Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer

PURPOSE

To assess the level of fatigue during the course of adjuvant radiotherapy (RT) of breast cancer patients and its relation to anxiety, depression, serum cytokines, and blood count levels.

METHODS AND MATERIALS

Forty-one patients who received adjuvant RT after breast-conserving surgery were prospectively studied. All patients underwent RT without concomitant chemotherapy. Patients rated their fatigue with two standardized self-assessment instruments, the Fatigue Assessment Questionnaire and a visual analog scale on fatigue intensity, before RT, during weeks 1-5 of RT, and 2 months after RT completion. In addition, the anxiety and depression levels were assessed with the Hospital Anxiety and Depression Scale. A differential blood cell count and the serum levels of the cytokines interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha were determined in parallel to the fatigue assessments.

RESULTS

Fatigue intensity as assessed with the visual analog scale increased (p <0.001) until treatment week 4 and remained elevated until week 5. Two months after RT, the values had fallen to the pretreatment levels. Fatigue measured with the Fatigue Assessment Questionnaire did not increase significantly during treatment, but the subscores on physical (p = 0.035) and cognitive (p = 0.015) fatigue were elevated during treatment weeks 4 and 5. Affective fatigue did not change significantly. Anxiety, as rated with the Hospital Anxiety and Depression Scale, declined during RT (p = 0.002), but the Hospital Anxiety and Depression Scale depression score did not change significantly. IL-1beta, IL-6, and tumor necrosis factor-alpha levels did not change during therapy and did not correlate with fatigue. Peripheral blood cell levels declined significantly during therapy and were still low 2 months after treatment. Until treatment week 5, lymphocytes were reduced to almost 50% of their initial values. Hemoglobin levels did not correlate with fatigue.

CONCLUSIONS

We observed an increase in fatigue during adjuvant RT of patients with breast cancer. Fatigue returned to pretreatment levels 2 months after treatment. No evidence was found that anxiety, depression, serum levels of IL-1beta, IL-6, tumor necrosis factor-alpha, or declining hemoglobin levels were responsible for the treatment-induced fatigue.

Influenza virus and factors that are associated with ICU admission, pulmonary co-infections and ICU mortality

Purpose

While most influenza patients have a self-limited respiratory illness, 5–10% of hospitalized patients develop severe disease requiring ICU admission. The aim of this study was to identify influenza-specific factors associated with ICU admission and mortality. Furthermore, influenza-specific pulmonary bacterial, fungal and viral co-infections were investigated.

Methods

199 influenza patients, admitted to two academic hospitals in the Netherlands between 01-10-2015 and 01-04-2016 were investigated of which 45/199 were admitted to the ICU.

Results

A history of Obstructive/Central Sleep Apnea Syndrome, myocardial infarction, dyspnea, influenza type A, BMI > 30, the development of renal failure and bacterial and fungal co-infections, were observed more frequently in patients who were admitted to the ICU, compared with patients at the normal ward. Co-infections were evident in 55.6% of ICU-admitted patients, compared with 20.1% of patients at the normal ward, mainly caused by Staphylococcus aureus, Streptococcus pneumoniae, and Aspergillus fumigatus. Non-survivors suffered from diabetes mellitus and (pre-existent) renal failure more often.

Conclusions

The current study indicates that a history of OSAS/CSAS, myocardial infarction and BMI > 30 might be related to ICU admission in influenza patients. Second, ICU patients develop more pulmonary co-infections. Last, (pre-existent) renal failure and diabetes mellitus are more often observed in non-survivors.

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A history of OSAS/CSAS, myocardial infarction and BMI > 30 are risk factors for ICU admission.

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Non-survivors suffer more often from diabetes mellitus and (pre-existent) renal failure.

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ICU patients develop renal failure and bacterial/fungal co-infections more often.

