Acute phase reactant proteins in cancer

Haptoglobin in Juvenile Idiopathic Arthritis

BACKGROUND

Haptoglobin (Hp), a liver derived acute phase inflammatory protein (APP), has scarcely been studied in juvenile idiopathic arthritis (JIA). Hp can occur in blood as two isoforms (Hp1 and Hp2) in precursor and mature forms. Routine clinical chemistry immunoturbidimetry does not discern these forms. It is unknown how different forms relate to disease activity in JIA. Our aims were to determine allele frequency and plasma concentrations of different Hp forms at higher versus lower JIA disease activity and compare to other APPs.

METHODS

Plasma from JIA (n = 77) and healthy (n = 42) children were analyzed for apparent Hp allelic frequency and densitometric concentrations of alpha forms by Western blot (WB). Polymerase chain reaction (PCR) (buffy coat) was performed in a subset to estimate conformity with genetics. At higher versus lower juvenile arthritis disease activity score (JADAS27) (which includes erythrocyte sedimentation rate (ESR)), total mature Hp concentration from WB was compared and correlated against immunoturbidimetry and total protein, albumin, serum amyloid A (SAA) and C-reactive protein (CRP).

RESULTS

At 300-fold dilution needed to study mature forms in Western blot, precursors were undetectable. Hp2 contributed most signal in most samples. Hp allele frequency was similar in JIA and controls. Both mature forms, taken separately or by sum, declined following treatment, but remained above concentrations of healthy controls, even in a remission subset that achieved JADAS27 < 1. Densitometry correlated with immunoturbidimetry. Hp concentrations correlated with JADAS27, albumin (negatively), CRP and SAA with immunoturbidimetric method correlating strongest to JADAS27 (Spearman R ~ 0.6, p < 0.0001).

CONCLUSION

Hp allele frequency in JIA is similar to the general population, indicating that children with JIA should have the same possibility as in healthy children to produce preHp2 (zonulin), thought to increase intestinal permeability. Circulating Hp concentrations largely parallel other APPs and ESR; none of these measures correlate very strongly to JADAS27 score but Hp can be measured from capillary sampling which is impossible with ESR.

Prognostic role of pre-treatment serum ALB in Patients with oropharyngeal cancer: A retrospective cohort study

BACKGROUND

The morbidity of oropharyngeal cancer (OPC) is continuing to rise in numerous developed countries. An accurate prognostic assessment is needed to evaluate the malignant degree or risk classification to optimize treatment. Albumin (ALB) as an independent prognostic indicator of cancer survival has been established in previous studies. This study investigated the prognostic value of pre-treatment serum ALB in OPC patients.

METHODS

The clinicopathological data of 246 patients diagnosed with OPC from 2010 to 2019 were analyzed retrospectively. Analyze the relationship between ALB and clinicopathological characteristics of patients. The optimal cut-off values for ALB were determined via Cutoff Finder (Method for cutoff determination: Survival: significance (log-rank test)). To determine the independent prognostic factors, the Cox proportional hazards model was used to perform univariate and multivariate analyses of the serum ALB levels related to overall survival (OS) and disease-free survival (DFS).

RESULTS

The optimal cut-off point for ALB was 39.15 g/L determined via Cutoff Finder. Serum ALB levels were significantly associated with age (P=0.047), Presence of comorbidity (P=0.009), Charlson score index (P=0.007), Hemoglobin (P<0.001), Neutrophil to Lymphocyte Ratio (P=0.002), Albumin-To-Alkaline Phosphatase Ratio (P<0.001), Alkaline phosphatase (P=0.005), T stage (P=0.016), and HPV status (P=0.002). In the univariate and multivariate analyses, ALB was found to be an independent prognostic indicator for DFS (HR =0.39, 95% CI:0.23-0.66, P=0.000) and OS (HR =0.46, 95% CI: 0.25-0.83, P=0.01) in OPC patients.

CONCLUSIONS

Pre-treatment serum ALB could serve as a valuable prognostic biomarker for the prognostic stratification of OPC patients.

On detection of periodicity in C-reactive protein (CRP) levels

C-reactive protein (CRP) is an acute-phase plasma protein that can be used as a biomarker for activation of the immune system. A spectral analysis of CRP level over time for patients with gynaecological tumours has been reported by Madondo et al., using a periodogram method, suggesting that there is no significant periodicity in the data. In our study, we investigate the impact of low sample number on periodogram analysis, for non-uniform sampling intervals—we conclude that data of Madondo et al. cannot rule out periodic behaviour. The search for patterns (periodic or otherwise) in the CRP time-series is of interest for providing a cue for the optimal times at which cancer therapies are best administered. In this paper we show (i) there is no evidence to rule out periodicity in CRP levels, and (ii) we provide a prescription for the minimum data sample rate required in future experiments for improved testing of a periodic CRP signal hypothesis. The analysis we provide may be used for establishing periodicity in any short time-series signal that is observed without a priori information.

Serum Glycoconjugates in Patients with Anemia and Myeloid Leukemia

Because of carbohydrate alterations in malignant cells, serum glycoproteins have drawn considerable attention. In the current investigation we determined total sialic acid (TSA), lipid bound sialic acid (LSA), protein bound hexoses (galactose+mannose), fucose, hexosamines (galactosamine+glucosamine) and mucoid protein concentrations in the serum of patients with anemia and myeloid leukemia. The results were compared with those obtained in healthy individuals. In the leukemia patients we observed significant increases in glycoconjugates compared with the controls (P < 0.001), and in TSA and fucose levels compared with the anemia patients (P < 0.001). LSA and hexosamine levels were significantly lower in anemia patients with respect to the leukemia patients (P < 0.01 and P < 0.05 respectively), whereas levels of mucoid proteins and hexoses did not show significant differences. Except for hexosamines, all the markers tested were significantly elevated in the anemia patients compared with the controls. The present study suggests that the glycoconjugates investigated might be useful biochemical markers for differentiating anemic from leukemic conditions.

ROC Analysis of Diagnostic Performance Utilizing Serum Antiproteases in Cancer Patients

Assessment of the accuracy of diagnostic procedures is made independent of diagnostic criteria by means of a receiver-operating-characteristics (ROC) curve. We performed ROC analysis for the major serum antiproteases: alpha-1-antitrypsin (A1AT) and alpha-2-macroglobulin (A2M), in 99 cancer patients compared with 71 normal individuals. A1AT and A2M were significantly higher in cancer patients (p < 0.0005). By comparing true positive and false positive rates for different serum levels, ROC analysis showed that serum A1AT quantification seems more useful in clinical practice than serum A2M.

Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus

AIM: C-reactive protein (CRP) is an acute-phase reactant and a known indicator of the malignant potential of the tumour. The aim of this study was to investigate the significance of preoperative CRP as a parameter of the perioperative course and long-term prognosis in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

METHODS: Serum CRP was determined preoperatively in 291 of 371 patients undergoing oesophagectomy for cancer from December 1989 to March 2004. Median patient age was 59 (28-79) year, 82.5% of patients were males. Squamous cell carcinoma was diagnosed in 151 (51.9%) and adenocarcinoma in 122 patients. Transhiatal oesophagectomy was done in 151 (51.9%) patients and 134 (46.0%) patients underwent the abdominothoracic procedure.

RESULTS: In 127 (43.6%) patients the preoperative serum CRP concentration was within the normal range (< 5 mg/dL), elevated CRP levels were measured in 164 (56.4%) patients. Tumour extension (P < 0.0005) and the number of lymph nodes affected by metastatic spread (P = 0.015) were significantly increased in the group with elevated CRP levels. Among the perioperative parameters both the number of blood transfusions (P = 0.006) and the general complication rate (P = 0.002) were higher in patients with elevated preoperative CRP levels. The long-term survival rate of 13.6 (0-109.8) mo was poorer in the group with elevated CRP levels compared to 18.9 (0-155.4) mo in the group with normal CRP levels (log-rank test: P = 0.107). Multivariate analysis with backward variables selection identified preoperative CRP as an independent prognostic factor of the long-term prognosis in patients with oesophageal carcinoma, with a hazard ratio of 1.182 (95% confidence interval: 1.030-1.356).

CONCLUSION: The preoperative serum CRP-level is an easily determined independent prognostic marker in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

The role of C-reactive protein as a prognostic indicator in advanced cancer

C-reactive protein (CRP) is a nonspecific but sensitive marker of inflammation. Interleukin-6 (IL-6), IL-1, and tumor necrosis factor alpha induce the synthesis of CRP in hepatocytes. Increased CRP level is considered to be an important risk factor for atherosclerosis, myocardial infarction, peripheral vascular disease, and ischemic stroke. It is positively correlated with weight loss, anorexia-cachexia syndrome, extent of disease, and recurrence in advanced cancer. Its role as a predictor of survival has been shown in multiple myeloma, melanoma, lymphoma, ovarian, renal, pancreatic, and gastrointestinal tumors. Measurement of CRP is simple, cheap, and routine and provides valuable information in palliative care.

No microheterogenous changes of plasma C-reactive protein found in man during various diseases

Increased levels of the acute phase protein C-reactive protein (CRP) in plasma may indicate severe acute abdominal disease, risk of serious postoperative complications or malignancy; serial measurements may indicate postoperative complications, relapse of intra-abdominal sepsis and complications during acute pancreatitis. The increase in CRP is an unspecific acute phase reaction, however, and low levels do not exclude these conditions. These facts are important obstacles to the clinical routine use of CRP measurements. The aim of this study was to look for possible biochemical microheterogeneity of CRP in single plasma samples from various large groups of patients to overcome these problems. Two-hundred-and-twelve patients with acute abdominal diseases, 274 patients with various forms and stages of cancer and 134 patients operated on due to benign diseases, were studied. The biochemical studies included SDS-PAGE, native PAGE and gel filtration for molecular weight determinations, isoelectric focusing and crossed immuno-electrophoresis for electrophoretic mobility studies and Concavalin A and ACA 34 as intermediary gels for possible lectin binding or complexation. Western blot analysis was also used to identify CRP. In summary, however, these more elaborate biochemical methods could not disclose any microheterogneity of CRP in plasma and thus did not add any diagnostic information to the crude levels.

Significance of preoperative elevation of serum C-reactive protein as an indicator for prognosis in colorectal cancer

BACKGROUND

C-reactive protein (CRP) is a product synthesized in hepatocytes and has been reported to be upregulated by such proinflammatory cytokines as interleukin-1, interleukin-6, and tumor necrosis factor. The significance of a preoperative serum elevation in CRP as a predictive indicator for the malignant potential and prognosis in colorectal cancer has not been elucidated.

METHOD

One hundred and twenty consecutive patients with colorectal cancer, whose local lesions were resected in our department, were selected. Any patients with inflammatory diseases such as infection or collagen diseases were excluded from the current study. The preoperative serum CRP level was measured, and the relationship between the serum elevation of CRP and both the clinicopathologic factors and prognosis of the patients was investigated.

RESULTS

The incidences of liver metastases, peritonitis carcinomatosa, histopathologic lymph nodes metastasis, and intravascular invasion in patients with a preoperatively elevated serum CRP level were significantly more frequent than in those with a negative serum protein level. The survival rates of the patients without a preoperative elevation of the serum CRP proved to be significantly more favorable than that of the patients with such an elevation (P <0.001).

CONCLUSIONS

A preoperative serum elevation of CRP was thus found to be an indicator of the malignant potential of the tumor as well as a predictor of the prognosis of patients with colorectal cancer.

Pre-operative plasma levels of C-reactive protein, albumin and various plasma protease inhibitors for the pre-operative assessment of operability and recurrence in cancer surgery

Pre-operative levels of the acute phase protein C-reactive protein (CRP), albumin (assessing nutritional status), the tumour marker CEA and three plasma protease inhibitors, i.e. C1-esterase inhibitor, alpha-2-macroglobulin and antithrombin III, were prospectively studied in 183 patients with various solid cancers. First, the predictive value of abnormal levels for operability at the primary operation was studied. Secondly, the predictive value of abnormal levels for cancer recurrence and metastases was evaluated during 2 years of follow-up. The results show that malignancy induces increased CRP and C1-esterase inhibitor levels and decreased albumin levels in serum. These changes, as well as raised alkaline phosphatase and lowered haemoglobin levels, also correlate to the 'overall' tumour burden. The most important conclusion is, that increased pre-operative CRP levels (CRP > or = 10 mg/l; sensitivity, 79%; specificity, 71%) and/or low albumin levels (albumin <37 g/l; sensitivity, 94%; specificity, 54%) are seen in inoperable cancer patients compared with patients having operable cancers. The second main important conclusion is, that high pre-operative C1-esterase inhibitor levels (C1-esterase inhibitor >152%; sensitivity, 45%; specificity, 90%), and in some patients a high alkaline phosphatase level, are seen in patients exhibiting early cancer recurrence (within 2 years post-operatively).

