Cost-effectiveness of omalizumab in real world uncontrolled allergic asthma patients

OBJECTIVE

To estimate the cost-effectiveness of omalizumab compared with standard of care in the treatment and control of severe persistent asthma, using the outcomes from the Portuguese subpopulation of the eXpeRience registry.

METHODS

This was a pragmatic cost-effectiveness analysis based on real world data from the eXpeRience registry which recruited 62 patients with uncontrolled persistent allergic asthma from 20 participating centers in Portugal. Response to omalizumab treatment was measured prospectively up to 24 months by the physician's Global Evaluation of Treatment Effectiveness (GETE). Retrospective data on patients' clinical symptoms, asthma control, lung function, exacerbations, and healthcare utilization were available for up to 12 months before omalizumab initiation and served as the standard of care comparator. The number of exacerbations (severe and non-severe), the number of clinical episodes, the number of days absent from work and/or school, and GETE response to therapy were considered as effectiveness outcomes. Following a societal perspective, as cost indicators, both direct and indirect costs were considered. Direct costs relate to the cost of omalizumab, standard of care and clinical episodes (emergency room visits, hospitalizations, and unscheduled doctor visits). Indirect costs relate to the societal cost of work absenteeism. Unit costs for clinical episodes and drugs were taken from official sources within the Portuguese Health Authority. A univariate sensitivity analysis was performed.

RESULTS

A rate of 1.5 exacerbations per patient-year was estimated following omalizumab treatment compared with 8.2 exacerbations per patient-year prior to omalizumab initiation, implying an 82.1% reduction in the incidence of exacerbations following omalizumab treatment relative to standard of care alone. A 54.1% reduction in GETE score was also observed in favor of omalizumab treatment. The mean cost per person-year was 3023є in the 12 months of standard of care prior to omalizumab and 16,111є in the period of treatment with omalizumab. The incremental cost-effectiveness ratios were 2244є/exacerbation avoided, and 1750є/unit decrease in GETE classification.

CONCLUSION

Our results demonstrate that adding omalizumab to the treatment of patients with uncontrolled severe persistent asthma reduces the number of exacerbations, improving overall treatment effectiveness at an acceptable cost from a societal perspective.

Effect of calcium on e-cadherin expression in breast-tumor cells

E-cadherins are homophilic adhesion molecules the expression of which is tightly linked to the invasiveness and the differentiated state of the cells. E-cadherin expression seems also inversely related to the expression of vimentin, an intermediate filament implicated in the metastatic potential of some cells. In breast tumor cells MCF-7, we have previously shown that calcium influences cell growth and promotes cell differentiation. In view of the importance of cell adhesion mechanisms in cell growth and invasion, we sought to determine whether calcium affects the regulation of E-cadherin expression and modifies the relationship between E-cadherin and vimentin expression. To address this question, cells were grown at low (0.04 mM) or high (2.5 mM) concentration of calcium and cadherin and vimentin expression was assessed by flow cytometry analyses. Our results show that calcium enhances cadherin expression in cadherin positive cells and decreases vimentin expression in these cells; in cadherin negative cells, calcium only decreases the expression of vimentin. The modifications of E-cadherin and/or vimentin expression suggests that drugs that can modify intracellular calcium may contribute to overcoming the progression of breast tumor cells toward increasingly malignant phenotypes.

Acute insulin response to arginine in deceased donors predicts the outcome of human islet isolation

Despite a stringent donor selection, human islet isolation remains frustratingly unpredictable. In this study, we measured acute insulin response to arginine (AIRarg), an in vivo surrogate measure of islet mass, in 29 human deceased donors before organ donation, and correlated values with the outcome of islet isolation. Thirteen isolations (45%) met the threshold for clinical islet transplantation. Among all measured donor characteristics, the only discriminating variable between successful or unsuccessful isolations was donor AIRarg (p < 0.01). Using a threshold of 55 microIU/mL (ROC curve AUC: 72%), isolation was successful in 12/19 donors with high AIRarg and in 1/10 donors with low AIRarg (p < 0.001). The negative and positive predictive values were 90 and 63%, respectively. If used to select donors in the entire cohort, AIRarg would have increased our success rate by 40% and avoided 56% of unsuccessful isolations while missing only 8% of successful preparations. Our results suggest that donor AIRarg is markedly superior to body mass index (BMI) and other criteria currently used to predict isolation outcome. If routinely performed in deceased donors, this simple test could significantly reduce the failure rate of human islet isolation.

1,25-Dihydroxyvitamin D3 protects human pancreatic islets against cytokine-induced apoptosis via down-regulation of the Fas receptor

Beta cell loss occurs at the onset of type 1 diabetes and after islet graft. It results from the dysfunction and destruction of beta cells mainly achieved by apoptosis. One of the mediators believed to be involved in beta cell apoptosis is Fas, a transmembrane cell surface receptor transducing an apoptotic death signal and contributing to the pathogenesis of several autoimmune diseases. Fas expression is particularly induced in beta cells by inflammatory cytokines secreted by islet-infiltrating mononuclear cells and makes cells susceptible to apoptosis by interaction with Fas-ligand expressing cells. We have previously demonstrated that 1,25(OH)2D3, the active metabolite of vitamin D, known to exhibit immunomodulatory properties and prevent the development of type 1 diabetes in NOD mice, is efficient against apoptosis induced by cytokines in human pancreatic islets in vitro. The effects were mainly mediated by the inactivation of NF-kappa-B. In this study we demonstrated that 1,25(OH)2D3 was also able to counteract cytokine-induced Fas expression in human islets both at the mRNA and protein levels. These results were reinforced by our microarray analysis highlighting the beneficial effects of 1,25(OH)2D3 on death signals induced by Fas activation. Our results provides additional evidence that 1,25(OH)2D3 may be an interesting tool to help prevent the onset of type 1 diabetes and improve islet graft survival.

Kinetics of diabetes-associated autoantibodies after sequential intraportal islet allograft associated with kidney transplantation in type 1 diabetes

OBJECTIVE

Presence or occurrence of pancreas auto-antibodies (aAb) has been shown to be of poor prognosis for islet cell transplantation. The aim of the study was to monitor the kinetics of these aAb after sequential intra-portal islet plus kidney transplantation with pre-Edmonton immunosuppressive regimen in order to determine whether the sequential protocol of transplantation was involved in the occurrence of the immune response.

PATIENTS AND METHODS

Three patients with IDDM and a previous (IAK) or simultaneous (SIK) kidney transplantation received 3 or 4 ABO compatible islet preparations. Islets (> 8 000 IEQ/kg post culture) were sequentially transplanted within a 12 day period via a per-cutaneous catheter. Immunosuppressive treatment included cyclosporine, steroïds and mycophenolate. Plasma ICAs, GAD 65, IA2 and C peptide (C-p) levels were monitored. Type II HLA phenotype was determined in donors and recipients.

