POS0857 PHARMACOKINETICS, SAFETY, AND EFFICACY OF SUBCUTANEOUS BRODALUMAB FOR SYSTEMIC SCLEROSIS WITH MODERATE-TO-SEVERE SKIN THICKENING: A SINGLE-ARM, OPEN-LABEL, MULTI-DOSE, PHASE 1 TRIAL

Background

Systemic sclerosis (SSc) is a rare autoimmune disease that causes fibrosis of the skin and internal organs. The mechanism of SSc pathogenesis and progression is not clear yet and SSc is therefore a disease with high unmet medical need. Though recent evidence reveals that interleukin-17 (IL-17) may play an essential role in the pathogenesis of multiple autoimmune inflammatory diseases, the role of IL-17 in SSc has not been established.

Objectives

This trial assessed the pharmacokinetics (PK), safety, and efficacy of multiple subcutaneous doses of brodalumab, a fully human anti–IL-17RA monoclonal antibody that inhibits the activity of IL-17A, IL-17C, IL-17F, IL-17A/F, and IL-17E (also called IL 25), in Japanese SSc patients with moderate-to-severe skin thickening.

Methods

In this trial, eligible patients (the modified Rodnan skin score (mRSS):10-29, present with the first symptoms of SSc other than Raynaud’s phenomenon within 60 months at enrolment) were enrolled and received subcutaneous brodalumab 210 mg every 2 weeks (Q2W) during the 52-week period. Primary endpoints were PK and safety. Secondary endpoints included change from baseline in mRSS and Composite Response Index in SSc (CRISS) score. Exploratory endpoints included lymphocyte subset testing.

Results

Eligible 8 patients were enrolled. Mean (SD) age was 53.6 (10.6) years. All patients had diffuse cutaneous SSc, total mRSS was 23.1 (5.1) and disease duration was 2.2 (1.9) years. Mean (SD) serum brodalumab trough concentration increased to 21.8 (16.7) μg/mL at week 2 and remained almost constant at week 52. Drug-related treatment-emergent adverse events were observed in three patients: oral candidiasis (n=3), vulvovaginal candidiasis (n=1), and arthralgia (n=1). A rapid decrease in mRSS was observed as early as week 4 (-1.3 vs baseline, p<0.005), which continued until week 52 (-10.125 vs baseline, p<0.0001). Brodalumab reduced dermal thickness of the lesional skin consistent with the decrease in mRSS. All patients achieved a CRISS score ≥0.6 at week 24, which continued until week 52. Brodalumab induced Th17/Treg balance to Treg dominance over 52 weeks (vs baseline, p<0.05). The rapid decrease in the number of immunoglobulin G class-switched memory B cells and plasmablasts (vs baseline, p<0.01) was accompanied by an increase in the number of transitional B cells (vs baseline, p<0.05) by week 52.

Conclusion

Brodalumab demonstrated a rapid and sustained decrease in mRSS over 52 weeks in Japanese SSc patients with moderate-to-severe skin thickening, which could be attributed to its direct effects on fibroblasts and indirect effects via impacts on B and T cell subsets.

References

None.

Mean Change from Baseline in mRSS and Mean mRSS over the 52-week follow up. (Mean +/- SD)

Table 1.

Other efficacy endpoints

BaselineWeek 12Week 24Week 52Number of finger digital ulcersmean1.91.610.3SD2.32.31.60.7P valueNA0.170.040.04Percent predicted FVC, %mean86.787.185.985.3SD13.114.41414.1P valueNA0.70.450.3Percent predicted DLCO, %mean92.689.388.989.1SD22.522.919.422.2P valueNA0.060.090.18PGA, mmmean48.647.943.445.8SD23.925.72624.6P valueNA0.660.040.71CGA, mmmean68.953.539.530.3SD23.91916.713.9P valueNA<.001<.001<.001J-HAQ-DI scoremean0.220.170.130.19SD0.490.440.350.35P valueNA0.40.170.7

Acknowledgements

We gratefully acknowledge the patients and their families for their participation in this trial. We thank all the investigators who had a part in this study for their contribution.

Disclosure of Interests

Takemichi Fukasawa: None declared, Ayumi Yoshizaki: None declared, Hisashi Kagebayashi Employee of: Kyowa Kirin Co., Ltd., Shinichi Sato Consultant of: Kyowa Kirin Co., Ltd.

