Inhaled fosamprenavir for laryngopharyngeal reflux: Toxicology and fluid dynamics modeling

Objectives

Approximately 25% of Americans suffer from laryngopharyngeal reflux (LPR), a disease for which no effective medical therapy exists. Pepsin is a predominant source of damage during LPR and a key therapeutic target. Fosamprenavir (FOS) inhibits pepsin and prevents damage in an LPR mouse model. Inhaled FOS protects at a lower dose than oral; however, the safety of inhaled FOS is unknown and there are no inhalers for laryngopharyngeal delivery. A pre-Good Lab Practice (GLP) study of inhaled FOS was performed to assess safety and computational fluid dynamics (CFD) modeling used to predict the optimal particle size for a laryngopharyngeal dry powder inhaler (DPI).

Methods

Aerosolized FOS, amprenavir (APR), or air (control) were provided 5 days/week for 4 weeks (n = 6) in an LPR mouse model. Organs (nasal cavity, larynx, esophagus, trachea, lung, liver, heart, and kidney) were assessed by a pathologist and bronchoalveolar lavage cytokines and plasma cardiotoxicity markers were assessed by Luminex assay. CFD simulations were conducted in a model of a healthy 49-year-old female.

Results

No significant increase was observed in histologic lesions, cytokines, or cardiotoxicity markers in FOS or APR groups relative to the control. CFD predicted that laryngopharyngeal deposition was maximized with aerodynamic diameters of 8.1-11.5 μm for inhalation rates of 30-60 L/min.

Conclusions

A 4-week pre-GLP study supports the safety of inhaled FOS. A formal GLP assessment is underway to support a phase I clinical trial of an FOS DPI for LPR.

Level of Evidence

NA.

Potential Roles of Activin in Head and Neck Squamous Cell Carcinoma Progression and Mortality

BACKGROUND/AIM

Activin, a member of the TGF-β super family of cytokines, is involved in head and neck squamous cell carcinoma (HNSCC). This study examined the constituents of the activin axis in order to further elucidate the role of activin A in HNSCC progression.

MATERIALS AND METHODS

Immunohistochemistry (IHC), reverse transcription polymerase chain reaction (RT-PCR), MTT, and matrigel invasion assays, in addition to analysis of the tumor cancer genome atlas (TCGA), were employed.

RESULTS

IHC in HNSCC and oral leukoplakia (OPL) lesions demonstrated increased expression of the inhibin subunit βA (INHBA) (p<0.0001), as well as activin receptor type IB (ACVR1B) (p<0.0032) compared to normal mucosa. TCGA analysis revealed increased INHBA expression was associated with lymph node positive tumors (p=0.024), decreased overall survival (p=0.0167), and decreased promoter methylation (p<0.0001). Concomitant up-regulated expression of gene pathways strongly correlated with INHBA expression demonstrated further deleterious effects on survival (p<0.0148).

CONCLUSION

Activin may be an important component of early carcinogenesis in OPL and HNSCC with unfavorable effects on clinical end-points such as survival.

Oral Premalignant and Malignant Lesions in Fanconi Anemia Patients

OBJECTIVE

There is a lack of data supporting cancer surveillance in pediatric Fanconi Anemia patients. We sought to describe the rates of upper aerodigestive lesions and malignancy in this population to augment current management guidelines.

METHODS

A retrospective cohort study of patients with Fanconi Anemia from a quaternary referral center between 2007-2021 was completed for head and neck cancer risk.

RESULTS

One hundred and five FA patients were reviewed. Average age at presentation was 11.3 years old and 90.5% of patients underwent hematopoietic stem cell transplant (HSCT). A total of 8.6% of patients had leukoplakia or erythroplakia and 3.8% developed malignancy. The standardized incidence ratio of head and neck malignancy was 483.8. Patients presented with leukoplakia and malignancy at an average age of 14.6 and 25.1 years old, respectively. Malignancies were aggressive and marked by recurrence. There were no premalignant or malignant lesions found on flexible laryngoscopy. This series represents the largest longitudinal series of pediatric FA head and neck lesions.

CONCLUSIONS

Fanconi Anemia patients should begin screening for head and neck cancer at age 10 or after HSCT.

LEVEL OF EVIDENCE

Level 4 Laryngoscope, 133:1745-1748, 2023.

Using Bland-Altman Analysis to Identify Appropriate Clonogenic Assay Colony Counting Techniques

OBJECTIVE

Determine the interchangeability of various methods utilized for counting colonies in clonogenic assays.