RESULTS

Patient #1 had high anti-GAD levels (26.5 UI/l) before the IAK, while anti-IA2 and ICA levels were low. After the transplantation, C-p levels increased to 4.9 ng/ml at one month before becoming undetectable at 2 months. GAD levels remained high, ICA and IA2 aAb were undetectable. Patients #2 and #3 did not have significant levels of aAb before the islet transplantation. A slight increase in GAD was observed with each islet transplantation, followed by an overt but transient increase in ICA. IA2 levels remained undetectable. Three months after the transplantation and 2 weeks after the increase of ICA, C-p levels, that were >3.4 ng/ml at one month, fell below 0.2 (N: 0.5-2).

CONCLUSION

The immunosuppressive regimen used in kidney transplantation is unable to control perfectly anti-pancreas aAb production. Moreover, these results seem to indicate that the benefits of sequential islet transplantation lie more in the increased islet mass they provide than in potential immune benefit.

Non-esterified fatty acids are deleterious for human pancreatic islet function at physiological glucose concentration

AIMS/HYPOTHESIS

Whether excess glucose (glucotoxicity) and excess non-esterified fatty acids (lipotoxicity) act synergistically or separately to alter beta-cell function on Type 2 diabetes remains controversial. We examined the influence of non-esterified fatty acids, with or without concomitant increased glucose concentrations, on human islet function and on the expression of genes involved in lipid metabolism.

METHODS

Human islets isolated from non-diabetic and non-obese donors were cultured with 5.5, 16 or 30 mmol/l glucose, and when appropriate with 1 or 2 mmol/l non-esterified fatty acids. After 48 h, glucose-stimulated insulin secretion, insulin content, triglyceride content and expression of different genes were evaluated.

RESULTS

Non-esterified fatty acids decreased glucose-stimulated insulin secretion, insulin content and increased triglyceride content of human isolated islets, independently from the deleterious effect of glucose. Increased glucose concentrations also decreased glucose-stimulated insulin secretion and insulin content, but had no influence on triglyceride content. Glucose-stimulated insulin secretion of islets appeared to be significantly correlated with their triglyceride content. Glucose and non-esterified fatty acids modified the gene expression of carnitine palmitoyltransferase-I, acetyl-CoA carboxylase, acyl-CoA oxidase and uncoupling protein 2.

CONCLUSION/INTERPRETATION

In our model of isolated human islets, increased glucose and non-esterified fatty acids separately reproduced the two major beta-cell alterations observed in vivo, i.e. loss of glucose-stimulated insulin secretion and reduction in islet insulin content. Our results also suggest that this deleterious effect was, at least in part, mediated by modifications in lipid metabolism gene expression.

Hepatocyte nuclear factor 4 alpha isoforms originated from the P1 promoter are expressed in human pancreatic beta-cells and exhibit stronger transcriptional potentials than P2 promoter-driven isoforms

The nuclear receptor hepatocyte nuclear factor (HNF) 4 alpha is involved in a transcriptional network and plays an important role in pancreatic beta-cells. Mutations in the HNF4 alpha gene are correlated with maturity-onset diabetes of the young 1. HNF4 alpha isoforms result from both alternative splicing and alternate usage of promoters P1 and P2. It has recently been reported that HNF4 alpha transcription is driven almost exclusively by the P2 promoter in pancreatic islets. We observed that transcripts from both P1 and P2 promoters were expressed in human pancreatic beta-cells and in the pancreatic beta-cell lines RIN m5F and HIT-T15. Expression of HNF4 alpha proteins originating from the P1 promoter was confirmed by immunodetection. Due to the presence of the activation function module AF-1, HNF4 alpha isoforms originating from the P1 promoter exhibit stronger transcriptional activities and recruit coactivators more efficiently than isoforms driven by the P2 promoter. Conversely, activities of isoforms produced by both promoters were similarly repressed by the corepressor small heterodimer partner. These behaviors were observed on the promoter of HNF1 alpha that is required for beta-cell function. Our results highlight that expression of P1 promoter-driven isoforms is important in the control of pancreatic beta-cell function.

[Human pancreatic stem cell and diabetes cell therapy]

Cell therapy offers today important perspectives for the treatment of type 1 diabetes. The current utilization of primary human islets of Langerhans nevertheless forbids all hope of developing this treatment on a large scale. The recent description of the persistence of stem cells capable of proliferating and differentiating in the adult pancreas offers an attractive alternative for the production in vitro of homologous insulin-secreting cells. We first reproduced in vitro from human islet preparations the proliferation of ductal epithelial structures and their progressive organization. Thereafter, we focused on the description of a reproducible source of human ductal cells by the transdifferentiation of exocrine preparations. More recently we described in these exocrine derived ductal cells the the expression the of insulin promoter factor-1 (IPF-1/otherwise known as PDX-1), a transcription factor essential for the differentiation of ductal cells into endocrine cells during both development and pancreatic regeneration. If the proliferation and differentiation of these cells is confirmed, this approach could lead to the description of an abundant source of human pancreatic stem cells for the production ex vivo of human insulin secreting cells and may even allow autologous cell therapy, in the absence of immunosuppression.

Identification and purification of functional human beta-cells by a new specific zinc-fluorescent probe

Pancreatic beta-cells contain large amounts of zinc. We took advantage of this to try to localize, quantify, and isolate insulin-producing cells from islet preparations. Our study was designed to identify a non-toxic zinc-sensitive fluorescent probe able to selectively label labile zinc in viable beta-cells and to exhibit excitation and emission wavelengths in the visible spectrum, making this technique exploitable by most instruments. We tested Newport Green, a probe excitable at 485 nm with a dissociation constant in the micromolar range corresponding to a low affinity for zinc. The loading of the lipophilic esterified form of Newport Green was easy, rapid, specific, and non-toxic to cells. Confocal microscopy highlighted an intense fluorescence associated with secretory granules. Regression analyses showed a good relationship between zinc fluorescence and islet number (r = 0.98) and between zinc fluorescence and insulin content (r = 0.81). The determination of Zn fluorescence per DNA enabled us to assess the quality of the different islet preparations intended for islet allografting in terms of both purity and viability. Cell sorting of dissociated Newport Green-labeled cells resulted in a clear separation of beta-cells, as judged by insulin content per DNA and immunocytochemical analysis. This zinc probe, the first able to specifically label living cells in the visible spectrum, appears very promising for beta-cell experimentation, both clinically and for basic research.

