[Distribution of lymphocytes to tumor tissue and regional lymph nodes in patients with gastric cancer--the effects of oral administration of OK-432]

We attempted to clarify the accumulation of radiolabeled lymphocytes to tumors and regional lymph nodes in patients with gastric carcinoma. The effects of oral administration of OK-432 were also studied. Five patients with gastric cancer and one who underwent endoscopic mucosal resection, were entered in the study. Prior to the tracer study in 3 patients with gastric cancer, 5 KE of OK-432 was administered for 2 days. Peripheral mononuclear cells were separated and labeled with [111] In-tropolone. After the resection of stomach, tumor tissue, normal gastric mucosa, regional lymph nodes, and non-regional lymph nodes were dissected and radioactivity was measured by a gamma-counter. Accumulation of lymphocytes to the tumor tissue and n1 lymph node station was more than two times that in the normal gastric mucosa and ten times that in non-regional lymph nodes. Accumulation of lymphocytes to the n2 station was strongly enhanced by oral administration of OK-432.

Expression of facilitative glucose transporters in gastric tumors

BACKGROUND/AIMS

Although cancer cells are known to have an increased rate of glucose metabolism, the complete mechanism for increased glucose uptake in tumor cells is unknown.

METHODOLOGY

The presence of mRNA for 5 facilitative glucose transporter (GLUT) isoforms was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) in paired samples of normal gastric mucosa and gastric tumor from 20 individuals. Expression of GLUT proteins was immunohistochemically determined in 70 resected gastric cancer specimens.

RESULTS

By using RT-PCR, GLUT2 mRNA was detected in 80% of normal gastric mucosal samples, while GLUT4 mRNA was seen in only 40%, GLUT1 mRNA was not detected in normal gastric mucosa. In gastric carcinoma samples, GLUT1 mRNA was detected in 19 out of 20 cases (95%) and GLUT2, GLUT3, and GLUT4 mRNAs in all samples. By immunohistochemistry, GLUT1 protein was detected in 19% of the tumors. A majority of tumors (61%) expressed 1 or more transporter protein. The presence of GLUT1 protein in a tumor was positively correlated with the tumor's invasion into the gastric wall, lymphatics or blood vessels and with lymph node metastases. The post-operative survival of patients with tumor expressing GLUT1 protein was significantly worse than those with tumor without GLUT1 protein.

CONCLUSIONS

Gastric cancer cells may acquire the ability to produce GLUT1 mRNA by malignant transformation. Increased expression of the high-affinity glucose transporters, GLUT1 and/or GLUT4, in tumor cells may drain glucose preferentially to the tumor at the expense of the tumor-bearing host.

Glucose uptake in the human gastric cancer cell line, MKN28, is increased by insulin stimulation

The expression of the insulin-responsive glucose transporter (GLUT) 4 was studied in three histologically different human gastric cancer cell lines, MKN28, MKN45, and STSA. RT-PCR demonstrated GLUT1 and GLUT4 mRNA in all three cell lines. MKN28 cells expressed GLUT4 protein more than MKN45 and STSA cells by immunohistochemistry. Insulin stimulation of MKN28 cells resulted in a 22% increase in glucose uptake over that found under basal conditions (0.60 +/- 0.05 fmol/cell per min after insulin stimulation versus 0.53 +/- 0.07 fmol/cell per 3 min at basal). No increase in glucose uptake occurred with insulin stimulation in MKN45 or STSA cells. We conclude that the insulin responsive GLUT4 is expressed in MKN28, MKN45, and STKM1 human gastric cancer cell lines, albeit in different amounts. The greater expression of this transporter in MKN28 cells is likely responsible for the cell's ability to increase glucose uptake with insulin stimulation. However, the role played by GLUT4 in regulating the amount of glucose uptake would not be large in those human gastric cancer cell lines.