Irradiation differentially affects substratum-dependent survival, adhesion, and invasion of glioblastoma cell lines

Effects of ionising radiation on extracellular matrix (ECM)-modulated cell survival and on adhesion and invasion are not well understood. In particular, the aggressiveness of glioblastoma multiforme has been associated with tumour cell invasion into adjacent normal brain tissue. To examine these effects in more depth, four human glioblastoma cell lines (A-172, U-138, LN-229 and LN-18) were irradiated on fibronectin (FN), Matrigel, BSA or polystyrene. Major findings of this study include a significantly increased survival of irradiated A-172 but not of irradiated U-138, LN-229, and LN-18 cells on FN or Matrigel compared to cells irradiated on polystyrene or BSA. Irradiation induced a dose-dependent increase in functional β1- and β3-integrins in all four glioma cell lines. This integrin induction caused improved cell adhesion to FN or Matrigel. In contrast to U-138, LN-229 and LN-18 cells, irradiation strongly impaired A-172 cell invasion. Invasion of all cell lines was inhibited by anti-integrin antibodies, the disintegrin echistatin and the MMP-2/-9 inhibitor III. Additionally, β1- and β3-integrins modulated basal and radiation-altered gelatinolytic activity of MMP-2. Tested glioblastoma cell lines showed a differential cellular susceptibility to FN or Matrigel which affected the cellular radiosensitivity. Three out of four glioma cell lines demonstrated a combination of a substratum-independent survival after irradiation and an invasive potential which was not affected by irradiation. β1- and β3-integrins were identified to play a substantial, regulatory role in survival, adhesion, invasion and MMP-2 activity. Detailed insights into radioresistance and invasion processes might offer new therapeutic strategies to enhance cell killing of lethal high-grade astrocytoma.

Changes in mitotic rate and cell cycle fractions caused by delayed fixation

The mitosis frequency and flow cytometric data of malignant neoplasms are important, both for diagnosis and for prognosis. It is unclear to what extent these factors are affected by a delay in the fixation of tumor biopsies. We have thus studied the mitotic activity and DNA content in human soft-tissue sarcoma xenotransplants, fixed for periods of 5 minutes and 3, 6, 9 and 12 hours after biopsy. On average, the mitoses counted by two observers were 13% and 10% below initial values after 3 hours, and decreased by 46% and 39% after 12 hours. The mitosis decrease was related to the degree of mitotic activity of individual tumors, and was minimal in the sarcomas with the lowest mitotic rate. These results were reproducible. However, numerous pyknotic mitotic figures were observed, so the decrease in counts is largely due to their reduced identifiability, and only partly attributable to a completion of the cell cycle. Well-preserved mitotic figures demonstrable after 12 hours appear to indicate that the proliferation activity only gradually decreases in unfixed biopsies. The flow cytometric data did not change substantially; only a slight increase in the G2 + M-phase fraction was observed. General conclusions from the results are limited by the fact that the investigated sarcomas had a higher mitotic activity than most carcinomas. Nevertheless, early fixation of biopsies is desirable to accurately measure mitosis counts for the grading of malignancy.

Cell adhesion to the extracellular matrix protein fibronectin modulates radiation-dependent G2 phase arrest involving integrin-linked kinase (ILK) and glycogen synthase kinase-3beta (GSK-3beta) in vitro

