The effect of l-arginine supplementation and surgical trauma on the frequency of myeloid-derived suppressor cells and T lymphocytes in tumour and blood of colorectal cancer patients

PURPOSE

l-arginine (L-arg) deficiency causes immunosuppression, but it is unknown if L-arg supplementation in colorectal cancer (CRC) patients restores immune system activity. Our objective was to investigate the effect of L-arg supplementation on the frequency of monocytic (M) and polymorphonuclear (PNM) myeloid-derived suppressor cells (M-MDSCs and PMN-MDSCs, respectively).

METHODS

We enrolled 65 CRC patients (34 males, 31 females) aged 69 ​± ​10 years into a prospective, randomised, double-blind study. Twenty-eight patients received L-arg and 37 received placebo for 9 days at a dose of 10 ​g/day. The frequency changes in MDSC, CD4⁺ cells and the concentration of C-reactive protein (CRP) were assessed before supplementation with L-arg (test 1), after 9 days of supplementation (test 2), and after surgery on day 11 (test 3).

RESULTS

The frequency of M-MDSC in the tumours of patients receiving L-arg supplementation was higher than in placebo-treated patients, as was the frequency of PMN-MDSC and M-MDSC in the mucosa. CRP concentration in the serum of placebo-treated patients in test 2 was higher than in test 1, and the concentration in the serum of patients with L-arg supplementation in test 2 was lower than in test 1. Moreover, the expression pattern of the argininosuccinate synthase 1 (ASS1) suggests that CRC is not auxotrophic for L-arg.

CONCLUSIONS

The results of this study do not support the hypothesis that L-arg supplementation in CRC patients can reduce immunosuppression by decreasing the frequency of suppressor cells and increasing the frequency of effector CD4⁺ T cells.

Extremely High Mortality Rate after a Successful Gastrectomy for Cancer in Older Adults

PURPOSE

Poor physiological reserve for withstanding major cancer surgery in older adults is an important concern in the selection of patients for oncologic gastrectomy. The present study aimed to analyze mortality patterns among patients who underwent gastrectomy for cancer according to age groups. The primary outcomes of this study were early- and middle-term results: 30-day and 3-, 6-, 12-, and 36-month mortality rates.

MATERIALS AND METHODS

A retrospective review of 288 patients who underwent surgical resection for gastric cancer in two centers was carried out. Patients were stratified into four groups according to age: 29-50 years (group I, n=27), 51-65 years (group II, n=117), 66-75 years (group III, n=81), and 76-92 years (group IV, n=58). Statistical calculations focused on the differences in the survival rates between groups I and II as well as between groups II and IV.

RESULTS

The middle-aged patients (group II) had significantly better 3-year survival than either the youngest (group I) or the oldest patients (group IV). The 6-month mortality rates were 16.9% in group III and 29.3% in group IV. Two-thirds of the patients from groups III and IV who died between 2 and 6 months after surgery had an uneventful postoperative course.

CONCLUSIONS

Age is an important prognostic factor of middle-term survival after gastrectomy for cancer. Geriatric assessment and better patient selection for major surgery for cancer are required to improve the outcome of gastrectomy for cancer in patients aged over 75 years.

The relationship between HER2 overexpression and angiogenesis in gastric cancer

In gastric cancer, HER2 protein overexpression is considered to be conducive to the higher proliferation activity of the tumor cells. Tumor formation is associated with angiogenesis in order to secure an abundant supply of oxygen and glucose to cancer cells. The aim of the study was to assess if HER2 overexpression is related to higher microvessel density (MVD) in the tumor stroma.The archival samples of primary tumor from 144 consecutive patients that underwent gastric resection for cancer between August 1, 2006 and December 31, 2013 in the Department of Oncological Surgery of Medical University of Gdańsk were analyzed. CD34 was used as a marker of MVD in the tumor stroma. Both CD34 and HER2 protein expressions were tested by immunohistochemistry.The assays were unsuccessful to estimate HER2 in 10 cases and CD34 in 14 cases due to technical reasons. The results were obtained for 128 patients. HER2 0 and HER2 1+ were considered negative, while HER2+ and HER2 3+ were recognized as positive. Mean MVD (mean number of vessels in the visual field) was 32.4 (median 29.5). Microvessel density was insignificantly higher in HER2 positive tumors. The slight difference was also seen between IHC 2+ and 3+ groups. The differences did not reach the level of statistical significance.Statistical analysis performed in our study did not reveal the significant relationship between HER2 overexpression on the tumor cells and MVD in the tumor stroma.