Thymidine phosphorylase/platelet-derived endothelial cell growth factor is upregulated in advanced solid types of gastric cancer

Previous studies demonstrated that the immunohistochemical expression of thymidine phosphorylase (dThdPase) was related with distant metastasis and disease progression. In this study we investigated the production of dThdPase/platelet-derived endothelial cell growth factor in gastric cancer quantitatively. In a total of 75 tumour tissues and 60 normal gastric mucosa specimens, dThdPase protein concentrations were determined by ELISA. The amount of dThdPase was significantly higher in the tumour tissue than in the normal tissue. Intratumoural dThdPase concentrations were significantly higher in Borrmann types I and II macroscopically, in poorly differentiated and solid type histologically, in the medullary type of the tumour stroma, and in the tumour-invading serosa. In the medullary type of the amount of tumour stroma, protein levels of dThdPase were positively correlated with the vertical diameter of the tumour (r = 0.580, P = 0.019). By immunohistochemical study, dThdPase expression on tumour cells was observed in all seven specimens with high dThdPase protein levels, but not in all 14 cases with low dThdPase protein levels (P < 0.05). In summary, these data indicated that dThdPase is up-regulated in advanced solid types of gastric cancer, suggesting that dThdPase production in carcinoma cells might be induced by the microenvironment.

Tumor-associated metabolic alterations in patients with gastric and esophageal cancer

BACKGROUND/AIMS

This study was conducted to elucidate tumor-induced alterations in pace maker enzymes and possible effects of pre-operative nutritional support on those enzymes in gastrointestinal (GI) cancer patients.

METHODOLOGY

Three pacemaker enzymes; phosphoenolpyruvate carboxykinase (PEPck) for gluconeogenesis, malic enzyme for de novo fatty acid synthesis, and lipoprotein lipase (LPL) for triglyceride clearance in liver and adipose tissues were examined in 22 patients with gastrointestinal cancers, both with or without pre-operative total parenteral nutritional support. Five patients with normal nutrition and liver function but undergoing cholecystectomy were used as controls.

RESULTS

Activity of hepatic malic enzyme was significantly decreased (p < 0.05) and activity of hepatic PEPck was slightly elevated in patients with advanced stage cancer. LPL activity in the abdominal subcutaneous tissue was increased by advanced tumor bearing (p < 0.05). Pre-operative total parenteral nutrition for 1 week resulted in significant stimulation of LPL activity in adipose tissue from patients with advanced cancer compared to that from controls (6.53 +/- 4.99 U/g tissue and 1.32 +/- 0.18 U/g tissue, respectively).

CONCLUSIONS

Effects of tumor bearing on key regulatory enzymes were evident only at the advanced stages. Pre-operative hyperalimentation may increase fat storage at the peripheral tissue by stimulating tissue LPL activity even at the advanced stage disease.

Insulin resistance in cancer patients is associated with enhanced tumor necrosis factor-alpha expression in skeletal muscle

The roles of tumor necrosis factor (TNF)-alpha and the facilitative glucose transporter (GLUT) 4 on the induction of insulin resistance in peripheral tissues of cancer patients was examined by quantitative competitive PCR on biopsies of abdominal rectal muscle from patients with gastrointestinal cancer. The degree of insulin resistance in these patients was measured by the euglycemic hyperinsulinemic glucose clamp using a high physiologic insulin concentration (100 microU/ml). Quantitative competitive PCR was carried out using DNA competitors constructed by deleting 20-30 bp between the two primer annealing sites. Decreased glucose uptake (M value) in peripheral tissues was accompanied by a significantly increased TNF-alpha mRNA in skeletal muscle (r=0.867, p=0.0025). GLUT4 mRNA, however, was positively correlated with M values (r=0.739, p=0.015). The amounts of mRNAs for TNF-alpha and GLUT4 in skeletal muscle were not correlated. Serum TNF-alpha concentrations remained below the limit of detection. These findings suggest that the insulin resistance in peripheral tissues of cancer patients is in part due to the induction TNF-alpha mRNA and the down regulation of GLUT4 mRNA in peripheral tissues.