Cell adhesion to extracellular matrix (ECM) is thought to confer resistance against cell-damaging agents, that is, drugs and radiation, in tumour and normal cells in vitro. The dependence of cell survival on beta1-integrin-linked kinase (ILK), protein kinase Balpha/Akt (PKBalpha/Akt) and glycogen synthase kinase-3beta (GSK-3beta) activity, which participate in beta1-integrin signalling and cell cycle progression was investigated as a function of radiation exposure. Colony-formation assays on polystyrene, fibronectin (FN), laminin (LA), bovine serum albumin (BSA) or poly-L-lysine (poly-L) (0-8 Gy), kinase assays, flow cytometric DNA and annexin-V analysis and immunoblotting were performed in nonirradiated and irradiated (2 or 6 Gy) A549 human lung cancer cells and CCD32 normal human lung fibroblasts. Cell contact to FN in contrast to polystyrene elevated basal ILK, PKBalpha/Akt and GSK-3beta kinase activities in A549 and CCD32 cells, as well as the basal amount of A549 G2 phase cells. Irradiation on FN or LA as compared to polystyrene, BSA or poly-L significantly improved cell survival. Following irradiation, kinase activities were stimulated strongly on polystyrene but showed to be less prominent on FN, which was because of the FN-related basal induction. Following irradiation, FN compared to polystyrene enlarged and prolonged G2 arrest in both the cell lines. For the analysis of phosphatidylinositol-3 kinase (PI3-K) dependence of protein kinases and cell cycle transition, the PI3-K inhibitors LY294002 and wortmannin were used showing decreased kinase activities, antiproliferative and radiation-dependent G2 accumulation-abrogating effects accompanied by downregulation of cyclin D1 and phospho-pRb in cells attached to polystyrene. Fibronectin partly abrogated these effects PI3-K-independently. These findings suggest a novel pathway that makes direct phosphorylation of GSK-3beta by ILK feasible after irradiation. Conclusively, the data indicate that ILK, PKBalpha/Akt and GSK-3beta are involved in modulations of the cell cycle after irradiation. These interactions are strictly dependent on ECM components in a cell line-specific manner. Our findings provide molecular insights into mechanisms likely to be important for ECM-dependent cell survival and cellular radioresistance as well as tumour growth.

Predictive assays for the therapy of rectum carcinoma

Cytofluorometric DNA measurements showed that about 55% of rectum carcinoma (129 patients) had tumours with an abnormal DNA content (DNA aneuploidy). For patients with such a tumour the prognosis was worse than for patients with DNA diploid tumours. From the DNA histograms the number of S-phase cells was calculated. In tumours with the stage pT3, which disseminated to lymph nodes or metastasized, a higher number of S-phase cells was found than in tumours with the staging pT3N0M0. In all untreated tumours cells with micronuclei were found. This demonstrated cell loss. In most tumours this effect was considerable. The ratio:number of S-phase cells/number of cells with micronuclei may allow a rough estimate for cell turnover. In patients with a bad prognosis and in those patients who had a local recurrence after resection of the tumour this ratio was high. In 34 patients the parameters were measured before and after preoperative radiotherapy. In some tumours a rapid increase of S-phase cells occurred after irradiation, this effect might express repopulation. In these patients a local recurrence was frequently found. From the data obtained so far a prediction for local recurrences might be possible from the determination of nuclear protein bound SH-groups. The determination of micronuclei indicated that it can be used as a measure for radiation response in tumours. All parameters show a high variability between individual tumours. A further study is useful whether the measured parameters are suitable as predictors.

Induction of interleukin 6 by ionizing radiation in a human epithelial cell line: control by corticosteroids

The cutaneous radiation syndrome after therapeutic or accidental exposure of human skin to ionizing radiation (IR) is accompanied by inflammatory processes which are controlled partly by proinflammatory cytokines. Besides tumour necrosis factor (TNF)-alpha and interleukin (IL)1, the pluripotent cytokine IL-6 belongs to the key mediators of inflammation. So far, there are no reports about the regulation of IL-6 by IR in epidermal cells. As an in vitro model to study the effects of IR on IL-6 gene expression, we treated the human epithelial HeLa cell line with different single X-ray doses between 1 and 20 Gy. Twenty-four hours after irradiation the IL-6 secretion was dose-dependently enhanced as measured by ELISA. At the transcriptional level, a slight increase of IL-6 transcripts was already detectable 1 h after irradiation, with maximum levels at 2 h, and a decline to baseline levels between 8 and 24 h. Addition of the transcriptional inhibitor actinomycin D inhibited the inducibility of IL-6 mRNA by TPA and IR. As the IL-6 promoter contains multiple binding sites for activated glucocorticoid receptors within the 5' regulatory region, the potential modulation of IL-6 expression by the corticosteroids hydrocortisone, dexamethasone and mometasone furoate was included in our study to modify the radiation-induced stress response. All corticosteroids applied could efficiently downregulate TPA- or radiation-induced IL-6 expression on both gene expression and protein levels. Mometasone furoate, followed by dexamethasone, was found to be most effective at low concentrations (1 nM), whereas hydrocortisone had to be applied at about 100-fold higher concentrations to achieve comparable inhibition. This experimental model is aimed at understanding the molecular circuits following IR, and thus to provide a basis for the treatment of radiation effects in skin.