OP0112 THE EVER-LARGEST ASIAN GWAS FOR SYSTEMIC SCLEROSIS AND TRANS-POPULATION META-ANALYSIS IDENTIFIED SEVEN NOVEL LOCI AND A CANDIDATE CAUSAL SNP IN A CIS-REGULATORY ELEMENT OF THE FCGR REGION

Background

Genome-wide association studies (GWASs) have identified 29 disease-associated single nucleotide polymorphisms (SNPs) for systemic sclerosis (SSc) in non-human leukocyte antigen (HLA) regions (1-7). While these GWASs have clarified genetic architectures of SSc, study subjects were mainly Caucasians limiting application of the findings to Asians.

Objectives

The study was conducted to identify novel causal variants for SSc specific to Japanese subjects as well as those shared with European population. We also aimed to clarify mechanistic effects of the variants on pathogenesis of SSc.

Methods

A total of 114,108 subjects comprising 1,499 cases and 112,609 controls were enrolled in the two-staged study leading to the ever-largest Asian GWAS for SSc. After applying a strict quality control both for genotype and samples, imputation was conducted using the reference panel of the phase 3v5 1,000 genome project data combined with a high-depth whole-genome sequence data of 3,256 Japanese subjects. We conducted logistic regression analyses and also combined the Japanese GWAS results with those of Europeans (6) by an inverse-variance fixed-effect model. Polygenicity and enrichment of functional annotations were evaluated by linkage disequilibrium score regression (LDSC), Haploreg and IMPACT programs. We also constructed polygenic risk score (PRS) to predict SSc development.

Results

We identified three (FCRLA-FCGR, TNFAIP3, PLD4) and four (EOMES, ESR1, SLC12A5, TPI1P2) novel loci in Japanese GWAS and a trans-population meta-analysis, respectively. One of Japanese novel risk SNPs, rs6697139, located within FCGR gene clusters had a strong effect size (OR 2.05, P=4.9×10-11). We also found the complete LD variant, rs10917688, was positioned in cis-regulatory element and binding motif for an immunomodulatory transcription factor IRF8 in B cells, another genome-wide significant locus in our trans-ethnic meta-analysis and the previous European GWAS. Notably, the association of risk allele of rs10917688 was significant only in the presence of the risk allele of the IRF8. Intriguingly, rs10917688 was annotated as one enhancer-related histone marks, H3K4me1, in B cells, implying that FCGR gene(s) in B cells may play an important role in the pathogenesis of SSc. Furhtermore, significant heritability enrichment of active histone marks and a transcription factor C-Myc were found in B cells both in European and Japanese populations by LDSC and IMPACT, highlighting a possibility of a shared disease mechanism where abnormal B-cell activation may be one of the key drivers for the disease development. Finally, PRS using effects sizes of European GWAS moderately fit in the development of Japanese SSc (AUC 0.593), paving a path to personalized medicine for SSc.

Conclusion

Our study identified seven novel susceptibility loci in SSc. Downstream analyses highlighted a novel disease mechanism of SSc where an interactive role of FCGR gene(s) and IRF8 may accelerate the disease development and B cells may play a key role on the pathogenesis of SSc.

References

[1]F. C. Arnett et al. Ann Rheum Dis, 2010.

[2]T. R. Radstake et al. Nat Genet, 2010.

[3]Y. Allanore et al. PLoS Genet, 2011.

[4]O. Gorlova et al. PLoS Genet, 2011.

[5]C. Terao et al. Ann Rheum Dis, 2017.

[6]E. López-Isac et al. Nat Commun, 2019.

[7]W. Pu et al. J Invest Dermatol, 2021.

Disclosure of Interests

None declared

POS0881 EFFICACY AND SAFETY OF SUBCUTANEOUS BRODALUMAB, A FULLY HUMAN ANTI–IL-17RA MONOCLONAL ANTIBODY, FOR SYSTEMIC SCLEROSIS WITH MODERATE-TO-SEVERE SKIN THICKENING: A MULTICENTER, RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND PHASE 3 STUDY

Background

Systemic sclerosis (SSc) is a rare chronic connective tissue disease of unknown cause characterized by autoimmunity, vasculopathy, and fibrosis of the skin and various internal organs. It is considered to constitute an area of high unmet medical needed due to limited treatment options and no sufficiently effective treatments. Our previous study (the single-arm, open-label, phase 1 study) indicated that brodalumab, a fully human anti-IL-17RA monoclonal antibody, had a potential to improve skin sclerosis in SSc patients, which could be attributed to its direct effects on fibroblasts and indirect effects via impacts on both B cell and T cell subsets (NCT04368403).

