Britanin - a beacon of hope against gastrointestinal tumors?

Britanin is a bioactive sesquiterpene lactone known for its potent anti-inflammatory and anti-oxidant properties. It also exhibits significant anti-tumor activity, suppressing tumor growth in vitro and in vivo. The current body of research on Britanin includes thirty papers predominantly related to neoplasms, the majority of which are gastrointestinal tumors that have not been summarized before. To drive academic debate, the present paper reviews the available research on Britanin in gastrointestinal tumors. It also outlines novel research directions using data not directly concerned with the digestive system, but which could be adopted in future gastrointestinal research. Britanin was found to counteract liver, colorectal, pancreatic, and gastric tumors, by regulating proliferation, apoptosis, autophagy, immune response, migration, and angiogenesis. As confirmed in pancreatic, gastric, and liver cancer, its most commonly noted molecular effects include nuclear factor kappa B and B-cell lymphoma 2 downregulation, as well as Bcl-2-associated X protein upregulation. Moreover, it has been found to induce the Akt kinase and Forkhead box O1 axis, activate the AMP-activated protein kinase pathway, elevate interleukin-2 and peroxisome proliferator-activated receptor-γ levels, reduce interleukin-10, as well as downregulate matrix metalloproteinase-9, Twist family bHLH transcription factor 1, and cyclooxygenase-2. It also inhibits Myc-HIF1α interaction and programmed death ligand 1 transcription by interrupting the Ras/ RAF/MEK/ERK pathway and mTOR/P70S6K/4EBP1 signaling. Future research should aim to unravel the link between Britanin and acetylcholinesterase, mast cells, osteolysis, and ischemia, as compelling data have been provided by studies outside the gastrointestinal context. Since the cytotoxicity of Britanin on noncancerous cells is significantly lower than that on tumor cells, while still being effective against the latter, further in-depth studies with the use of animal models are merited. The compound exhibits pleiotropic biological activity and offers considerable promise as an anti-cancer agent, which may address the current paucity of treatment options and high mortality rate among patients with gastrointestinal tumors.

Senescent adipocytes and type 2 diabetes - current knowledge and perspective concepts

Among civilization diseases, the number of individuals suffering from type 2 diabetes (T2DM) is expected to increase to more than a billion in less than 20 years, which is associated with, e.g., populational aging, poor diet, sedentary lifestyle, genetic predispositions, and immunological factors. T2DM affects many organs and is characterized by insulin resistance, high glucose levels, and adipocyte dysfunction, which are related to senescence. Although this type of cellular aging has beneficial biological functions, it can also act unfavorable since senescent adipocytes resist apoptosis, enhance cytokine secretion, downregulate cell identity genes, and acquire the senescence-associated secretory phenotype that renders a more oxidative environment. Opposing T2DM is possible via a wide variety of senotherapies, including senolytics and senomorphics; nevertheless, further research is advised to expand therapeutic possibilities and benefits. Consequences that ought to be deeply researched include secretory phenotype, chronic inflammation, increasing insulin resistance, as well as impairment of adipogenesis and functioning of adipocyte cells. Herein, despite reviewing T2DM and fat tissue senescence, we summarized the latest adipocyte-related anti-diabetes solutions and suggested further research directions.

The artificial oxygen carrier erythrocruorin-characteristics and potential significance in medicine

The diminishing supply and increasing costs of donated blood have motivated research into novel hemoglobin-based oxygen carriers (HBOCs) that can serve as red blood cell (RBC) substitutes. HBOCs are versatile agents that can be used in the treatment of hemorrhagic shock. However, many of the RBC substitutes that are based on mammalian hemoglobins have presented key limitations such as instability and toxicity. In contrast, erythrocruorins (Ecs) are other types of HBOCs that may not suffer these disadvantages. Ecs are giant metalloproteins found in annelids, crustaceans, and some other invertebrates. Thus far, the Ecs of Lumbricus terrestris (LtEc) and Arenicola marina (AmEc) are the most thoroughly studied. Based on data from preclinical transfusion studies, it was found that these compounds not only efficiently transport oxygen and have anti-inflammatory properties, but also can be modified to further increase their effectiveness. This literature review focuses on the structure, properties, and application of Ecs, as well as their advantages over other HBOCs. Development of methods for both the stabilization and purification of erythrocruorin could confer to enhanced access to artificial blood resources.