METHODS

Clonogenic assays of 2 head and neck cancer cell lines were counted through 4 different counting modalities: Manual counting pen, via microscope, 1 publicly available automated algorithm, and a semiautomated algorithm presented by the authors. Each method counted individual wells (N = 24). Pen and microscopic counts were performed by 2 observers. Parameters included both low-growth (<150 colonies/well) and high-growth (>150 colonies/well) cell lines. Correlational and Bland-Altman analyses were performed using SPSS software.

RESULTS

Interobserver manual pen count correlation R2 value in both growth conditions was 0.902; controlling for only low-growth conditions decreased R2 to 0.660. Correlation of microscopic versus pen counts R2 values for observers 1 and 2 were 0.955 and 0.775, respectively. Comparing techniques, Bland-Altman revealed potential bias with respect to the magnitude of measurement (P < .001) for both observers. Correlation of microscopic counts for both interobserver (R2 = 0.902) and intraobserver (R2 = 0.916) were analyzed. Bland-Altman revealed no bias (P = .489). Automated versus microscopic counts revealed no bias between methodologies (P = .787) and a lower correlation coefficient (R2 = 0.384). Semiautomated versus microscopic counts revealed no bias with respect to magnitude of measurement for either observer (P = .327, .229); Pearson correlation was 0.985 (R2 = 0.970) and 0.965 (R2 = 0.931) for observer 1 and 2. Semiautomated versus manual pen colony counts revealed a significant bias with respect to magnitude of measurement (P < .001).

CONCLUSION

Counting with a manual pen demonstrated significant bias when compared to microscopic and semiautomated colony counts; 2 methods were deemed to be interchangeable. Thus, training algorithms based on manual counts may introduce this bias as well. Algorithms trained to select colonies based on size (pixels2) and shape (circularity) should be prioritized. Solely relying on Bland-Altman or correlational analyses when determining method interchangeability should be avoided; they rather should be used in conjunction.

Oral and Inhaled Fosamprenavir Reverses Pepsin-Induced Damage in a Laryngopharyngeal Reflux Mouse Model

OBJECTIVE

More than 20% of the US population suffers from laryngopharyngeal reflux. Although dietary/lifestyle modifications and alginates provide benefit to some, there is no gold standard medical therapy. Increasing evidence suggests that pepsin is partly, if not wholly, responsible for damage and inflammation caused by laryngopharyngeal reflux. A treatment specifically targeting pepsin would be amenable to local, inhaled delivery, and could prove effective for endoscopic signs and symptoms associated with nonacid reflux. The aim herein was to identify small molecule inhibitors of pepsin and test their efficacy to prevent pepsin-mediated laryngeal damage in vivo.

METHODS

Drug and pepsin binding and inhibition were screened by high-throughput assays and crystallography. A mouse model of laryngopharyngeal reflux (mechanical laryngeal injury once weekly for 2 weeks and pH 7 solvent/pepsin instillation 3 days/week for 4 weeks) was provided inhibitor by gavage or aerosol (fosamprenavir or darunavir; 5 days/week for 4 weeks; n = 3). Larynges were collected for histopathologic analysis.

RESULTS

HIV protease inhibitors amprenavir, ritonavir, saquinavir, and darunavir bound and inhibited pepsin with IC50 in the low micromolar range. Gavage and aerosol fosamprenavir prevented pepsin-mediated laryngeal damage (i.e., reactive epithelia, increased intraepithelial inflammatory cells, and cell apoptosis). Darunavir gavage elicited mild reactivity and no discernable protection; aerosol protected against apoptosis.

CONCLUSIONS

Fosamprenavir and darunavir, FDA-approved therapies for HIV/AIDS, bind and inhibit pepsin, abrogating pepsin-mediated laryngeal damage in a laryngopharyngeal reflux mouse model. These drugs target a foreign virus, making them ideal to repurpose. Reformulation for local inhaled delivery could further improve outcomes and limit side effects.

LEVEL OF EVIDENCE

NA. Laryngoscope, 133:S1-S11, 2023.

Abstract 5950: A novel biguanide as a potential head and neck cancer therapeutic in Fanconi anemia

Introduction: Fanconi Anemia (FA) patients develop head and neck squamous cell carcinoma (HNSCC) at significantly elevated rates and conventional adjunctive chemotherapy and radiation are exquisitely toxic to these patients. We endeavor to find a safer chemotherapeutic agent for treatment of head and neck cancer in this population. Currently, agents such as metformin are in FA clinical trials for marrow failure and are also high interest agents in head and neck cancer chemoprevention. HNSCC in FA is a disease model that has applications to typical head and neck cancer, as its mutational defects are felt to be similar.