Beneficial effect of 1,25 dihydroxyvitamin D3 on cytokine-treated human pancreatic islets

We examined whether 1,25 dihydroxyvitamin D(3) (1,25 D(3)), the active form of vitamin D involved in the regulation of the immune system, may also protect human pancreatic islet cells from destruction induced by cytokines. In this study, we specifically investigated the effect of 1,25 D(3) on oxidative stress and major histocompatibility complex (MHC) induction, both implicated in cytokine-induced islet cell dysfunction and destruction. We also investigated the effects of 1,25 D(3) on interleukin (IL)-6, a pleiotropic cytokine implicated in the pathogenesis of immunoinflammatory disorders. Human pancreatic islets, isolated from heart-beating donors, were treated with a combination of three cytokines, IL-1beta+tumor necrosis factor alpha+interferon gamma, in the presence or absence of vitamin D, and compared with with untreated control cells. Metabolic activity was assessed by cell viability and insulin content. Oxidative stress was estimated by heat shock protein 70 (hsp70) expression, cell manganese superoxide dismutase (MnSOD) activity and nitrite release, a reflexion of nitric oxide (NO) synthesis. Variation of immunogenicity of islet preparations was determined by analysis of the MHC class I and class II transcripts. Inflammatory status was evaluated by IL-6 production. After 48 h of contact with cytokines, insulin content was significantly decreased by 40% but cell viability was not altered. MHC expression significantly increased six- to sevenfold as well as NO and IL-6 release (two- to threefold enhancement). MnSOD activity was not significantly induced and hsp70 expression was not affected by the combination of cytokines. The addition of 1,25 D(3) significantly reduced nitrite release, IL-6 production and MHC class I expression which then became not significantly different from controls. These results suggest that the effect of 1,25 D(3) in human pancreatic islets cells may be a reduction of the vulnerability of cells to cytotoxic T lymphocytes and a reduction of cytotoxic challenge. Hence, 1,25 D(3) might play a role in the prevention of type 1 diabetes and islet allograft rejection.

Human pancreatic ductal cells: large-scale isolation and expansion

The in vitro differentiation of pancreatic stem cells has recently been shown to represent a new source of beta cells for cell therapy in diabetes. Human ductal cell differentiation, in vitro, has been documented in three-dimensional (3D) culture and recently substantiated. Although encouraging, the optimization of the ductal cell source, expansion and differentiation ex vivo are mandatory for clinical relevance. We compared three sources of human ductal cells (hDC) (method A1-2, B, and C). The classical main duct isolation of hDC by explant (A1), or enzymatic digestion (A2), was compared with two indirect methods: from 3D cultured human islet/duct-enriched fractions (B) and dedifferentiated exocrine fractions (C). Method A: few viable hDC were obtained from the main duct. Method B: embedding islet/duct rich fraction in 3D collagen gels expands the cytokeratin 19 (CK19)-positive ductal component in the form of ductal cysts, as we described previously; monolayers derived from digested cysts were 80% ductal (CK19). Method C: initially adherent amylase-positive exocrine clusters contained 12% (CK19) to 22% (CK7) ductal cells. One-week exocrine cultures were amylase negative and 46% (CK19) to 63% (CK7) ductal. Cell viability varied: <20% (A1), 81+/-12% (B), 91+/-2% (C). Extrapolating total yields we obtained (+/-SEM): 10.5+/-4.6 x 10(3) (A1), 36+/-18 x 10(3) (A2), 292+/-50 x 10(6) (B), 1696+/-526 x 10(6) (C) viable hDC per pancreas. A secondary monolayer expansion of cyst-derived hDC (method B) was achieved with NuSerum (4.2-fold on plastic, 2.6-fold on 804G matrix; p < 0.05 vs. control cells on plastic). First passage exocrine-derived ductal cells also responded to matrix and to growth factors, albeit not significantly. In conclusion, this study demonstrated that an abundant hDC supply can be obtained from islet/duct or exocrine fractions followed by monolayer expansion with NuSerum. If their differentiation capacity is confirmed, in particular exocrine-derived ductal cells may represent a promising abundant source of islets for allogenic and autologous diabetes cell therapy.

Adult human cytokeratin 19-positive cells reexpress insulin promoter factor 1 in vitro: further evidence for pluripotent pancreatic stem cells in humans

Human pancreatic cells with a typical ductal phenotype and potential to proliferate can be obtained in vitro, but the differentiation capacity of these putative human pancreatic stem cells remains to be documented. We investigated the protein and mRNA expression of insulin promoter factor 1 (IPF-1) (or pancreas/duodenal homeobox 1), a transcription factor critical for pancreatic development and endocrine cell neogenesis, in human pancreatic ductal cells derived from cultured exocrine tissue. In vitro, exocrine cells rapidly adhered (within 12 h) and were de-/transdifferentiated to ductal cells after 3 days with a dramatic loss of amylase protein (n = 4, 92 +/- 3.3%, P < 0.05 vs. day 1) and a simultaneous increase of ductal cytokeratin 19 protein (n = 4, 3.4-fold on day 3 and 7-fold on day 9, P < 0.05 vs. day 1). IPF-1 protein and mRNA levels were low to undetectable in exocrine preparations before culture. After 2 days of culture, a 3.2-fold increase in IPF-1 protein was observed, corresponding to the characteristic 46-kDa protein in Western blots. Reverse transcriptase-polymerase chain reaction confirmed a 10.5-fold increase in IPF-1 mRNA levels after 3 days of culture (n = 5, P < 0.001 vs. day 1). Double immunocytochemistry showed direct evidence that IPF-1 appeared during culture in these exocrine-derived ductal cells (cytokeratin 7-positive) and was not merely in contaminating endocrine cells (chromogranin A-positive). In conclusion, we describe herein the first converging evidence on both the molecular and protein level that human cells with a typical ductal phenotype derived ex vivo from pancreatic exocrine tissue (obtained from healthy donors) can reexpress IPF-1 in culture, suggesting their pancreatic precursor/stem cell potential.

Expression of peroxisome proliferator-activated receptor gamma (PPARgamma) in normal human pancreatic islet cells

AIMS/HYPOTHESIS

Thiazolidinediones are reported to improve pancreatic islet morphology and beta-cell function in rodents, supporting the hypothesis of a direct action of thiazolidinediones on endocrine islet cells. In this study we examined the expression of the peroxisome proliferator-activated receptor gamma, a nuclear receptor that is activated by naturally occurring fatty acids and synthetic thiazolidinediones, in normal human endocrine pancreatic cells.