Do surgeons use double gloves during surgery? Results of a survey

<b>Introduction:</b> The perforation of gloves during surgical procedures is quite common. A cheap and quite effective method of reducing the risk of blood-borne infections is wearing two pairs of gloves. Unfortunately, some surgeons are reluctant to it, and they report decreased dexterity and sensation. The aim of the study was to evaluate surgeons' double-gloving practices to determine the factors related to compliance. <br><b>Material and methods:</b> An anonymous, 21-question survey in Polish was sent by post to 41 surgical departments. The questions concerned: demographic data, type of surgical gloves used, allergy to latex, number of surgeries performed, frequency of using double gloves and negative impressions from using them and finally, the frequency of needlestick injuries during surgical procedures. <br><b>Results:</b> We received 179 questionnaires back. More than 62% of the surgeons believe that double gloves provide better protection than a single pair, 24% do not believe in this, and 14% have no opinion. Only 0.6% of respondents always use double gloves during surgery, 19% double glove in at least 25% of cases and 68% do it occasionally. 13% of the surgeons declared that they had never worn double gloves. During high-risk procedures, 86% of respondents wear double gloves. About half of respondents (50.3%) report discomfort while wearing double gloves; 45% - decreased dexterity; about 30% complain of numbness and tingling; and 64% - decreased sensation. <br><b>Conclusion:</b> Due to the high number of surgical glove perforations and relatively high prevalence of needlestick injuries, it is necessary to use methods that reduce the risk of transmission of pathogens. The habit of using a double pair of gloves should be implemented especially among young surgeons starting to train in their specialities. Consequently, the period of initial discomfort will be combined with the acquisition of surgical skills, which will allow for gradual acclimatization.

Biological assessment of new tetrahydroacridine derivatives with fluorobenzoic moiety in vitro on A549 and HT-29 cell lines and in vivo on animal model

A new series of tetrahydroacridine derivatives with the fluorobenzoyl moiety was synthesized and evaluated for cytotoxic activity against lung cancer cell lines A549 and colorectal cancer HT29. The cytotoxic activity of the compounds was compared on the somatic cell line-EAhy926. Compounds showed high cytotoxic activity on A549 cells (IC₅₀ 183.26-68.07 μM) and HT29 cells (IC₅₀ 68.41-19.70 μM), higher than controls-etoposide (IC₅₀ 451.47 μM) toward A549 and 5-fluorouracil (IC₅₀ 1626.85 μM) against HT29. Derivative 4 was the most cytotoxic to A549, whereas for the cell lines HT29 compound 6. Selected compounds showed similar cytotoxicity to the EAhy926 cell line (IC₅₀ about 50 μM). In the hyaluronidase inhibition assay, all compounds exhibited anti-inflammatory activity, including 4 exhibiting the best inhibitory activity-IC₅₀ of 52.27 μM when the IC₅₀ heparin was 56.41 μM. Mathematical modeling was performed to determine LD₅₀ after intraperitoneal, oral, intravenous and subcutaneous administration and to predict potential mutagenicity and carcinogenicity of the compounds analyzed. Obtained results showed that tested derivatives are slightly toxic compounds, and LD₅₀ values (mg/kg) ranged from 680 to 1200 (oral rat model), the analyzed compounds have low mutagenic potential, and differences between derivatives are insignificant and very low probability of carcinogenicity. To confirm mathematical calculations, an in vivo test was carried out on a laboratory mouse model for two selected compounds. It allowed to qualify compounds: 6 to category 4 of the GHS scale, and 4 to category 3 of the GHS scale.

Novel tetrahydroacridine derivatives with iodobenzoic moieties induce G0/G1 cell cycle arrest and apoptosis in A549 non-small lung cancer and HT-29 colorectal cancer cells

A series of nine tetrahydroacridine derivatives with iodobenzoic moiety were synthesized and evaluated for their cytotoxic activity against cancer cell lines—A549 (human lung adenocarcinoma), HT-29 (human colorectal adenocarcinoma) and somatic cell line—EA.hy926 (human umbilical vein cell line). All compounds displayed high cytotoxicity activity against A549 (IC₅₀ 59.12–14.87 µM) and HT-29 (IC₅₀ 17.32–5.90 µM) cell lines, higher than control agents—etoposide and 5-fluorouracil. Structure–activity relationship showed that the position of iodine in the substituent in the para position and longer linker most strongly enhanced the cytotoxic effect. Among derivatives, 1i turned out to be the most cytotoxic and displayed IC₅₀ values of 14.87 µM against A549 and 5.90 µM against HT-29 cell lines. In hyaluronidase inhibition assay, all compounds presented anti-inflammatory activity, however, slightly lower than reference compound. ADMET prediction showed that almost all compounds had good pharmacokinetic profiles. 1b, 1c and 1f compounds turned out to act against chemoresistance in cisplatin-resistant 253J B-V cells. Compounds intercalated into DNA and inhibited cell cycle in G0/G1 phase—the strongest inhibition was observed for 1i in A549 and 1c in HT-29. Among compounds, the highest apoptotic effect in both cell lines was observed after treatment with 1i. Compounds caused DNA damage and H2AX phosphorylation, which was detected in A549 and HT-29 cells. All research confirmed anticancer properties of novel tetrahydroacridine derivatives and explained a few pathways of their mechanism of cytotoxic action.

The testing of an artificial modified bacterial cellulose auricle skeleton in an animal model

The aim of this study was to assess whether modified bacterial cellulose can be used for an artificial auricle skeleton.

INTRODUCTION

The auricle is a part of the external ear. It consists of skin, cartilage, muscles and adipose tissue. The cartilage gives shape to the structure. There are several indications for reconstruction, such as congenital anomalies, mechanical injuries, and burns, and a range of methods have been proposed for the complete reconstruction of the auricle.