Objectives

To evaluate the efficacy and safety of brodalumab for SSc patients with moderate-to-severe skin thickening in a phase 3, multicenter, randomized, placebo-controlled, double-blind study.

Methods

Eligible patients (modified Rodnan skin score (mRSS):10-29, present with the first symptoms of SSc other than Raynaud’s phenomenon within 60 months at enrolment) were randomized (1:1) to receive subcutaneous brodalumab 210 mg every 2 weeks (Q2W) or placebo during the 52-week placebo-controlled period. Primary endpoint was change from baseline of mRSS at week 24. Patients with an increase in mRSS of ≥5 points and ≥20% from baseline at or after week 24 were permitted to receive open-label treatment with brodalumab.

Results

A total of 100 patients was randomized to the brodalumab group (n=50) or the placebo group (n=50). Forty-six and 45 patients had diffuse cutaneous SSc in the brodalumab and placebo groups, respectively. In both groups, 47 patients completed the 24-week follow-up. Forty-four and 43 patients in the brodalumab and placebo groups completed the 52-week follow-up, respectively. At or after week 24, 38 patients (placebo, n=37; brodalumab, n=1) were switched to the active drug. Brodalumab achieved the primary endpoint (treatment difference of least square mean: −21.2 [95% CI -23.9, 18.5]; P<0.0001), and demonstrated a rapid, sustained reduction in mRSS over 52 weeks. Brodalumab also elevated the composite response index in SSc (CRISS) score, suppressed new development of digital ulcers, deterioration of respiratory function, and progression of lung lesions. Moreover, treatment of brodalumab improved the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) score, global assessment by physician (CGA) and patient (PGA), the Japanese version of the health assessment questionnaire-disability index (J-HAQ-DI) score, and the functional assessment of chronic illness therapy-fatigue (FACIT-Fatigue) score. The safety profile did not differ from that previously observed in other diseases such as psoriasis and ankylosing spondylitis and non-radiographic axial spondyloarthritis.

Conclusion

Brodalumab demonstrated a rapid, sustained, and significant decrease in skin sclerosis. Moreover, the outcome of brodalumab treatment suggested its therapeutic effects on lung/respiratory functions, digital ulcers, the symptoms of gastroesophageal reflux disease, and QOL without any noteworthy safety concerns.

References

None.

Figure 1.

mRSS over the 24-week follow up. (Mean +/- SD)

Table 1.

Secondary endpoints at week 24

BrodalumabPlacebomeanSDmeanSDDifference95% CIP valueMedian CRISS score1NA0NANANA<0.0001Cumulative new digital ulcer count0.10.285.06.5-4.9[-6.8, -3.0]<0.0001Percent predicted FVC*, %0.194.43-5.047.395.23[2.73, 7.72]<0.0001Percent predicted DLCO*, %-0.596.808-5.966.7735.38[2.60, 8.16]0.00022FSSG score*-2.35.9910.111.16-12.4[-16.1, -8.7]<0.0001PGA*, mm-6.821.9426.124.17-32.9[-42.3, -23.4]<0.0001CGA*, mm-34.014.6913.823.05-63.4[-71.9, -54.9]<0.0001J-HAQ-DI*-0.0450.2340.6980.7065-0.743[-0.958, -0.527]<0.0001FACIT-Fatigue subscale score*2.2346.869-9.40414.765811.638[6.920, 16.356]<0.0001

*Change from baseline

Acknowledgements

We gratefully acknowledge the patients and their families for their participation in this trial. We thank all the investigators who had a part in this study for their contribution.

Disclosure of Interests

Takemichi Fukasawa: None declared, Ayumi Yoshizaki: None declared, Hisashi Kagebayashi Employee of: Kyowa Kirin Co., Ltd., Shinichi Sato Consultant of: Kyowa Kirin Co., Ltd.

Interleukin-25 is involved in cutaneous T-cell lymphoma progression by establishing a T helper 2-dominant microenvironment

BACKGROUND

Interleukin (IL)-25 is a member of the IL-17 family, which can promote and augment T-helper (Th) type 2 responses. The expression of IL-25 and its cognate receptor, IL-25 receptor (IL-25R), is upregulated and correlated with disease activity in Th2-associated diseases.

