A cancer-associated galactosyltransferase isoenzyme

Glycans as Biomarkers: Status and Perspectives

Protein glycosylation is a ubiquitous and complex co- and post-translational modification leading to glycan formation, i.e. oligosaccharide chains covalently attached to peptide backbones. The significance of changes in glycosylation for the beginning, progress and outcome of different human diseases is widely recognized. Thus, glycans are considered as unique structures to diagnose, predict susceptibility to and monitor the progression of disease. In the »omics« era, the glycome, a glycan analogue of the proteome and genome, holds considerable promise as a source of new biomarkers. In the design of a strategy for biomarker discovery, new principles and platforms for the analysis of relatively small amounts of numerous glycoproteins are needed. Emerging glycomics technologies comprising different types of mass spectrometry and affinity-based arrays are next in line to deliver new analytical procedures in the field of biomarkers. Screening different types of glycomolecules, selection of differentially expressed components, their enrichment and purification or identification are the most challenging parts of experimental and clinical glycoproteomics. This requires large-scale technologies enabling high sensitivity, proper standardization and validation of the methods to be used. Further progress in the field of applied glycoscience requires an integrated systematic approach in order to explore properly all opportunities for disease diagnosis.

Glycans as a Target in the Detection of Reproductive Tract Cancers

The significance of changes in glycosylation for the beginning, progress and outcome of different human diseases is highly recognized. In this review we summarized literature data on the alteration of glycans in cancer, especially glycoforms of tumor markers of reproductive tract cancers: prostate-specific antigen (PSA) and cancer antigen 125 (CA125). We aimed to highlight the diagnostic potential and relevance of glycan microheterogeneity and to present some novel methods for cancer detection. A computerized search of articles published up to 2007 was performed through the PubMed database. Search terms utilized included prostate/ovarian cancer glycosylation, prostate/ovarian cancer detection, PSA/CA125 glycosylation. Additional sources were identified through cross-referencing and researching in available biomedical books. The comparative studies of sugar chain structures of the PSA and CA125 indicated specific structural alterations associated with malignant transformation, in relation to glycan branching, sialylation and fucosylation. These glycan modifications should be better in distinguishing between benign and malignant conditions than the measurement of marker concentrations alone, which is widely used in practice. Cancer-associated changes in the glycosylation could yield more sensitive and discriminative diagnostic tests for reproductive tract cancer detection, i.e. for improvement of the clinical utility of known tumor markers or the discovery of new ones.

Evaluation of beta1,4-galactosyltransferase as a potential biomarker for the detection of subclinical disease after the completion of primary therapy for ovarian cancer

OBJECTIVE

Approximately 50% of patients with ovarian cancer who have normal CA 125 levels at the completion of therapy have persistent disease. In an effort to improve the ability to detect small volume disease, we have evaluated the usefulness of N-acetylglucosamine:beta1,4-galactosyltransferase as a potential biomarker for the detection of subclinical disease after the completion of primary therapy for ovarian cancer.

STUDY DESIGN

The sera of 33 patients with stage IIIC epithelial ovarian cancer in complete clinical remission after chemotherapy (CA 125 <35 units/mL and negative computed tomography scan) who underwent second-look surgery were examined for N-acetylglucosamine:beta1,4-galactosyltransferase activity. The values were determined from sera that had been obtained before primary cytoreductive operation and before second-look surgery after the completion of platinum-based chemotherapy. Determinations of the levels of CA 125 were performed with the Bayer Immuno ITM CA-125 II assay. N-acetylglucosamine:beta1,4-galactosyltransferase activity was determined by measuring the transfer of galactose from uridine diphosphate- carbon 14-labeled galactose to the terminal N-acetylglucosamine residue of a very well-defined synthetic acceptor, N-acetylglucosamine:beta1,6GalNAc(alpha)-o-benzyl, which is a portion of the core structure of mucin glycoproteins. The cutoff value of N-acetylglucosamine:beta1,4-galactosyltransferase was determined to be 22,000 counts/min, based on the analysis of 25 healthy control subjects. Correlation between serum CA 125 and N-acetylglucosamine:beta1,4-galactosyltransferase levels was determined with the use of the Pearson correlation coefficient. The ability of galactosyltransferase to identify small volume disease correctly was also evaluated.