[Clinical significance of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in peripheral blood of patients with gastric carcinoma]

Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in peripheral blood were measured in 54 patients with gastric carcinoma; 46 were primary and 8 were recurrent cases. There were no significant associations between MMP-9 concentrations and clinicopathological factors. TIMP-1 levels were significantly increased in advanced and recurrent cases, and in cases with peritoneal dissemination and lymph node metastasis, suggesting that TIMP-1 concentration in the peripheral blood could be a new tumor marker for the recurrence of gastric carcinoma.

Acute effects of distal pancreatectomy on portal and peripheral blood insulin concentrations in patients undergoing total gastrectomy

The influence of distal pancreatectomy on portal and peripheral blood immunoreactive insulin (IRI) and immunoreactive glucagon (IRG) concentrations was evaluated in patients undergoing total gastrectomy. There were 22 patients studied, 12 of whom did not undergo distal pancreatectomy (group 1), and 10 who did (group 2). In group 2, the increase in portal blood IRI concentrations after a glucose infusion of 25 g over 30 min was suppressed, and reelevation of the portal blood IRG concentration after the glucose-induced depression was inhibited compared to group 1. In contrast, the peripheral blood IRI concentration did not reflect these changes in the portal blood IRI concentration. The rise in the arterial ketone body ratio (AKBR) and the fall in the total ketone body concentration after glucose infusion were also attenuated after distal pancreatectomy in group 2. These findings suggest that distal pancreatectomy has an immediate suppressive effect on the pancreatic secretion of insulin and glucagon, and might disturb metabolism in the liver.

Insulin resistance and the alterations of glucose transporter-4 in adipose cells from cachectic tumor-bearing rats

BACKGROUND

Insulin resistance may play an important role in cancer cachexia; however, its mechanisms remain to be clarified.

METHODS

Cellular mechanisms of insulin resistance in tumor-bearing rats (TBR) were investigated in isolated adipose cells by measuring 3-O-[14C]methyl glucose transport activity and glucose transporter-4 (GLUT4) protein in low-density microsomes at a basal state and in the plasma membrane at an insulin-stimulated state.

RESULTS

The insulin-stimulated glucose transport activity in adipose cells from TBR was significantly lower than that of control rats (CTR) (0.51 +/- 0.25 and 2.27 +/- 0.11 fmol/cell/min, respectively). The amount of GLUT4 in low-density microsomes at a basal state and in plasma membrane at an insulin-stimulated state was less in TBR than in CTR.

CONCLUSIONS

These data suggest that the insulin resistance seen in the adipose cells of these tumor-bearing rats was caused in part by both a decreased amount of GLUT4 protein in a basal state and a decreased translocation of GLUT4 in response to insulin stimulation.

Role of insulin resistance in decreasing lipoprotein lipase activity in tumor-bearing rats

The role of insulin resistance in the tumor-induced decrease in tissue lipoprotein lipase (LPL) activity was studied in vivo and vitro in methylcholanthrene-induced sarcoma-bearing rats. Intraperitoneal (i.p.) injection of 2U of regular insulin resulted in high-adipose LPL activity in control rats (CTR) of 122.0 +/- 42.4 U/mg tissue, but it had little effect on tumor-bearing rats (TBR), which showed a value of only 9.6 +/- 5.5 U/mg tissue (P = 0.002). When adjusted for serum insulin concentrations, adipose LPL activity remained significantly different between the TBR and CTR at 0.19 +/- 0.17 and 0.78 +/- 0.29 U/mg tissue, respectively (P = 0.02). Following the in vitro incubation with either 1.44 g/l glucose of 1 x 10-8 U insulin of adipose tissue fragments obtained from the TBR and the CTR, measurable LPL activity was maintained in the tissue from the CTR for 2 h but not in that from the TBR. These results suggest that the decreased LPL activities seen in the tumor-bearing state may be mediated by insulin resistance.