OBJECTIVES

To examine the expression and function of IL-25 in cutaneous T-cell lymphoma (CTCL).

METHODS

Expression and location of IL-25 in lesional skin was investigated with immunohistochemistry. The effect of various cytokines on IL-25 production from normal human epidermal keratinocytes was assessed by quantitative reverse-transcription real-time polymerase chain reaction. Serum IL-25 levels were measured by enzyme-linked immunosorbent assay. The direct effect of IL-25 on tumour cells was also examined using CTCL cell lines and peripheral blood mononuclear cells in patients with Sézary syndrome.

RESULTS

IL-25 expression was increased in epidermal keratinocytes in lesional skin of CTCL. Th2 cytokines, IL-4 and IL-13, and periostin induced IL-25 expression by normal human epidermal keratinocytes. Serum IL-25 levels were increased in patients with advanced CTCL and correlated with serum lactate dehydrogenase levels. MyLa cells expressed IL-25R and its expression was augmented by stimulation with IL-25. IL-25 enhanced IL-13 production from MyLa cells via phosphorylation of signal transducer and activator of transcription 6. Peripheral blood mononuclear cells from one patient with Sézary syndrome expressed IL-25R and showed increase of IL-13 production by IL-25.

CONCLUSIONS

Th2 cytokines highly expressed in CTCL lesional skin induce IL-25 production by epidermal keratinocytes, which may, in turn, lead to formation of a Th2-dominant microenvironment through the direct induction of IL-13 by tumour cells.

Micro/extended-nano sampling interface from a living single cell

Single-cell analysis is of increasing importance in many fields, but is challenging due to the ultra-small volumes (picoliters) of single cells. Indeed, analysis of a specific analyte might require the analysis of a single molecule or several molecules. Analytical processes usually include sampling, chemical processing, and detection. Although several papers have reported chemical processing and detection methods for single cells, a sampling method compatible with maintaining the viability of a single cell during sampling has yet to be developed. Here, we propose a femtoliter sampling method from a living single cell using micro/nanofluidic device technology. The sampling of 39 fL of cytoplasm from a single human aortic endothelial cell was demonstrated and its viability after sampling was confirmed.

A potential contribution of antimicrobial peptide LL-37 to tissue fibrosis and vasculopathy in systemic sclerosis

BACKGROUND

LL-37 is an antimicrobial peptide with pleiotropic effects on the immune system, angiogenesis and tissue remodelling. These are cardinal pathological events in systemic sclerosis (SSc).

OBJECTIVES

To elucidate the potential role of LL-37 in SSc.

METHODS

The expression of target molecules was evaluated by immunostaining and quantitative reverse-transcription real-time polymerase chain reaction in human and murine skin. The mechanisms regulating LL-37 expression in endothelial cells were examined by gene silencing and chromatin immunoprecipitation. Serum LL-37 levels were determined by enzyme-linked immunosorbent assay.

RESULTS

In SSc lesional skin, LL-37 expression was increased in dermal fibroblasts, perivascular inflammatory cells, keratinocytes and, particularly, dermal small vessels. Expression positively correlated with interferon-α expression, possibly reflecting LL-37-dependent induction of interferon-α. In SSc animal models, bleomycin-treated skin exhibited the expression pattern of CRAMP, a murine homologue of LL-37, similar to that of LL-37 in SSc lesional skin. Furthermore, Fli1^+/- mice showed upregulated expression of CRAMP in dermal small vessels. Fli1 binding to the CAMP (LL-37 gene) promoter and Fli1 deficiency-dependent induction of LL-37 were also confirmed in human dermal microvascular endothelial cells. In the analysis of sera, patients with SSc had serum LL-37 levels significantly higher than in healthy controls. Furthermore, serum LL-37 levels positively correlated with skin score and the activity of alveolitis and were significantly elevated in patients with digital ulcers compared with those without.

CONCLUSIONS

LL-37 upregulation, induced by Fli1 deficiency at least in endothelial cells, potentially contributes to the development of skin sclerosis, interstitial lung disease and digital ulcers in SSc.