RESULTS

There was a significant correlation between serum CA 125 and N -acetylglucosamine:beta1,4-galactosyltransferase levels before the operation (r = 0.57; P =.03) but not before second-look surgery (r = 0.10; P =.57). Thirteen patients (39.4%) had residual disease at second-look surgery. Elevated N-acetylglucosamine:beta-1,4galactosyltransferase activity >22,000 cpm correctly identified 10 of these patients (76.9%). The sensitivity, specificity, and positive and negative predictive values of N-acetylglucosamine:beta1,4-galactosyltransferase activity (>22,000 counts/min) for the prediction of residual disease at second-look surgery were 77%, 45%, 48%, and 77%, respectively.

CONCLUSION

Our comparative study of serum CA 125 and N -acetylglucosamine:beta1,4-galactosyltransferase levels showed a significant correlation between the two tumor markers before the beginning of ovarian cancer therapy. This correlation disappeared before second-look surgery because 60% of patients with normal serum CA 125 and N-acetylglucosamine:beta1,4-galactosyltransferase levels. CA 125 antigen appears to be inferior to N -acetylglucosamine:beta1,4-galactosyltransferase in the detection of small-volume residual disease. N-acetylglucosamine:beta1,4-galactosyltransferase may be useful as a biomarker in the monitoring of patients with ovarian cancer when the serum CA 125 level is normal. These findings require confirmation in larger studies.

Clinical characteristics of a newly developed ovarian tumour marker, galactosyltransferase associated with tumour (GAT)

In this study clinical studies were conducted on galactosyltransferase associated with tumour (GAT) as a newly developed marker of ovarian cancers. The positive rates of GAT with a cut-off value of 16 U/ml (which corresponds to the mean + 2 standard deviations (S.D.) for healthy females) were 4.7% for benign ovarian tumours, 4.5% for endometriosis and 45.9% for ovarian cancers. GAT showed a positive rate comparable to that of CA546 or CA72-4 among other tumour markers (CA602, CA125, CA546, CA72-4, STN and SLX) examined in ovarian cancers. However, it showed lower positive rates for benign ovarian diseases and, in particular, it gave the lowest positive rate for endometriosis among the aforementioned tumour markers. Furthermore, the receiver operating characteristic (ROC) analysis for discriminating between ovarian cancer and endometriosis showed a significantly high area under the curve (AUC) for GAT compared with that of the other markers. GAT showed the lowest correlation coefficients with other markers, and the positive rate and the diagnostic efficiency were increased by its combination assay with CA602 and/or CA546. Furthermore, the accuracy of the diagnosis of ovarian cancer improved by examining GAT after screening with CA602 or ultrasonography. These results suggest that GAT is a suitable marker for distinguishing ovarian cancers from benign gynaecological diseases, particularly endometriosis, and is useful for combination assay or secondary screening for ovarian cancers.

Clinical relevance of serological markers in the detection and follow-up of pancreatic adenocarcinoma

Pancreatic adenocarcinoma is a relatively common malignancy and its incidence is increasing. Prognosis in these patients is poor, and surgery, the only effective treatment, saves only a minority of patients. The number in this small group of patients might be increased by early detection of pancreatic tumours. This review examines the current status of pancreatic tumour associated proteins in the detection of pancreatic cancer. As well as existing markers, the review also reports on newer markers that may offer advantages over existing ones in the detection of pancreatic adenocarcinoma. This is particularly important because recent studies have identified high-risk groups susceptible to pancreatic cancer. Future research in pancreatic cancer should be directed at earlier detection, and tumour markers may play an important role in this process.

A novel mechanism for isoprenaline-stimulated proliferation of rat parotid acinar cells involving the epidermal growth factor receptor and cell surface galactosyltransferase

Chronic injections of epidermal growth factor (EGF) or the beta-adrenergic receptor agonist isoprenaline resulted in rat parotid gland hypertrophy and hyperplasia. Introduction of a polyclonal antibody to EGF or the EGF-receptor (EGF-R) caused a specific retardation of acinar cell proliferation when injected along with the growth factor. Meanwhile, only the antibody to EGF-R caused a dose-dependent retardation of proliferation on co-administration with isoprenaline both in vivo and in vitro. The antibody injected alone had no effect on cell growth. When cells were incubated in the presence of EGF, plasma membranes from isoprenaline-treated and control animals showed phosphorylation of the EGF-R tyrosine moieties and transient increases in membrane-associated phospholipase C gamma. Isoprenaline did not stimulate phosphorylation of the EGF-R in isolated plasma membranes. However, activation of the phosphotyrosine-signalling pathway could be duplicated by incubating isoprenaline-treated acinar cells, but not control cells, with bovine galactosyltransferase. Immunopurified EGF-R demonstrated variations in reactivity with two different lectins after treatment of the cells with the beta-agonist as well as increased galactosyltransferase substrate capacity in vitro. In addition, incubation of intact acinar cells and isolated plasma-membrane fractions from isoprenaline-treated rats with UDP-[14C]galactose resulted in an increased incorporation of label into the EGF-R. The results suggest that the carbohydrate moiety of the EGF-R has been altered in isoprenaline-treated animals allowing galactosyltransferase now to recognize this receptor. This interaction may in part mediate proliferation of parotid acinar cells. Indeed, we have previously shown that an antibody to galactosyltransferase is capable of blocking isoprenaline-mediated acinar cell proliferation in vivo [Humphreys-Beher, Schneyer, Kidd & Marchase (1987) J. Biol. Chem. 262, 11706-11713].