NF-kappaB and AP-1 are responsible for inducibility of the IL-6 promoter by ionizing radiation in HeLa cells

PURPOSE

To investigate the mechanisms leading to initiation by ionizing radiation of IL-6 transcription in HeLa cells.

MATERIALS AND METHODS

HeLa cells were irradiated with X-rays at a dose rate of approximately 1 Gy/min or treated with TPA (100 ng/ml). Transient transfection analysis with truncated IL-6 promoter CAT constructs was used to identify the radiation-sensitive region within the IL-6 promoter/enhancer.

RESULTS

For basal expression of the IL-6 gene in unirradiated control cells the presence of the binding site for the nuclear factor kappa B (NF-kappaB) and the multiple response elements (MRE) were necessary. After deletion of either the activator protein (AP)-1 or the MRE site, radiation-induced IL-6 promoter CAT activity was significantly reduced, whereas after deletion of the NF-kappaB site it was completely abolished. Maximal radiation-induced IL-6 promoter CAT activity was observed when the AP-1, NF-kappaB and MRE motifs were present. In electrophoretic mobility shift analyses (EMSA), X-ray-inducible activity was found for NF-kappaB and AP-1 at the MRE constitutive, but no inducible activities were detectable. The nuclear factor IL-6 (NF-IL6) element showed no specific radiation-responsive activity.

CONCLUSIONS

These results demonstrate that NF-kappaB plays a major role in X-ray-inducible IL-6 expression in HeLa cells. The fact that IL-6 promoter activity was dramatically enhanced in the presence of the MRE and distal AP-1 binding motif is indicative of a cooperative mode of transcriptional activation involving all three transcription factor systems. These data provide new insights into the prodromal events of radiation-induced inflammation of epithelial cells and putatively the cutaneous radiation syndrome.

Tissue engineering with HaCaT cells and a fibroblast cell line

Most skin models consist of primary cells. Our aim was to develop a highly reproducible skin model consisting only of cell lines to investigate irradiation effects. The spontaneously immortalized human keratinocyte line HaCaT is known for its capacity for epidermal differentiation. As an organotypic coculture, HaCaT cells were grown air-exposed on top of a dermis equivalent consisting of a murine fibroblast cell line (L929) in collagen. The technique for the preparation of this coculture system is described. After 3 weeks a multilayered epithelium with signs of differentiation developed. The expression of several markers for differentiation and basal membrane formation were compared with those of healthy human skin by immunohistochemical staining. In the epithelium of the skin model several cytokeratins, especially keratin 10, and involucrin were expressed comparable to normal skin. Laminin expression was found along the basal zone of the epithelium. BrdU labeling indicating proliferation was mainly found in the basal parts of the epithelium. Differentiated cells showing DNA fragmentation were detected in the upper parts of the epithelium by the TUNEL assay. Fluorescence in situ hybridization was used to discriminate between HaCaT and L929 cells in the coculture. Some L929 cells growing on top of the epithelium could be detected. This might have been due to an invasion of highly proliferating L929 cells and might be one of the limits of tissue engineering with cell lines. In conclusion, the organotypic coculture used as a skin model is a promising additional tool for addressing specific research questions.

