First-in-human study of SBRT and adenosine pathway blockade to potentiate the benefit of immunochemotherapy in early-stage luminal B breast cancer: results of the safety run-in phase of the Neo-CheckRay trial

BACKGROUND

Luminal B breast cancer (BC) presents a worse prognosis when compared with luminal A BC and exhibits a lower sensitivity to chemotherapy and a lower immunogenicity in contrast to non-luminal BC subtypes. The Neo-CheckRay clinical trial investigates the use of stereotactic body radiation therapy (SBRT) directed to the primary tumor in combination with the adenosine pathway inhibitor oleclumab to improve the response to neo-adjuvant immuno-chemotherapy in luminal B BC. The trial consists of a safety run-in followed by a randomized phase II trial. Here, we present the results of the first-in-human safety run-in.

METHODS

The safety run-in was an open-label, single-arm trial in which six patients with early-stage luminal B BC received the following neo-adjuvant regimen: paclitaxel q1w×12 → doxorubicin/cyclophosphamide q2w×4; durvalumab (anti-programmed cell death receptor ligand 1 (PD-L1)) q4w×5; oleclumab (anti-CD73) q2w×4 → q4w×3 and 3×8 Gy SBRT to the primary tumor at week 5. Surgery must be performed 2-6 weeks after primary systemic treatment and adjuvant therapy was given per local guidelines, RT boost to the tumor bed was not allowed. Key inclusion criteria were: luminal BC, Ki67≥15% or histological grade 3, MammaPrint high risk, tumor size≥1.5 cm. Primary tumor tissue samples were collected at three timepoints: baseline, 1 week after SBRT and at surgery. Tumor-infiltrating lymphocytes, PD-L1 and CD73 were evaluated at each timepoint, and residual cancer burden (RCB) was calculated at surgery.

RESULTS

Six patients were included between November 2019 and March 2020. Median age was 53 years, range 37-69. All patients received SBRT and underwent surgery 2-4 weeks after the last treatment. After a median follow-up time of 2 years after surgery, one grade 3 adverse event (AE) was reported: pericarditis with rapid resolution under corticosteroids. No grade 4-5 AE were documented. Overall cosmetical breast evaluation after surgery was 'excellent' in four patients and 'good' in two patients. RCB results were 2/6 RCB 0; 2/6 RCB 1; 1/6 RCB 2 and 1/6 RCB 3.

CONCLUSIONS

This novel treatment combination was considered safe and is worth further investigation in a randomized phase II trial.

TRIAL REGISTRATION NUMBER

NCT03875573.

Intraoperative electron radiotherapy in early invasive ductal breast cancer: 6-year median follow-up results of a prospective monocentric registry

Background

Intraoperative electron radiotherapy (IOERT) can be used to treat early breast cancer during the conservative surgery thus enabling shorter overall treatment times and reduced irradiation of organs at risk. We report on our first 996 patients enrolled prospectively in a registry trial.

Methods

At Jules Bordet Institute, from February 2010 onwards, patients underwent partial IOERT of the breast. Women with unifocal invasive ductal carcinoma, aged 40 years or older, with a clinical tumour size ≤ 20 mm and tumour-free sentinel lymph node (on frozen section and immunohistochemical analysis). A 21 Gy dose was prescribed on the 90% isodose line in the tumour bed with the energy of 6 to 12 MeV (Mobetron®-IntraOp Medical).

Results

Thirty-seven ipsilateral tumour relapses occurred. Sixteen of those were in the same breast quadrant. Sixty patients died, and among those, 12 deaths were due to breast cancer. With 71.9 months of median follow-up, the 5-year Kaplan–Meier estimate of local recurrence was 2.7%.

Conclusions

The rate of breast cancer local recurrence after IOERT is low and comparable to published results for IORT and APBI. IOERT is highly operator-dependent, and appropriate applicator sizing according to tumour size is critical. When used in a selected patient population, IOERT achieves a good balance between tumour control and late radiotherapy-mediated toxicity morbidity and mortality thanks to insignificant irradiation of organs at risk.