Changes in normal glycosylation mechanisms in autoimmune rheumatic disease

To investigate potential mechanisms controlling protein glycosylation we have studied the interrelationship between lymphocytic galactosyltransferase (GTase) activity and serum agalactosylated immunoglobulin G levels (G(0)) in healthy individuals and patients with rheumatoid arthritis and non-autoimmune arthritis. In RA there was reduced GTase activity and increased G(0). A positive linear correlation between B and T cell GTase was found in all individuals. The relationship between GTase and G(0) was found to be positive and linear in the control population and negative and linear in the RA population. Sulphasalazine therapy maintained normal levels of GTase and caused a reduction in G(0) in the RA population. IgG anti-GTase antibodies (abs) were significantly increased in the RA population, whereas IgM anti-GTase abs were significantly decreased in both the RA and the non-autoimmune arthritis groups. These data describe a defect in RA lymphocytic GTase, with associated abnormal G(0) changes, which is corrected by sulphasalazine. A possible regulatory mechanism controlling galactosylation in normal cells is suggested, in which there is parallel control of B and T cell GTase. IgM anti-GTase abs may be integrated into this normal regulatory process. This is disrupted in RA, where the positive feedback between GTase and G(0) is lost and there is an associated increase in IgG anti-GTase abs, which may result from isotype switching as IgM anti-GTase abs are reduced. We suggest that these mechanisms are of relevance to the pathogenesis of RA, and that their manipulation may form part of a novel therapeutic approach.

A solid-phase assay for beta-1,4-galactosyltransferase activity in human serum using recombinant aequorin

We have developed a sensitive and rapid solid-phase assay for the serum enzyme UDPGal:beta-D-GlcNAc beta-1,4-galactosyltransferase (beta 1,4-GT) (EC 2.4.1.38) that employs the recombinant bioluminescent protein aequorin as the enzyme label for product detection. The substrate for beta 1,4-GT is a neoglycoprotein, bovine serum albumin containing covalently attached GlcNAc residues (GlcNAc-BSA), and it was immobilized by adsorption in microtiter plate wells. Serum samples were added to each well along with saturating levels of UDPGal and Mn2+. Galactosylation of the neoglycoprotein acceptor by the serum beta 1,4-GT produces the N-acetyllactosamine derivative Gal beta 1, 4GlcNAc-BSA. The product formed is quantified by adding the biotinylated plant lectin Ricinus communis agglutinin-I, which binds specifically to N-acetyllactosamine, followed by the addition of streptavidin and the biotinylated aequorin. Aequorin produces a flash of light in response to Ca2+ and is detectable to 10(-19) mol in a luminometer. Using this assay, the beta 1,4-GT activity in human serum and the activity of a semipurified beta 1,4-GT are linear with time and serum concentration over a wide range. The reaction is dependent on UDPGal and Mn2+, is highly reproducible with a low background, and can be performed in a few hours. Assays employing aequorin have a wider range of linearity than those employing horseradish peroxidase as an enzyme label. These results demonstrate that the assay for beta 1,4-GT is useful for determining activity in heterogeneous samples and also demonstrate the utility of the recombinant protein aequorin for solid-phase assay methods.

Serum diagnostic tests for pancreatic cancer

Serological tests for pancreatic cancer have been criticized too harshly as a result of being tested in inappropriate roles. They are never likely to become sufficiently specific for screening an asymptomatic population unless some way can be found of defining a population with a particularly high risk for the disease. Nor are they appropriate in the investigation of the jaundiced patient. The markers that are carried by secreted mucins seem the most promising and in view of the marked heterogeneity of carbohydrate expression on mucins a combination of tests for two or three carefully selected markers is likely to be better than one. The high cost per test that results from using commercially available radioimmunoassay kits with a short shelf-life can be reduced by using enzyme-linked assays which have a much longer shelf-life. These tests are likely to be of most help in the investigation of non-jaundiced patients with unexplained abdominal pain or weight loss. In this group of patients it seems probable that serological tests will compliment scanning techniques but further studies are needed to assess this.