MATERIAL AND METHODS

A bacterial cellulose membrane, at least 25 mm in thickness, was produced in vitro by Acetobacter xylinum culture. The entire artificial human auricle skeleton was made to scale to allow its implantation into an animal model - Wistar rats. Forty rats were divided into four groups of 10 animals. Each group was assigned a different resection time: 14 days, 30 days, 90 days or 720 days. After each resection, an examination of the artificial skeleton and the tissues surrounding it was conducted. The surgical procedure was based on the Nagata technique.

RESULTS

Resection after 14, 30, 90 and 720 days shows the progression of the healing process and integration of the artificial skeleton into the animal body. There are no signs of change in the shape or structure of the skeleton.

DISCUSSION

Several surgical techniques and biotechnological methods have been developed over the past few years to improve the results of facial reconstruction. Other approaches can be used to create auricle cartilage, based on scaffolds and chondrocytes.

CONCLUSION

My findings indicate that modified bacterial cellulose can be used to form an effective artificial auricle which appears to maintain its shape and elasticity, with no signs of degradation.

The first homemade colonoscopy trainer

Introduction Colonoscopy trainers have gained recognition for improving endoscopy skills and preparing for real procedures on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for small medical centers. However, a solution might be to construct a device for themselves. Aim Our goal was to build a relatively cheap and easy-to-construct simulator for residents who want to start learning colonoscopy. Materials and methods The box model colonoscopy trainer was designed and constructed. The artificial colon was made from 2 layers of fabric and rubber rings between them. Velcro attached to the artificial colon and to the box, and the tarp straps that simulate peritoneal adhesions allow the bowel to be arranged in many different configurations. Moreover, some aspects of polypectomy training have been incorporated in the colonoscopy simulator. Results The self-constructed simulator was found to be an effective training device, with the total cost of parts not exceeding $30. Conclusions In this paper, we present the first homemade simulator for colonoscopy training. It offers the opportunity for skills acquisition in a preclinical setting.

A simple and low- cost technique for Closed Incision Negative-Pressure Therapy

Surgical site infection (SSI) makes patient care more expensive by prolonging antibiotic usage and hospital stay. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSI. We present a simple and low-cost vacuum dressing that may improve surgical wound healing and prevent high-risk wounds from complications.

The Value of Scoring Systems for the Diagnosis of Acute Appendicitis

Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis.

MATERIAL AND METHODS

The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results.

RESULTS

Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively).

CONCLUSIONS

Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis.

In vivo evaluation of nerve guidance channels of PTMC/PLLA porous biomaterial

INTRODUCTION

Peripheral nerve disruptions, frequently occurring during limb injuries, give rise to serious complications of patients recovery resulting from limitations in neural tissue regeneration capabilities. To overcome this problem bridging techniques utilizing guidance channels gain their importance. Biodegradable polymeric tubes seem to be more prospective then non-degradable materials - no necessity of implant removal and possibilities of release of incorporated drugs or biologically active agents that may support nerve regeneration process are the main advantages.

MATERIAL AND METHODS

Polymer blend of commercial poly(L-lactic acid) (PLLA) and in-house synthesized poly(trimethylene carbonate) (PTMC) were processed in an organic solvent - phase inversion process on a supporting rod - to form a guidance porous tube of 1.1 mm inner diameter. In vivo experiments on rat's cut femoral nerve by using either the tubes or end-to-end suturing (control group) involved 22 and 19 rats, respectively. Motor recovery of operated limbs, neuroma occurrence and histopathology of explanted nerves were evaluated after 30, 60 and 90 days of implantation.

RESULTS

Motor recovery of the limbs was of similar rate for the two animal groups. The neuroma formation was evident in over 90% control specimens, while for the bridging group it was less than 40% of all evaluable samples (p = 0.0022). Biocompatibility of applied materials was affirmed by moderate tissue response.

CONCLUSIONS

Application of the biodegradable PLLA/PTMC polymeric tubes effectively supports regeneration of discontinued nerves. The applied material prevents neuroma formation, by reducing the scar tissue formation time and, thus, accelerating the process of neural tissue restoration.

Evaluation of surgical glove perforation after laparoscopic and open cholecystectomy

BACKGROUND

Surgical gloves provide a protective barrier against blood-born pathogens. Studies reveal glove perforation rates of up to 45%, which are often unrecognized by the surgeon or nurse. The goal of this study was to evaluate how often glove perforation occurs after laparoscopic and open cholecystectomy.

METHODS

Gloves from the operating surgeon and the first assistant were collected after operation and tested immediately using two methods : 1. Water leak test - the approved standardized method to detect holes after filling up the gloves with 1000ml of water. 2. Electrical resistance test - method to detect gloves conductivity immersed in saline bath.

RESULTS

Altogether, 376 gloves were studied. The overall perforation rate was 8%. Perforations more frequently were observed after laparoscopic than open cholecystectomy. The gloves worn by the operator were more likely to be perforated than those worn by the assistant surgeon in both types of operations. The most common site of perforation was in the index finger of the non- dominant hand. Thirty percent of gloves conducted electrical current, while 22% of them had no macroscopic evidence of perforation.