METHODS

Human islets were isolated from pancreata harvested in ten brain-dead lean non-diabetic adult donors. We analysed the gene and protein expression of the human peroxisome proliferator-activated receptor gamma and evaluated the effects of peroxisome proliferator-activated receptor gamma agonist on insulin secretion in human islet preparations.

RESULTS

The RT-PCR carried out on total RNA from four distinct human islet preparations demonstrated the presence of peroxisome proliferator-activated receptor gamma mRNA. Western blot analysis showed the consistent expression of peroxisome proliferator-activated receptor gamma protein. Peroxisome proliferator-activated receptor gamma was shown to be present in all three endocrine cell types studied (alpha, beta and delta cells) by immunohistochemistry.

CONCLUSION/INTERPRETATION

We found that peroxisome proliferator-activated receptor gamma is highly expressed in human islet endocrine cells, both at the mRNA and protein levels. These results support the hypothesis of a direct influence of peroxisome proliferator-activated receptor gamma agonist on human pancreatic endocrine cells.

Human pancreatic islet quality control: easy assessment of metabolic functions

We describe simplified and rapid methods to assess islet function with the aim to develop better protocols for islet isolation and to determine islet characteristics before transplantation. These methods are also useful in the assessment of the potentially beneficial or deleterious effects of compounds added to the culture media in stimulation experiments. To this end, we took advantage of the multiscreen assay system produced by Millipore SA. This 96-well unit allowed the free-floating culture of islets on filter membranes, the rapid vacuuming and collection of conditioned media or reaction buffer and thus successive testing of the same number of islets, possibly at different culture times. We estimated islet viability by determination of the metabolic activity of cells, normal function of islets by their ability to metabolize glucose and to synthesize and secrete insulin and of nitrite release, a reflection of nitric oxide (NO) status of cells, which may be involved in a signaling pathway during glucose-stimulated insulin secretion or in cytokine inducible pathway. Assays may be performed either on selected islets or on aliquots of semi-purified preparations designated for grafting, allowing thus the rapid estimation of graft function of the entire preparation. This herein described system may be also extended to many other functional tests.

Effects of vitamin D3 derivatives on growth, differentiation and apoptosis in tumoral colonic HT 29 cells: possible implication of intracellular calcium

In addition to the effects on tumor cell differentiation and growth inhibition, vitamin D3 derivatives may exert other cellular actions such as the inhibition of angiogenesis or the induction of apoptosis. In this study, we demonstrated that vitamin D3 derivatives, 1,25-dihydroxyvitamin D3, the natural derivative and Ro 23-7553, a synthetic derivative, displayed complex effects in tumoral colonic HT 29 cells. Indeed, as a function of the stage of culture, they induced either apoptosis or differentiation along with a constant cell cycle blockade in G1. Intracellular calcium analysis indicated that treatment resulted in disturbance in the distribution of calcium suggesting a possible role for intracellular calcium in the observed effects. The association of 9-cis-retinoic acid, the ligand of RXR, with vitamin D3 derivatives modified the demonstrated effects, indicating in our model, a preferential effect of vitamin D3 derivatives via the heterodimeric form of the receptor.

Vitamin-D3 derivatives and breast-tumor cell growth: effect on intracellular calcium and apoptosis

Vitamin-D3 derivatives are now well-recognized growth inhibitors of numerous tumoral cells and in particular breast-cancer cells. However, the mechanisms by which they operate are not well established. Among the wide range of physiological and biological functions of vitamin-D3 derivatives, the best described include their action on calcium homeostasis. In this study, we sought to establish whether the effects of vitamin-D3 derivatives on breast-cancer cell growth may be in part related to intracellular calcium modulation and induction of apoptosis. To address these questions, we used, in addition to 1,25(OH)2D3, the active metabolite of vitamin D3, a non-calcemic 1,25(OH)2D3 derivative: Ro 23-7553 [16-ene-23-yne-1,25(OH)2D3], which in our hands was more potent than the parent compound in inhibiting breast-cancer cell growth. We showed that the efficiency of both compounds in growth inhibition was higher in the estradiol-receptor-positive-breast-tumor MCF-7 cells than in the estradiol-receptor-negative MDA-MB 231 cells. In MCF-7 cells in particular, important modifications of intracellular calcium related to the emptying of intracellular pools were observed. The depletion of Ca++ from intracellular stores was followed by the induction of apoptosis. Such a phenomenon was never observed in MDA-MB 231 cells. Our results suggest that the action of vitamin-D3 derivatives on the depletion of calcium stores, which was more significant in MCF-7 than in MDA-MB 231 cells, may induce apoptosis in the former cells and account for the high efficiency of vitamin-D3 derivatives on growth inhibition of MCF-7 breast-tumor cells.

1,25-dihydroxyvitamin-d-3 and breast-cancer - growth-inhibition by 2 analogs (ro23-4319 and ro23-7553) and detection of receptors in routinely formalin-fixed paraffin-embedded material

In addition to the regulation of calcium absorption and bone mineralization, the active form of vitamin D-3, 1,25-dihydroxyvitamin D-3 (1,25(OH)(2)D-3), has been shown to inhibit the proliferation and induce the differentiation of a wide range of normal and malignant cells via binding to a specific intracellular receptor. In this study, we demonstrated that the growth of estrogen receptor positive (MCF-7 and T47D) and negative (MDA-MB-231 and BT-20) human breast cancer cells was inhibited in a dose-dependent manner by 22-ene-1,25(OH)(2)D-3 (Ro23-4319) and 16-ene-23-yne-1,25(OH)(2)D-3 (Ro23-7553), two noncalcemic analogues of 1,25(OH)(2)D-3. Moreover, we showed that the antitumor effect exerted by the antiestrogen 4-hydroxytamoxifen was enhanced by Ro23-7553 in MCF-7 cells. Taken together, these results provide further evidence for the clinical interest of the noncalcemic analogues of 1,25(OH)(2)D-3 both for patients with estrogen receptor positive and negative breast tumors. These observations combined with the potential pronostic Value of the 1,25(OH)(2)D-3 receptor (VDR) status in breast cancer led us to test an immunohistochemical method performed on 32 routinely formalin-fixed paraffin-embedded breast tumor samples which were until now unusable for VDR detection. We compared this method, involving a pretreatment of the tissue sections in a microwave oven, with the conventional biochemical assay. Our results showed that breast tumors were massively stained (80% to 98% of the tumor cell nuclei) and that the parallelism observed between the staining intensity and the VDR concentration, could be proposed to either select a responsive population of patients or to carry out retrospective studies intended to specify the pronostic interest of VDR in breast cancer. We also demonstrated, as others, that no relationship existed between the presence of VDR and the age of the patients, the presence of estrogen and progesterone receptors and the lymph node involvement.