Protease inhibitors and carcinogenesis: a review

This brief review article deals with the subject of anticarcinogenic activity of protease inhibitors (PI). Three basic premises are made: (1) Although PI are prevalent constituents of dietary staples such as soy products, which have been epidemiologically associated with reduced cancer incidences at multiple target sites, they are unlikely to be the active anticarcinogenic entities. Cooked soy products, which are devoid of PI activity, are equally as effective at reducing cancer development as raw soy products. Isoflavones are likely to represent major chemopreventive agents in soy, although other constituents may well contribute. (2) Although supplementation of diets with PI (natural or synthetic), or direct topical administration, results in lower cancer incidences in many experimental models in vivo, this effect appears to be indirect. Dietary PI are, in general, poorly absorbed from the GI tract, and never reach target organs in any measurable quantity. The most attractive hypothesis is that dietary PI could induce synthesis and distribution of endogenous PI (acute-phase reactants), which have widespread effects on cell growth and behavior. Effects of topical administration of PI also encompass prominent anti-inflammatory effects. (3) A spectrum of PI inhibit in vitro transformation induced by a variety of carcinogenic agents. Their effects can be grouped into three basic categories, affecting: (a) signal transduction pathways; (b) DNA repair processes; and (c) nuclear proteases. I suggest that the nuclear multicatalytic protease activity, in particular the chymotrypsin-like activity, represents an important cellular target for which considerable anecdotal support can be garnered.

A prospective study of tumor recurrence and the acute-phase response after apparently curative colorectal cancer surgery

BACKGROUND

Approximately 70% of patients who are going to develop tumor recurrence following curative colorectal surgery do so within 24 months of surgery.

PATIENTS AND METHODS

The relationship was prospectively examined between an ongoing acute-phase response and subsequent clinical relapse in 36 colorectal cancer patients who had undergone a curative resection. Approximately 4 months after their operation, patients were grouped according to the presence (n = 15) or absence (n = 21) of an acute-phase response (C-reactive protein > 5 mg/L) and were followed-up for a minimum of 24 months.

RESULTS

Age, tumor site, and serum carcinoembryonic antigen concentrations were similar in both groups. There was a significantly higher recurrence rate in patients with an acute-phase response (11 of 15) compared to those with no acute-phase response (2 of 21, P < 0.01).

CONCLUSIONS

These results are consistent with the presence of an acute-phase response being an important predictive factor in the early stages of tumor recurrence in patients who have had apparently curative colorectal surgery.

Glycosylation of alpha-1-proteinase inhibitor and haptoglobin in ovarian cancer: evidence for two different mechanisms

The change in glycosylation of the two acute-phase proteins, alpha-1-proteinase inhibitor (API) and haptoglobin (Hp), in progressive ovarian cancer is different. This has been shown by monosaccharide analysis and lectin-binding studies of proteins purified from serum. In the glycan chains of API, there is decreased branching (more biantennary chains), less branches ending in alpha 2-3 sialic acid, more branches ending in alpha 2-6 sialic acid and more fucose, probably linked alpha 1-6 to the core region. On the other hand, Hp shows increased branching (more triantennary chains), more branches ending in alpha 2-3 sialic acid, less branches ending in alpha 2-6 sialic acid, and more fucose, probably in the alpha 1-3 linkage at the end of the chains. This is surprising because API and Hp are thought to be glycosylated by a common pathway in the liver. We have also shown that the fucose-specific lectin, lotus tetragonolobus, extracts abnormal forms of both Hp and API in ovarian cancer, but the expression of this Hp is related to tumour burden and the expression of this API is related to lack of response to therapy. It is suggested that this difference in the behaviour of API and Hp in ovarian cancer may be associated with the different changes in their glycosylation. Of the many mechanisms that could explain these findings, a likely one is that a pathological process is removing API with triantennary chains from the circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Alteration in rat apolipoprotein C-III gene expression and lipoprotein composition during inflammation

A cloned rat apolipoprotein (apo) C-III cDNA was used as a hybridization probe to measure apo C-III mRNA levels in rats after induction of inflammation. Hepatic apo C-III mRNA levels decrease to a minimum value of 46% of normal 72 h after the induction of inflammation. The changes observed are very similar to the changes in mRNA levels of rat apo A-IV, while the hepatic mRNA levels for apo A-I and apo C-I during inflammation remain relatively constant. Alterations in apo C-III gene expression during inflammation were associated with changes in lipoprotein particle size and composition. A decrease of approximately twofold in the amount of apo C-III-containing HDL particles was found in rats 24 h after the induction of inflammation. The average size of apo C-III-containing HDL particles in rats during inflammation is significantly larger than that of the control group. A decrease in the concentration of apo A-I-containing HDL particles was also observed in these rats. The results indicate altered apolipoprotein gene expression associated with alterations in the size and composition of HDL particles.

Usefulness of serum glycoconjugates in precancerous and cancerous diseases of the oral cavity

Sera from 47 healthy controls, 18 normal individuals with the habit of tobacco chewing, 43 patients with oral precancerous (PC) conditions, and 40 patients with oral cancer (OC) were studied for the levels of total sialic acid (TSA), lipid-bound sialic acid (LSA), mucoid proteins, and protein-bound hexoses (PBH) (galactose and mannose). The changes in the glycoconjugate levels were insignificant between the controls and the normal tobacco chewers. All four parameters were significantly elevated in oral PC patients compared with controls. The levels of PBH and LSA showed significant increase in the oral PC patients compared with the normal tobacco chewers. A significant increase was observed in the levels of TSA, LSA, mucoid proteins, and PBH in OC patients compared with controls, normal tobacco chewers, and patients with oral PC. Increasing levels of all the biomarkers were found with progression of the malignant disease. Elevations in the levels of TSA and LSA were statistically significant in Stage IV patients compared with Stage III patients. The patients with metastases had higher levels of the biomarkers than the patients with primary OC. However, elevations only in LSA levels were statistically significant. These results suggest that evaluations of the serum glycoconjugate levels may be useful in diagnosis of the patients with oral PC or OC. In addition to their value in early detection, they can also help in staging of the disease.

Serum alpha-1-proteinase inhibitor with abnormal properties in ovarian cancer

It was previously reported that sera from ovarian cancer patients contained abnormal forms of alpha-1-proteinase inhibitor (API) that predicted unresponsiveness to chemotherapy. These molecules were detected by extracting the sera with the fucose-specific lectin, lotus tetragonolobus, and analysing the extracts by electrophoresis. In a new study of ovarian cancer, we report that API cannot be extracted by lotus from fresh sera, unless the specimens are subjected to repeated cycles of freezing and thawing. Furthermore, increases in lotus-extractable API in the pretreated sera are also associated with a poor response to chemotherapy. This would suggest that lotus is extracting the same molecules in both studies. It seems likely that the discrepancy between the two studies is due to the length of time the specimens were stored prior to analysis. We present evidence suggesting that the API extracted by lotus is present in serum as soluble complexes, the detailed composition of which is unclear. The change in the properties of API in cancer may be very important with respect to tumour spread.