Methods: We completed cell proliferation assays on FA-derived HNSCC cell lines MOP FA-1 and VU-1131. MTT, Cell Titer Glo, trypan blue, and clonogenic assays were completed on each cell line to evaluate the effect of N1-hexyl-N5-benzyl-biguanide (HBB) in comparison with standard cisplatin chemotherapy. We also compared the caspase activity in an effort to evaluate a putative mechanism of HBB cellular inhibition.

Results: HBB showed a statistically significant dose-dependent inhibition of cellular proliferation. In MTT assays, 5 uM HBB showed 28-46% inhibition at 72 hours and 10uM HBB showed 77-82% inhibition at 72 hours. There was an additive inhibition of cellular proliferation when HBB was combined with low-dose cisplatin.

Conclusion: HBB is a novel biguanide that inhibited cellular proliferation in two FA HNSCC cell lines and chemosensitized to low-dose cisplatin. This may be an alternative adjunct treatment agent, or may be chemosensitizing for low-dose cytotoxic agents such as platinum-based chemotherapeutics in this unique population.

Citation Format: Hunter Archibald, Beverly Wuertz, Frank Ondrey. A novel biguanide as a potential head and neck cancer therapeutic in Fanconi anemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5950.

Abstract PO-044: A pilot concept for cancer education outreach to community K-8 schools

Introduction: The authors examined feasible mechanisms for a cancer research lab at a university to improve racial/cultural cancer disparities issues in Minneapolis/St. Paul, Minnesota. The goal was to find tangible mechanisms to preliminarily and proactively attend to racial disparities issues based on recent events in our community. Materials and Methods: The authors identified four domains of activity that could potentially be deployed to the local Black community. These consisted of improved community education, improved health care access, improved researcher education about racism/cultural bias, and education on the concept of trauma informed care. Community cancer education outreach was judged most feasible program’s researchers. In the past, education outreach had been performed at K-8 school science fairs and a community cancer education program where we have been instructors (an entity called Mini-medical school). Demographics for past interactions were analyzed to gauge directing further outreach. Results: In the Twin cities proper 16-19% of the residents are Black (Primarily African American and Somali); in the larger metropolitan area 8-9%, and 6-7% overall in Minnesota. We found that our research program outreach had occurred at a school with only 4.4% Black/African American students. At the larger Cancer education program (Mini medical school), approximately 3.5% of attendees were African American. Both of these outreach activities occurred in communities with much lower percentage than the 16-19% Black community demographic (P&lt;0.001). Discussion: We plan to contact primary schools in local communities of color where we can participate at science or technology fairs as educators/judges based on our scientific expertise. Further, through these local schools and their communities, Cancer disparities education (such as the mini-medical school) could be tailored to neighborhood school communities as part of this outreach. The authors felt participation in this activity by Black physicians/scientists/students, inexpensive access, and maximizing student/family availability for the program would be necessary to optimize the experience. We conclude that such a grass root pilot would provide useful education for the community, perhaps improve cancer research interests in primary grade students, and could feasibly be extended to additional cancer research labs at our university, based on the results of a 1-2 school pilot effort.

Citation Format: Juliana M. Ondrey, Frank Ondrey. A pilot concept for cancer education outreach to community K-8 schools [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-044.

Retinoids Augment Thiazolidinedione PPARγ Activation in Oral Cancer Cells

BACKGROUND/AIM

Head and neck squamous cell carcinoma affects nearly 500,000 people annually. Augmenting PPARγ functional activation is linked with multiple anti-carcinogenic processes in aerodigestive cell lines and animal models. PPARγ/RXRα heterodimers may be key partners in this activation.

MATERIALS AND METHODS

CA 9-22 and NA cell lines were treated with the PPARγ agonist ciglitazone and/or the RXRα agonist 9-cis-retinoic acid. PPARγ functional activation, cellular proliferation, apoptosis activity, and phenotype were subsequently analyzed.

RESULTS

Ciglitazone and 9-cis-retinoic acid independently activated PPARγ and down-regulated the carcinogenic phenotype in vitro. Combination treatment significantly augmented these effects, further decreasing proliferation (p<0.0001), and increasing PPARγ functional activation (p<0.0001), apoptosis (p<0.05), and adipocyte differentiation markers (p<0.0001).