1,25-dihydroxyvitamin D3 receptors in normal and malignant human colorectal tissues

1 alpha,25-Dihydroxyvitamin D3, (1,25(OH)2D3), the active metabolite of vitamin D3, has important physiological effects on growth and differentiation in a variety of malignant and non-malignant cell types. In order to better understand the significance of 1,25(OH)2D3 receptors (VDR) in human colorectal cancer, we determined the levels of VDR in paired samples (malignant and adjacent normal tissues) of 24 colorectal cancer bearing patients. Our results demonstrated differences in the relative abundance of VDR between normal and transformed tissues according to the localization of the tumor. While colonic tumors exhibited significantly higher VDR values than their normal counterparts, the contrary seemed to occur in the rectal tumors. In colonic tumors, we found significant correlations between VDR levels and the absence of node involvement or a low Astler-Coller stage. The increased VDR values in colonic tumors as compared with the normal adjacent tissues, may warrant, at least in this type of cancer, the action of 1,25(OH)2D3 or its non-calcemic analogs, to help induce cell differentiation and growth inhibition.

Effect of extracellular ATP on breast tumor cell growth, implication of intracellular calcium

We studied the effects of purine nucleotides and particularly adenosine triphosphate (ATP) in two (one hormonosensitive, MCF7 and one hormonoinsensitive, MDA-MB 231) human breast tumor cell lines. As described in other cells, we observed that purine nucleotides produced transient elevations in intracellular calcium ions, [Ca2+]i, in both types of cells as determined from Indo-1 fluorescence of loaded cells. In the absence of external calcium the [Ca2+]i transients consisted of single narrow peaks while an extension of peak duration along with a biphasic appearance were observed in the presence of external calcium. The potency of different purine nucleotides in elevating [Ca2+]i was ATP > ADP >> AMP > adenosine (which was inefficient) proving the presence of P2 purinergic receptor subtypes. Suramin, a compound known to compete with ATP for its binding sites, nearly abolished the effect of ATP on [Ca2+]i increase. while verapamil, a calcium channel blocker, was unable to abolish such an an ATP-induced [Ca2+]i increase. The concentrations of ATP required to increase [Ca2%bdi ranged from 10(-7) M to 10(-3) M, the maximal effect being obtained with 10(-4) M ATP. At this latter concentration, ATP induced cell growth inhibition which was dose-independent as triggered only when maximal elevation of [Ca2+]i was attained. This ATP concentration also induced maximal apoptotic features in both types of cells. Together, our results highlighted an 'all or none' effect of ATP on breast tumor cell growth mediated by its effect on [Ca2+]i liberation from intracellular stores, the first rise of [Ca2+]i being further amplified by an influx of calcium from extracellular space. The attainment of sufficient [Ca2+]i level then triggers cellular events.

Comparative study of intracellular calcium and adenosine 3',5'-cyclic monophosphate levels in human breast carcinoma cells sensitive or resistant to Adriamycin: contribution to reversion of chemoresistance

Multidrug resistance (MDR) corresponds to the cross-over resistance of tumour cells to structurally unrelated cytotoxic chemotherapeutic drugs. One of the mechanisms causing this resistance is the enhanced expression of a transmembrane drug efflux pump P-glycoprotein (P-170). Reversal of P-glycoprotein-associated MDR has received much attention in recent years. In experimental cell lines, P-170 and the glutathione redox cycle seem to contribute to this phenomenon; P-170 may be inactivated by calcium and calmodulin antagonists and the glutathione redox cycle altered by buthionine sulphoximine (BSO). Treatment of human MCF-7 breast cancer cells with chemosensitizers (CS), such as verapamil, trifluoperazine or BSO, for 72 hr resulted in an enhanced sensitization of cells to Adriamycin, trifluoperazine being the most potent compound in the reversion of chemoresistance. In these Adriamycin sensitive or resistant cells, treated or not by the CS, the possible role of calcium and cyclic adenosine monophosphate (cAMP) in mediating the reversion of chemoresistance to Adriamycin was investigated. It was found that intracellular calcium was approximately 2-fold higher in resistant than in sensitive cells, the opposite was true for cAMP. Modifications in calcium and cAMP levels were observed in MCF-7 resistant cells after treatment with verapamil and BSO; trifluoperazine had no effect on these two parameters. These results seemed to rule out any implication of calcium and cAMP levels in the contribution of these three chemosensitizers in the mechanisms of reversion of chemoresistance to Adriamycin.

Calcium regulation of heparan sulfate proteoglycans in breast cancer cells

Breast tumor cells have been shown to be responsive to calcium in that external calcium modifies cell calcium, shape and growth. In order to highlight some of the numerous mechanisms by which calcium is operating, we investigated its influence on the cell microenvironment and particularly its effect on membrane-associated heparan sulfate proteoglycans. The breast cancer cells MCF-7 were grown either at low (0.04 mM) or high (2.5 mM) calcium concentration. After 3 days of culture, cells were labeled with Na2(35)SO4 for 24 h and cell-associated proteoglycans extracted and purified. We showed that calcium enhances approximately twofold the synthesis of sulfated proteoglycans and, among these sulfated proteoglycans, chemical treatments indicated a specific two- to threefold increase of heparan sulfate proteoglycans. In view of the increasing implication of heparan sulfate proteoglycans in numerous mechanisms such as cell-cell contact, cell-matrix interactions and cell growth control, it appears that calcium may be a target for modulating metastatic and growth processes in breast tumor cells.

Influence of cAMP on E-cadherin expression and cell surface heparan sulfate proteoglycan synthesis in human breast cancer cells

The growth of MCF-7 and MDA-MB-231 human breast cancer cells was inhibited by treatment with dibutyryl cAMP (dBcAMP, 10(-4) M). The effects on E-cadherin expression and cell surface associated heparan sulfate proteoglycans (HSPG) synthesis, both implicated in cell adhesion, were investigated. dBcAMP was demonstrated to increase E-cadherin expression in the E-cadherin positive MCF-7 cells. However, in the E-cadherin negative MDA-MB-231 cells, the treatment did not induce expression of this cell adhesion molecule. Furthermore, in the two cell lines, an increase of the [35S] Na2SO4 incorporation into the cell surface sulfated PG was observed subsequently to dBcAMP treatment. Interestingly, the proportion of cell surface HSPG was also enhanced by this treatment. Taken together, these results demonstrate that the decrease of the proliferation observed in the human breast cancer cells after dBcAMP treatment is associated with an increase in the cell-cell and cell-matrix interactions. This suggests that the metastatic process which involves lack of cohesiveness and migration of the cells may probably be counteracted by cAMP in the human breast cancer cells.