Alpha 1-antichymotrypsin as a possible biochemical marker for Alzheimer-type dementia

We measured serum alpha 1-antichymotrypsin levels in 38 patients with Alzheimer-type dementia, 89 control subjects, 2 subjects with Down's syndrome, 20 with vascular dementia, 18 with Parkinson's disease, 14 with spinocerebellar degeneration, 15 with cerebrovascular disease without dementia, and 14 with Duchenne muscular dystrophy. Cerebrospinal fluid (CSF) levels of alpha 1-antichymotrypsin were also measured in 15 patients with Alzheimer-type dementia, 26 control subjects, 6 with vascular dementia, 7 with cerebrovascular disorder, and 11 with degenerative disorders. In control subjects, there were no age-related changes or sex differences. Serum and CSF levels were significantly and specifically higher in patients with Alzheimer-type dementia than in other subjects (serum, p less than 0.001; CSF, p less than 0.05). Serum levels of alpha 1-antichymotrypsin were significantly elevated in the early stage of Alzheimer-type dementia, whereas there was no definite correlation between serum levels and the degree of dementia. CSF levels of alpha 1-antichymotrypsin tended to parallel the severity of dementia. Serum levels were not correlated with CSF levels. These data indicate that serum and CSF levels of alpha 1-antichymotrypsin might be independently upregulated in Alzheimer-type dementia. We concluded that the measurement of serum levels of alpha 1-antichymotrypsin could be useful as a screening marker for Alzheimer-type dementia. In addition, CSF levels also could be a useful marker for Alzheimer-type dementia, because they might reflect the state of dementia.

Prognostic importance of anemia related parameters in patients with carcinoma of the cervix uteri

The authors investigated the pretreatment values of hemoglobin, hematocrit, plasma iron and other laboratory parameters in 121 patients with cervical cancer treated by combined intracavitary and external irradiation. A pronounced correlation was found between plasma iron values and the length of disease-free survival. The correlation between hematocrit values and disease-free survival was less pronounced and the correlation between hemoglobin values and disease-free survival did not reach statistical significance. It is suggested that anemia-related parameters may reflect the aggressiveness of the disease or its spread.

Modulation of dipyridamole action by alpha 1 acid glycoprotein. Reduced potentiation of quinazoline antifolate (CB3717) cytotoxicity by dipyridamole

Dipyridamole potentiates the cytotoxicity of N10-propargyl-5,8-dideazafolic acid (CB3717), an antifolate inhibitor of thymidylate synthase, by inhibiting both thymidine (TdR) salvage and deoxyuridine (UdR) efflux. Dipyridamole binds to the serum component alpha 1acid glycoprotein (alpha 1AGP) and hence the effects of alpha 1AGP on dipyridamole-induced changes in nucleoside transport and CB3717 cytotoxicity have been investigated. Using A549 lung cancer cells in vitro, alpha 1AGP reduced the inhibition of nucleoside transport by dipyridamole in a concentration-dependent manner. Between 10 and 200 times the concentration of dipyridamole was needed to inhibit TdR uptake to the same degree in medium containing 1 mg/ml alpha 1AGP (a physiological concentration) when compared to the uptake in alpha 1AGP-free medium. Although dipyridamole inhibited UdR efflux more than TdR efflux, inhibition of UdR efflux was reduced less than the inhibition of TdR efflux in the presence of 1 mg/ml alpha 1AGP. Thus, clinically achievable levels of dipyridamole (2.5-7.5 microM), even in the presence of physiological alpha 1AGP concentrations, caused significant inhibition of nucleotide uptake and efflux. The cytotoxicity of CB3717 was increased 2-3-fold by 3 and 10 microM dipyridamole in alpha 1AGP-free medium, whereas dipyridamole did not significantly (P greater than or equal to 0.05) potentiate CB3717 cytotoxicity in the presence of 1 mg/ml alpha 1AGP. Measured free dipyridamole levels indicated that the impaired inhibition of nucleoside transport and the lack of potentiation of CB3717 cytotoxicity in the presence of alpha 1AGP was due solely to the binding of dipyridamole to alpha 1AGP. It is concluded that alpha 1AGP levels will be a major determinant of the ability of dipyridamole to modulate the activity of antimetabolites in vivo.

Serum protein changes after abdominal surgery

Changes in the concentrations of 11 serum proteins following surgery for a variety of conditions have been investigated. Protein changes were analogous to those observed after injury or trauma, but showed differences in the detailed behaviour of the pattern of change. Marked increases in the concentrations of five acute-phase reactant proteins (APRP) were seen, with maximum concentrations usually being reached 2 days after surgery in patients who made an uncomplicated recovery from their operations. Considerable differences were observed between the patterns of change of APRP in patients who developed complications during recovery and in patients who made an uncomplicated recovery from surgery. Concentrations of C-reactive protein and alpha-1 antichymotrypsin (ACT) were much higher in the patients who developed complications, with ACT concentrations providing the clearest separation between the groups. The main factor influencing the changes in APRP during the recovery period appeared to be the development of sepsis. Preoperative concentrations of APRP had no prognostic value for identifying patients at risk of developing complications. The study suggests that the localisation of inflamed tissue involved in the disease processes may influence the detailed behaviour of the acute-phase reactant proteins.

Synthesis of alpha 1-acid glycoprotein by the human prostate

In order better to define the extent of protein synthesis capacity of the human prostate, we have studied the translation of selected serum proteins using isolated poly(A)+ RNA preparations and the rabbit reticulocyte lysate system. The translation of alpha 1-acid glycoprotein could be conclusively demonstrated but there was no apparent translation of albumin and plasmatic transferrin. Labeled alpha 1-acid glycoprotein was identified by specific immunoprecipitation with a commercial anti alpha 1-acid glycoprotein antiserum and correct processing by canine pancreatic microsomal membranes. Furthermore, we have shown by the immunoperoxidase technique that alpha 1-acid glycoprotein was indeed localized mainly in prostatic epithelial cells in 2 out of 2 patients with benign prostatic hypertrophy and in 3 out of 11 patients with prostatic adenocarcinoma. The significance of the synthesis and secretion of alpha 1-acid glycoprotein by prostatic cell themselves is presently unknown. However, we think that it could represent an interesting subject to explore further in relation with prostatic inflammation.