Alteration in isoenzyme patterns of serum galactosyltransferase activity in ovarian cancer patients: preliminary results

Isoelectric focusing on agarose gel was used to separate the isoenzymes of serum galactosyltransferase (uridine diphosphogalactose: N-acetylglucosaminyl galactosyltransferase, EC 2.4.1.22) from 8 healthy women, and 11 ovarian cancer patients of whom 4 were in clinical remission. In all cases, we found 7 major peaks with isoelectric points ranging from 4.0-5.4. The most acidic peaks were preferentially elevated in the tumor-bearing patients, particularly the peak with pI 4.44.

Identification and partial characterization of a new pancreatic cancer-related serum glycoprotein by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and lectin blotting

The combination of sodium dodecyl sulfate-polyacrylamide gel electrophoresis and peanut agglutinin lectin blotting has been used to identify a pancreatic cancer-related glycoprotein in serum. Its high molecular weight and its lectin-binding characteristics suggest that it probably is a mucin. Comparison with immunoblotting with Ca 19-9 antibody suggests that the epitopes for Ca 19-9 and peanut agglutinin may be variably expressed on different sites of the same mucin. The peanut agglutinin-binding glycoprotein was demonstrated in 12 of 34 pancreatic cancer sera, including four with normal Ca 19-9 assay, and none of 96 control sera, including sera from patients with obstructive jaundice and other cancers. These preliminary results suggest that it may become a useful addition to the current serum markers for pancreatic cancer. The technique of sodium dodecyl sulfate-polyacrylamide gel electrophoresis and lectin blotting may well prove valuable in the search for other cancer-related glycoprotein markers.

Separation and partial characterization of two galactosyltransferase isoforms from malignant ascitic fluid

Galactosyltransferase was isolated from human malignant ascites by ammonium sulphate precipitation, alpha-lactalbumin affinity chromatography and by the removal of contaminating immunoglobulins with protein A chromatography. Two isoforms of galactosyltransferase were separated by DEAE chromatography, and partially characterised by gel filtration, non-denaturing polyacrylamide gel electrophoresis, concanavalin A binding and enzyme kinetics. The two forms isolated were compared with the isoenzymes previously described and the biochemical basis for the difference between the two forms discussed.

Methods of early diagnosis in genitourinary cancer

The commonly employed methods for the early detection of urologic cancers remain the traditional techniques of a carefully performed history and physical examination. Newer developments include, among others, prostate-specific antigen and monoclonal antibodies in prostate cancer, flow cytometry in bladder cancer, computerized axial tomography (CAT) scanning in renal cancer, and ultrasound in testicular cancer. These and other new diagnostic techniques, with further testing and wider use, will hopefully permit the earlier diagnosis of genitourinary cancer.

Evaluation of galactosyltransferase isoenzyme II in a human colon carcinoma-derived cell line, HCT-8

Polyacrylamide gel electrophoresis of galactosyltransferase (GT) extracted from a human colon adenocarcinoma cell line, HCT-8, demonstrated the presence of two peaks of activity: a slow-moving peak, referred to as GT-II, and a more anodally migrating peak, designated as GT-I, which was also found for normal human serum. However, if GT solubilized from HCT-8 cells was separated by isoelectric focusing, no unique isoenzymes could be detected. Total GT activity from HCT-8 cells was purified by alpha-lactalbumin-Sepharose affinity chromatography followed by ion exchange chromatography on either DEAE-cellulose or FPLC using a Mono Q anion exchange resin. Three major peaks of activity were resolved from anion exchange chromatography. Electrophoresis of each peak revealed a GT pattern identical with that originally observed for the crude (detergent) solubilized homogenate. No enrichment of either GT-I or GT-II was observed in the three enzyme fractions. The data suggest that GT-II may be an artifactual activity of cancer cells composed of GT-I associated with some contaminating protein.

