Carcinoembryonic antigen level in peritoneal washing is a prognostic factor in patients with gastric cancer

This study was designed to evaluate the usefulness of carcinoembryonic antigen (CEA) and sialyl-Tn antigen (STN) levels in peritoneal washings in gastric cancer patients. At the time of laparotomy, peritoneal washings were collected from 96 gastric cancer patients and CEA and STN levels were determined. Patients with elevated CEA (100 ng/g protein) had a high incidence for peritoneal metastasis, lymph node metastasis and serosal invasion. In addition, prognosis in patients with high CEA level was significantly poorer than in those without it. The peritoneal CEA is a prognostic factor in patients with gastric cancer.

Clinical analysis of small-sized peripheral lung cancer

OBJECTIVE

In Japan, with the initiation of the lung cancer screening program, small-sized peripheral lung cancer in which the diameter is 2 cm or less has been increasing. The purpose of this study is to determine the clinicopathologic behavior of small-sized lung cancer.

METHODS

Four hundred ninety-six patients with cT1 N0, peripheral, resected non-small-cell lung cancer, who were operated on between 1980 and 1996, were selected, grouped by tumor diameter or histologic type, and then analyzed for clinicopathologic behavior. On the basis of measured diameter roentgenographically, the patients were divided into two groups; group c-S with lesions 2 cm or less in diameter and group c-L with lesions 2.1 to 3 cm in diameter.

RESULTS

Lymph node metastasis was recognized in 18% of group c-S, in 23% of group c-L, and in 21% for the entire clinical group. The rate of those with the progressive state was 19% in group c-S and 26% in group c-L. The 5-year survival was 79.5% in group c-S and 69.3% in group c-L (i.e., there was a significant difference between the two groups).

CONCLUSION

Compared with the patients with lesions 2.1 to 3 cm in diameter, the patients with small-sized lung cancer had a milder progressive state and a better prognosis.

Loss of heterozygosity during the development and progression of differentiated adenocarcinoma of the stomach

In a recent allelotypic analysis of differentiated adenocarcinoma of the stomach, loss of heterozygosity (LOH) was found frequently on chromosomes 2q, 4p, 5q, 6p, 11q, 14q, 17p, 18q, and 21q. To clarify the sequence of these chromosomal losses during gastric carcinogenesis, microsatellite analysis of the chromosome arms described above was performed in 25 early and 29 advanced differentiated adenocarcinomas of the stomach. LOH on these chromosome arms fell within a range of 20-50 per cent. On 4p, 7q, 14q, 17p, and 21q, LOH was detected at a similar frequency in both early and advanced carcinomas, while LOH on 2q, 5q, 6p, 11q, and 18q was observed more than twice as frequently in advanced than in early lesions. Mean fractional allelic losses (FALs) were 0.221 in early and 0.413 in advanced carcinomas, representing a significant difference P < 0.05). These results suggest that LOH on 4p, 7q, 14q, 17p, and 21q is a relatively early event, while LOH on 2q, 5q, 6p, 11q, and 18q typically accumulates during the progression of gastric carcinogenesis.

Induction of DNA fragmentation by total-body irradiation in murine liver

Total-body irradiation (TBI) is an accepted modality to treat patients with disseminated tumors. The influence of the treatment on normal tissues is evaluated using mice by measuring the rate of the induction and distribution of apoptosis, as well as DNA fragmentation which occurs in the murine liver within hours of irradiation. Unanesthetized female C3H/He mice were exposed to gamma-ray TBI of 2, 7, and 20 gray (Gy) delivered from 60Co at a dose rate of 114 cGy/min. Frozen sections of livers which were excised from the animals at various times after irradiation were stained by hematoxylin-eosin (H-E) to count numbers of apoptotic cells, or were examined to detect DNA fragmentation. The percentages of apoptotic cells and length of the period during which the maximum levels of the percentages were exhibited showed a dose-dependent increase in the sections stained with H-E. No positive cells for 3'-OH ends of fragmented DNA were found in the liver before TBI, whereas positive cells were observed immediately after irradiation without dose-dependency, these positive cells returned to nearly basal levels after several hours. Positive cells were observed prior to showing apoptosis, suggesting that DNA fragmentation occurs immediately after TBI independent of apoptosis. The difference in the time courses between induction of DNA fragmentation and of apoptosis was not observed in other organs or in the samples treated with the detergent. These results suggested that the 3'-OH ends newly generated by TBI were masked by a detergent-soluble DNA-binding molecule which might be preferentially present in the murine liver.