A case of palmoplantar lichen planus in a patient with congenital sensorineural deafness

We report a case of palmoplantar lichen planus in a 7-year-old Japanese girl with congenital deafness, who presented with erythematous eruptions and hyperkeratosis, with peeling and fissures on her soles, palms and digits. On histological examination of a skin biopsy from the lesion on her wrist, lichen planus was identified. Using computed tomography of the inner ears, bilateral cochlear dysplasia was found. The patient's DNA was sequenced; no sequence variants were detected in the GJB2 gene encoding connexin-26, but she had a missense mutation in SLC26A4 (solute carrier family 26, member 4). Mutations in SLC26A4 are known causes of hearing loss, but this is a novel mutation, which has not been reported previously. In addition, there have been no reports of cutaneous symptoms in previously reported patients with mutations in SLC26A4. To our knowledge, therefore, this is the first report of palmoplantar lichen planus associated with sensorineural deafness accompanied by a mutation in the SLC26A4 gene.

Efficacy of neoadjuvant chemotherapy followed by radical hysterectomy in locally advanced non-squamous carcinoma of the uterine cervix: a retrospective multicenter study of Tohoku Gynecologic Cancer Unit

OBJECTIVE

Radical hysterectomy (RH) is a standard treatment for locally advanced non-squamous cell carcinoma (N-SCC) of the uterine cervix, but there have been no reports on whether neoadjuvant chemotherapy (NAC) followed by radical hysterectomy could improve the outcome of patients with this disease.

MATERIALS AND METHODS

This multicenter retrospective study enrolled 77 patients with Stage IB2 to IIB N-SCC of the uterine cervix. Of these, 27 patients were treated with NAC prior to radical hysterectomy (NAC group) and 50 with RH alone (RH group). The two-year recurrence-free survival (RFS) rate, progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Clinical parameters such as clinical stage, histological type, and postoperative treatment were also examined between the groups.

RESULTS

While the two-year RFS rates were 81.5% and 70.0% in NAC and RH groups, respectively (p = 0.27) and the median PFS was 51 months and 35 months in NAC and RH groups, respectively (p = 0.35), the median OS was 58 months and 48 months in NAC and RH groups, respectively, which was significant (p = 0.0014). The median OS of patients with mucinous adenocarcinoma in NAC group was significantly higher than that in RH group: 58 months versus 37 months (p = 0.03).

CONCLUSION

NAC prior to RH may offer the prognostic advantage of patients with locally advanced N-SCC of the uterine cervix, especially mucinous adenocarcinoma.

Low response rate of second-line chemotherapy for recurrent or refractory clear cell carcinoma of the ovary: a retrospective Japan Clear Cell Carcinoma Study

Clear cell carcinoma (CCC) of the ovary has been recognized to show resistance to anticancer agents in the first-line chemotherapy. Our aim was to evaluate the effect of second-line chemotherapy in a retrospective study. A total of 75 patients diagnosed with CCC and treated between 1992 and 2002 in collaborating hospitals were reviewed. Criteria for the patients' enrollment were 1) diagnosis of pure-type CCC at the initial operation, 2) treatment after one systemic postoperative chemotherapy, 3) measurable recurrent or refractory tumor, 4) at least two cycles of second-line chemotherapy and assessable for the response, and 5) adequate clinical information. Regimens of first-line chemotherapy were conventional platinum-based therapy in 33 cases, paclitaxel plus platinum in 24 cases, irinotecan plus platinum in 9 cases, and irinotecan plus mitomycin C in 7 cases. Treatment-free periods were more than 6 months in 24 cases (group A) and less than 6 months in 51 cases (group B). In group A, response was observed in two cases (8%): one with conventional platinum therapy and another with irinotecan plus platinum. In group B, three cases (6%) responded: two with platinum plus etoposide and one case with irinotecan plus platinum. Median overall survival was 16 months in group A and 7 months in group B (P = 0.04). These findings suggest recurrent or resistant CCC is extremely chemoresistant, and there is only small benefit of long treatment-free period in CCC patients. Another strategy including molecular-targeting therapy is warranted for the treatment of recurrent or refractory CCC.

Phase I trial of paclitaxel, doxorubicin, and carboplatin (TAC) for the treatment of endometrial cancer