Characterization of sialyltransferases from serum of normal and hepatoma Mc-29 bearing chickens

Sialyltransferase was measured in serum of normal and hepatoma Mc-29 bearing chickens. By preparative isoelectric focusing the multiple forms of sialyltransferase from both kind of serums was studied as well. By using influenza virus neuraminidase an attempt was made for partial structural characterization of the sialylation sites in asialofetuin applied as exogenous acceptor for sialyltransferase determination. It was established an elevated serum sialyltransferase activity in tumor bearing chickens with tumor an enzyme form was detected with pI-4.99 identical with an enzyme form described previously in solubilized plasma membrane preparations from hepatoma Mc-29. Monitoring of multiple forms of serum glycosyltransferases may be of value in answering the problem concerning the tissue origin of serum enzymes.

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.

Galactosyltransferases: physical, chemical, and biological aspects

Galactosyltransferases (GTs) are one of the members of a family of enzymes called glycosyltransferases involved in the biosynthesis of complex carbohydrates. These enzymes catalyze the transfer of galactose from UDP-galactose to an acceptor (glycoprotein, glycolipid) containing terminal N-acetylglucosamine or N-acetylgalactosamine residue. GTs occur in soluble (milk, serum, effusions, etc.) and insoluble (membrane) forms. The GT activities on the outer surface of the cells have been correlated with a host of cellular interactions, including fertilization, cell migration, embryonic induction, chondrogenesis, contact inhibition of growth, cell adhesion, hemostasis, intestinal cell differentiation, and immune recognition. GTs have been purified to homogeneity using affinity chromatography. Most GTs are found active in the pH range 6 to 8 and at temperatures between 35 to 40 degrees C. Manganese is an essential co-factor for GT activity. Isoenzymes of GT have been recognized, especially in tumor tissues, malignant effusions, and sera of cancer patients using polyacrylamide gel electrophoresis in the presence and absence of SDS. Depending on the source of the enzyme, the molecular weights of GTs range between 40,000 to 80,000 daltons. Carcinoma-associated GT isoenzyme has been reported to have a higher molecular weight than the normal GT isoenzyme. Development of monoclonal antibody against the cancer-specific GT isoenzyme will provide help in the development of an immunoassay for the measurement of this isoenzyme in the sera and an aid in the radioimmunolocalization of the tumors in cancer patients.

Characterization of monoclonal antibodies to serum galactosyltransferase

Monoclonal IgG and IgM antibodies (mAbs) directed against serum galactosyltransferase (GalTase) activities were prepared and characterized for their relative specificity for GalTase isoenzymes I and II (GalTase I and GalTase II). After immunization of mice with purified GalTase, 7 of 1680 fusion products screened were positive for anti-GalTase activity in a solid-phase assay; of these 7, 2 were found to bind GalTase I in a somewhat selective manner while 1 (C6) was relatively specific for GalTase II. The Ka for anti-GalTase mAbs ranged from 2.7 X 10(7) to 1.1 X 10(8) M-1. Enzymatically active GalTase could be recovered from an affinity column of C6 coupled to Sepharose 4B following application of a cell extract from a human colon cancer cell line, confirming that the mAb is directed against GalTase. A sandwich RIA was developed to measure soluble GalTase II in serum by using a combination of two isoenzyme nonspecific mAbs (F5 and V10) coated on a solid-phase support followed by the addition of antigen and GalTase II-specific 125I-labeled C6. This assay was specific for GalTase II with a sensitivity of approximately 10 ng/ml. Evaluation of 240 sera demonstrated higher levels of GalTase II in patients with gastrointestinal cancer (48 ng/ml). However, in contrast to previous results with a radiochemical assay, some normal sera contained GalTase II (mean, 14 ng/ml) and some patients with liver disease had elevated levels (mean, 23 ng/ml). These studies demonstrate the production of moderate-affinity antibodies directed to serum GalTase isoenzymes and the development of an RIA useful in the study of GalTase.

Serum galactosyltransferase isoenzymes as markers for solid tumours in humans

High resolution agarose isoelectric focusing was used to compare the galactosyltransferase isoenzyme patterns of serum from 9 healthy controls with those from 38 patients with either breast, lung, ovarian, stomach or colonic cancer. At least 12 peaks of enzyme activity were found in every sample, the healthy controls having major forms with isoelectric points of 4.74, 4.87, 4.96, 5.16 and 5.23. Thirty patients (79%) had elevated levels of at least one isoenzyme and 23 (61%) had at least 3 isoenzymes elevated compared to only 10 (26%) patients who had elevated total serum galactosyltransferase activity. The isoenzymes which were most often elevated in the cancer patient group had isoelectric points of 4.93, 5.16 and 4.61. One isoenzyme with an isoelectric point of 4.43 was preferentially elevated in patients with ovarian cancer. Those isoenzymes containing little or no sialic acid were rarely elevated in cancer patients. Although no cancer-associated isoenzyme was detected the quantitative differences observed in the cancer patient group were striking.

