maldevelopment which, we believe, results from a single embryonic defect, probably of genetic origin. The cardinal manifestations of this association are craniosynostosis, radiohumeral synostosis (RHS), and femoral bowing. Specific secondary defects include midface hypoplasia with characteristic facial appearance and ears, neonatal femoral fractures, and multiple minor anomalies of the limbs. Though the differential diagnosis includes such disorders as the campomelic syndrome, osteogenesis imperfecta (OI) and certain of acrocephalosyndactyly syndromes, the unique combination of clinical and radiographic abnormalities allows ready differentiation. The cause cannot be determined from these two cases.

Conditioned suppression of a thymus-independent antibody response

An illness-induced taste aversion was conditioned in mice by pairing cyclophosphamide, an immunosuppressive drug, with the consumption of saccharin, a novel drinking solution. Two weeks after conditioning, animals were injected with the hapten trinitrophenyl (TNP) coupled to the thymus-independent carrier, lipopolysaccharide. Serum antibodies to TNP were titered 6 days later by passive hemagglutination. Relative to control groups, conditioned animals provided with saccharin at the time of antigenic stimulation and, again, 3 days later showed a significant attenuation of their anti-TNP antibody response. In a second experiment, the conditioned stimulus (CS) consisted of the novel saccharin drinking solution plus the noxious internal effects of an injection of LiCl. Conditioned animals reexposed to the CS again showed the lowest antibody titers, but differed significantly from only one of the control groups. Taken together, the results of these experiments confirm previous reports of conditioned immunosuppression and suggest that the effects of conditioning on a primary humoral antibody response can be observed in response to a T-cell independent antigen in the mouse.

Rapid staining technique for Trichomonas vaginalis. Preliminary report

A simple, rapid, staining method for the identification of Trichomonas vaginalis has been tested on cultured trichomonads and specimens of vaginal discharge. Fifty-eight stained slides of vaginal discharge were examined and trichomonads were correctly identified in the 31 specimens from patients with confirmed vaginal trichomoniasis. No false-positive results were obtained. This staining procedure could prove a useful addition to wet-film and cultural methods.