Doxorubicin, platinum compounds, and taxanes represent the chemotherapeutic agents with the greatest activity in endometrial cancer. We conducted an optimal-dose determination of combination chemotherapy consisting of paclitaxel (TXL), doxorubicin, and carboplatin (CBDCA) (TAC) in patients with endometrial cancer. Patients with epithelial endometrial cancer requiring adjuvant therapy were enrolled between June 2003 and March 2005. No patients had received prior radiotherapy, and only two patients had previously undergone chemotherapy. Doxorubicin was infused on day 1, and TXL followed by CBDCA was administered on day 2. The starting dose was doxorubicin 35 mg/m2, TXL 120 mg/m2, and CBDCA area under the curve (AUC). The dose of each agent was gradually escalated. Patients were scheduled to receive at least four cycles of therapy. If patients experienced grade 4 neutropenia or neutropenic fever with grade 3 neutropenia, they were permitted to be administered granulocyte colony–stimulating factor after the second course. Twenty-seven patients were enrolled. Although four patients out of 27 experienced dose-limiting toxicities, a maximum tolerated dose was not established at the final dose level. Five patients (three for recurrent and two for advanced) had measurable lesions. There were four responders (three for partial response and one for complete response) in our series. The recommended dose of TAC therapy for endometrial cancer was doxorubicin 45 mg/m2 for day 1, TXL 150 mg/m2 and CBDCA AUC 5 for day 2.

Expression of p-STAT3 in human colorectal adenocarcinoma and adenoma; correlation with clinicopathological factors

BACKGROUND

The signal transducer and activator of transcription 3 (STAT3) is a key signalling molecule implicated in the regulation of growth and malignant transformation. Constitutive activation of STAT3 is seen in several tumour derived cell lines, and in a wide variety of human malignancies.

AIMS

To examine the relation between p-STAT3 (activated form of STAT3) expression and clinicopathological factors in human colorectal adenocarcinoma and adenoma.

METHODS

Immunohistochemical analyses were carried out on tissues from 44 colorectal adenomas and 95 colorectal adenocarcinomas, comprising 18 intramucosal carcinomas and 77 invasive carcinomas.

RESULTS

Seventy seven of these 139 samples (55.4%) showed immunoreactivity for p-STAT3. Positive staining for p-STAT3 was seen in 69 of the 95 carcinomas. Only eight of the 44 adenomas showed immunopositivity for p-STAT3, resulting in a significant difference between total adenocarcinomas and adenomas (p < 0.001). Among the 95 cases of colorectal adenocarcinoma, p-STAT3 immunoreactivity was significantly correlated with the depth of tumour invasion (p < 0.05), venous invasion (p < 0.05), lymph node metastasis (p < 0.05), and increasing stages of the Dukes' classification (p < 0.01). Expression of p-STAT3 was detected by Western blot analysis in two different cultured human colorectal carcinoma cell lines and six colon carcinoma tissue samples obtained at surgery.

CONCLUSION

This is the first study to report a significant correlation of p-STAT3 expression with the depth of tumour invasion. These findings suggest that p-STAT3 expression is an important factor related to carcinogenesis and/or tumour invasion of colorectal adenocarcinoma.

Expression of Tie-1 and 2 receptors, and angiopoietin-1, 2 and 4 in gastric carcinoma; immunohistochemical analyses and correlation with clinicopathological factors

AIMS

There is strong evidence that tyrosine kinases are involved in the regulation of tumour progression, cellular growth and differentiation. Recently, many kinds of tyrosine kinase receptors have been reported, and among them Tie-1 and 2 constitute a major class. Angiopoietin (Ang)-1 is known as a ligand of the Tie-2 tyrosine kinase receptor. The aim of this study was to determine the expression profile of Tie-1 and 2 and Ang-1, 2 and 4 in gastric adenocarcinoma.

METHODS AND RESULTS

Eighty-nine cases of surgically resected human gastric adenocarcinoma were studied by immunohistochemistry. Of these, 60 (67.4%), 61 (68.5%), 69 (77.5%), 75 (84.3%), and 47 cases (52.8%) showed positive staining in the cytoplasm of carcinoma cells for the Tie-1 and 2 and Ang-1, 2 and 4 proteins, respectively. The expression of Ties and Angs was significantly correlated with several type of histological differentiation and several clinicopathological factors.

CONCLUSIONS

Ties and Angs were highly expressed in human gastric adenocarcinoma cells. These findings suggest that the Tie-Ang receptor-ligand complex is one of the factors involved in the cellular differentiation and progression of human gastric adenocarcinoma.

Expressions of parathyroid hormone-related protein (PTHrP) and PTH/PTHrP-receptor (PTH/PTHrP-R) in gastrointestinal stromal tumours (GISTs), leiomyomas and schwannomas

BACKGROUND

Gastrointestinal stromal tumours (GISTs) are rare, c-kit and CD34 positive, and different from other mesenchymal tumours of the gastrointestinal tract (e.g. leiomyomas and schwannomas). The purpose of this study was to investigate the roles of parathyroid hormone-related protein (PTHrP) and parathyroid hormone/parathyroid hormone-related protein-receptor (PTH/PTHrP-R) in the growth and differentiation of GISTs.