Unintended dose to the lower axilla in adjuvant radiotherapy for breast cancer: Differences between tangential beam and VMAT

BACKGROUND AND PURPOSE

To evaluate dosimetric differences in unintended dose to the lower axilla between 3D-standard (3DCRT), tangential beam forward intensity modulated radiotherapy (F-IMRT) and volumetric modulated arc therapy (VMAT). The objective is to evaluate whether results of clinical trials, such as the ACOSOG-Z011 trial, that evaluated omission of axillary clearance can be extrapolated towards more conformal techniques like VMAT.

MATERIALS AND METHODS

Twenty-five consecutive patients treated with whole breast radiotherapy alone (WBRT) using a F-IMRT technique were identified. Three additional plans were created for every patient: one plan using a single 270° arc (VMAT 1x270°), another using two small ≤90° opposing arcs (VMAT 2x < 90°) and thirdly a 3DCRT plan without F-IMRT. Axillary levels I-II were contoured after the treatment plans were made.

RESULTS

The volume of the axilla level I that was covered by the 50% isodose (V50%) was significantly higher for VMAT 2x < 90° (71.3 cm³, 84% of structure volume, p < 0.001) and VMAT 1x270° (68.8 cm³, 81%, p < 0.01) compared to 3DCRT (60.3 cm³, 71%) and F-IMRT (60.8 cm³, 72%). The V50% to the axilla level II, however, was low for all techniques: 12.3 cm³ (12%); 8.9 cm³ (9%); 4.3 cm³ (4%); 4.4 cm³ (4%) for VMAT 2x < 90°, VMAT 1x270°, 3DCRT, F-IMRT, respectively. For the higher doses (V90% and above), no clinically relevant differences were seen between the different modalities.

CONCLUSION

WBRT treatments with VMAT do not lead to a significant reduction of the unintended axillary dose in comparison with a tangential beam setup. Hence, concerning tumor control, VMAT can be applied to clinical situations similar to the Z0011 trial. The intermediate axillary dose is higher with VMAT, but the clinical consequence of this difference on toxicity is unknown.

Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials

BACKGROUND

Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy.

METHODS

To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs).

FINDINGS

Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82-0·89; p<0·0001). 10-year breast cancer mortality was similarly reduced (18·9% vs 21·3%; RR 0·87, 95% CI 0·83-0·92; p<0·0001), as was all-cause mortality (22·1% vs 24·8%; RR 0·87, 95% CI 0·83-0·91; p<0·0001). Death without recurrence was, if anything, lower with dose-intense than with standard-schedule chemotherapy (10-year risk 4·1% vs 4·6%; RR 0·88, 95% CI 0·78-0·99; p=0·034). Recurrence reductions were similar in the seven trials (n=10 004) that compared 2-weekly chemotherapy with the same chemotherapy given 3-weekly (10-year risk 24·0% vs 28·3%; RR 0·83, 95% CI 0·76-0·91; p<0·0001), in the six trials (n=11 028) of sequential versus concurrent anthracycline plus taxane chemotherapy (28·1% vs 31·3%; RR 0·87, 95% CI 0·80-0·94; p=0·0006), and in the six trials (n=6532) testing both shorter intervals and sequential administration (30·4% vs 35·0%; RR 0·82, 95% CI 0·74-0·90; p<0·0001). The proportional reductions in recurrence with dose-intense chemotherapy were similar and highly significant (p<0·0001) in oestrogen receptor (ER)-positive and ER-negative disease and did not differ significantly by other patient or tumour characteristics.

INTERPRETATION

Increasing the dose intensity of adjuvant chemotherapy by shortening the interval between treatment cycles, or by giving individual drugs sequentially rather than giving the same drugs concurrently, moderately reduces the 10-year risk of recurrence and death from breast cancer without increasing mortality from other causes.

FUNDING

Cancer Research UK, Medical Research Council.

Shielding disk position in intra-operative electron radiotherapy (IOERT): A Monte Carlo study

PURPOSE

In IOERT breast treatments, a shielding disk is frequently used to protect the underlying healthy structures. The disk is usually composed of two materials, a low-Z material intended to be oriented towards the beam and a high-Z material. As tissues are repositioned around the shield before treatment, the disk is no longer visible and its correct alignment with respect to the beam is guaranteed. This paper studies the dosimetric characteristics of four possible clinical positioning scenarios of the shielding disk. A new alignment method for the shielding disk in the beam is introduced. Finally, it suggests a new design for the shielding disk.