Instability of xenotransplanted soft tissue sarcomas. Morphologic and flow cytometric results

Human tumors transplanted into nude mice are widely considered to be identical to the tumor of origin. In addition, high histologic constancy of xenografts over many passages is generally accepted. We have checked these prerequisites for a therapy-orientated application of the nude mouse model using soft tissue sarcomas. Twenty-two primary soft tissue sarcomas and their xenografts were compared histologically and flow cytometrically over numerous passages. More than 30% of transplants showed a variation in cell differentiation, cell content, frequency of mitosis, tendency to necrotize, and connective tissue content compared to the original tumor. Furthermore, transplants from various regions in one tumor showed divergent results. Analyses of serial transplants showed histologic and flow cytometrical discrepancies in about 50% of cases, and new cell lines occurred in 26%. Our results show that the genetic instability found in human neoplasias also applies to xenotransplants and that the therapy-related usefulness of the nude mouse model is limited.

Kinetics of cell proliferation in the pre-implanted mouse embryo in vivo and in vitro

The cell proliferation of pre-implanted mouse embryos was investigated after development in vivo and in vitro. The studies were started at the pronuclear stage, 2 h post conception (p.c.) and continued until the hatching of blastocysts, 120-144 h p.c. The number of cell nuclei, the DNA content of each nucleus, the mitotic index and the labelling index were determined. From these data it was possible to calculate the length of the cell generation cycle and its various phases. With the exception of the first cell cycle the S-phase was constant. The G1- as well as the G2-phase varied in length during the different cell cycles. From 31-72 h p.c. the increase in cell number was exponential. After cultivation in vitro this increase was smaller than in vivo. At later periods the proliferation rate decreased with proceeding development. In late blastocysts most of the cells were in the G1-phase. The development of the embryos was somewhat faster in vivo than in vitro. But in principle conditions were comparable.

The respiratory burst of neutrophils, a prognostic parameter in head and neck cancer?

Flow cytometric measurements of the respiratory burst of granulocytes (PMN) from 27 patients with advanced carcinomas of the head and neck revealed two types of responses to a stimulus with phorbol myristate acetate (PMA) before, during, and after radiochemotherapy. (1) The majority (74%) of patients responded quantitatively normal (31-fold increase of fluorescence intensity after PMA stimulation, as in controls) but exhibited functional subpopulations in 63% of samples with varying degrees of hyperreactive PMN. (2) A subgroup of 7 patients did not respond to PMA before and during treatment ("nonresponders"), but in two cases responded after therapy. Survival analysis revealed a significantly (P less than 0.02) decreased mean survival time of nonresponders (36 weeks vs greater than 70 weeks in "responders"). Thus, the respiratory burst of PMN could serve as a prognostic parameter in head and neck cancer.

Serial xenotransplantation of a human embryonal carcinoma in experimental urology

The rare incidence of testicular germ cell tumours makes it necessary for clinicians to look for a valid experimental model to investigate basic tumour properties and different therapeutic modalities preclinically in order to improve clinical cure rates. A human embryonal carcinoma with hCG-production was successfully established in nude mice for more than 40 passages. We were able to show striking maintenance of histological and ultrastructural features, tumour markers (Beta-hCG) and DNA indices of the original tumour during subsequent xenograft passages as well as stability of tumour growth. Dedifferentiation of the tumour with changing growth fractions or loss of hCG production was not evident.

Proliferation kinetics and prognosis in gastric cancer after resection

The influence of proliferation and proliferation kinetics on prognosis in gastric cancer after complete resection are controversial. In a prospective study we investigated the tumour specimens of 111 patients after resection of gastric cancer, who received 200 mg intravenous (i.v.) bromodeoxyuridine (BrdU) pre-operatively. The following biological parameters were analysed in the tumour tissue using flow-cytometry: DNA ploidy, proportion of S-phase cells, BrdU labelling index (LI), DNA synthesis time (T(s)), potential tumour doubling time (T(pot)), proliferating cell nuclear antigen (PCNA) and Ki-67 LI. The median follow-up time was 40 months (range 19-62 months). Besides the established pathohistological prognostic factors, univariate analysis revealed a prognostic influence on survival for BrdU LI, T(pot) and the proportion of S-phase cells. By multivariate Cox analysis of the completely resected cases, only tumour stage and T(pot) had a significant, independent influence on survival. By classification and regression trees (CART) analysis, resection status, tumour stage and T(pot) defined risk groups with significantly different outcomes. A short T(pot) was a predictor of better survival in stage I, II and IIIA tumours. Ploidy and the other investigated proliferation-related parameters failed to demonstrate any influence on prognosis after resection of gastric cancer.