CONCLUSION

Many of gloves might have microperforations that can not be detected using water leak test.

Modified bacterial cellulose tubes for regeneration of damaged peripheral nerves

INTRODUCTION

The subject of the experiment was bacterial nanocellulose, a natural polymer produced by bacteria - Gluconacetobacter xylinus. Following a specific modification process a cartilage-like material for restoration of damaged tissues may be produced. The obtained implants with excellent biocompatibility, mouldability, biophysical and chemical properties perfectly fit the needs of reconstructive surgery. The goal of the experiment was to develop and analyze cellulosic guidance channels in vivo for the reconstruction of damaged peripheral nerves.

MATERIAL AND METHODS

The experiments were conducted on Wistar rats, femoral nerve. Cellulose was produced according to a self-patented method. In the experimental group tubulization was applied, whereas in the control traditional end-to-end connection was used. Observation time was 30, 60, 90, and 180 days. Results evaluation included histological analysis and postoperative observation of motor recovery.

RESULTS

The overgrowth of connective tissue and disorganisation of neural structures was evident in 86.67% of control specimens, while for cellulosic group it was only 35% (p = 0.0022). Tubulization prevented the excessive proliferation of connective tissue and isolated from penetration with scar tissue. Autocannibalism, being probably an evidence of neurotrophic factors amassment, was observed in cellulosic group but not in the control one. Motor recovery did not differ significantly (p > 0.05). Biocompatibility of implants was affirmed by very small level of tissue response and susceptibility to vascularisation.

CONCLUSIONS

Cellulosic neurotubes effectively prevent the formation of neuromas. They are of very good biocompatibility and allow the accumulation of neurotrophic factors inside, thus facilitating the process of nerve regeneration.

Intraoperative parathyroid hormone measurement in thyroidectomized patients: preliminary report

BACKGROUND

Hypocalcemia is the most frequent complication after thyroid surgery. Intraoperative measurement of parathormone levels (ioPTH) in patients undergoing thyroid surgery has been recently described as an accurate method of predicting postoperative parathyroid dysfunction. The aim of the study was to evaluate utility of ioPTH and parathormone level measured 24 hours after surgery (24PTH) as prognostic factors of hypoparathyroidism and consequent hypocalcemia.

SUBJECTS AND METHODS

Fifty-four patients (50 females and 4 males) underwent 55 operations: subtotal thyroidectomy (44), total thyroidectomy (8), completion thyroidectomy due to goiter reoccurrence and cancer (2 and 1 patients, respectively). PTH and serum calcium levels were assessed one day prior to surgery, intraoperatively during wound closure, on the first postoperative day and 2 months after surgery. Hypoparathyroidism was defined as parathormone level less than 15 pg/ml.

RESULTS

Seventeen patients presented ioPTH levels below 15 pg/ml. Twelve of them had low 24PTH levels. Only one patient with ioPTH (but not 24PTH) below 15 pg/ml developed persistent hypoparathyroidism, resulting in low parathormone level 2 months after surgery. Three investigated subjects with ioPTH greater than 15 pg/ml had low 24PTH levels but none of them developed persistent hypoparathyroidism. One patient with ioPTH and 24PTH within reference range presented hypoparathyroidism at the 2-month follow-up, presumably due to postoperative iodotherapy.

CONCLUSIONS

This study suggests that ioPTH and 24PTH levels are not useful prognostic factors of persistent hypoparathyroidism but may indicate transient parathyroid gland dysfunction.

[Assessment of VEGF and VEGF receptor concentrations in patients with benign and malignant thyroid tumors]

Neoangiogenesis is a significant event in a cascade of growth and progression of solid tumors. Assessment of the tissue expression and measurement of the concentrations of angiogenic and antiangiogenic factors, contributing to this process, in body fluids, can be used not only for an early diagnosis of tumors and their staging but also as an important parameter of treatment efficiency evaluation. The aim of this study is to evaluate the concentrations of crucial angiogenic cytokine VEGF and its soluble receptors in peripheral blood of patients with benign and malignant thyroid tumors. The study comprised 35 patients with thyroid cancer and 10 patients with follicular neoplasm, both diagnosed by means of ultrasound-guided fine-needle aspiration biopsy. For these patients surgical treatment was instituted. The examined angiogenic factors were determined preoperatively and 4 weeks after the surgical procedures. The results were compared with the control group which comprised 10 healthy individuals. Analysing obtained results, we demonstrated high VEGF concentrations and low soluble VEGF receptor concentrations in patients with benign and malignant thyroid tumors. This fact confirms a vital role of VEGF in angiogenesis of thyroid tumors and a hypothetical antiangiogenic activity of its soluble receptors. Disequilibrium of the above-mentioned angiogenic factor concentrations is probably essential for the growth and progression of benign and malignant thyroid tumors.