METHODS

As the first step, the IOERT machine "Mobetron 1000" was modeled by using Monte Carlo simulation, tuning the MC model until an excellent match with the measured PDDs and profiles was achieved. Four possible shielding disk positioning scenarios were considered, determining the dosimetric impact. Furthermore, in our center, to prevent beam misalignment, we have developed a shielding disk equipped with guiding rods. Having ascertained a correct alignment between the disk and the beam, we can propose a new internal design of the shielding disk that can improve the dose distribution with a better coverage of the treated area.

RESULTS

All MC simulations were performed with a 12 MeV beam, the maximum energy of Mobetron 1000 and a 5.5 cm diameter flat tip applicator, this applicator being the most clinically used. The simulations were compared with measurements performed in a water phantom and showed good results within 2.2% of root mean square difference (RMSD). The misplacement positions of the shielding disk have dosimetric impacts in the treatment volume and a small translation could have a significant influence on healthy tissues. The D-scenario is the worst which could happens when the shielding disk is flipped upside down, giving up to 144% dose instead of 90% at the surface of the Pb/Al shielding disk. A new shielding design used, together with our alignment tool, is able to give a more homogeneous dose in the target area.

CONCLUSIONS

The accuracy of shielding disk position can still be problematic in IOERT dosimetry. Any method that can ascertain the good alignment between the shielding disk and the beam is beneficial for the dose distribution and is a prerequisite for an optimized shield internal design that could improve the coverage of the treated area and the protection of healthy tissues.

[Not Available]

Male breast cancer is a rare disease, accounting for less than 1% of all breast cancer cases. It is often diagnosed late, at a more advanced stage than its female counterpart. Therefore, it is more commonly treated with mastectomy. In early stages, a conservative treatment associating lumpectomy, sentinel lymph node (SLN) biopsy and whole-breast external beam radiotherapy (EBRT) is possible and has been described. Recently, intra-operative radiation therapy (IORT) has been assessed as an alternative to EBRT in selected female breast cancer cases. Its use has never been described in male patients. In this article, we present the case of a 56 years old man treated with lumpectomy with the excision of the nipple-areola complex, SLN biopsy, and IORT with electron beams (IOERT), for early breast cancer disease. This case demonstrates that the IORT technique is feasible on men with early breast cancer (pT1N0).

HSP110, caspase-3 and -9 expression in physiological apoptosis and apoptosis induced by in vivo embryonic exposition to all-trans retinoic acid or irradiation during early mouse eye development

Apoptosis is an essential physiological process in embryonic development. In the developing eye of vertebrates, three periods of developmental apoptosis can be distinguished: early, intermediate and later. Within the apoptosis pathway, caspases play a crucial role. It has also been shown that HSP110 may have a potential role in apoptosis. The aim of this research was to study the expression of HSP110, caspase-3 and -9 in physiological, retinoic- or irradiation-induced apoptosis during early eye development. Seven pregnant C57Bl/6J mice received 80 mg kg(-1) of all-trans retinoic acid mixed with sesame oil. Seven pregnant NMRI mice received 2 Gy irradiation at the same gestational day. Control mice of both strains (seven mice of each) were not submitted to any treatment. Embryos were harvested at 3, 6, 12 and 24 h after exposition, fixed, dehydrated and embedded. Coronal sections (5 microm) were made. Slide staining occurred alternatively using anti-caspase-3, anti-caspase-9 and anti-HSP110 immunohistochemistry. HSP110 and caspase-3 expression presented similar topographic and chronological patterns, whereas expression of HSP110 was more precocious in retinoic acid-treated embryos. After retinoic exposure, caspase-3- and HSP110-positive cells were increased in the region of the optic vesicle. By contrast, after irradiation, caspase-3- and HSP110-positive cells were noticeably increased in the optic vesicle, peri-optical mesoderm but less in lens placode. HSP110 was expressed before caspase-3. By contrast, caspase-9 was expressed by a very small number of cells in the optic vesicle either under physiological or under teratogenic conditions. Thus, it seems that activation of caspase-9 is dispensable in early eye developmental apoptosis.