[Portal and peripheral blood insulin concentrations and arterial ketone body ratio before and after glucose infusion during gastrectomy]

The effect of glucose infusion on portal and peripheral blood immunoreactive insulin (IRI) concentrations and arterial ketone body ratio (AKBR) during gastrectomy were evaluated on twenty patients divided into two groups. Portal and peripheral blood IRI concentrations, AKBR, total ketone body concentration (TKB: acetoacetate + beta-hydroxybutyrate), and blood glucose were determined before and 30, 60, and 120 minutes after 25g glucose infusion in 30 minutes in ten patients (group 1) and 50 g glucose infusion in 30 minutes in ten patients (group 2). In both groups, the rate of increase in the portal blood IRI concentration was markedly higher than that in the peripheral blood IRI concentration after glucose infusion and AKBR increased and TKB decreased with the increase of the portal blood IRI concentration. These findings suggest that the peripheral blood IRI concentration does not reflect the pancreatic insulin secretion after glucose infusion during surgery and that portal insulin plays an important role for elevating and maintaining AKBR at higher levels. On the other hand, in both groups, the blood glucose had its peak just after completion of glucose infusion and then decreased gradually. After glucose infusion, however, the blood glucose in group 2 increased markedly and was significantly higher than that in group 1. It is suggested that, during surgery, glucose infusion rate of 50 g in 30 minutes may be too rapid.

Alimentary hyperglycemia in patients with subtotal gastrectomy is associated with decreased insulin secretion but not with insulin resistance

BACKGROUND

It is not clear whether alimentary hyperglycemia in gastrectomized patients is related with glucose tolerance or not.

METHODS

Glucose tolerance, insulin secretion, and peripheral insulin sensitivity were evaluated in 36 patients who underwent subtotal gastrectomy for gastric cancer using the oral glucose tolerance test (OGTT), the intravenous glucose tolerance test (IVGTT) and the euglycemic hyperinsulinemic glucose clamp technique (Glucose clamp).

RESULTS

Patients were categorized into three groups by OGTT; 8 cases were in group I (normal), 19 cases in group II (alimentary hyperglycemia), and 9 cases in group III (glucose intolerance). Both glucose disappearance rate (K value expressed as, %/min) and insulinogenic index as determined by IVGTT were significantly lower in groups II (1.00 +/- 0.24, 0.21 +/- 0.18, respectively) and III (0.90 +/- 0.13, 0.11 +/- 0.14, respectively), compared with group I (1.58 +/- 0.71, 0.35 +/- 0.18, respectively). Peripheral insulin sensitivity as measured by glucose clamp was not decreased in groups II and III.

CONCLUSIONS

These results suggest that in patients with alimentary hyperglycemia, glucose tolerance was impaired due to a decreased pancreatic sensitivity to blood glucose and not due to insulin resistance.

[Usefulness of palliative care for the patients with recurrent gastric cancer by home-IVH]

Depending upon the type of cancer involved, the period of the end stage varies greatly, and with it decreases the quality of life (QOL). In gastric cancer, for example, the terminal stage is usually short and the QOL diminishes abruptly. Thus, it takes time keeping this decrease in QOL to minimum, despite the complications, so that the patient's last days will be even somewhat more acceptable. Improvement in QOL for the patient who cannot eat due to recurrent gastric cancer can be effectively achieved by alleviation through IVH. With this in mind, the conditions consonant with the application of home IVH are as follows: 1) The patient's pain can be kept under control at home. 2) The patient wishes to remain. 3)There is sufficient human support at home. The caretakers in the family, and especially the key person(s) must exert much effort and labor and they need rest as well. Home medical care in the terminal stage presupposes a social environment involving day care, short stay, and hospice nursing facilities of all kinds. At present, public services of this kind differ with the community, much remains uninformed to public, and clinic-hospital networking will be needed more than ever. In this difficult situation, the home-care medical services provided by the private sector are effective. These services are only for the short term, of course, and there will be a financial problem. Various measures (tax deduction, public assistance) must be considered to support the patients and caretakers.