Intracellular calcium and breast-cancer cell-growth and differentiation

The growth of normal human breast epithelial cells in vitro, as well as those of other cell types is strongly influenced by the concentration of calcium in the culture medium [Ca++]e. The aim of this study was to ascertain if calcium also affects breast tumor cell growth in vitro. To address this question, the metastatic breast cancer cells MCF-7 were grown at low (0.04 mM, L-Ca) and high (2.5 mM, H-Ca) [Ca++]e. In each culture condition, we estimated intracellular calcium levels (Ca++]i from Indo-1 fluorescence by the ratio method. We showed that [Ca++]i increased with [Ca++]e, the [Ca++]i values ranging from approximately 50 to 250 nM. Changes of [Ca++]i ware accompanied by changes of cell shape and cell kinetic parameters. In H-Ca, cells were flat and 3 times larger than in L-Ca and the percentage of cells in the S+G2+M phases as well as the percentage of Ki-67 positive cells rapidly dropped on days 3-4 of culture in contrast to cells grown in L-Ca. In H-Ca, the cell growth arrest corresponded to maximal [Ca++]i which was stable during the stationary phase; at that time, a switch from H-Ca to L-Ca resulted in a drop of [Ca++]i and a resumption of cell growth.. In H-Ca, modifications in cell differentiation parameters such as diminution of ER expression and increases of lipid content and EMA expression were observed as compared to cells grown m L-Ca. Our results suggest that MCF-7 cells have retained some calcium dependency and that agents that can increase [Ca++]i in breast tumor cells may limit their proliferation and trigger at least a partial differentiation.

cAMP effect on extracellular matrix synthesis in human breast cancer cells

The effect of a cAMP derivative (N6, O2-dibutyryl cyclic adenosine 3',5'-monophosphate: dBcAMP) on the cell cycle and on the synthesis of typical extracellular matrix (ECM) components, i.e. collagen and glycosaminoglycans (GAG), was studied in two hormone-responsive human breast cancer cell lines VHB-1 and MCF-7. The data showed that dBcAMP induced a decrease in the proportion of cells in S + G2 + M phases due to an increase of the non-cycling (G0 phase) cell number as revealed by the Ki-67 antigen immunocytochemical study. The collagen synthesis, estimated by [3H] proline incorporation into the cellular proteins followed by an enzymatic digestion with highly purified bacterial collagenase, was not modified by dBcAMP. In contrast, the GAG synthesis, analysed by [3H] glucosamine incorporation, was increased two-fold in the dBcAMP treated cells. As a comparison we also tested 4-hydroxy-Tamoxifen (4-OH-Tam) since it induces similar cell cycle perturbations as dBcAMP. However, we did not observe a stimulation of the GAG synthesis following 4-OH-Tam treatment. These data demonstrated that the increased GAG synthesis is due to cAMP and is not a consequence of perturbations in the cell cycle. We can therefore assume that the ECM modifications induced by dBcAMP may contribute to the growth inhibition of the hormone-responsive human breast cancer cells.

Binding of transferrin to membrane-associated proteoglycans in breast-cancer cells

Cell surface associated proteoglycans were isolated from MCF-7 breast tumor cells by mild trypsin digestion, extraction by guanidine-hydrochloride and purification by ion-exchange chromatography. Immunological studies showed that transferrin can bind to membrane associated proteoglycans (MAPG). However, these MAPG are not recognized by anti-transferrin receptor antibodies either in an intact, or in a form stripped of glycosaminoglycan chains. Considering the possible involvement of secreted transferrin in proliferation or differentiation of breast tumor cells, we suggest that transferrin binding to MAPG may be related to a specific function of transferrin.

C-myc overexpression, c-mil, c-myb expression in a breast tumor cell line. Effects of estrogen and antiestrogen

In breast tumor cell lines, c-myc amplification is frequently associated with estrogen unresponsiveness. We, however, succeeded in characterizing an estrogen-responsive cell line VHB1 derived from a duct cell carcinoma, which exhibits c-myc amplification and overexpression. We therefore studied the effects of estrogen and antiestrogen on c-myc expression in this particular cell line. We also investigated these effects on the expression of c-mil and c-myb oncogenes, also expressed but not amplified in VHB1 cells. Short-(1 h) and long-(72 h) term stimulations were performed. Our experiments showed that estradiol (E2 10(-8) M) was still able to stimulate c-myc expression equally either after short or long-term treatment. In the same way, the antiestrogen 4-hydroxytamoxifen equally decreased c-myc expression but the reversal effect of E2 after long-term antiestrogen treatment was more pronounced than after short-term treatment. The effects of E2 and 4-OH Tam on the expression of the not-amplified c-mil and c-myb oncogenes were stronger than those observed on c-myc expression; however, the E2 reversal effect was identical either after short or long-term antiestrogen treatment. Our results may enlighten some aspects of the complex action of some of the early- and late-growth regulated genes in breast cancer.

Cyclic AMP stimulation of transferrin secretion by breast cancer cell grown on extracellular matrix or in two-compartment culture chambers

Extrahepatic synthesis and secretion of transferrin (Tf), the major iron-carrying protein, have been described in normal and tumoral tissues suggesting a potential role for paracrine or autocrine function. In breast tumor cell MCF-7, we have previously shown a Tf secretion stimulated by estradiol which might confer selective growth advantages of these rapidly proliferating cells. The present work refers to possible additional Tf functions related to differentiation of breast tumor cells. We induced MCF-7 cell differentiation by the cyclic AMP derivative, dibutyryl cAMP (dB cAMP) and studied Tf secretion in different culture conditions after labeling with [35S] methionine. Our results demonstrate that dB cAMP stimulates Tf secretion only in culture environment that permits access to the basolateral surface and caters to the polarity requirements of the cell. These results suggest that Tf may also act as a modulator of cellular differentiation in breast cancer cells.

Beta-adrenergic receptors in human breast cancer: identification, characterization and correlation with progesterone and estradiol receptors

Besides the variety of other cellular processes in which beta-adrenergic compounds have been involved, their effect on the second messenger cAMP is thought to be related to the growth and differentiation of malignant cells. Because beta-adrenergic receptor could be an easy target for a new combination treatment, we attempted to identify and characterize adrenergic receptor in breast tumor and sought for correlations with estradiol and progesterone receptors. Using L[3H]-dihydroalprenolol, a potent beta-adrenergic antagonist, we demonstrated in human breast tumor the presence of beta-adrenergic receptors with high affinity (Kd 1-3 nM) as shown by Scatchard analyses. Natural and synthetic agonists and antagonists inhibited the [3H] DHA binding, mainly in the order of beta 2-subtype potency. We verified that these receptors were normally coupled with G-protein. A slight correlation was shown between adrenergic and progesterone receptors, and no correlation between adrenergic and estrogen receptors. The presence of specific beta-adrenergic receptors functionally coupled with G protein incited us to study their physiological regulation, since it is tempting to speculate that circulating or locally released catecholamines or other natural compounds may participate in the process of growth and differentiation of the mammary gland through adrenergic receptors.