Purification and partial characterization of a malignancy-associated glycoprotein

The isolation from cancer patient serum of a glycoprotein (Cc) associated with the presence of a variety of malignancies was previously reported. Although preliminary chemical and physical data indicated that Cc was different from identified circulating glycoproteins, subsequent immunological studies suggested that it was closely related to alpha 1-acid glycoprotein. Further analysis revealed the presence of two components in some Cc preparations and prompted a re-examination of the isolation and characterization data. In the present study, Cc was purified by a modified protocol which involved the use of pleural fluid obtained from individuals with cancer, and an alpha 1-acid glycoprotein antibody column to remove contaminating alpha 1-acid glycoprotein. Typically, the material not retained by the antibody column gave a single band with Mr 53,000 when subjected to sodium dodecyl sulfate-polyacrylamide electrophoresis. Amino terminal analysis revealed that the protein contained a blocked amino terminus, and carbohydrate analysis indicated that complex, asparagine-linked saccharide units were present. The product could be distinguished from alpha 1-acid glycoprotein and other previously described circulating glycoproteins by several criteria, including molecular weight, isoelectric point, and amino acid and carbohydrate composition. One of three preparations isolated had an apparent Mr of 59,000. Carbohydrate analysis as well as deglycosylation studies showed that the change in molecular weight was due to increased glycosylation.

RNA polymerase activity and protein synthesis in mouse tumor-host liver compared to benign para-neoplastic reactions

Elevated protein synthesis in mouse tumor-host liver is the net result of both stimulatory and inhibitory responses. This study compares the directional change in transcription and synthesis of liver and plasma proteins in tumor-host liver as compared with para-neoplastic conditions, such as malnutrition, inflammation, benign cell proliferation and protein deficiency. A methylcholanthrene-induced sarcoma was used in weight stable mice (C57BI/6J). Inflammation was induced by s.c. turpentine injection, and benign cell proliferation by injection of heat-killed Corynebacterium parvum. DNA-dependent RNA-polymerase activity (I, II and III) (EC2.7.7.6) was measured in isolated hepatic nuclei. Protein synthesis was measured by labelling of hepatic and plasma proteins following the injection of a "flooding dose" of the labelled amino acid. Benign hepatic cell proliferation and sterile inflammation caused increased rates of transcription, while malnourished and healthy control animals had lower hepatic transcription than animals bearing a malignant tumor. Inflammation was associated with increased activities of free (nonchromatin engaged) RNA polymerase, which was not found in any other para-neoplastic condition or in the tumor-host liver. A protein- and calorie-deficient state was associated with depressed hepatic and plasma protein synthesis compared with the tumor condition. Tumor-host livers had a nonsecretory protein synthesis rate equal to that of normal livers, but 45% higher plasma protein synthesis. Animals with inflammation and benign cell growth had liver protein synthesis rates which were approximately 50% higher than in tumor-bearing animals, but plasma protein synthesis in tumor-bearing animals was comparable with that of animals which had inflammation. Benign cell growth was not associated with an overall elevated plasma protein synthesis. The translation rate per transcription activity was highest in normal animals and decreased in animals suffering from either tumor, protein deficiency or benign cell proliferation. Hepatic protein synthesis in tumor-host livers is high considering the degree of anorexia and malnutrition, although not as high as in livers from animals with pronounced inflammation. This counter-regulation in tumor-host livers may indicate a compensatory state to maintain protein synthesis against attenuating factors such as the declining food intake. Protein metabolism in tumor-host livers represents an unusual combination of findings.

Orosomucoid:prealbumin ratio--a marker of the host-tumor relationship in head and neck cancer

The OPR was studied in 203 patients with squamous cell carcinoma of the head and neck at the time of diagnosis, before any specific treatment. The mean initial OPR value was significantly higher in cancer patients than in 63 healthy controls: 5.29 +/- 3.09 vs. 2.63 +/- 1.07; P less than 0.001. There was no significant difference by anatomic site, but the OPR was significantly lower in stage I-II disease than in stage III-IV: 5.10 +/- 3.85 vs. 3.23 +/- 1.99, P less than 0.001. An initial OPR under or over 6 seems to be an important prognostic factor: at 2 years, 51% of patients with an OPR less than 6 were alive vs. only 24.5% of those with an OPR greater than 6, P less than 0.001. The difference was also noted in patients with stage III-IV disease (mean survival: 16 months vs. 7 months, P less than 0.001) and in 89 of the patients who received chemotherapy (mean survival 16 months vs. 6 months, P less than 0.001) whatever the response to chemotherapy. The OPR index, which explores nutritional and acute phase reactant proteins, seems to reflect the host-tumor relationship. Its initial value is strongly related to prognosis at 2 years.

[Hematologic or hemostaseologic "paraneoplastic syndromes" as prognostic factors?]

Paraneoplastic syndromes are early but seldom appearing remote effects of tumors. In contrast, hematological or hemostaseological tumor signs can be demonstrated nearly in every tumor patient, mostly, however, after prolonged disease. The signs result from interaction between tumor and host, they depend upon the monocyte-macrophage system and are mediated by interleukin-1. Therefore, strictly speaking, they are no paraneoplasias. By genetic instability and increasing heterogeneity, the tumor cell gradually overcomes this defence line and the clinical pictures of different metastatic diseases equalize slowly. Finally, main causes of death are equally occurring infectious and hemostaseological complications. They demonstrate the final breakdown of this defence system.

Tumour necrosis factor in man: clinical and biological observations

Eighteen patients with advanced cancer have been treated intravenously with human recombinant tumour necrosis factor (rhTNF). The drug produced febrile reactions at all doses although these were preventable by steroids and indomethacin. Doses at or above 9 x 10(5) units (400 micrograms)m-2 were associated with hypotension, abnormal liver enzymes, leucopenia and mild renal impairment in a substantial proportion of patients. RhTNF was cleared from plasma with a half life of approximately 20 minutes but non-linear pharmacokinetics lymphoma, improvements in their tumours were recorded. RhTNF was noted to produce rapid increases in serum C-reactive protein concentrations. Endogenous TNF levels were not found to be elevated in 72 cancer patients. TNF deserves further therapeutic evaluation and these observations support its biological importance as an endogenous pyrogen, mediator of acute phase protein responses, and a mediator of endotoxic shock.