Concentration of metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 in the serum of patients with benign and malignant thyroid tumours treated surgically

OBJECTIVES

Neoplastic angiogenesis is an essential stage of growth, progression and invasion of solid tumours. The process of basement membrane degradation and remodelling of the extracellular matrix (EMC) involves proteolytic enzymes called metalloproteinases. Among the numerous proteolytic enzymes of this group the key role is played by metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2). Tissue expression and concentration of these compounds in body fluids have been used in early diagnostics of tumours development, assessment of tumours advancement and treatment results monitoring. The aim of the study was to evaluate the concentration of MMP-2 and TIMP-2 in blood serum of patients with benign and malignant thyroid tumours and the effect of surgical treatment on these parameters in the postoperative period as well as assessment whether to MMP-2 and TIMP-2 serum concentration in patients with thyroid cancer positively correlates with the clinical staging classification of the International Union Against Cancer (UICC).

PATIENTS AND METHODS

The study group consisted of 53 patients with various types of thyroid cancer and 23 patients with benign thyroid tumours, while 26 healthy adults served as controls. According to clinical staging classification of thyroid cancer the 32 patients were classified with stage I, 6 with stage II, 8 with stage III and 7 with stage IV. We have found higher mean concentration of MMP-2 in 53 patients with thyroid cancer as compared to the control group and the group of 23 patients with benign thyroid tumours. All patients were treated operatively. Additionally, a significant effect of radical surgical treatment on mean concentration of MMP-2 and TIMP-2 in patients with papillary and follicular thyroid cancer was demonstrated.

CONCLUSIONS

MMP-2 and its tissue inhibitor TIMP-2 apparently play a significant role in the pathogenesis of thyroid cancer. Evaluation of their concentration in peripheral blood serum may be useful for the differentiation between benign and malignant thyroid tumours. Serum MMP-2 and TIMP-2 concentrations in patients with thyroid cancer did not significantly correlate with the clinical staging of thyroid cancer.

HMGI(Y) gene expression as a potential marker of thyroid follicular carcinoma

BACKGROUND

We assessed HMGI(Y) gene expression in thyroid tumors, control thyroid tissue and in the blood of patients diagnosed with papillary and follicular thyroid cancers to try to differentiate between malignant and benign disease.

METHODS

HMGI(Y) gene expression was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) in 60 cases of thyroid tumors. Among this number 11 were diagnosed as papillary carcinoma, 37 as follicular carcinoma, and 12 as follicular adenoma. All carcinoma cases selected for this study were classified according to the tumor, lymph node metastases, distant metastases (TNM) classification.

RESULTS

HMGI(Y) gene expression was detected only in follicular carcinomas, whereas in papillary carcinomas, follicular adenomas and control tissues there was no positive reaction. In follicular carcinomas the percentage of positive cases (number of samples with presence of HMGI(Y) gene transcript) was the highest and reached approximately 84. There was no statistical dependence between the presence of HMGI(Y) gene expression and tumor size or the presence of lymph node and distant metastases. HMGI(Y) gene expression was also analyzed in whole blood taken from a selected group of patients diagnosed with papillary or follicular carcinomas. Among follicular carcinomas there were 83% of positive cases, whereas among papillary carcinomas there were only 6%.

CONCLUSIONS

On the basis of our study, we conclude that HMGI(Y) gene expression analysis could be helpful in differentiation between follicular carcinoma and adenoma.

Soluble intracellular adhesion molecules (sICAM-1, sVCAM-1) in peripheral blood of patients with thyroid cancer

The growth of a neoplasm and its ability to form metastases is a multistep process dependent on angiogenesis and immunological reactions of the organism. In this process adhesive factors are also involved. The aim of this work was estimation of the concentration of soluble intercellular adhesion molecules (sICAM-1) and vascular cellular adhesion molecules (sVCAM-1) in the serum of peripheral blood of patients with thyroid cancer before operation. The study comprised 48 patients ( 38 women and 10 men) aged from 18 to 87 years, in whom thin needle aspiration biopsy revealed cancer of the thyroid. Postoperative histopathological examination showed papillary cancer in 35 patients, oxyphilic cancer in 5 patients, anaplastic cancer in 4 and medullary cancer in 4 patients. In those patients, using the immunoenzymatic method ELISA, the concentration of sICAM-1 and sVCAM-1 in the serum of peripheral blood was determined. The control group comprised 26 healthy persons. We found statistically significant increase of sICAM-1 concentration in serum in all forms of cancer, in comparison with the control group. Mean concentrations of sICAM-1 were as follows: in papillary cancer patients 455.23+/-28.66 vs. 299.62+/-11.54 ng/ml, p<0.05; in oxyphilic cancer 455.60+/-95.21 vs. 299.62+/-11.54 ng/ml, p<0.05; in anaplastic cancer 570.00+/-170.89 vs. 299.62+/-11.54 ng/ml, p<0.05; and in medullary cancer 512.00+/-11.46 vs. 299.62+/-11.54 ng/ml, p<0.05. The mean concentration of sVCAM-1 in serum was statistically significantly higher than in the control group only in case of anaplastic cancer (1033.75+/-86.30 vs. 644.58+/-27.30 ng/ml; p<0.05). We evaluated the correlation coefficient between the concentration of sICAM-1 and sVCAM-1 in the serum of patients with thyroid cancer. Positive correlation was observed between the concentration of sICAM-1 and sVCAM-1. The obtained results confirm essential role of the investigated adhesive factors in the process of thyroid cancer growth.