Apoptosis in human embryonal cell carcinoma: preliminary results

Disorders in the regulation of apoptotic cell death may contribute to cancer. Furthermore, lymphocytes are supposed to play a role in counteracting tumorigenesis by inducing apoptosis in different human tumors. In this study, for the first time, tumor cell and lymphocyte apoptosis were investigated systematically in human embryonal cell carcinoma. DNA fragmentation and DNA condensation were measured simultaneously on double-fluorescence-labeled testis tumor sections using immunofluorescence microscopy. Different apoptotic indices (AIs), based either on biochemical (DNA fragmentation) or morphological criteria (DNA condensation) alone or on a combination of both, were determined in different histological regions in and around the tumor. Using morphological criteria alone, 40-75% of all apoptotic cells were not detected. Based on previous observations this finding might be related to subsets of apoptotic cells which induce the process of DNA condensation without activation of processes responsible for DNA fragmentation. Moreover, the AIs of tumor cells and lymphocytes were highest in the tumor region, compared with regions around the tumor and distant from it; these findings are discussed in the context of the Fas/FasL system.

The effects of lead and X-rays, alone or in combination, on blastocyst formation and cell kinetics of preimplantation mouse embryos in vitro

Two-cell embryos in late G2-phase (cytofluorometrically determined) at 32 hours post-conception were treated in vitro with PbC12 (0 . 1 or 1 . 0 micrograms per ml). An additional group was X-irradiated 1 hour later (0 . 94 Gy) with or without lead treatment. Lead alone impaired formation and hatching of blastocysts. The combined treatment increased this deleterious effect on preimplantation development but synergism was not observed. Cell proliferation was disturbed by lead alone but to a higher degree by lead plus X-rays. A pronounced reduction of cell number per embryo was found during the period after reaching the morula stage although the labelling index increased. Apparently cell death occurred. Unlabelled S-phase cell nuclei (comparison between autoradiographic results and cytofluorometric DNA-determinations on the same isolated cell nuclei) and cell nuclei with a hyperploid (0 . 1 microgram PbC12 + 0 . 94 Gy) or hypoploid (1 . 0 microgram PcC12 + 0 . 94 Gy) DNA-content may have contributed to this cell loss. Labelling of cell nuclei which according to their DNA-content were not in S-phase was only observed when 0 . 1 microgram PbC12 alone or in combination with X-rays was used. This effect may be due to unscheduled DNA-repair synthesis or to the induction of chromosome aberrations (acentric fragments or non-disjunction).

Intercomparison of apoptosis morphology with active DNA cleavage on single cells in vitro and on testis tumours

Apoptosis morphology (DNA condensation) and endonucleolytical DNA cleavage (TdT assay) were measured simultaneously on double fluorescence labelled cells employing confocal laser scanning and conventional immunofluorescence microscopy. In vitro experiments on irradiated HL-60 cells revealed a high correspondence of non-apoptotic (normal) cells without detectable DNA cleavage, versus apoptotic cells and apoptotic bodies showing DNA cleavage. Experiments performed on histological slides of testis tumours reflected a heterogeneous picture: non-apoptotic (normal) cells, apoptotic cells, and apoptotic bodies appeared either with or without detectable DNA cleavage. These data allowed the characterization and quantitation of the grade of disturbance/heterogeneity of the apoptosis programme in vivo. Furthermore, the measured apoptotic index (AI) based on apoptosis morphology was lower than the AI assessed by DNA cleavage, in contrast to published work. Taken together, these methods represent a new approach and might be suitable for improved correlation with clinical parameters. In addition, the data presented confirm frequently published doubts regarding the ability of the TdT assay to detect apoptosis as defined by morphological criteria in tumours.