Pharmacokinetics of cisplatin in combined cisplatin and 5-fluorouracil therapy: a comparative study of three different schedules of cisplatin administration

BACKGROUND

Cisplatin is widely used in combination chemotherapy against a variety of tumors; however, the optimal administration schedule of cisplatin is still controversial. To clarify the pharmacokinetic differences according to the administration schedules of cisplatin, we compared three different administration schedules of cisplatin such as single short-term infusion, daily short-term infusion and daily continuous infusion in combination with 5-fluorouracil. Preliminary clinical responses and toxicities were also investigated.

METHODS

A total of 12 courses in combination of cisplatin and 5-fluorouracil therapy was studied. The schedules of cisplatin tested were as follows: single short-term infusion (80 mg/m2, day 1,2 h div., n = 4), daily short-term infusion (20 mg/m2, days 1 to 5, 2 h div., n = 4), daily continuous infusion (100 mg/m2, 120 h, n = 4). In all schedules, 5-fluorouracil was continuously administered at a dose of 800 mg/m2/day on days 1 to 5. The area under the time-concentration curve (AUC) and the maximum concentration (Cmax) of total and free Pt were investigated.

RESULTS

The highest AUC of total and free Pt and the lowest Cmax of free Pt were observed in the daily continuous infusion (total AUC; 162.53 +/- 18.39 micrograms h/ml, free AUC; 5.50 +/- 0.9 micrograms h/ml, free Cmax; 0.07 +/- 0.01 microgram/ml, mean +/- SEM). Two patients in the single short-term infusion and one patient in the daily continuous infusion indicated partial responses clinically. No nephrotoxicity or ototoxicity was observed. All toxicities were mild and tolerable in all regimens; however, the incidence of GI toxicity in daily continuous infusion seemed to be relatively higher.

CONCLUSIONS

Daily continuous infusion of cisplatin gave the best pharmacokinetic results and to evaluate the clinical advantage of this schedule a prospective randomized trial should be conducted with sufficient numbers of patients.

Establishment and characterization of a new human extrahepatic bile duct carcinoma cell line (ICBD-1)

A new human extrahepatic bile duct carcinoma cell line (ICBD-1) was established from surgically resected tumor of a 71-year-old Japanese male patient. ICBD-1 cells proliferate in a layer with a population doubling time of 31.5 h and secrete tissue polypeptide antigen. ICBD-1 cells have a tetraploid pattern with a DNA index of 1.83 and chromosome counts showed equally distribution in a range from 65 to 69. IC50 values for ICBD-1 cells were 200 ng/ml for adriamycin, 400 ng/ml for mitomycin C, 2 microg/ml for cisplatin and 300 ng/ml for 5-fluorouracil. ICBD-1 cells were successfully transplanted to male nude mice, inducing progressive tumor growth. Histologically, nude mouse tumors were less differentiated than the original human tumor. Tumor cells showed alveolar structures with thin fibrous stroma, classified as poorly-differentiated adenocarcinoma. ICBD-1 is the fourth established cell line that originate from extrahepatic bile duct carcinoma and it will be applicable for the experimental studies of this disease.

Three-dimensional reconstruction of intravascular ultrasound images of coronary stents using an ECG-gated pull-back device

Three-dimensional reconstruction (3D-R) of intravascular ultrasound (IVUS) images is not yet satisfactory because of artifacts caused by cardiac movement. This problem can be overcome with a new device, an electrocardiographic (ECG)-gated pull-back system. Using this device a catheter is pulled back stepwise gated by the ECG, and IVUS dynamic images of an entire cardiac cycle are acquired at each step. We performed 3D-R of IVUS images of stents using this new device in six patients with Palmaz-Schatz coronary stent implantation. We obtained precise 3D images in all cases, and stent structure was visualized in detail. In conclusion, use of an ECG-gated pull-back device enables precise 3D-R of IVUS images and provides useful information on the coronary artery.