Energy depletion in the liver and in isolated hepatocytes of tumor-bearing animals

Cancer cachexia has a great impact on morbidity and mortality in patients undergoing surgery. Failure to maintain lean tissue against tumor-induced hypermetabolism results in cumulative weight loss and ultimate failure of the host. Cellular free energy is among the factors that regulates metabolic pathways and may be altered in the tumor-bearing state. We studied in-vivo and in-vitro ATP levels and metabolic parameters in Fischer rats bearing a methylcholanthrene-induced sarcoma to elucidate the energy state. Tissue ATP was measured in freeze-clamped liver and muscle in 15 tumor-bearing rats (TBR) at different tumor burdens and their pair-fed controls (CTR) by bioluminescence assay. Plasma metabolites, hormones, and enzymes were determined in the same animals. Liver ATP level was lower in TBR with a 5% tumor burden: 3.07 +/- 0.56 (SE) nmole/mg tissue vs CTR: 5.33 +/- 0.60 (P < 0.05), 10% TBR: 2.48 +/- 0.54 vs CTR: 4.05 +/- 0.63 (n.s.), and 20% TBR: 1.91 +/- 0.21 vs CTR: 3.86 +/- 0.40 (P < 0.01). Muscle ATP was not different between TBR and CTR. This progressive loss of liver ATP was associated with decreased plasma insulin level (P < 0.001) and with increased alkaline phosphatase level (P < 0.01) by multiple regression. In vitro, hepatocytes were isolated from 8 TBR and 8 CTR by in-situ liver perfusion with collagenase and the cellular ATP was measured before and after 60 min incubation with glucogenic substrates. Hepatocytes from TBR decreased ATP by 42% (P < 0.05) in 10 mM lactate with higher gluconeogenesis, while control hepatocytes maintained the ATP.(ABSTRACT TRUNCATED AT 250 WORDS)

[Portal blood immunoreactive insulin concentration after glucose infusion in elderly patients during gastrectomy compared with younger patients]

We evaluated the effect of aging on portal blood immunoreactive insulin concentration, AKBR, and keton body concentration (acetoacetate + beta-hydroxybutyrate) after glucose infusion (25 g glucose in an hour) in patients undergoing gastrectomy. Twenty-seven patients studied were elderly (above 65 years) and twenty-eight were younger (below 60 years). There was no significant difference in portal blood immunoreactive insulin concentration after glucose infusion between the two groups of patients. In elderly patients, however, AKBR was significantly lower and keton body concentration was significantly higher than those in younger patients, and these imply that suppression of ketogenesis and activation of hepatic mitochondrial function due to insulin may be reduced in elderly patients. These findings suggest that, during gastrectomy, pancreatic insulin secretion may not be impaired in elderly patients, but insulin action may be attenuated with aging.

[Prolonging home residence and treatment of cancer in patients with recurrent stomach cancer]

A study was conducted on 27 patients with cancer of the stomach who died from a postoperative recurrence of the cancer, 26 of whom died in the hospital and one of whom died at home. The period from the manifestation of initial symptoms of the recurrence to confirmed diagnosis was less than two months in 20 of the 26 cases (77%). The period from confirmed diagnosis to terminal hospitalization was in excess of three months in 11 of the 26 cases (42%). Of these cases, there were some in which it appeared that the time spent at home could have been extended through means such as another operation, insertion of an intraperitoneal access apparatus, or insertion of a subselective movable catheter. Forty-six percent (46%) of the patients were notified of their diagnosis, but none of them were notified of the recurrence of the cancer, suggesting the difficulty of notifying a patient of a diagnosis of cancer recurrence. A private home-care medical system was used in the case of the patient who had died at home of terminal stomach cancer. There were no major problems with this system other than the complaint that it placed a great financial burden on the family.