Correlation of Hsp110 expression with caspase-3 and -9 during apoptosis induced by in vivo embryonic exposition to retinoic acid or irradiation in early mouse craniofacial development

OBJECTIVE

To analyze the expression and role of three proteins (HSP110, caspase-3 and caspase-9) during craniofacial development.

DESIGN

Seven pregnant C57Bl/6J mice received, by force-feeding at gestation day 9 (E9), 80 mg/kg of all-trans retinoic acid mixed to sesame oil. Seven pregnant NMRI mice received two grays irradiation at the same gestation day. Control mice of both strains (seven mice for each strain) were not submitted to any treatment. Embryos were obtained at various stages after exposition (3, 6, 12 and 24 h), fixed, dehydrated and embedded. Coronal sections (5 microm) were made. Slide staining occurred alternatively using anti-Hsp110, anti-caspase-3 and anti-caspase-9 immunohistochemistry.

RESULTS

Expression of HSP110, caspase-3 and caspase-9 was found in cells of well-known locations of programmed cell death. After retinoic acid exposure, expressions were increased especially in neural crest cells of mandibular and hyoid arches. Quantification of positive cells shows that caspase-9 and Hsp110 were expressed before caspase-3. After irradiation, the expression of the three proteins quickly increased with a maximum 3 h after irradiation. For all three models of apoptosis (physiological, retinoic-induced and irradiation-induced) HSP110 positive cells were more numerous than caspase-3 positive cells. Caspase-3 positive cells were more numerous than caspase-9 positive cells especially in mesectodermal irradiation-induced apoptotic cells.

CONCLUSION

The findings show a potential function of HSP110 in apoptosis during embryo development. Caspase-3-expressing cells are more numerous than cells expressing caspase-9, especially irradiation-induced apoptotic neural crest cells. This suggests that other caspases, still to be identified, may activate caspase-3 in this model.

Traitement par radio-chimiothérapie néoadjuvante et chirurgie du cancer du col utérin localement avancé

OBJECTIVES

Concomitant chemoradiation is the "new gold standard" for dealing with locally advanced cervical carcinoma, but what about surgery? We don't know yet to what extent surgery is necessary and how radical it must be when it is performed. In this study, we present the analysis of the results obtained in patients treated by concomitant chemoradiation followed by radical surgery.

MATERIALS AND METHODS

Twenty-two patients, median age 49 years, with I(b) - III(a) cervical tumors were enrolled to be treated by concomitant chemoradiation followed by radical surgery. The chemoradiation protocol included external radiotherapy to the pelvis: 45 Gy; Cisplatin 40 mg/m(2) in continuous intravenous infusion once a week (5 weeks) followed by brachytherapy one week later. Surgery was performed 4 to 6 weeks later and consisted in radical hysterectomy with pelvic lymphadenectomy.

RESULTS

20/22 patients underwent surgery after chemoradiation because of a diagnosis of lung metastases in one and presence of a nonresectable metastasis for the other. A complete pathological response was demonstrated in 12/20 patients (60%), a microscopic residual tumor in 7 patients (35%), and residual disease <1cm in 1 patient (5%).

CONCLUSION

This study showed a particularly high rate of pathologic responses (T(0)+T(mic): 95%) and of local control. We don't know yet if surgery is a real necessity or if it could be less extended after concomitant chemoradiation.

[Expression of caspase 3 and p53 during physiological apoptosis and apoptosis induced by three teratologic agents during early craniofacial development of the mouse embryo]

The neural crest-derived mesectoderm gives rise to physiologic apoptosis areas in early vertebrate embryos. Certain teratologic agents increase this phenomenon. The purpose of this work was to detect caspase 3 (which is associated with the apoptosis cascade) and p53 in cell death areas, both during physiological apoptosis and during apoptosis induced by three agents (retinoic acid, methyl-triazene, irradiation). Antibody revelation was performed using the aBC peroxidase kit. Quantifications were also performed on histological sections. We observed caspase 3 uptake on some apoptotic and preapoptotic cells in control embryos, and in the embryos exposed to the three teratogens. Immunoreactivity generally preceded the development of cytological features of apoptosis. However, p53 was expressed only in the embryos exposed to ionizing radiation and methyl-triazene (an alkylating agent), but not significantly in embryos exposed to retinoic acid. The present results throw some light on apoptosis mechanisms in several teratologic conditions.