Cell kinetics (SAMBA 200) of estradiol stimulated long-term phenol red withdrawn cultured breast cancer cells

When estradiol stimulation was performed on hormone-responsive MCF-7 human breast cancer cells maintained in phenol red-containing medium until 24h before experiments, the cell number and the cell surface transferrin receptor level, an early marker of estradiol stimulation, were strongly increased. In contrast, similar treatment performed on MCF-7 cells grown in phenol red-free medium up to 12 months before experiments induced no stimulating effect on the cell number, although transferrin receptors were still enhanced. Since the appearance of transferrin receptors occurs before the cells begin DNA synthesis in late G1 phase, we assumed that the discrepancy between cell counts and cell surface transferrin receptors might involve cell kinetic perturbations. The proportion of cells in the (S + G2) phases and the duration of the cell cycle phases were analysed using the SAMBA 200 cell image processor. The data presented in this study failed to indicate any block in the cell cycle and the duration of the S and G2 phases were found to be unchanged. The lack of effect of estradiol stimulation on the growth of MCF-7 cells maintained several months without phenol red is not thus a consequence of cell cycle perturbations.

Functional beta-adrenergic receptors in breast cancer cells

Using L-[3H]dihydroalprenolol [( 3H]DHA), a potent beta-adrenergic antagonist, we demonstrated in breast cancer cells the presence of beta-adrenergic receptors with high affinity (Kd 1-9 nM) as shown by Scatchard analyses. Natural and synthetic agonists inhibited the [3H]DHA binding in the following order of potency: L-isoproterenol = L epinephrine much much greater L-norepinephrine, identical to the well-established order of potency for these compounds in producing beta-adrenergic responses. We verified that these compounds actually stimulated cAMP production in breast cancer cells. At the present time, the pathophysiological significance of beta-adrenergic receptors remains unclear. In view of the importance of cAMP in lactose production and in tumor growth mechanisms, it seems to be important to characterize the beta-adrenergic receptors in breast cancer cells in more detail and study their possible involvement in breast tumor growth.

Secretion of transferrin by human breast cancer cells

Transferrin (Tf), the major iron-binding protein in the plasma of vertebrate species is an essential growth factor for cells in serum-free media and appears to be involved in the regulation of growth and differentiation of human tissues. We report here that human breast cancer cells secrete a factor immunologically similar to Tf. The secretion of Tf by the hormone-responsive cell-line MCF-7 is stimulated by 17 beta-estradiol and reduced by the antiestrogen 4-hydroxy tamoxifen. These data suggest that Tf secreted by breast cancer cells may be an additional autocrine growth factor confering selective advantages to rapidly proliferating breast cancer cells and perhaps permit tumor cell growth in poorly vascularized areas.

Opposite effects of estrogen and catecholestrogen on hormone-sensitive breast cancer cell growth and differentiation

Catecholestrogens and especially 2-hydroxyestrone (2OH-E1) are estradiol metabolites locally formed in breast cancer cells. The present study demonstrates that the two parent compounds, estradiol (E2) and its metabolite 2OH-E1, exert opposite effects on hormone-sensitive breast cancer cell growth assessed by cell counts and transferrin receptor levels, and also on cell differentiation assessed by secreted proteins such as alpha-lactalbumin and gross cystic disease fluid protein (GCDFP-15). The present findings may highlight estradiol regulation in hormone-sensitive breast cancer cells.

Assay of Gcdfp-15 by Elisa: An Available Method for in Vitro Studies of Functional Differentiation in Human Breast Cancer

An enzyme-linked immunosorbent assay (ELISA) was applied to a light protein, isolated from human breast cyst fluid (BCF) termed « gross cystic disease fluid protein - 15 Kda » (GCDFP-15), a potential differentiation marker in in vitro human breast cancer studies. The detection limits of this procedure, performed in microtiter plates, were 0.5 to 250 ng/well corresponding to 10 ng/ml to 5 ng/ml of sample or antigen solution. Possible cross-reaction with various antigens, especially those found in culture media, were investigated. The correlation coefficient between enzymoassay and radioimmunoassay was 0.978. The results showed that quantification of GCDFP-15 by ELISA is a specific and highly sensitive method. This procedure may be of interest in in vitro studies on the functional differentiation of breast cancer cells.

Involvement of cell surface transferrin receptor in the assessment of estradiol stimulating effect on cultured breast cancer cells

In order to find the reasons for the conflicting results depicted during the estradiol stimulations of cultured MCF7, breast cancer cells we investigated, besides cell counts, the cell surface transferrin receptor as an additional means of assessing the effect of estradiol. In this study we report results obtained using different culture conditions, i.e. short-term or long-term phenol-red withdrawn cells grown either in calf-serum supplemented media or defined media. Our results point out concurrent variations of cell counts and transferrin receptors when short-term phenol-red withdrawn cells were grown in defined media. Discrepancies were, however, observed when short-term phenol-red withdrawn cells were grown in serum-supplemented media or when long-term phenol-red withdrawn cells were grown in defined media. In both cases, only transferrin receptors account for estradiol stimulation. These results highlight the importance of transferrin receptor measurement in cultured breast cancer cell experiments and suggest cell kinetic perturbations due, in all likelihood, to serum factors or factors secreted by long-term phenol-red withdrawn cells.

Characterization of catecholestrogen membrane binding sites in estrogen receptor positive and negative human breast cancer cell-lines

A specific membrane-binding of an estradiol metabolite, the catecholestrogen (CE) 2 hydroxyestrone (2OH-E1), was demonstrated in two receptor-positive (MCF7 and VHB1) and one receptor-negative (MDA-MB-231) human mammary carcinoma cell lines. The three cell lines were found to be able to synthesise and inactivate CE. Solubilization of membrane bound CE results in a high molecular weight component whose specificity differs from that of the classical estrogen receptor. Apparent dissociation constants were 6-10. 10(-9) M and binding capacities were higher in the receptor-positive cell lines than in the receptor-negative one. Since CE are susceptible to rapid degradation, the presence of such a site may be relevant in the protection and concentration of 2OH-E1 which has been shown to have "in vitro" anti-estrogenic properties in MCF7 breast tumor cells.