Acute metabolic effects of human recombinant tumor necrosis factor beta in the rat

BACKGROUND

Cancer cachexia is associated with several alterations in host metabolism, including hypoaminoacidemia and an increase in gluconeogenesis (GLC) and lipolysis. Tumor necrosis factor beta (TNF beta), a lymphokine released by mitogen-activated T lymphocytes and several cancer cell lines, causes an increase in lipolysis in 3T3L1 adipocytes. Since little is known about the metabolic effects of TNF beta in vivo, we examined its acute effects in the rat.

METHODS

Twenty-eight male Fischer rats were injected intraperitoneally with TNF beta (250 micrograms/kg) or saline (CTL), and after 4 h, isolated hepatocytes were obtained (by in situ collagenase liver perfusion [n = 12]) or aortic blood was collected (n = 16). Hepatocytes were incubated with 10 mM alanine (ALA) or 10 mM lactate (LAC), and glucose production was measured. Rates of GLC (nmol glucose/10(6) cells/min) were determined by linear regression. Plasma lactate, glucose, insulin, and amino acids (AA) (nmol/ml) were measured, and values were expressed as means +/- SEM. Comparisons between groups were made by unpaired t test or Mann-Whitney U test, and significance was defined as p < 0.05.

RESULTS

TNF beta caused a 130% increase in gluconeogenesis from alanine (2.7 +/- 0.5 vs 1.2 +/- 0.2 nmol glucose/10(6) cells/min, TNF vs CTL), and a 60% increase from lactate (7.5 +/- 1.0 vs 4.6 +/- 0.5 nmol glucose/10(6) cells/min, TNF vs CTL). Plasma insulin levels in TNF treated rats were 1.2 +/- 0.2 ng/ml compared to 1.1 +/- 0.2 ng/ml in CTL. Total amino acid levels in TNF treated rats were 3,175 +/- 111 nmol/ml compared to 3,190 +/- 103 nmol/ml in CTL.

CONCLUSION

In vivo TNF beta causes an increase in hepatic gluconeogenesis from alanine and lactate with no change in plasma insulin or amino acids.

[Chemotherapy-induced thrombotic occlusion of mesenteric arteries--case report and review of the literature]

We encountered two chemotherapy (CDDP and 5-FU) cases related to mesenteric thrombotic occlusion. Case 1 was a 26 yo male with adrenal carcinoma recurrence. He had been treated by CDDP and 5-FU. Five days after completion of the second course, he suffered from acute abdomen. Laparotomy revealed thrombotic occlusion of the superior mesenteric artery. Most of the small intestine and a part of the ascending colon were necrotic. Case 2 was a 60 yo female with lung and hepatic metastasis from uretal tumor. CDDP based chemotherapy was initiated. Severe abdominal pain and melena occurred one day after completion of the second course of chemotherapy. The inferior mesenteric artery was occluded and the descending colon was necrotic. Recently, a variety of chemotherapy-induced vascular lesions, including thrombotic microangiopathy, myocardial infarction and cerebral infarction, have been reported. CDDP and 5-FU were shown to be related to the acute thrombotic occlusion of the major vessels. Although the incidence is rare, the prognosis is poor. Acute vascular obstruction should be taken into consideration as a possible course of chemotherapy-related complications.

A preoperative assessment of adjacent organ invasion by stomach carcinoma with high resolution computed tomography

Adjacent organ invasion by stomach carcinoma on computed tomography (CT) was studied. CT images of tumors and their adjacent organs, whose invasion was assessed at surgery, were retrospectively analyzed in 51 gastric cancer patients. An absence of fat planes or an irregularity of the border between the tumor and adjacent organs was not found to be significantly related with invasion. The mean densities of the region of interest (ROI) set at the border were greater at the invasion sites (60.0 +/- 38.1) than at noninvasion sites (35.6 +/- 55.5) (P < 0.05). The standard deviation of the densities in the ROI was not affected by invasion. The discriminant function determined invasion to the pancreas, liver, and colon with an accuracy of 75%, 61%, and 78%, respectively. In diagnosing the invasion of stomach cancer on CT, the conventional criteria were not practical, while a quantitative analysis of the density in the ROI with high resolution CT was considered to improve the accuracy.