METHODS

Nineteen GISTs, six leiomyomas and five schwannomas were examined in this study.

RESULTS

All of the GISTs and leiomyomas, and four of the schwannomas (80.0%) were positive for PTHrP. Immunohistochemical staining revealed that all of the leiomyomas, 90% of the GISTs and 80% of the schwannomas expressed PTH/PTHrP-R. Furthermore, both PTHrP and PTH/ PTHrP-R were expressed in the cytoplasm of identical cells in all of these tumours.

CONCLUSION

Our results suggest that both PTHrP and PTH/PTHrP-R play an important role in the growth and differentiation of GISTs, leiomyomas and schwannomas.

An evaluation of a new radiographic technique utilizing a concave table

In conventional radiography systems, it is apparent that only the area immediately around the central x-ray beam can be evaluated accurately. Consequently in some instances, spinal radiography for example, several exposures are needed at various points along the body to create an accurate image for diagnosis. However, if the film and body part are in a concave shape such that the radius of the curve is equal to the film focal distance, the x-ray beam will penetrate the body and strike the film at two-dimensionally right angles in all areas. Using the spine as an example we found the curved technique had three major advantages over the traditional flat technique: lack of distortion, more uniform beam intensity due to a constant focal film distance, and improved resolution at the periphery of the radiograph because of lack of a cross over effect. It was concluded that an accurate evaluation of larger body parts can be made with minimal distortion utilizing the principles of a curved table technique.

Unscheduled expression of cyclins by anti-cancer drug exposure

The scheduled expressions of cyclins are observed in the normal cells or the tumor cells whose phenotype is characterized by scheduled expression of cyclins, while unscheduled expression of cyclins were reported in several leukemic and solid tumor cell lines by anti-cancer drugs. We studied the effects of cytotoxic concentrations of Taxol (TXL) on cyclin D1 and B1 expression on human ovarian cancer cell lines. In KFr13 cells, the control group showed low degree of cyclin D1 and moderate degree of cyclin B1 expression in all cell cycles, while 1 microM TXL exposure resulted remarkable cyclin D1 and B1 expression in G2+M phase cells. OVCAR-3 cells showed relatively high degree of cyclin D1 expression and mild to moderate degrees of cyclin B1 expression in control group. 1 microM TXL showed no significant changes in cyclin D1 expression, while decreased expression cyclin B1 in G0+1 and S and moderate degree of expression in G2+M.

[Recent problems on the endocrine and chemotherapy]

The endometrial carcinoma, as well as the breast cancers and some kinds of ovarian cancers, was considered to a hormone dependent carcinoma. Even if we tried to do the endocrine therapy using such as medroxy progesterone acetate (MPA), we could expect only 30% of anti-tumor effects on the endometrial carcinoma. Endocrine therapy was thought to have a different action mechanisms from the other anti-cancer drugs. Whereas cisplatin (CDDP) has strongly an effectiveness for ovarian cancers, but the drug resistance of cancer cells for CDDP was causing a serious problem. This paper will be discussed about the problems of the endocrine and chemotherapy from the point of view of cell cycle analysis. Additionally, we would like to describe about the new anticancer drug such as Taxol.

[Relationship between the cell cycle and production of hCG in choriocarcinoma cells]

Human choriocarcinoma cells in vitro (ENAMI-1) were exposed to various concentrations of MTX (10(-8)M, 10(-7)M, 10(-6)M, 10(-4)M) for 48 hr, and after removal of MTX, cells were harvested and measured by FCM every 24 hr for 96 hr. Although the growth of cells were inhibited in MTX more than 10(-7)M in concentration, hCG-beta levels were elevated markedly. It was showed that hCG positive cells were accumulated in G1-phase by flow cytometric two color analysis with monoclonal antibody. In the presence of MTX more than 10(-7)M in concentration, the cells were accumulated in S-phase. After removal of 10(-7)M MTX, S-phase cells migrated toward G2 + M phase on the other hand in the presence of MTX more than 10(-6) M in concentration cells stopped moving to G2 + M phase. Immunoperoxidase with monoclonal antibodies against BrdU and hCG-beta has got the same phenomena resulted by FCM. It was confirmed that hCG was an useful marker for choriocarcinoma.