Multivariate analyses as aids to diagnosis and assessment of prognosis in gastrointestinal cancer

The role of carcinoembryonic antigen (CEA), gamma glutamyl transpeptidase (gamma GT), phosphohexose isomerase (PHI), pseudouridine (psi) and acute phase reactant proteins (C-reactive protein (CRP) alpha 1-antichymotrypsin (ACT) and alpha 1-acid glycoprotein (AGP] in assessing the prognosis of gastrointestinal neoplasms and the discriminant function in distinguishing benign from malignant diseases of the GI tract was examined. In stomach cancer pre-operative levels of CRP can help in the identification of the patients with a resectable tumour; the pre-operative biochemical measurements do not give any further information on prognosis once stage and site are taken into account. In colorectal cancer pre-operative ACT levels give additional prognostic information once the clinical factors, Dukes stage, sex and age have been accounted for; PHI levels are on the border line of significance. A discriminant function has been devised using sex, CEA, psi, gamma GT, ACT and PHI that can identify 89% of Dukes "D" patients prior to surgery with a misclassification of 7% of other cases of colorectal cancer. A discriminant function using all the biochemical variates separated the cancer from non-cancer patients. The false positive rate for cancer was 16% and a false negative rate of 19%, when the cut-off level was set at 0.7.

The detection and evaluation of human tumor metastases

Many biochemical indices are purported to have clinical utility in the detection and management of neoplasia. Experience gained during the past decade tends to indicate their having a more important role in the detection and monitoring of metastases than of the primary lesion. From this present review of some of the commoner human tumours, it is concluded that such marker substances are important adjuncts in the management of germ cell and certain endocrine and endocrine-related tumours. The carcinoembryonic antigen (CEA) provides a marker for many gastrointestinal cancers, but there are no presently available substances with clinical usefulness for either breast or lung neoplasms. Alternative approaches to the detection of metastases are also presented. The particular use of antibody probes at an immunohistochemical level has been claimed to be able to detect micrometastastic disease in bone marrow or tumour-related monoclonal antibody probes may have application to other cancers in the future.

Galactosyltransferase isoenzyme II in the detection of pancreatic cancer: comparison with radiologic, endoscopic, and serologic tests

We assessed the value of several serologic markers in detecting pancreatic carcinoma in a prospective study of 270 patients. The sensitivity and specificity of galactosyltransferase isoenzyme II (GT-II), carcinoembryonic antigen (CEA), alpha-fetoprotein, ferritin, C1q binding, and ribonuclease were determined. GT-II was the most sensitive (67.2 per cent) and specific (98.2 per cent) for discriminating between benign and malignant disease and was more sensitive and specific than CEA, the next most useful marker. Sensitivity was 64 per cent for ultrasound, 79.4 per cent for computerized body tomography (CBT), and 92.8 per cent for endoscopic retrograde cholangiopancreatography (ERCP). As a single test, only ERCP was more sensitive than GT-II, but more sensitive diagnoses resulted when GT-II was combined with ultrasound (92 per cent), CBT (88 per cent), or ERCP (100 per cent). Serum GT-II may be useful both by itself and in combination with imaging techniques in distinguishing benign from malignant pancreatic disease; however, this test does not discriminate between pancreatic carcinoma and other gastrointestinal neoplasms.

The use of con A Sepharose as an affinity adsorbent in a simple assay of serum sialyl and fucosyltransferase and its application in tumour diagnosis

A considerably simplified assay for recording sialyl- and fucosyltransferase in human serum is presented. Serum samples incubated with labeled nucleotide-sugar and glycosylated endogenous acceptor molecules were adsorbed to Con A Sepharose and quantitated by scintillation counting. The results correlated with those of a much more time consuming acid precipition method, and displayed a higher diagnostic sensitivity due to the improved specificity of the method and the combined recording of the two activities. A correlation between serum sialyl- and fucosyltransferase activities as well as quantitative agreement between the amount of incorporated sialic acid and fucose indicated that rhe endogenous acceptor molecules were rate-limiting for transfer and may themselves have diagnostic potential.