Protein synthesis in hepatocytes isolated from patients with gastrointestinal malignancy

To investigate the effect of remote and proximate cancer on hepatic protein metabolism, we determined rates of total protein synthesis by hepatocytes (HPS) isolated from 31 patients undergoing liver wedge biopsy: 7 patients with benign disease, 14 with gastric cancer, and 10 with colorectal cancer (5 of whom had liver metastases). Patients with malignant disease without weight loss had a threefold higher rate of total HPS (4,980 +/- 814 pmol/h per 10(5) viable cells) than patients with benign disease without weight loss (1,278 +/- 318 pmol/h per 10(5) viable cells, P less than 0.001). Among the patients with gastric cancer, eight with preoperative weight loss had lower rates of HPS (380 +/- 90 pmol/h per 10(5) viable cells) than those without weight loss (4,061 +/- 401 pmol/h per 10(5) viable cells, P less than 0.002). The highest rates of HPS were seen in patients with colorectal cancer with liver metastases (8,005 +/- 1,975 pmol/h per 10(5) viable cells) vs. colorectal cancer patients without liver metastases (3,060 +/- 575 pmol/h per 10(5) viable cells, P less than 0.03). These data indicate that modulation of hepatic protein synthesis occurs in malignancy in man. However, the stimulatory influence of the tumor-bearing state may be overridden by the inhibitory effects of cachexia.

A novel tumour marker related to the c-myc oncogene product

We have studied the utility of the c-myc oncogene product as tumour marker using a set of monoclonal antibodies raised against synthetic peptides constructed from sequence data of the human c-myc oncoprotein. One antibody, Myc1-9E10, raised against the C-terminal 32 amino acids, has been shown to detect specifically the 62 kDa c-myc gene product in tumour cells. Immunoblotting of sera and urine with this antibody consistently revealed a single 40 kDa band (p40). Quantitative analysis using dilution dot immunoblotting demonstrated a considerable increase in the titre of p40 in the sera of 51 patients with a wide range of advanced solid tumours when compared with 17 healthy controls and 50 patients with non-malignant diseases. Serial measurement of the p40 titre in 12 patients with resected colorectal carcinoma shows a gradual return to normal with a half-life of 7 days. Our data suggests that p40 may be a useful new marker for monitoring tumour activity.

A modified pharmacokinetic model for platinum disposition in ovarian cancer patients receiving cisplatin

We have fitted a first-order multicompartment pharmacokinetic model to plasma platinum concentrations measured in nine ovarian cancer patients who received intravenous infusions of cisplatin for 6 h. The time-course of ultrafilterable plasma platinum was similar in all patients studied, and was fitted by a single compartment within the limits of experimental detection. However, the time-course of protein-bound platinum showed marked differences between patients, the differences being explained by distribution to two peripheral compartments. The wide inter-patient variation observed in protein-bound plasma platinum concentrations supports the view that pharmacokinetic modelling should be carried out separately for each patient, since averaging plasma concentrations would have obscured some individual pharmacokinetic characteristics.

Purification of two species of exudate cysteine-proteinase inhibitors that are acute-phase reactants in the carrageenin-induced inflammation in rats

Two species of cysteine-proteinase inhibitors (CPIs) have been purified to homogeneity from exudate in the carrageenin-induced inflammation in rats. The exudate CPIs were separated into two forms (named CPI-1 and -2) in affinity chromatography on S-carboxymethyl-papain-Sepharose, the final stage of purification. CPI-1 and -2 gave different mobilities in polyacrylamide gel electrophoresis (PAGE), probably because of different isoelectric points (pI 4.47 for CPI-1 and pI 4.21 for CPI-2). Both CPI-1 and -2 showed immunological identity in double immunodiffusion and same molecular mass of 68 kDa when analysed by SDS-PAGE. These results indicate that CPI-1 and -2 are very similar but distinct CPIs. CPI-1 and -2 are acute-phase reactants and probably represent two species of T-kininogens having inhibitory activity toward cysteine proteinases.

Studies of cellular retinol-binding protein (CRBP) in squamous-cell carcinomas of the head and neck region

Cellular retinol-binding protein (CRBP) concentration was determined by radioimmunoassay in biopsies from normal mucosa and squamous-cell cancers of the head and neck region in 26 patients. The plasma concentrations of retinol, retinol-binding protein (RBP), prealbumin, albumin, orosomucoid and alfa1-antitrypsin were also determined. In all patients the tumours contained significantly higher concentrations of CRBP (median = 185 micrograms/g tissue protein; range: 27-1,017 micrograms/g) than normal mucosa (median = 14 micrograms/g tissue protein; range 6-97 micrograms/g). CRBP could not be detected in patient plasma. The tumor/normal mucosa CRBP concentration ratio showed a significant inverse correlation to a histopathological malignancy grade score evaluating the tumour-host relationship, suggesting that tumours with high CRBP relative to normal mucosa are biologically less aggressive. Tumour CRBP showed no correlation either to CRBP concentration in normal mucosa, or to plasma retinol or plasma retinol-binding protein concentration. CRBP concentration in normal mucosa, however, showed a significant correlation to plasma retinol-binding protein concentration. Most of the patients had low levels of plasma retinol and retinol-binding protein compared to matched controls. Whether this has any relationship to the development of the tumour, or whether the active inflammation induced by the cancer leads to a low plasma retinol concentration, is unknown.

The role of serum tumour markers to aid the selection of lung cancer patients for surgery and the assessment of prognosis

We have measured the following ten serum proteins in a sample of 290 patients presenting with possible lung cancer: carcinoembryonic antigen (CEA), alpha 1-acid glycoprotein (AGP), C-reactive protein (CRP), ferritin (FER), prealbumin (PAB), third component of complement (C3), immunoglobin E (IgE), alpha 2-pregnancy-associated glycoprotein (PAG), beta 2-microglobulin (beta 2-m) and retinol binding protein (RBP). It is found that, with the exception of PAG, C3 and IgE, there are significant differences between protein concentrations in the subsequently diagnosed cancer and non-cancer patients. However, protein concentrations in the cancer patients who were suitable for surgery do not differ significantly from the concentrations in inoperable patients. The prognostic significance of the proteins in the inoperable and operable cancer patients is also envisaged. In the operable group C3 appears to be useful, whilst AGP and RBP are prognostic indicators in the inoperable group.

Cancer serum index and prostatic acid phosphatase for detection of progressive prostatic cancer

The ratio of alpha 1 acid glycoprotein/prealbumin, referred to as a cancer serum index, has been proposed as a marker for neoplastic disease. In a series of 130 patients with prostate cancer, the cancer serum index was measured along with serum prostatic acid phosphatase. A significant difference for both the cancer serum index and serum prostatic acid phosphatase was detected between those patients with no evidence of active disease after treatment and those with progressive disease after treatment.