Expression of C-ERBB2 and P65 genes and their protein products in follicular neoplasms of thyroid gland

C-ERBB2 and P65 gene expression was investigated by reverse transcriptase polymerase chain reaction method (RT-PCR) in thirty follicular thyroid cancers and twenty follicular adenomas. Additionally, the cancers and adenomas were stained by immunohistochemistry for the expression of their protein products. We did not observe P65 gene expression in any of the analyzed follicular cancers (n=30) but it was observed in 13 out of 20 (65%) follicular adenomas. The presence of C-ERBB2 gene expression was found in 18 (90%) follicular adenomas but not in cancers. There were 10 (50%) adenomas and 11 (36.7%) cancers with positive staining for C-ERBB2 protein and 15 (75%) adenomas and 2 (6.7%) cancers with positive staining for P65 protein. We conclude that expression of C-ERBB2 and P65 genes is associated with follicular adenoma but not with cancer of thyroid gland.

Evaluation of the levels of bFGF, VEGF, sICAM-1, and sVCAM-1 in serum of patients with thyroid cancer

Tumour growth and development depend on a complex cascade of angiogenic factors. The aim of the study is evaluation of the level of growth factors VEGF and bFGF, and adhesion molecules sICAM-1, sVCAM-1 in the serum of patients with papillary thyroid cancer. The study comprised 35 patients aged 21-68 years (mean age 46+/-14) who had papillary thyroid cancer diagnosed on the basis of thin needle aspiration biopsy, and were qualified for operative treatment. This group comprised 28 women and seven men. The control group was 26 healthy individuals. Serum concentrations of bFGF, VEGF, sICAM-1, and sVCAM-1 were evaluated by the enzyme-linked immunosorbent assay (ELISA) method. We have observed significantly higher mean concentrations of bFGF, VEGF, and sICAM-1 in the serum of patients with thyroid cancer compared with the control group. There was no significant difference between the sVCAM-1 concentrations of the thyroid cancer group and the control group.

Recurrences of thyroid cancer after radical surgery and complementary treatment: are macroscopic, microscopic, scintigraphic, and biochemical criteria sufficient in the evaluation of radicality of primary treatment?

From 1974 to 1999, 1,001 patients were operated on for thyroid cancer, including 778 (78%) for differentiated thyroid cancer and 223 (22%) for other thyroid malignant neoplasms. Radical operations were performed in 716 (92%) patients with differentiated thyroid cancer and in 85 (38%) patients with other thyroid malignant neoplasms. After surgery, all patients underwent various methods of complementary treatment, depending on cancer type and grading (levothyroxine, 131I, radiotherapy and/or chemotherapy). These patients had no evidence of persistent disease after finishing treatment (Tg, CEA, calcitonin, scintigraphy). We observed recurrences of thyroid cancer, although macroscopic, microscopic, biochemical, and scintigraphic criteria of radicality were present. At 18 months' to 24 years' follow-up, we observed recurrences in 94 (11.7%) of 801 patients treated radically, including in 53 (7.4%) of 716 patients with differentiated thyroid cancer and in 41 (48%) of 85 patients with other thyroid malignancies. Among 37 patients with thyroid bed recurrence, 18 (48.6%) underwent radical operations and 19 (51.4%) palliative ones. Of 33 patients with regional lymph node recurrence, radical operations were performed in 26 (78.8%) and palliative ones in seven (21.2%). Of 24 patients with distant metastases, four (17%) (with single metastasis) underwent surgery (three radical operations and one palliative one). Other methods of treatment were used in the remaining patients. Occurrence of thyroid cancer recurrences in the thyroid bed and lymph nodes indicates that macroscopic, microscopic, and scintigraphic criteria of radicality are not sufficient. Recurrences after radical surgery are more infrequent in patients with differentiated thyroid cancers than in those with other thyroid malignant neoplasms. In many patients, thyroid bed and lymph node recurrences can be removed radically during surgery.

Estimation of concentration of chosen adhesive factors in suprarenal tumours of 'incidentaloma' type

The role of adhesive molecules in the pathogenesis of adrenal gland tumours formation remains unclear. Here we present the concentrations of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intracellular adhesion molecule-1 (sICAM-1) in the blood of patients with adrenal "incidentaloma". We found that the mean concentrations of sVCAM and sICAM in the serum of the patients with adrenocortical cancers were significantly higher than those of the patients with benign adenomas or control cases. These results suggest that the levels of adhesion molecules may be a marker of malignancy of adrenal incidentalomas.

Matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases and angiogenic cytokines in peripheral blood of patients with thyroid cancer

Stimulation of growth of endothelial cells from preexisting blood vessels, i.e., angiogenesis, is one of the essential elements necessary to create a permissive environment in which a tumor can grow. During angiogenesis, the matrix metalloproteinase (MMP) family of tissue enzymes contributes to normal (embriogenesis or wound repair) and pathologic tissue remodeling (chronic inflammation and tumor genesis). The proposed pathogenic roles of MMPs in cancer are tissue breakdown and remodeling during invasive tumor growth and tumor angiogenesis. Tissue inhibitors of metalloproteinases (TIMPs) form a complex with MMPs, which in turn inhibits active MMPs. Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are unique among mediators of angiogenesis with synergistic effect, and both can also be secreted by thyroid cancer cells. The goal of the study was to evaluate the plasma blood concentration of VEGF, bFGF, MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1, and TIMP-2 in patients with cancer and in normal subjects. Twenty-two patients with thyroid cancers (papillary cancer, 11; partly papillary and partly follicular cancer, 3; anaplastic cancer, 5; medullary cancer, 3) and 16 healthy subjects (controls) were included in the study. VEGF, bFGF MMPs, and TIMPs were evaluated by enzyme-linked immunosorbent assay (ELISA). In patients with thyroid cancer, normal VEGF concentrations (74.29 +/- 13.38 vs. 84.85 +/- 21.71 pg/mL; p > 0.05) and increased bFGF (29.52 +/- 4.99 vs. 6.05 +/- 1.43 pg/mL; p < 0.001), MMP-2 (605.95 +/- 81.83 vs. 148.75 +/- 43.53 ng/mL; p < 0.001), TIMP-2 (114.19 +/- 6.62 vs. 60.75 +/- 9.18 ng/mL; p < 0.001), as well as lower MMP-1 (0.70 +/- 0.42 vs. 3.87 +/- 0.53; p < 0.001) levels have been noted. Increased plasma levels of MMP-3 and MMP-9 were also found in patients with medullary carcinoma. In conclusion, predominance of MMP-2 over TIMP-2 and TIMP-1 over MMP-1 as well as increased concentration of bFGF in peripheral blood are common features in patients with thyroid cancer.

p53, MDM2, bcl-2 staining in follicular neoplasms of the thyroid gland

Sixty-two follicular adenomas of the thyroid were investigated by immunohistochemistry for the expression of p53, MDM2 and bcl-2 proteins. The wild type of 393 aminoacid nuclear p53 phosphoprotein is the product of a gene located on the short arm of chromosome 17. The p53 protein controls the growth of transformed cells in a culture and thus termed a suppressor gene product. Mouse double minute 2 (MDM2) gene product has been described to occur in malignant epithelial tissue, the protein product of this gene binds to and presumably inactivates the growth suppressive effect of wild type p53 protein. Bcl-2 is an oncogene whose product inhibits apoptosis in many cells types. Some scattered nuclei in two adenomas (3.2%) stained positively for p53. The adenomas with positive staining for p53 were subserially sectioned, but no signs of invasion were found, both patients are alive and well. In 12 adenomas (19%) there was positive reaction for MDM2 protein, whereas none of them where p53 positive. All cases were strongly positive for bcl-2 staining. We conclude that p53 protein expression is not confined to follicular adenomas, while MDM2 and bcl-2 genes products are.

Angiogenesis of endocrine gland tumours--new molecular targets in diagnostics and therapy

Angiogenesis is one of the key stages in the development of neoplastic tumours, in which a small group of mutated cells transforms into a large malignant tumour metastasising to the neighbouring tissues and organs. The studies on the significance of neoangiogenesis in the progression of endocrine gland neoplasms have recently become one of the most rapidly evolving branches of molecular endocrinology. The induction of angiogenesis has been demonstrated to result from the imbalance between positive and negative factors which control this process. Our paper presents the results of current studies on the role of factors such as molecular markers of angiogenesis (e.g. vascular endothelial growth factor and basic fibroblast growth factor), metalloproteinases (which regulate the decomposition of the extracellular matrix) and their inhibitors, and adhesive molecules (e.g. soluble vascular cellular adhesion molecule-1 and soluble intracellular adhesion molecule-1) in the pathogenesis and diagnostics of endocrine gland tumours in humans. Also, we discuss new therapeutic strategies for inhibiting the growth of neoplasms by blocking the formation of blood vessels using angiogenesis antagonists, which inhibit various stages of angiogenesis. More and more data are being accumulated suggesting that these preparations could, in the near future, be used in the pharmacotherapy of some endocrine gland neoplasms.

Distinct immunological and biochemical properties of thyroid peroxidase purified from human thyroid glands and recombinant protein produced in insect cells