Serum levels of glycosyltransferases and related glycoproteins as indicators of cancer: biological and clinical implications

Many studies have suggested that malignant transformation is associated with fundamental changes in the cell surface; similar changes have been described for normal stem cells and cells of embryonic or fetal origin. There is now evidence that the tumor cell secretes or sheds glycoproteins and glycosyltransferases into the surrounding medium and into serum. There are claims that some of these serum glycoproteins and glycosyltransferases are associated with, or specifically related to, the extent of tumor growth and may serve as a cancer marker. A cancer-associated galactosyltransferase isoenzyme (GT-II) has been described and purified. Different isoelectric forms of fucosyltransferase have also been described as indicative of malignancy. The articles to be published in CRC Critical Reviews in Clinical Laboratory Sciences will analyze the evidence for the association of these membrane factors with tumor growth. In order to better understand the possible significance of altered glycoproteins and of increased or different forms of glycosyltransferases during tumor growth, recent data on glycoprotein synthesis will be discussed including the new concepts on the control of glycoprotein synthesis through lipid intermediates. The possible mechanisms whereby malignant transformation could alter glycoprotein synthesis will be discussed with particular emphasis on the significance of these alterations to the biology of the malignant cell. Changes in surface membrane glycoproteins have long been implicated in the ability of a cell to metastasize. Secretion and/or shedding of the cell surface may also be important in the process of metastasis and in altering the host immune response. Detection and the study of these "shed" materials in patients appear to be indicating a new approach to cancer biology detection and therapy.

Abnormalities of serum cholinesterase isozyme in liver cirrhosis and hepatoma (Part II)

The pattern of serum cholinesterase (ChE) isozyme appeared to be characteristically abnormal in liver cirrhosis and hepatoma. In liver cirrhosis an abnormal fast moving peak was observed in 92.5% of fifty three patients studied. Further, diminishing activities of ChE 3 and 4, accompanied by an emergence of weak bands with unusual rates of flow, were noted in 58.5%. The latter abnormality was always associated with the former one. The pattern in hepatoma was essentially the same with liver cirrhosis, though diversity of bands was also present in some cases. It was ascertained that these abnormalities was due to sialic acid content bound to the enzyme, but was not due to production of abnormal enzyme protein moiety. It was suggested by clinical analysis that the degree of the abnormality of the isozyme may be useful for the diagnosis and prognostic evaluation of liver cirrhosis.

The expression of the epithelial blood-group substances: normal and malignant tissues

The blood-group isoantigens are macromolecules localized to the plasma membranes of certain epithelial tissues. These substances are not detectable on the epithelium once it has undergone malignant transformation. Results of this investigation have demonstrated that the loss of detectability of the blood-group isoantigens does not appear to be related to a "masking" effect by an increase in surface sialic acid. Using fluorescein-labeled lectins specific for sugar subunits which are components of the blood-group oligosaccharide chain, it was found that the malignant cells and cells of the parabasal layer of normal oral epithelium had high levels of N-acetyl-D-glucosamine (GlcNAC), the subterminal sugar residue of the blood-group chain. The basal cells of normal epithelium and a minority of the malignant cells demonstrated levels of D-galactose-N-acetyl-D-galactosamine, which are the most proximal blood-group sugar subunits, as well as subunits of other membrane antigens. Our results indicate that malignant cells seem to be capable of synthesizing the blood-group oligosaccharide chains to the same level as the normal cells of the parabasal layer of stratified squamous epithelium. This level is just subjacent to the terminal D-galactose residue of the blood-group precursor chain. Increased or decreased differentiation characteristics of squamous cell carcinomas did not alter the level of blood-group synthesis. However, there may be a correlation between the level of synthesis of these antigens and the ability of the cells to demonstrate motility and to proliferate.

Vitamin A and galactosyl transferase of tracheal epithelium

We developed an assay for galactosyl transferase (uridine diphosphategalactose:glycoprotein galactosyltransferase, EC 2.4.1.22) in microsomes of rat tracheal epithelium and characterized the properties of this enzyme system. We found that vitamin A deficiency greatly depressed galactosyl transferase activity. Activity could be restored within 48 h by dosing the animal with retinyl acetate. Adding retinol to the microsomes from tracheal epithelium of vitamin A-deficient rats also restored galactosyl transferase activity to some extent. Full restoration was achieved by pre-incubating retinol with the microsomal preparation for 30 min. Optimal concentration of pre-incubated retinol was 10(-8) M. Pre-incubation with retinyl phosphate and retinoic acid stimulated galactosyl transferase activity in microsomes from tracheas of deficient rats; pre-incubation with dolichyl phosphate, anhydroretinol and the dimethylacetylcyclopentenyl analog of retinoic acid did not. We concluded that vitamin A is involved in the galactosyl transferase system of rat tracheal epithelium, possibly by being linked to galactose.