Tumor markers: value and limitations in the management of cancer patients

Sixteen tumor markers are reviewed, and measured to the ideal: produced by the tumor cell alone absent in health and in benign disease present in all patients with a given malignancy level in the blood representative of tumor mass detectable in occult disease. The only marker that approaches the ideal is human chorionic gonadotropin (HCG) in gestational trophoblastic tumors. In this malignancy, the HCG level suggests the diagnosis and stage, confirms response to therapy, and predicts relapse. The three most widely used and intensely studied tumor markers are carcinoembryonic antigen (CEA), alphafetoprotein (AFP), and HCG. CEA cannot be used in screening for cancer, but in carcinoma of the colon its elevation preoperatively increases the likelihood of advanced disease and postoperative recurrence. Postoperatively, elevated titers are often but not invariably associated with recurrent disease. AFP and HCG are useful in the management of nonseminomatous germ cell testicular tumors. Like CEA, they cannot be used for screening. They are more likely to be increased with advancing stage, and after therapy rising levels almost always mean recurrent disease. Some markers are valuable in specific circumstances, such as calcitonin in screening for familial medullary carcinoma of the thyroid. In multiple myeloma, immunoglobulins are useful in determining the tumor mass and response to therapy. In neuroblastoma, catecholamine metabolites are useful primarily in making the diagnosis. In some malignancies, the absence of effective therapy lowers the value of the marker, as for AFP in hepatoma. The remaining markers are too unreliable or too little studied to be useful in the management of an individual patient with cancer. The purpose of this paper is to provide the clinician with an understanding of the limitations of the present tumor markers that will lead to wiser use of the tests, and to provide standards to which future tumor markers should be measured.

Relation between raised concentrations of fucose, sialic acid, and acute phase proteins in serum from patients with cancer: choosing suitable serum glycoprotein markers

Serum concentrations of fucose, sialic acid, and eight acute phase proteins were measured in single specimens from patients with cancer in order to determine whether the raised concentrations of protein bound sugars commonly found in cancer correlate with increased concentrations of the acute phase proteins. Strong positive correlations were found only with alpha 1-acid glycoprotein, alpha 1-antitrypsin, and haptoglobins. Changes in protein bound sugars and acute phase proteins were also examined in relation to patients' disease states. Serum fucose was raised more often in patients with advanced disease than in those in whom the spread of the tumour was more restricted; increased sialic acid concentrations, however, were found with a similar frequency in both these groups. Combined use of fucose and sialic acid values gave a high degree of marker positivity which could be only slightly improved on by including measurement of acute phase proteins. The combined use of serum fucose and sialic acid concentrations may have value in monitoring patients with cancer: the sialic acid provides an index of the acute phase response and the fucose a measure of the tumour spread.

Serum C-reactive protein response to therapeutic embolisation: possible role in management

In a prospective study over 12 months, serum C-reactive protein concentration was measured serially in 20 consecutive patients who underwent therapeutic embolisation for various forms of malignancy and in 13 patients who had diagnostic coeliac or hepatic angiography without embolisation. All the patients who underwent successful embolisation showed a C-reactive protein response and in all cases the height of the response correlated well with the estimated size of the embolised tumour. Patients who recovered uneventfully showed a prompt fall in C-reactive protein from its peak values towards normal. In contrast, patients undergoing angiography alone showed only a minor increase in C-reactive protein concentration unless there were intercurrent complications. These results, together with the commercial availability of rapid and precise assays for C-reactive protein, indicate that serial measurement may be useful in the confirmation of tissue necrosis and assessment of its extent; also in the recognition of intercurrent complications following therapeutic embolisation.

Acute phase glycoproteins in sera of patients with sarcomas receiving methotrexate infusion therapy

The serum concentrations of alpha-1-acid glycoprotein, haptoglobin and alpha-1-antitrypsin have been estimated serially in eight patients with malignant tumours of bone and soft tissue, who received a total of thirty-four intravenous infusions of high-dose methotrexate. The serum glycoprotein levels taken before the first drug exposure did not relate with the prognosis of these patients. A tumour mass (40 mm) did not influence the serum levels of these glycoproteins. The presence of a pleural effusion was associated with increased serum levels of these glycoproteins. These assays appear to be of no value in monitoring the course of the disease in this group of cancer patients.

Plasma proteinase inhibitors in Morris hepatoma-bearing rats: changes in the blood level and synthesis in tissue slices

The antiproteinase activities against trypsin, chymotrypsin, elastase, papain and rat leucocyte proteinases were determined in plasma from control and Morris hepatoma-bearing rats. Bovine trypsin and chymotrypsin were similarly inhibited by the two types of plasma whereas porcine pancreatic elastase, papain and rat leucocyte neutral proteinases were more efficiently inhibited by plasma from tumour-bearing rats. The increased plasma concentrations of some proteinase inhibitors, as determined by rocket immunoelectrophoresis, are suggested to be responsible for the observed differences in inhibition. The highest increases in plasma of tumour-bearing rats were observed for alpha 2-macroglobulin and alpha 1-acute-phase globulin. The synthesis and secretion of six proteinase inhibitors: antithrombin III, alpha 1-proteinase inhibitor, alpha 1-macroglobulin, alpha 2-macroglobulin, alpha 1-acute-phase globulin and haptoglobin, as well as albumin, were measured in tissue slices from rat liver and Morris hepatoma after incubation with [14C]leucine. Local inflammation inflicted upon the tumour-bearing rats increased formation of acute-phase proteins in liver slices but not in hepatoma slices.

Serum carcinoembryonic antigen and acute phase reactant proteins in the pre-operative detection of fixation of colorectal tumours

Fixity of colorectal tumours carries a poor prognosis, but only if it is the consequence of malignant spread. Pre-operative radiotherapy may be beneficial but selection depends on clinical examination which is often inaccurate or impossible. We therefore investigated if serum concentrations of carcinoembryonic antigen and acute phase reactant proteins (APRPS) which may be elevated in patients with colorectal cancer could determine the degree and nature of local spread prior to operation. Carcinoembryonic antigen (CEA), alpha 1 acid glycoprotein (AGP) and C-reactive protein (CRP) were measured pre-operatively in 100 patients with colorectal tumours, 89 of whom had a carcinoma. Thirty-two (36 per cent) were fixed, 18 (56 per cent) by malignancy (FM) and 14 (44 per cent) by inflammation (FI). Levels of CEA, AGP and CRP were all significantly higher in the serum of patients with fixed tumours (P less than 0.05). Concentrations of AGP greater than 1.4 g/l or CRP greater than 15 mg/l were accurate predictors of tumour fixation (specificity 87 and 90 per cent; sensitivity 78 and 78 per cent. CEA appeared more accurate in determining the nature of fixation. A value of greater than 50 ng/ml predicted 82 per cent of FM tumours (specificity 100 per cent; sensitivity 87 per cent). Thus, pre-operative measurement of serum CEA and APRP appear able to predict fixation of colorectal tumours.