Establishment and characterization of a new cell line (VHB-1) derived from a primary breast carcinoma

A continuous line of human breast carcinoma cells, VHB-1, was established in culture following collagenase treatment of an infiltrating duct cell carcinoma. The cells displayed an epithelial pattern and multiplied rapidly. Maintained in monolayer culture, the VHB-1 cells exhibited a 30-h doubling time and a plating efficiency of 20%. The cells possessed an abnormal karyotype with a mode of 70-74 chromosomes per cell. The karyotype was heavily rearranged and numerous marker chromosomes were found. Transplantation of the cells into nude mice produced tumors bearing histological resemblance to the original material. The VHB-1 cells contained significant levels of prolactin receptors, were steroid hormone (estrogen, progesterone, androgen, glucocorticoid) receptor positive, and were capable of functional differentiation in vitro. These characteristics make the VHB-1 cell line a suitable model for studying the biological properties of human breast tumors.

Further characterization of the light breast cyst fluid protein, GCDFP-15

A light protein of breast cyst fluid from women with gross cystic disease, termed GCDFP-15 in the literature, has been investigated. This light protein was purified by preparative electrophoresis on sodium dodecyl sulfate polyacrylamide gel. Its isoelectric point has been determined as 3.75 and its molecular weight has been estimated at 17 400. The light protein was a glycoprotein containing about 163 amino acid residues; the glucidic fraction corresponded to 11% of the molecular weight. The N-terminal amino acid was blocked and the C-terminal amino acid was determined as valine. Antisera raised against this light protein have proved to be specific. In the literature, there is evidence suggesting that apocrine secretion is of prime importance in conditioning the biochemical composition of breast cyst fluid. Further information is needed to substantiate the hypothesis that in gross cystic disease the apocrine epithelium itself or some of its functional aspects are associated with the risk of neoplasia. The physicochemical characterization of the breast cyst fluid protein can contribute to the study of its biosynthesis and provide a better understanding of the physiopathology of gross cystic disease and its relationship to breast carcinoma.

Catecholestrogen binding sites in breast cancer

The binding of 2-hydroxyestrone (2OH E1), a catecholestrogen which is the main end product of the 2-hydroxylation of estrogen, was investigated in breast cancers. 2OH E1-specific bindings were found in the cytosol (Kd = 0.54 +/- 0.10 nM) and in the endoplasmic reticulum (Kd = 3.36 +/- 1.32 nM). The dissociation rate constants of complexes between [3H]2OH E1 and cytosol or membrane binding sites were 3.30 h-1 and 8.30 h-1 respectively. Qualitative analysis of [3H]2OH E1 cytosolic complexes demonstrated a specific binding component with a mol. wt of 330,000 Daltons. Specificity experiments showed that nonestrogenic hormones were unable to compete with 2OH E1 for its binding sites, whereas triphenylethylene derivatives and catecholamines were potent 2OH E1 competitors. The presence of 2OH E1 specific bindings suggests a potential role of catecholestrogen in breast cancer.

Transferrin receptors in cultured breast cancer cells

Transferrin receptors were demonstrated on the cell membrane of breast cancer epithelial cells in primary or long-term culture. Diferric transferrin binding was saturable, specific and was not related to DNA content or clinical and histological features of the tumour. However a good correlation (p less than 0.01) was found between transferrin binding and thymidine incorporation. These results suggest the possibility of transferrin receptor measurement as a reflection of the proliferative activity of cultured breast tumour cells.

Estradiol and progesterone receptors in breast cancer: prognostic value after relapse

The prognostic significance of estradiol (ER) and progesterone receptors (PgR) for survival from relapse has been studied in two groups of breast cancer patients: group 1, 35 patients in whom receptor levels were measured at the time of mastectomy; group II, 49 patients in whom receptor levels were measured at the time of recurrence. ER+ (greater than 10 fmoles/mg) patients had a better survival from relapse than ER- patients. High levels of PgR (greater than 50 fmoles/mg) had a prognostic significance only in group II patients.

Characterization of prolactin receptors in human breast cancer

In order to perform measurement of PRL binding and to improve the knowledge of pathophysiological variations in human mammary cancers, we have investigated in detail the binding characteristics of PRL in membranes prepared from these tumors. The optimization of the assay requires the selection of membranous components of light density (less than 1.17); the tracer could be either 125I-PRL after affinity purification on PRL receptors or 125I-hGH without a purification step. It is favorable to utilize a high amount of protein and 200 000 cpm (2 ng) of tracer. Demonstration of the presence of receptors for PRL with a high affinity (Kd= 3 X 10(-10) M) in breast cancer is presented. The hormonal specificity of these receptors is studied: only lactogenic hormones (hGH, oPRL, hPRL, and hPL) are able to compete for binding of 125I-hPRL whereas bGH or insulin are without effect. Considering the known effect of PRL on cell multiplication, it is tempting to suggest that this hormone could have a crucial role in the development of breast tumor in humans and that therapies which would suppress secretion of PRL and GH could be beneficial.

Effect of bromocriptin treatment on prolactin and steroid receptor levels in human breast cancer

We have investigated the effect of bromocriptin, a prolactin-lowering drug, on prolactin, estradiol and progesterone receptors in breast cancers. Doses of 2.5 mg per os of bromocriptin were given twice daily for 4 days before surgery. The efficiency of the treatment was evaluated by assaying the plasma prolactin level. The results obtained for the treated population (n = 30) was compared to those obtained for an untreated one (n = 120) during the same period. Bromocriptin does not increase the available prolactin receptors in breast cancer specimens. Unmasking in vitro receptors with MgCl2 3 M leads in both cases to an increase in prolactin receptors. The number of positive estradiol receptor tumors was increased after bromocriptin treatment. Neither the rate of positivity nor the level of progesterone receptors is changed by the treatment. This study demonstrates clearly the inefficiency of bromocriptin in unmasking in vivo prolactin receptors in breast cancer.

[Receptors for steroid hormones apart from breast cancer. Practical value]

The steroid receptor (ER, PgR) content of breast cancer specimens is now widely used as an indicator for hormone sensitivity which is a prerequisite for endocrine therapy. Is it conceivable to extend this steroid receptor determination to other types of tumors in order to select patients who would eventually benefit from an hormonal therapy? It seems that most normal or tumoral tissues contain detectable amount of steroid receptors. The values of each receptor comprise a continuum from very low to relatively high, suggesting that previous considerations of hormone dependence on the basis of presence or absence of hormone receptors may be oversimplified. The steroid receptor concentrations are however higher in target tissues, and could be of clinical interest in endometrium and prostatic cancers. The date are however insufficient to draw firm conclusions regarding their usefulness for treatment.