A resected case of hilar type double primary lung cancer following endobronchial brachytherapy

A 61-year-old man with squamous cell carcinoma of the right B1 and the left second carina which extended to the left main bronchus, was treated with low dose rate brachytherapy bilaterally prior to resection. A complete response was gained at the right B1 and the left main bronchus, a resection of the left apical segment and the second carina was carried out with bronchoplastic procedures. The patient remains disease-free 2 years after the operation and maintains a good quality of life. In this case, the preoperative treatment with brachytherapy was effective.

CD34-positive cell yield in peripheral blood of cancer patients during radiation therapy

For the purpose of evaluating the feasibility of inducing CD34-positive cells in peripheral blood by radiation therapy, we examined the changes in CD34-positive cells in 21 cancer patients (16 with lung cancer and five with esophageal cancer) during thoracic radiotherapy using flow cytometry and CD34 monoclonal antibody. Although assays of granulocyte-colony-forming units (G-CFU) and granulocyte-monocyte-colony-forming units (GM-CFU) were also performed for 16 of the patients during radiation therapy, in most of these cases there was approximately one G-CFU or GM-CFU for every 100 CD34-positive cells. Seven of the 21 cancer patients showed percentages of CD34-positive cells of more than 3% (more than mean + 2 S.D.; standard deviation) of mononuclear cells in peripheral blood in at least one of the examinations. However, six of these seven patients were in stage IV with distant metastases (four with lung cancer and two with esophageal cancer), and another lung cancer patient was in stage III. Therefore, CD-34 positive cells were shown to appear in peripheral blood especially in the patients with advanced stages of malignancy, and further examinations are needed to induce CD34-positive cells by radiation therapy for possible application of ultra-high dose chemotherapy supported by peripheral blood stem cell transplantation.

Immunohistochemical study of c-fos-positive lymphocytes infiltrated into human squamous cell carcinomas of the head and neck during radiation therapy and its clinical significance

C-fos has been reported to be one of the immediate early genes in signal transduction systems after many kinds of stresses, including ionizing radiation. Changes in c-fos expression induced by radiation therapy in tumor tissues have not yet been reported. In this study, we have attempted to determine whether c-fos expression is induced by radiotherapy in human squamous cell carcinomas of the head and neck and to establish a possible correlation between c-fos expression and the therapeutic effects of radiation therapy. Twenty-seven patients with tumors of the oral cavity, oropharynx, and maxillary sinus were examined, all of which were confirmed as squamous cell carcinomas. After obtaining the patients' informed consent, biopsies were performed before treatment and at doses of 4, 10, and 20 Gy of radiotherapy, and the specimens were preserved in liquid nitrogen for further examination. Serial sectioning of 6 micrometer was performed using a cryostat, and samples were immunohistochemically stained using the streptoavidin-biotin peroxidase method and a monoclonal antibody against c-fos. Three of the 27 patients with squamous cell carcinoma showed slight expression of c-fos in their tumor cells before and/or at 4 or 10 Gy of radiotherapy. The tumors showed high radiosensitivity. Concerning tumor-infiltrating lymphocytes, the rate of moderate or remarkable grades of c-fos-positive lymphocytes before radiotherapy and at radiation doses of 4, 10, and 20 Gy was 8.0, 29.2, 4.8, and 0%, respectively. The relationship between the immunohistochemical findings and the antitumor effect at a radiation dose of 20 Gy was examined on the corresponding H&E-stained sections. In patients whose infiltration of c-fos-positive lymphocytes into tumor tissues were moderate or remarkable at 4 Gy of radiotherapy, the tumors responded significantly well to radiation therapy (P < 0.025, chi2 test), and the patients took a significantly favorable clinical course (P < 0.05, chi2 test). In a sample from one of the patients, c-fos-positive lymphocytes were identified as CD4 positive and CD8 negative. Therefore, the high radiosensitivity of squamous cell carcinomas in our samples could be explained by an overexpression of c-fos in the tumor-infiltrating lymphocytes induced by small doses of radiation therapy, and these activated lymphocytes exerted a cytotoxic effect against the cancer cells.