[Why radiation for the postmastectomy patient?]

We can identify a subgroup of patients with a high risk of loco-regional relapse after mastectomy. When those patients are irradiated, their absolute loco-regional relapse risk drops for more than 10% with a relative risk reduction of 66% (p < 0.0001). The severe complication rate is below 1%. With earlier radiotherapy techniques, there was an excess in long term cardiac mortality among irradiated patients. Even if the breast specific survival was improved with radiotherapy, the overall survival was not better. Three recent randomised trials have shown that postmastectomy radiotherapy adds 10% survival benefit to an adjuvant systemic treatment. The impact of radiotherapy on overall survival is more pronounced for less advanced tumors.

Effects of irradiation on facial development in mouse embryos

The purpose of this study was to observe the effects of irradiation on the craniofacial development of NMRI mouse embryos. Two populations of pregnant mice were irradiated with a single dose of 2 Gray on day 8 of gestation for the first population (Po. 1) and on day 9 of gestation for the second population (Po. 2). On gestational days 9 to 17, embryos were submitted to histological and scanning electron microscope examinations. The two populations of embryos presented a high percentage of centro-facial hypoplasia (74.7% for Po. 1 and 75% for Po. 2) which was more pronounced in the latter one. Ocular anomalies were present in 16% of the first population. Cases of anencephaly, cleft palate and anomalies of the central nervous system were found in both populations.

Effects of irradiation and methyl-triazene on craniofacial development in mouse embryos: a semiautomated morphometric analysis

OBJECTIVE

The purpose of the present study was a 2D-semiautomated morphometric analysis of craniofacial growth in nuclear magnetic resonance imaged (NMRI) mouse embryos.

METHODS

The NMRI mouse embryos were exposed in utero to either a single dose of 2 Gy X-irradiation on day 9 of gestation (113 embryos) or to 1.5 mg methyl-triazene administered orally to their pregnant mothers on gestational day 10.5 (124 embryos). An additional group of 108 embryos was used as controls. Digitized pictures of embryos from gestational days 14 to 17 were taken in lateral right view using a video system. Landmarks were located and digitized for computerized analysis of growth changes in relation to developmental stages of the face.

RESULTS

The results revealed that the snout of control embryos lengthens during the developmental period considered. The snout of embryos previously submitted to methyl-triazene displayed micrognathia, and all treated fetuses exhibited macroscopic signs of microcephaly with a reduced mandible. The snouts of irradiated embryos appeared shortened at the 14-day stage and continued to shorten as development proceeded. A shortening of the midface was detected macroscopically in 83% of the cases.

CONCLUSION

The results of this morphometric analysis enabled us to trace the developmental progression of the induced dysmorphosis and to assess the differences compared with normal development.

[What is the role of radiotherapy in the treatment of breast cancer in 1995?]

In 1995, radiotherapy continues to remain one important component in the treatment of breast cancer both for the breast conserving approach and after a mastectomy in case of more locally advanced disease: it helps to improve the local control and so to safe more breast or to avoid a relapse in the mastectomy scar, a source of distress for the woman. Nevertheless, this modality requires a precise technique and integration with surgery and chemotherapy. Besides this curative approach, radiotherapy plays an important role in the treatment of brain or bone metastases where it is quite useful to improve the patient's quality of life.