The biosynthesis of thyroid hormone from thyroglobulin is catalysed by thyroid peroxidase (TPO), an integral membrane protein. TPO is also a major autoantigen in autoimmune thyroid disease and autoantibodies to TPO are markers for disease activity. Large quantities of purified TPO are essential for elucidating its structure and understanding its role in disease activity. We describe the high yield purification of full-length recombinant human TPO from baculovirus infected insect cells and compare it to purified native TPO from human thyroid glands. In contrast to native human TPO, the human TPO produced in insect cells as a recombinant protein was insoluble and resistant to solubilisation in detergents. Reversible substitution of lysine residues with citraconic anhydride led to increased solubility of the recombinant TPO, allowing high-yield purification by monoclonal antibody chromatography. The purified enzyme preparation was shown to be TPO by its reactivity with monoclonal and polyclonal antibodies by enzyme linked immunosorbent assay and Western blotting. Both the human and recombinant purified TPO preparations also react with sera from patients with autoimmune thyroid disease, although the binding of conformational dependent autoantibodies was considerably lower to the recombinant TPO than to the native TPO. This suggests that the recombinant TPO may differ in some aspects of its tertiary structure. The purified recombinant TPO was devoid of enzyme activity, in contrast to the enzymatically active, purified human TPO preparations. Both preparations contained comparable amounts of haem (R(z)=0.269), but a shift in the Soret band of recombinant TPO (402 nm) from that of natural TPO (409 nm) indicates that the lack of enzymatic activity of the recombinant enzyme may be due to changes in the protein backbone surrounding the haem. Both the purified native and recombinant TPO, under non-denaturing conditions, show evidence of high molecular mass oligomers, although the latter preparation is prone to a greater degree of aggregation. In conclusion, our studies indicate that recombinant TPO generated in insect cells is conformationally distinct from the native TPO, is insoluble and enzymatically inactive, consistent with the difficulties associated with its purification and crystallisation.

[Antigens CA-50 and CA-242 in digestive tract and thyroid neoplasms]

The aim of the study was to assess the CEA antigen and glycoproteins associated antigen CA-50 and CA-242 in tumours of digestive tract and thyroid gland. 84 patients were the material of the study-33 with digestive tracts' neoplasms (among them 22 cases of large bowel cancer and 11 with cancer of pancreas) and 51 with thyroid neoplasms (30 patients with well differentiated thyroid cancer, 21 follicular adenomas of thyroid). There were assessed level of CA-50 and CA-242 glycoprotein associated antigens. Results were compared with CEA-for digestive tract cancer and Tg levels in thyroid neoplasm respectively. In large bowel cancer (22 cases) there were in 10 patients (45%) with elevated level of CEA, 14 patients with elevated CA-50 (63%) and the same number for CA-242 (14 patients-63%). In cancer of pancreas (total 11 patients) there were CEA elevated level in 3 (27%) patients, CA-50 in 7 (64%) patients and CA-242 in 6 (55%) patients. Patients with well differentiated thyroid cancer (30 cases) revealed elevated level of Tg in 24 (80%) patients, CA-50 in 4 (13%), and CA-242 in 4 (13%) ones. The patients with follicular adenomas (21) had elevated Tg level in 17 (80%) cases, CA-50 in 3 (14%) cases and CA-242 in one patient (4.7%).

Human thyroid peroxidase (TPO) isoforms, TPO-1 and TPO-2: analysis of protein expression in Graves' thyroid tissue

Thyroid peroxidase (TPO) is the key enzyme involved in the biosynthesis of thyroid hormones and is an important autoantigen in autoimmune thyroid disease. Different messenger RNA species coding for TPO are present in thyroid tissue, including the species coding for a 933-amino acid protein (termed TPO-1) and a second in which exon 10 is deleted and which is 57 residues shorter (termed TPO-2). However, it is not known whether the smaller, TPO-2 isoform is expressed as a protein in thyroid cells. In SDS-PAGE under reducing conditions, TPO appears in the thyroid microsome and purified protein preparations as a closely migrating double band of approximately 105 (larger form) and 100 kilodaltons (smaller form). We investigated the presence of the isoform TPO-2 polypeptide in Graves' thyroid tissue using rabbit antisera to three different synthetic peptides from exon 10 (specific for TPO-1) and a polyclonal rabbit and monoclonal anti-TPO antibody (both of which are specific for the two forms of TPO). The larger and smaller forms of TPO were purified by electroelution after gel electrophoresis of highly purified natural TPO from Graves' thyroid microsomes. Both of the purified forms of TPO react with all three anti-exon 10 peptide antibodies, the polyclonal anti-TPO and the monoclonal antibody anti-TPO. This shows that both forms of TPO contain exon 10-encoded polypeptide of TPO-1. Interestingly, the proportion of the larger and smaller forms of TPO varied in different Graves' thyroid microsome preparations. To investigate the presence of the smaller TPO-2 isoform in the purified natural TPO preparation, affinity depletion of TPO-1 using the anti-exon 10 peptide antibodies was carried out. The binding of anti-exon 10 peptide antibodies to the immunodepleted TPO-1 fraction was considerably diminished in comparison to binding of polyclonal anti-TPO, suggesting the presence of small amounts (< 10%) of TPO-2 expressed as a protein in thyroid cells. Our results extend previous observations by showing that the alternatively spliced form of TPO, in which exon 10 is excised, is expressed at low levels in Graves' thyroid tissue. Furthermore, we confirm that both the larger and smaller forms of TPO observed on gel electrophoresis contain TPO-1, suggesting that the difference is caused by posttranslational modifications. The presence of small amounts of TPO-2 in Graves' thyroid glands argues for its role in thyroid function, which remains to be clarified.