Expression of fas (CD95/APO-1) antigen induced by radiation therapy for diffuse B-cell lymphoma: immunohistochemical study

Most malignant lymphomas show relatively high degrees of radiosensitivity, in which apoptosis has been shown to play an important role. Recently, the Fas (CD95/APO-1)/Fas ligand system has been identified as a key regulator of apoptosis in some types of lymphoma cell lines. In this study, we aimed to determine whether Fas antigen expression is induced by radiotherapy for malignant lymphoma and to clarify its possible correlation with the therapeutic effect of radiation therapy. Fifty-six patients with tumors of the tongue, oropharynx, and maxillary sinus were examined; four were confirmed as malignant lymphoma, and the rest were identified as squamous cell carcinoma. After obtaining the patients' informed consent, biopsies were performed before treatment and at doses of 4, 10, and 20 Gy of radiotherapy, and specimens were preserved in liquid nitrogen until further examination. Serial sectioning of 6 micrometer was performed using a cryostat, and samples were immunohistochemically stained using the streptoavidin-biotin peroxidase method and a monoclonal antibody against Fas. Two of the four patients with malignant lymphoma showed Fas antigen expression on their tumor tissue at 4 and 10 Gy of radiotherapy. These tumors showed high radiosensitivity and disappeared at a dose of 20 Gy of radiotherapy. In samples from these two patients, DNA ladder formation was identified at 10 Gy. In 52 squamous cell carcinomas, staining for the Fas antigen showed negative or only slightly positive results. However, in one of the cases of squamous cell carcinoma, lymphocytes infiltrating into cancer tissue showed Fas antigen expression at 4 Gy of irradiation, and these lymphocytes disappeared on the tumor tissue at 10 Gy. Therefore, the high radiosensitivity of malignant lymphoma among our samples could be explained by the overexpression of Fas antigen induced by small doses of radiation therapy, and Fas ligand could be produced by infiltrating lymphocytes or may be expressed simultaneously on the lymphoma cells.

Analysis of the fragile histidine triad gene in primary gastric carcinomas and gastric carcinoma cell lines

The FHIT (fragile histidine triad) gene has been isolated from the chromosome region 3p14.2, which includes the fragile site locus FRA3B and the breakpoint of the t(3;8) of familial renal carcinoma. FHIT has been suggested to be a candidate tumor suppressor gene for digestive tract carcinomas. To evaluate the significance of FHIT gene abnormalities in gastric carcinogenesis, we examined the allelic status and transcripts of the gene in 23 primary gastric carcinomas as well as 7 gastric carcinoma cell lines. Four of the seven (57%) cell lines exhibited homozygous deletions of variable sizes at 3p14.2 all of which included D3S1300, which is located close to, or within, FRA3B. However, only 2 of 16 (13%) informative cases showed loss of heterozygosity at D3S1300 in the primary tumors. Direct analysis by reverse transcriptase polymerase chain reaction failed to reveal abnormal transcripts, including exon skipping and sequence changes, in the primary tumors or in the cell lines without homozygous deletions. These results suggest that FHIT gene abnormalities are infrequent in primary gastric carcinomas and that the frequent homozygous deletions seen in cell lines might simply reflect the plasticity of the genome at FRA3B under culture conditions.

[Bronchial hyperresponsiveness in patients with vasospastic angina pectoris (VSAP)]

To determine the relationship between airway and coronary artery spasmogenesity in patients with vasospastic angina pectoris (VSAP), we measured the bronchial responsiveness to inhaled methacholine in 21 VSAP patients (V-group) and compared it to that of 17 chest pain syndrome patients with normal coronary (N-group). In the V-group, logarithmic values of the minimum cumulative dose required to decrease respiratory conductance from the baseline (Log Dmin) was significantly lower than that in N-group (0.47 +/- 0.60 log units vs. 0.98 +/- 0.60 log units respectively, p < 0.05). Log Dmin was significantly correlated with the dose of acetylcholine which induced a greater than 90% stenosis of the coronary artery (r = 0.383, p < 0.05). We concluded that both the coronary artery and the airway show hyperresponsiveness to cholinergic agonists in patients with VSAP.

Microvessel count predicts metastasis and prognosis in patients with gastric cancer

BACKGROUND AND OBJECTIVES

In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and prognosis.

METHODS

A total of 55 patients with gastric cancer were included in this study. Microvessel count was determined by immunohistochemical staining using antifactor VIII-related antigen antibody. Histologically recognizable blood vessels within tissue sections served as internal control for immunostaining. Normal mouse IgG diluted to an equivalent protein concentration was used as a negative control in place of the primary antibody in each experiment.