The place for surgery in central recurrences of invasive cancer of cervix uteri

Between 1988 and 1991, at the Jules Bordet Institute in Brussels, 11 patients were submitted to a surgical treatment due to an uterus cervix central recurrence. The majority were of the epidermoid type. The primary stage of the lesion at the moment of diagnosis varied from stage Ib to stage IIIb lesions. Six of the eleven patients were not submitted to an adequate initial treatment. These recurrences appeared between the 4th and the 264th month after the initial treatment. The treatments, which were determined according to the site of recurrence, consisted of: an anterior pelvic exenteration for four patients, a total exenteration for one patient, for two of them a total hysterectomy with bilateral salpingo-oophorectomy and partial cystectomy, a cervix amputation for another one and finally, for the last three ones, a laparotomy with debulking or derivation colostomy. The mortality during and after the operation was nil but there were several short term complications. After a minimal 19 months follow-up we could see that three patients survived, one was generalized and seven died. Due to the scarce number of patients and pathological disparity of them, the authors reviewed the literature concerning this problem, in order to determine some guidelines for similar cases. In spite of its consequences, surgery seems to be the only valid solution to propose to these patients, not only to give them a chance to survive but also to improve their life quality.

The phosphatidylcholine metabolism in the renal tissue during experimental acute and chronic pyelonephritis in the rabbit

In 139 adult male rabbits unilateral pyelonephritis (PN) was induced. In a broad spectrum of enzymes and phospholipids also the content of phosphatidylcholine (PC) was determined. Only these latter values are reported here. PC showed markedly increased levels up to the 20-d-, and to the 31-d-series in the cortex. After 64 and 100 d of experimental PN the content of PC was less than the half of the normal values, and after 261 d of disease, it was only about 1/16 of the normal value (= 22.58 +/- 1.55 micrograms P/g wet weight). In the medulla the PC increased only till the 20-d-series, but showed a marked decrease in the 31-d-series already, which is in contrast to the corresponding cortical situation. Thereafter the medullary PC decreased successively, so that only about 5 per cent of the normal value were found in the contracted kidneys of the 261-d-series (n = 13.58 +/- 1.24 microgramsP/g wet weight). The increased PC-concentrations should be due mainly to the increased cell contents, the following reductions being due to the lower cell contents of this interstitium. Other factors (induced synthesis and/or reduced decomposition) may be responsible to a lesser degree of probability. The strongly decreased PC concentrations in the chronic and late-chronic series are caused by the low cell-contents, increasing vascular changes, the augmented connective tissue, and the general epithelial damage of the remaining nephrons.

Renal fumarase-activities during experimental and chronic human pyelonephritis

In chronic experimental and human pyelonephritis (PN) renal enzyme and phosphatide analyses as well as quantitative histological examinations were performed simultaneously. The results reported in this study only refer to fumarase (FUM) activities. Glomerular FUM-activities initially increased steeply up to 31 days, thereafter the values decreased, but being still elevated till 212 days. Only in the 261-days series the FUM-activities were absolutely decreased. In the cortical tubules of the rabbit kidneys the enzyme activities also steeply increased until 64 days, in the 100-days-series they were already depressed. After 212 and 261 days the tubular FUM-activities were extremely depressed. In the medulla the FUM-activities similarly showed steeply increasing values till 31 days. Thereafter a decrease was stated in the 64-days-series persisting up to 100 days. Finally, the values were pathologically depressed in the 212- and 261-days-series. In the "spontaneously healed up" tissue the glomerular FUM was slightly increased, the cortico-tubular one was more increased whereas the medullar activities were decreased. The human samples of pyelonephritic nephrocirrhosis showed about half than the normal FUM-activities in the glomerula. In the cortical tubules they were still more depressed. Also in the medulla the values were decreased. The significance calculations (universally applied t-test) showed an overwhelming majority of values with significance (p less than 0.001). The measured enzyme activities well correlate with the results of quantitative histological examinations.