Proximal renal tubular function in myelomatosis: observations in the fourth Medical Research Council trial

Proximal renal tubular function was studied in 522 consecutive patients entered into the Medical Research Council's fourth myelomatosis trial. Assessment was made at presentation after a 48 h period of hydration but before administration of chemotherapy. The most common abnormalities in the urine other than light chain proteinuria were raised concentrations of the low molecular weight proteins alpha 1-microglobulin and alpha 1-acid glycoprotein. These were usually accompanied by increases in urinary beta-N-acetyl-D-glucosaminidase concentrations. The concentration of these substances in the urine directly correlated with urinary free light chain output. This tubular proteinuria was seen whether or not patients had impaired glomerular function, as assessed by a rise in serum creatinine concentration. Urinary concentrations of retinol binding protein, however, were generally increased only when serum creatinine concentrations were raised. This applied even when there were high concentrations of light chains, alpha 1-microglobulin, alpha 1-acid glycoprotein, and beta-N-acetyl-D-glucosaminidase in the urine. There is therefore a selective tubular proteinuria in myelomatosis which is seen in almost all patients with urinary light chain values greater than 1 u/l. This proteinuria is generally reversible, when light chains no longer appear in the urine. Patients whose serum creatinine was greater than 200 mumol/l, however, had increased urinary output of retinol binding protein in addition to increased excretion of alpha 1-microglobulin, alpha 1-acid glycoprotein, and beta-N-acetyl-D-glucosaminidase. Tubular proteinuria in many of these patients presenting in renal failure persisted even when light chain output was reduced after chemotherapy.

Biochemical markers in non-Hodgkin's lymphoma stages III and IV and prognosis: a multivariate analysis

The prognostic value of different pretreatment laboratory and clinical findings at diagnosis was assessed in a series of 141 patients with generalized non-Hodgkin's lymphoma. Univariate and multivariate survival analysis (Cox's regression model) was performed, using serum analysis of deoxythymidine kinase (S-TK), beta 2-microglobulin, lactic dehydrogenase, alpha 1-acid glycoprotein = orosomucoid (S-alpha 1 AGP), haptoglobin and ferritin. In addition, Hb and the erythrocyte sedimentation rate (ESR) were measured. The clinical variables were age, presence or absence of B-symptoms, histopathology ('low-grade'; 'intermediate grade' and 'high-grade' malignancy) and bone marrow involvement. Of the 8 biochemical markers, all except Hb and the ESR showed a significant relationship to survival. Among the clinical variables, this finding was made for B-symptoms and histopathology. Using a multivariate analysis on all variables, S-TK was found to be the best factor for predicting duration of survival. The only significant additional information was provided by S-alpha 1 AGP. When only the clinical variables were taken into account, it was found that histopathology added significant information to that yielded by B-symptoms in the prediction of the survival time. When the biochemical variables were added to this model, only S-TK was of significant additional prognostic value.

Immunoglobulin A, G and E levels in Egyptians with cancer: influence of schistosomiasis

The main patient series consisted of 415 Egyptians attending the Cairo Cancer Institute and comprising 286 bladder cancer, 97 breast cancer, 14 head and neck cancer and 18 gastrointestinal cancer cases. Also included in the study were 36 patients with active schistosomiasis and 89 health controls. Serum IgA, IgG, IgG subclasses, IgE, Schistosoma and Ascaris-specific IgE (RAST) and the acute-phase protein CRP were measured in all, or sub-sets, of the main patient group. The well-established increase in IgE and IgG levels, and the more recently reported increase in the levels of IgG3 and IgG4 subclasses in patients with schistosomiasis, were also found in bilharzial bladder cancer, indicating that humoral immunity persists in cancer-bearing patients. However, the plasma protein profile in bilharzial bladder cancer is further modified by significant increases in the levels of IgA, IgG, IgG1, IgG2 and CRP when compared to levels in patients with Bilharzia in the absence of neoplastic change. Patients with cancers not associated with parasitic infestation also had significant increases in their serum levels of IgG1, IgG2, IgG, IgE and CRP when compared to healthy Egyptian controls, but 41% of these non-bladder cancer patients showed IgE responses to previous parasitic infestations suggesting that any immunological response to cancer would be on the background of a variable non-specific increase of IgE.

Serum haptoglobin and alpha 1-acid glycoprotein as indicators of the effectiveness of cis-diamminedichloroplatinum (CDDP) in ovarian cancer patients--a preliminary report

Twenty-one patients with adenocarcinoma of the ovary were given a maximum of five courses of CDDP by i.v. infusion every 4 weeks. With one exception, the serum levels of both haptoglobin and alpha 1-acid glycoprotein correlate with tumour burden before therapy and at follow-up. It is suggested that a more accurate assessment of the effectiveness of CDDP therapy may be obtained by estimating these serum proteins before each infusion than by an abdominal examination.

Changes in serum acute phase proteins in ovarian cancer patients receiving cis-diamminedichloroplatinum (CDDP) infusion therapy

Nine patients with adenocarcinoma of the ovary were given a number of courses of Cisplatin, by I.V. infusion. In four patients a complete clinical response was observed and these patients are disease-free one year after treatment. There was no clinical response in the remaining five patients who have subsequently died. Serial determinations of three acute-phase reactant proteins (alpha 1-acid glycoprotein, haptoglobin, alpha 1-antitrypsin) were performed before every infusion and after therapy. Constantly high or rising serum levels of haptoglobin and alpha 1-acid glycoprotein were associated with progression of the cancer, whereas in patients who were disease-free after therapy, these glycoproteins remained essentially in the normal range. The results suggest that serial measurements of haptoglobin and alpha 1-acid glycoprotein may have clinical value as aids in deciding the effectiveness of drug therapy in these patients.

Radioimmunoassay of a glycoprotein associated with malignancy

A glycoprotein associated with malignancy was purified from the 0.6M perchloric acid-soluble fraction of serum obtained from cancer patients. The purified glycoprotein contained sialic acid, which was responsible for binding to wheat-germ agglutinin-Sepharose. Gel electrophoresis showed one band with an apparent Mr of 50 000-55 000, and the isoelectric point was 4.4 +/- 0.1. The glycoprotein could be distinguished from carcinoembryonic antigen and alpha-fetoprotein. Iodination of this material with chloramine-T permitted development of a radioimmunoassay.