RESULT

The microvessel count ranged from 4.4 to 39.8 and the median count was 15.6. Microvessel count was significantly higher in patients with hepatic metastasis, lymph node metastasis, adjacent organ invasion, and lymphatic invasion. In patients who had undergone a curative operation, survival time in the hypervascular group was significantly shorter than that in the hypovascular group.

CONCLUSIONS

Microvessel count correlated well with tumor progression and may serve as a useful prognostic factor in patients with gastric cancer.

[Pharmacokinetic analysis of intra-peritoneal administration of cisplatin]

Pharmacokinetic parameters after intra-peritoneal administration of cis-platinum (CDDP) were evaluated and compared with those after intravenous administration. CDDP at a dose of 70 mg/m2 were administered intra-peritoneally in 5 patients with advanced gastric cancer (IP group). Pharmacokinetic parameters and toxicities were evaluated in these patients and compared with those in 4 esophageal cancer patients administered the same dose of CDDP intravenously (IV group). In IP group, Cmax of total- and free-Pt were 3.41 +/- 0.89 micrograms/ml and 1.10 +/- 0.30 micrograms/ml, and AUC of total- and free-Pt were 59.6 +/- 14.3 micrograms.hr/ml, 3.12 +/- 0.89 micrograms.hr/ml, respectively. On the other hand, Cmax and AUC of total- and free-Pt in IV group were 3.31 +/- 0.59 micrograms/ml. 1.13 +/- 0.21 micrograms/ml and 45.89 +/- 9.24 micrograms.hr/ml, 1.22 +/- 0.8 micrograms.hr/ml, respectively. AUC of free-Pt in IP group was significantly higher than in IV group. This result suggests that a more promising antitumor effect will be obtained systemically by intraperitoneal administration of CDDP. The incidence and grade of toxicities were similar in these two groups.

Microvessel count predicts metastasis and prognosis in patients with gastric cancer

BACKGROUND AND OBJECTIVES

In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and prognosis.

METHODS

A total of 55 patients with gastric cancer were included in this study. Microvessel count was determined by immunohistochemical staining using antifactor VIII-related antigen antibody. Histologically recognizable blood vessels within tissue sections served as internal control for immunostaining. Normal mouse IgG diluted to an equivalent protein concentration was used as a negative control in place of the primary antibody in each experiment.

RESULT

The microvessel count ranged from 4.4 to 39.8 and the median count was 15.6. Microvessel count was significantly higher in patients with hepatic metastasis, lymph node metastasis, adjacent organ invasion, and lymphatic invasion. In patients who had undergone a curative operation, survival time in the hypervascular group was significantly shorter than that in the hypovascular group.

CONCLUSIONS

Microvessel count correlated well with tumor progression and may serve as a useful prognostic factor in patients with gastric cancer.

ADP-ribosylation of tuftsin suppresses its receptor-binding capacity and phagocytosis-stimulating activity to murine peritoneal macrophages

Arginine-specific ADP-ribosyltransferase present in granules of chicken polymorphonuclear leukocytes (so-called heterophils) is released into the extracellular space by stimulus of calcium ionophore A23187 or opsonized zymosan [Terashima et al. (1996) J. Biochem. 120, 1209-1215]. In the present work, we examined extracellular targets of the released transferase and identified tuftsin, a phagocytosis-stimulating tetrapeptide derived from leukokinin, as a preferential substrate of the enzyme in chicken plasma. Specific binding of FITC-tuftsin to murine peritoneal macrophages, observed under a fluorescent microscope, was impaired by ADP-ribosylation of the labelled peptide. Phagocytic assay analyzed by flow cytometry revealed that ADP-ribosylation of tuftsin decreased its phagocytosis-stimulating activity towards the macrophages. Thus, the ADP-ribosylation of tuftsin apparently decreases its biological activity and ADP-ribosylation may possibly be involved in inflammatory processes through alterations in tuftsin activity.