Simplified and optimized kinetochore detection: cytogenetic marker for late-G2 cells

Cytogenetic detection of kinetochore proteins using the CREST antibody coupled with secondary antibodies labeled with different fluorescent probes has been optimized for several in vitro mammalian cell lines. This study investigated selected parameters including the influence of common fixatives (methanol, ethanol, methanol:acetic acid (3:1)), detergents (Triton-X100, Tween), fluorescent probes (CY3, BODIPY, FITC), washing protocols, and an antifading agent (paraphenylenediamine) on the detection of kinetochore proteins in control and X-ray (240 kVp)-irradiated cells. Utilizing an optimized fixation and staining protocol, a brilliant visualization of kinetochores in interphase cells was obtained in control as well as X-ray-irradiated interhase cells. Application of this improved kinetochore staining methodology readily permits discriminating cells containing either single or paired kinetochores, the latter of which are characteristic of late-G2 phase and prophase cells.

Growth, cell proliferation and morphological alterations of a mouse mammary carcinoma after exposure to X-rays and hyperthermia

A C57 mouse mammary carcinoma was irradiated with 10, 20 or 30 Gy of X-rays or heated to 43 degrees C for 30 min preceded or not by exposure to 10 Gy. Tumour growth, cell proliferation kinetics, induction of micronuclei and morphological changes in necrosis and vascular density were simultaneously determined. Treatment with radiation and/or hyperthermia produced only a delay in tumour growth of between 1 and 3.8 days. However, the effects of the treatments became more apparent when the amounts of muscle and necrosis were deducted from the originally measured tumour volume. Radiation-induced G2 block of the cells was observed at 12 h after irradiation alone. After the combined treatment, however, the G2 block was delayed beyond 12 h. Moreover, 24 h after the various treatments, the proportion of S-phase cells decreased considerably although the formation of micronuclei showed only a marginal increase. However, the ratio of S-phase cells to micronuclei was significantly reduced during this period. Whereas the amount of necrosis was markedly enhanced 5 days following treatment with 10 Gy plus heat, as well as after 30 Gy, no alterations in the density of small blood vessels could be observed during this period. These results clearly demonstrate that the apparent changes in tumour volume after X-rays and hyperthermia do not truly reflect the response of the constituent cells and that there are many other factors, for instance cell proliferation and morphological alterations, that influence the effects of radiation and hyperthermia on tumours.

Proliferation kinetics and PCNA expression of HL-60 cells following ionizing irradiation and granulocytic differentiation

The human promyelocytic leukaemia cell line, HL-60, was investigated with regard to proliferation and terminal differentiation following irradiation. The cells were X-irradiated and induced with 1.25% dimethyl sulfoxide (DMSO) towards the granulocytic lineage. Proliferation was measured via cell growth, clonogenicity and the bromodeoxyuridine/DNA incorporation assay. Immunohistochemical detection of proliferating cell nuclear antigen (PCNA) expression was used to discriminate cycling from non-cycling cells. The differentiation obtained was proved by testing for the immune function of the respiratory burst (NBT reduction test). The HL-60 cells studied revealed a high radiosensitivity (D0 = 0.63 Gy). After induction with DMSO, declines in cell growth, clonogenicity and PCNA positivity of the cells indicated a decrease in proliferation and an increase in differentiation. Starting on day 2 in culture, irradiation after seeding with 1 Gy accelerated the loss of the PCNA expression in induced cells (46% v. 3% PCNA-negative control cells on day 3). Induced cells gained the capability of exerting the respiratory burst, which was found to be dose-dependent radiosensitive (42%, and 12% NBT-positive cells after 1 and 2 Gy, respectively, v. 53% NBT-positive control cells on day 8). Subpopulations in the cell line were evident in all parameters investigated. We discuss the HL-60 cell, not only as a model comparable to human progenitor cells, but also as a suitable tool in radiobiological research with regard to proliferation and differentiation following ionizing irradiation.