Endometriosis causing intussusception of the ileum into the colon

Intussusception of the caecum occurs about twenty times less frequently in adults as compared to children and in 90% of these cases is caused by intestinal tumors. Intussusception of the ileum usually causes intestinal obstruction which requires urgent surgical intervention. So far only a few cases of intussusception due to the presence of endometrial tumor have been described. The clinical course, imaging and laboratory tests are not specific for endometriosis. The macroscopic appearance of the tumor during laparotomy is also not diagnostic. In case of endometriosis, the diagnosis can only be made on the basis of the histopathological examination of the excised tumor In this report, we present the diagnostic process and treatment of a patient with intussusception of the ileum to the ascending and transverse colon due to cecal tumor During the operation, the surgeon suspected a cancerous tumor and performed a right hemicolectomy The final diagnosis of endometriosis was made on the basis of the histopathological analysis.

Primary osteosarcoma of the breast: A case report

Osteosarcoma (OS) located in the breast is an extremely rare, malignant neoplasm. The current study presents the diagnostic process, treatment and follow-up of a 67-year-old female with OS of the breast. The diagnosis was made according to diagnostic imaging methods and microscopic examination with additional immunohistochemical staining. As a surgical treatment, tumourectomy with intraoperative histological examination and simple breast amputation was performed. No adjuvant chemotherapy was administered following surgery. Lung and bone metastases occurred without local recurrence 14 months following the surgery. In the present study, the details of the diagnostic examinations performed are evaluated and the consecutive phases of diagnostic and therapeutic proceedings are examined in comparison with the knowledge in the literature.

VEGF-C and VEGF-D overexpression is more common in left-sided and well-differentiated colon adenocarcinoma

Tumour vessel network formation, including blood and lymph vessels, is a major step involved in the process of carcinogenesis. The discovery of vascular growth factors has led to a better understanding of tumour biology, thus, creating new possibilities for cancer treatment that targets angiogenesis within tumour-associated stroma, including therapy for colon cancer patients. The present study evaluated the relationships between increased expression of lymphangiogenic factors (VEGF-C and VEGF-D) and vessel density in the tumour-surrounding stroma, patient survival and other standard prognostic factors. The expression of VEGF-C and VEGF-D and vessel density were immunohistochemically assessed in 114 primary tumour specimens from colon adenocarcinoma patients after surgical resection between January 1, 2003 and December 31, 2008. Concomittant overexpression of VEGF-C and VEGF-D was found in 51 (44.7%) colon tumours and low expression was observed in 63 (55.3%) cases. Mean vessel density was 52.87/field. A significant correlation was found between the expression of factors influencing lymph vessel growth and increased vessel density in the tumour-surrounding stroma (p=0.03). A relationship between lymphangiogenic factor overexpression and left-sided tumour location was also found (p=0.00002). Overexpression of these factors was likely to occur in well-differentiated tumours (p=0.003). No association between patient survival and the expression levels of lymphangiogenic factors was observed. The study results indicate that the overexpression of lymphangiogenic factors tends to be associated with tumours of favourable prognosis, i.e. well-differentiated and those localized in the left-side of the colon.

L-carnitine and cancer cachexia. I. L-carnitine distribution and metabolic disorders in cancer cachexia

Cancer cachexia (CC), a progressive loss of body mass, is associated with decreased energy production. Abnormally low levels of L-carnitine (LC) in skeletal muscle means that mitochondrial β-oxidation of long-chain fatty acids (LCFA) does not occur efficiently in patients with CC. We assessed the influence of CC on LC distribution and the effects of parenteral lipid emulsions on plasma LC levels and urinary excretion. Fifty patients with CC were randomly assigned to total parenteral nutrition (TPN) with long-chain triglycerides (LCTs), or LCTs plus medium-chain triglycerides (MCTs) as 50/50. Patients were further separated into those with body-mass index (BMI) ≤ 19 kg/m(2) and BMI >19 kg/m(2). Plasma concentrations of total LC (TC) and free LC (FC) and their urinary excretion were measured, along with skeletal muscle LC levels. On average, plasma FC and TC were higher than reference values in all patients. Patients with BMI ≤ 19 kg/m(2) had lower plasma FC and TC than those with BMI >19 kg/m(2). Skeletal muscle FC in the BMI ≤ 19 kg/m(2) group was lower than reference value, but within the normal range in others. LC and FC urinary excretion was higher than reference values. Plasma LC and its urinary excretion were higher in patients administered pure LCTs relative to those given MCTs/LCTs. A decrease in skeletal muscle LC in cancer patients with CC (BMI ≤ 19 kg/m(2)) correlates with an increase in its plasma levels and increased renal excretion. A diet of MCTs/LCTs reduces LC release from muscle to plasma and urine more effectively than LCTs.