GTP-dependent modification of a 21-kDa substrate with NAD+ in bovine brain soluble fraction is not ADP-ribosylation of small G-protein but tailing of tRNA

Labeling of 21-kDa material was observed when bovine brain soluble fraction was incubated with [adenylate-32P]NAD+ in the presence of GTP. The 21-kDa substrate, slightly smaller than C3 substrate in size, was labeled even without C3 exoenzyme. GTP could be replaced by nucleoside triphosphates other than ATP while ATP inhibited the GTP-induced labeling of 21-kDa substrate. After incubation of the soluble fraction with [adenylate-32P]NAD+ in the presence of GTP, [32P]ADP and [32P]ATP were detected in addition to [32P]AMP and [32P]ADP-ribose while only the last two nucleotides were observed without GTP. The 21-kDa substrate was labeled with [alpha-32P]ATP even in the absence of GTP, suggesting adenylylation rather than ADP-ribosylation. The labeled 21-kDa substrate, was extractable by phenol, disappeared with RNase treatment but not with tryptic digestion. Alkaline treatment of the phenol extract yielded an equal mixture of 3'-[32P]CMP and 2'-[32P]CMP. From these results we concluded that the 21-kDa labeling is a result of tRNA tailing with [alpha-32P]ATP generated from the [32P]AMP moiety of [adenylate-32P]NAD+. Results from reconstitution experiments using enzymes and tRNA purified from bovine brain soluble fraction, which are involved in this pathway, confirmed our conclusion.

The best site for bronchial stapling in left and right upper lobectomies: a comparative study

Bronchial stapling and postoperative bronchoscopy was performed in 22 left upper lobectomies (LUL) and 18 right upper lobectomies (RUL). Seven LUL cases and 15 RUL cases with staples positioned 2 bronchial rings (BR) from the entrance to the upper lobe bronchus (ULB) had no residual cartilaginous rings at the stump (RCRS). Deformity of the residual bronchus (DRB) was found in 6 of these 7 LUL cases, and 3 of these 15 RUL cases (p < 0.01), with a high rate of suffering from a severe cough. The remaining 15 LUL cases and 3 RUL cases had staples positioned 3 to 4 BR from the entrance to the ULB resulting in one or two RCRS. Only one LUL case with one RCRS was accompanied by DRB and coughing. These facts strongly imply a connection between cough and DRB. DRB was frequently seen in LUL cases with no RCRS (86%), was less likely to occur in cases with one RCRS (10%), and was absent in cases with two RCRS (p < 0.01). We conclude that bronchial staples applied during a LUL should be positioned 3 or 4 bronchial rings distal from the entrance to the left ULB.

Vesicular anthracycline accumulation in doxorubicin-selected U-937 cells: participation of lysosomes

The U-A10 cell line, a doxorubicin-selected variant of human U-937 myeloid leukemia cells, exhibits a redistribution of anthracyclines into a expanded vesicular compartment. The acidic nature of this compartment was confirmed by vital staining with a pH sensitive dye, LysoSensor yellow/blue DND-160. Identification of the vesicular compartment was performed by immunofluorescence analysis. Staining for the LAMP-1 and LAMP-2 antigens showed that the vesicles are enlarged lysosomes that are eccentrically placed near the nucleus of U-A10 cells. By contrast, the expression of the multidrug resistance-associated protein and the P-glycoprotein was observed predominately on the plasma membrane of the drug-resistant cells. The accumulation of daunorubicin into cellular compartments was quantified using radiolabeled drug. Exposing cells to 3[H]-daunorubicin and then isolating intact nuclei showed that nuclei from U-A10 cells accumulated twofold to threefold less anthracycline than nuclei from U-937 cells. However, when nuclei were isolated first and then exposed to 3[H]-daunorubicin, little difference in net nuclear drug accumulation was detected. Cytoplasts prepared from U-A10 and U-937 cells were exposed to 3[H]-daunorubicin to measure cytoplasmic drug accumulation. At external daunorubicin concentrations of 100 ng/mL or higher, cytoplasts from U-A10 cells accumulated significantly more daunorubicin than cytoplasts from U-937 cells. Moreover, studies with the lysosomotropic agent chloroquine showed that U-A10 cells accumulated twofold more chloroquine and showed twofold enhanced sensitivity to this agent as compared with parental U-937 cells. Fluorescence microscopy showed that chloroquine affects vesicular anthracycline sequestration in U-A10 cells with an associated increase in daunorubicin nuclear fluorescence. Although chloroquine did not alter anthracycline cytotoxicity in parental cells, it restored daunorubicin and doxorubicin sensitivity to U-A10 cells. Taken together, these studies demonstrate that U-A10 cells exhibit a redistribution of the lysosomal compartment. The trapping of drug into an expanded acidic vesicular compartment results in decreased nuclear drug accumulation and decreased cytotoxicity. Lysosomotropic agents, such as chloroquine, warrant further study as modulators of this acquired drug-resistance phenotype.

