Changes in circulating endothelial cells (CECs) during treatment with cisplatin-based chemotherapy for testicular cancer

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Background: Chemotherapy (CT)-induced endothelial damage is an important pathogenic factor for cardiovascular morbidity in testicular cancer (TC) patients (pts). Therefore, we studied early markers of endothelial damage as predictors of cancer treatment-related cardiovascular morbidity. Methods: We prospectively assessed markers of endothelial damage in TC pts treated at the University Medical Center Groningen, before, during, 4 weeks and one year after completion of standard CT (3 or 4 three weekly cycles with bleomycin, etoposide and cisplatin). The number of circulating endothelial cells (CECs), identified by CD146+, CD105+ and CD45− using the CellSearch system, and plasma levels of von Willebrand Factor (vWF) were measured. Results: 30 TC pts were included (median age 34 years, range 20–47). Before start of CT, CECs were not associated with disease stage or leukocyte count. The number of CECs progressively increased over the 9–12 week CT period [baseline: median (range) 25/mL (6–137); maximum number during CT: 134/mL (28–320; p<0.001); 4 weeks after completion of CT: 66/mL (18–316; p=0.005)]. One year post treatment, CECs were not different from baseline [N= 10; 13/mL (6–31; p=0.263)]. vWF levels also progressively increased during CT [baseline: median 105% (range 50–377); maximum level during CT: 289% (175–464; p<0.001); 4 weeks after completion of CT: vWF 124% (56–274; p=0.149)]. One year after CT, vWF levels were 115% (61–184; p=0.285). During CT, numbers of CECs and vWF levels correlated positively (r=0.283; p<0.001), whereas maximum CECs increase and maximum vWF increase were not associated (r=0.098; p=0.605). Two pts had a cerebral infarction during CT. In one pt, vWF increased before the event; in both pts CECs increased directly afterwards. Conclusions: During CT for disseminated TC, CECs and vWF progressively increased during consecutive cycles. CECs remained increased 4 wks after completion of CT, whereas vWF returned to baseline levels. The magnitude of changes was not equal in every pt. Therefore, both CECs and vWF might be early predictive markers for chemotherapy-induced cardiovascular toxicity, and may serve as intermediate endpoint in intervention studies.

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(1-->3)-beta-D-glucan and endotoxin in house dust and peak flow variability in children

House dust-associated bacterial endotoxins have been shown to be associated with asthma severity, and a similar role has been suggested for fungal (1-->3)-beta-D-glucans. In this study the relation between these agents and peak expiratory flow (PEF) variability was investigated in 148 children 7 to 11 yr of age of whom 50% had self- or parent-reported chronic respiratory symptoms. All children self-monitored twice daily their PEF for a period of 16 wk. Dust samples were collected from mattresses and from living room and bedroom floors, and endotoxin and (1-->3)-beta-D-glucan were measured in dust extracts. The relations with mean daily PEF variability (Ampl%mean) were investigated by linear regression analysis, adjusting for dust mite allergen levels, presence of pets, and type of floor cover. In unadjusted analyses the levels of both endotoxin and (1--> 3)-beta-D-glucan per square meter of living room floor were significantly associated with PEF-variability (but not when expressed per gram of sampled dust), particularly in atopic children with asthma symptoms. Adjusted analyses showed the same association for (1--> 3)-beta-D-glucan but not for endotoxin. Although no associations were found with microbial agent levels in bedroom floor or mattress dust, high levels of (1-->3)-beta-D-glucan in living room floor dust apparently increase PEF variability in asthmatic children.

Acute effects of air pollution on respiratory health of 50-70 yr old adults

The aim of this study was to investigate the association between daily changes in respiratory health and air pollution in 489 adults, aged 50-70 yrs, with and without chronic respiratory symptoms, living in urban and nonurban areas in the Netherlands. Subjects were selected from the general population with a screening questionnaire. During three consecutive winters starting in 1992/1993, peak expiratory flow (PEF) and respiratory symptoms were registered in a daily diary. Daily measurements of particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10), black smoke (BS), sulphate, sulphur dioxide (SO2) and nitrogen dioxide (NO2) were conducted. The difference in PM10, BS and sulphate concentrations between urban and nonurban areas was small, but there was more contrast in the concentrations of SO2 and NO2. In symptomatic subjects from urban areas, PM10, BS, sulphate and SO2 concentrations were associated with the prevalence of large decrements in morning PEF (>20% below the median). BS in particular was also associated with upper respiratory symptoms (URS). The magnitude of the effect estimates was in the order of an 80% increase in PEF decrements and a 20% increase in URS for a 40 microg x m-3 increase of the same day BS concentration. In symptomatic subjects from nonurban areas, no consistent associations between air pollution and health indicators were observed. However, the differences in effect estimates between urban and nonurban symptomatic panels were small and nonsignificant. In nonsymptomatic adults from both areas, no consistent pattern of associations with air pollution was found. In conclusion, air pollution effects were only found in symptomatic adults in the urban areas.