Citrate-synthase activities in the renal tissue during experimental and chronic human pyelonephritis

In chronic experimental and human pyelonephritis (PN) renal enzyme and phosphatide analyses and quantitative histological examinations were performed. The results reported in this study only refer to citrate-synthase activities (= condensing enzyme = CE). 139 rabbits developed unilateral experimental pyelonephritis, in further 19 rabbits the experimental PN did not settle or "healed up spontaneously". 31 samples of human pyelonephritic nephrocirrhotic kidneys and 20 samples of healthy human kidneys were examined in the same manner. The glomerular CE-activities in the rabbit increased steeply in the 20- and 31-days-series, remained at a high level up to the 100-days-series, showed normal values in the 213-days-series, and permitted a marked decrease to be seen in the 261-days-series only. The corticotubular CE-activities increased steeply in the 20- and 31-day-series, still being above the normal values in the 64-days-series. Thereafter, only reduced and strongly reduced values were observed. In the pyelonephritic medulla of rabbits the CE-activities increased very steeply during the 20-days-series, were still above the level of the normal values up to the 100-days-series, dropping then to pathologically reduced data in the 212-days-series. Thus the CE-activities showed a similar type of behaviour to that of the corresponding glomeruli. Chronically pyelonephritic contracted renal tissue in human beings also showed major reductions in CE-activities in all three tissue fractions studies. The significance calculations (universally applied t-test) showed an overwhelming majority of significant values (p less than 0.001).

Alanine-aminotransferase activities in the renal tissue during experimental and chronic human pyelonephritis

In chronic experimental and human pyelonephritis (PN) simultaneously renal enzyme and phosphatide analyses and quantitative histological examinations were performed. The results reported in this study refer only to alanine-aminotransferase (AlAT) activities. 139 rabbits developed unilateral experimental pyelonephritis, in further 19 rabbits the experimental PN did not settle or "healed up spontaneously". 31 samples of human pyelonephritis nephrocirrhotic kidneys and 20 samples of healthy human kidneys were examined. Glomerular AlAT-activities increased initially up to the 31-days series, thereafter they decreased without any exception. In the cortical tubules of the rabbit kidneys the enzyme activities increased also up to the 31-days-series, later on they decreased extremely. The medullary AlAT-activities similarly showed increasing values till the 31-days-series, which were followed by sharply depressed data. In the "spontaneously healed up" tissue the glomerular AlAT was increased more than 100%, the cortico-tubular one nearly 100%, and the AlAT of the medulla paralleled the increased values of the 20-days series nearly. The human samples of pyelonephritic nephrocirrhosis showed in all 3 fractions (glomerula, cortical tubules and medulla) extremely depressed AlAT-activities. The significance calculations (universally applied t-test) showed an overhelming majority of the values with significance (p less than 0.001). The measured enzyme activities correlate well with the quantitative histological examinations.

[Value of antibiotic combination therapy in chronic pyelonephritis--study on a large number of patients over a period of 15 years]

1. 448 patients with chronic pyelonephritis were treated over periods ranging from a minimum of 5 to a maximum of 15 years with our special form of intermittent long-term therapy with chemoprophylaxis in the intervals, the antibiotics - mostly in the form of combinations - and chemotherapeutics in the treatment-phases were always used only on the base of several antibiograms. During the last 11 years synergistic bactericidic combinations of antibiotics were used to an increasing degree. 2. A comparison of the efficacy of our form of therapy used now (since 1965/1966) with the results already published: 1966 (therapy span 1960-1965), 1970 (therapy span 1960-1969), and 1972 (therapy span 1960-1971) showed the following quotes of a transmission into a standstill (questionable healing) of the disease: 1966 (without periodic change of the urinary pH) 36,1% 1966 (with periodic change of the urinary pH) 69,4% 1970 (synergistic combinations of antibiotics) 68,3% 1972 (synergistic combinations of antibiotics) 78,7% 1976 (synergistic combinations of antibiotics) 82,1%. 3. On the basis of our results we consider the combinations of synergistic bactericidic antibiotics as a real enrichment of the therapy of chronic pyelonephritis.

Semiquantitative histological examinations of the kidneys of rabbits (64-day, 100-day and 212-day series) with experimentally induced pyelonephritis

The kidneys of each 8 rabbits of a 64-day series (group E) and a 100-day series (group F) and of 6 rabbits of a 212-day series (group G) with experimentally induced unilateral hematogenous obstructive E. coli pyelonephritis were histologically examined and the glomerular and tubular lesions quantitatively evaluated using an ocular micrometer. An attempt was made to correlate the morphological changes with the results of simultaneous enzyme analyses (acid and alkaline phosphatases, glutaminase I).