L-carnitine and cancer cachexia. II. Effects of lipid emulsion used in total parenteral nutrition on parameters of hemostasis and inflammatory state in L-carnitine deficiency in myocytes

Cancer cachexia (CC), a progressive loss of body mass, leads to malnutrition and deficiencies of essential substances including polyunsaturated fatty acids (PUFAs) and L-carnitine (LC). The availability of these 2 compounds determines the rate of eicosanoid synthesis, which modulates inflammatory processes and hemostasis. We compared the effects of administration of emulsions containing long chain triglycerides (LCTs) relative to a 50:50 mix of medium chain triglycerides (MCTs) with LCTs on hemostasis and inflammatory reactions in patients with CC. The study was conducted on 50 patients with CC (23 women, 27 men) aged 66 ± 11 years with a mean loss in body weight of 21 ± 9% in the previous 6 months. Twenty patients received MCTs/LCTs while 30 received LCTs. Total parenteral nutrition (TPN) was administered using the 'all in one' method (25 kcal/kg/day, protein 1.2 g/kg/day). Selected parameters of coagulation and inflammatory state were evaluated on days 1, 5, 7 and 11 of TPN. Initial concentrations of D-dimers, fibrinogen, plasminogen activator inhibitor type 1 (PAI-1), fibronectin, CRP and IL-6 significantly exceeded the upper limit of the reference values. After 10 days of TPN, we detected significant differences in inflammatory state and hemostasis. Immunological state and hemostasis varied depending on the type of fat emulsion administered. The most likely reasons are the 2-fold higher concentrations of PUFAs in LCTs relative to MCTs/LCTs and a deficiency of LC in skeletal muscles. Both of these factors may contribute to the observed increase in the rate of eicosanoid synthesis.

Expression of HER2 in colorectal cancer does not correlate with prognosis

Estimation of HER2 membranous expression is routinely used in breast and gastric cancers, as both a prognostic and a predictive factor. To date there is no evidence for similar application of HER2 expression in colorectal cancer (CRC) cells. In CRC, HER2 is sometimes overexpressed in the cell membrane and very often in the cytoplasm. This study was conducted to determine possible correlations between both membranous and cytoplasmatic expression of HER2 in CRC cells and the outcome of the disease. The prognostic significance of combined staining intensity in the cell membrane and cytoplasm in the entire CRC cell was also investigated. HER2 expression in resectable colorectal adenocarcinoma cells was evaluated by immunohistochemistry in specimens taken from 202 patients. The percentage of cancer cells with membranous or cytoplasmatic reactions and the staining intensity of the reaction in the whole cell were recorded. A membranous reaction was present in 27% of cases, and cytoplasmatic reaction in 66% of cases. The total staining intensity in the entire cell was evaluated as moderate (2+) in 32% of cases and strong (3+) staining in 15%. There was no correlation found between either membranous or cytoplasmatic HER2 expression and survival. Furthermore combined staining intensity did not provide any prognostic information. We conclude that HER2 expression in CRC does not correlate with prognosis.

Eicosanoids in prevention and management of diseases

Eicosanoids, which originate from polyunsaturated fatty acids (PUFAs), have a major impact on homeostasis maintenance as secondary signal transducers. Signal cascade, which includes reception, processing and signal transduction coming from the environment into the cell, determines the type of response evoked. Signal distortion may take place on every level of this cascade and this in consequence could lead to the development of many diseases. Any intervention into PUFAs metabolism leads to quantitative and qualitative changes of synthesized eicosanoids. Some of them promote, whereas others inhibit carcinogenesis, some are pro- or anti-inflammatory and the overall result depends on the outcome of these contradictory effects. The type and amount of produced eicosanoids depends on substrates' availability and activity of enzymes catalyzing different stages of their transformation. A particularly negative role was assigned to the over expression of phospholipase A2, cyclooxygenase-2, 5- and 12-lipoxygenases, while the contribution of other oxygenases and their metabolites is considerably less clear. The information about their interplay is extremely sparse and inadequate to understand intricacies of the mechanisms involved. There are indications that utilization of selected eicosanoids (their analogs, agonists or antagonists) could be a better way of disease prevention and treatment, more effective than excessive dietary supplementation of fatty acids. This review presents a more global picture of oxygenases and their PUFA metabolites giving a brief summary of our current understanding of perspectives and pitfalls of their regulation and mediatory action in human diseases.