Serum UDP-galactosyl transferase as a potential biomarker for breast carcinoma

UDP-galactose:N-acetylglucosamine galactosyltransferase (GT) is a membrane-bound enzyme active in the biosynthesis of the carbohydrate moiety of glycoproteins and glycolipids. A soluble form of GT, present in human serum, has recently been found to be elevated in the presence of various neoplasms. In this study, GT levels were measured in randomized serum samples obtained from normal controls (group I, n = 49), patients with benign breast disease (group II, n = 46), disease controls (group III, n = 50), patients with primary breast carcinoma (group IV, n = 53), and untreated metastatic breast cancer (group V, n = 23). Although substantial serum GT elevations were observed in individual control patients with active inflammatory or metabolic diseases, the mean GT levels were significantly higher in the groups with breast carcinoma (P < 0.001, 0.001, 0.02; P < 0.001, 0.001, 0.001 for groups IV and V vs groups, 1, II, and III, respectively). Furthermore, when serum GT levels were correlated with the properative clinical stage of breast cancer, significant elevations were found in 14.3% (3/21) of stage I, 66.7% (8/12) of stage II, 78.6% (11/14) of stage III, and 96.5% (28/29) of stage IV patients. These data indicate that serum GT levels are elevated in the presence of breast carcinoma and that the enzyme elevations correlate positively with the clinical stage of disease. Serum GT may be potentially useful in the detection of recurrent breast carcinoma and as a marker of tumor response to therapy for advanced disease.

Sensitivity and specificity of serum ribonuclease in the diagnosis of pancreatic cancer

The serum levels of a poly-[C]-specific acid ribonuclease (RNase) found in the pancreas was measured in 40 normal persons and 137 patients with pancreatic cancer, other cancers, obstructive jaundice, acute pancreatitis or chronic pancreatitis. Serum RNase increased by as much as 800 percent above normal in 69 percent of patients with pancreatic cancer. Analysis of the serum isoenzymes of RNase by isoelectric focusing did not reveal any unique RNases produced by the tumours. In contrast, serum RNase rose in only 8 percent of patients with other cancers, 11 percent of other patients with obstructive jaundice and in no patients with chronic pancreatitis. These data suggest that the finding of increased serum RNase is of adjunctive value inthe diagnosis of pancreatic carcinoma and may be particularly helpful in distinguishing it from other causes of biliary obstruction and from chronic pancreatitis.

Müllerian duct regression in the embryo correlated with cytotoxic activity against human ovarian cancer

A significant cytotoxicity index was obtained when human ovarian cancer cells in a microcytotoxicity assay were exposed during the S (DNA-synthesizing) phase of the cell cycle to purified fractions of testis exhibiting high Müllerian inhibiting substance bioactivity. The same effect was not observed when these fractions were tested against human glioblastoma or fibroblast lines. Most human ovarian cancers are said to resemble Müllerian tissues histologically. Müllerian inhibiting substance may thus deserve further study as a potential chemotherapeutic agent.

The charge heterogeneity of soluble human galactosyltransferases isolated from milk, amniotic fluid and malignant ascites

UDP-galactose: N-acetylglucosamine galactosyltransferase was isolated from pooled human milk, pooled amniotic fluid and from two different individual samples of malignant ascites. The purification procedure involving two successive affinity chromatography steps on N-acetylglucosamine--agarose and alpha-lactalbumin--agarose yielded an enzyme preparation homogeneous by size. Under non-denaturing conditions the ascites and amniotic fluid enzymes had identical electrophoretic mobility, but they moved faster than the milk enzyme. Isoelectric analysis in the presence and absence of urea resolved the milk enzyme into at least 13 different forms, nine of which had the same isoelectric points after refocusing. All enzyme forms showed similar activity when free N-acetylglucosamine, ovalbumin, sialic-acid-free ovine submaxillary mucin and glucose, in the presence of alpha-lactalbumin, were used as acceptor substrates. Comparative isoelectric focusing of the three galactosyltransferases revealed identical patterns of the amniotic and ascites enzymes, but only partial overlap with the milk enzyme, which was less negatively charged. Neuraminidase treatment of ascites and milk galactosyltransferases produced very similar focusing patterns. The possible structural basis for this charge heterogeneity is briefly discussed.