Purification of alpha-amylase by specific elution from anti-peptide antibodies

Chimeric alpha-amylase, produced by recombinant yeast cells, was purified by immunoaffinity chromatography by use of an anti-peptide antibody and an eluent containing an antigen peptide. Chimeric alpha-amylase was adsorbed by the antibody against the peptide corresponding to the C-terminal region of target alpha-amylase, and specifically eluted by the eluent containing the antigen peptide used for immunization. A low concentration of the peptide could competitively elute adsorbed alpha-amylase, and the rate-limiting step of the elution was mass transfer of desorbed alpha-amylase. With this specific method, target proteins can be effectively eluted, and highly purified under mild conditions, from the antibody ligand showing a high-affinity for the adsorption step

The usefulness of the ATP assay with serum-free culture for chemosensitivity testing of gastrointestinal cancer

In order to predict a patient's response to a drug prior to chemotherapy for gastrointestinal cancer, we developed an adenosine triphosphate (ATP) assay with serum-free culture (SF-ATPA) which enables fibroblast overgrowth to be suppressed. A total of 244 gastrointestinal cancer tissue samples were obtained from surgical resection. After enzymatic digestion, cells (2 x 10(4)/well) were cultured for 72 h with continuous exposure to drugs (single or combined use), and cell viability was evaluated by measuring the intracellular ATP level. 208 of 244 samples (85%) were considered to be evaluable in terms of drug response. There were no differences in the evaluability rates among the tumour types. A drug was judged as active using the criterion of < or = 50% reduction of the intracellular ATP level in a single-agent treated group compared with the level of the control. Similarly, in the combined drug treated group, drugs were considered as active using two different criteria (< or = 30% reduction of the intracellular ATP level for two drugs and < or = 20% for three drugs). Each tumour type had its own spectrum for chemosensitivity. Of 25 patients evaluated for assay-clinical correlations, 16 were examined by both single-agent and combined drug administration and the predictive accuracy of the assay was higher for the combined drug than for the single agent (88% versus 69%, respectively). In 25 patients, the true positive rate was 64% and the true negative rate was 100%, yielding an overall predictive accuracy of 84%. These results suggest that SF-ATPA may be useful for predicting drug response in patients with gastrointestinal cancer.

A pilot phase 2 study of surgical treatment after induction chemotherapy for resectable stage I to IIIA small cell lung cancer

BACKGROUND

To evaluate the feasibility and efficacy of surgical resection of the primary tumor and regional lymph nodes in patients with resectable stage I to IIIA small cell lung cancer (SCLC) who had responded to induction chemotherapy.

METHODS AND RESULTS

Twenty-two patients (age, 39 to 70 years; median, 60.5 years) with resectable stage I to IIIA SCLC were identified as candidates for induction chemotherapy. All patients received two to four cycles of preoperative chemotherapy IV every 3 weeks (CAV II: cisplatin, 80 mg/m2, day 1; doxorubicin hydrochloride (Adriamycin), 30 mg/m2, day 1; etoposide (VePesid), 60 mg/m2 day 1 to 5). The overall response rate to induction chemotherapy was 95.5% (complete response, 5 of 22; and partial response, 16 of 22). After induction chemotherapy, 21 patients (95.5%) underwent a surgical resection (one pneumonectomy, 19 lobectomies, one segmentectomy). The postoperative pathologic study revealed only SCLC in 15 patients, only adenocarcinoma in one patient, and no residual tumor in five patients. The median survival time was 61.9 months for both the 21 surgical patients and all 22 patients, while their actuarial 3-year survival rates were 66.7% and 63.6%, respectively, for a follow-up period from 41.1 to 107.6 months (median, 59.8 months). Patients with clinical stages I and II disease had significantly longer survival times than did those with stage IIIA disease (3-year survival rates, 73.3% and 42.9%, respectively; p=0.018). The major adverse reaction was an operation-related death for one patient with N2 disease, but no other serious side effects were observed.

CONCLUSION

This induction chemotherapy followed by surgery is feasible and may be beneficial for the treatment of resectable stage I to IIIA SCLC.