CONCLUSION

The efficacy of the combination of ciglitazone and 9-cis-retinoic acid afforded lowering treatment concentrations while maintaining desired therapeutic outcomes, optimistically supporting the feasibility and practicality of this novel treatment option.

Effects of PPAR-γ agonists on oral cancer cell lines: Potential horizons for chemopreventives and adjunctive therapies

BACKGROUND

Peroxisome proliferator-activated receptor-gamma (PPAR-γ) activators have anti-cancer effects. Our objective was to determine the effect of PPAR-γ ligands 15-deoxy-D^12,14 -Prostaglandin J₂ (15-PGJ₂ ) and ciglitazone on proliferation, apoptosis, and NF-κB in human oral squamous cell carcinoma cell lines.

METHODS

NA and CA9-22 cells were treated in vitro with 15-PGJ₂ and ciglitazone. Proliferation was measured by MTT colorimetric assay and cell cycle analysis performed via flow cytometry, apoptosis by caspase-3 colorimetric assay and poly-(ADP-ribose) polymerase cleavage on Western blot, and NF-κB activation by luciferase assays.

RESULTS

MTT assays demonstrated dose-dependent decreases after 15-PGJ₂ treatment in both cell lines, and S-phase cell cycle arrest was also demonstrated. NF-κB luciferase reporter gene activity decreased seven- and eightfold in NA and CA9-22 cells, respectively. Caspase-3 activity increased two- and eightfold in NA and CA9-22 cells, respectively.

CONCLUSIONS

Our results suggest these agents, in addition to activating PPAR-γ, can downregulate NF-κB and potentiate apoptosis in oral cancer cells.

PPARγ targeted oral cancer treatment and additional utility of genomics analytic techniques

OBJECTIVE

Peroxisome proliferator-activated receptor γ (PPARγ) agonists have been shown to have anti-proliferative, anti-angiogenic, and proapoptotic effects, leading to interest in their use as cancer therapeutics. Pioglitazone, a U.S. Food and Drug Administration-approved type II diabetes medication and PPARγ agonist, may have a role in adjuvant head-and-neck squamous cell carcinoma treatment or prevention. Therefore, the purpose of this study was: 1) to treat oral cavity cancer cells with the PPARγ activator, pioglitazone, to analyze gene expression changes; and 2) to compare those changes with our preexisting genomic data for development of hypothesis-driven additional basic and clinical studies.

STUDY DESIGN

Prospective in vitro.

METHODS

We utilized microarray technology, as well as OCPlus (Bioconductor open source software) and Ingenuity Pathway Analysis (Qiagen, Redwood City, CA), to analyze differential gene expression in tumor and pioglitazone-treated tumor cells on a genome-wide level to demonstrate the feasibility of such an approach and determine appropriate sample size for future investigations.

RESULTS

We found that approximately 35 samples are required to adequately power future studies. We next discovered that pioglitazone significantly affects Inducible T-Cell Costimulator (iCOS)-Ligand for the T-cell-specific cell surface receptor ICOS (iCOSL) and type II diabetes mellitus pathways as a putative anti-cancer mechanism.

CONCLUSION

Genome-wide analysis is possible for the exploration of differential pathway modulation and rapid hypothesis generation. Both inflammation and type II diabetes pathways were significantly altered and therefore might provide unique hypothesis-driven pharmacodynamic parameters for future in vitro or in vivo studies utilizing thiazolidinediones. These techniques could be applied to microarray or other high throughput data from a variety of hypothesis-generating research scenarios in otolaryngology (e.g., middle ear proteomics, sinus microbiome studies).

LEVEL OF EVIDENCE

NA. Laryngoscope, 127:E124-E131, 2017.

Airway reflux

An ever-increasing number of adult and pediatric disorders have been shown to be influenced or caused by airway reflux. This has become a controversial and complicated aspect of medicine that requires a multidisciplinary approach. Evidence indicates that it is not only the acidic components of gastric refluxate that injure extraesophageal tissues but also the nonacidic components, such as pepsin and bile. There is a realization that proton pump inhibitors will not be effective when nonacidic components of refluxate are causing the problem. New in vitro and in vivo models for the study of airway reflux and new therapeutic and surgical approaches are discussed in this review article.

NF-Kappa-B Downregulation Strategies in Head and Neck Cancer Treatment

OBJECTIVE: Multiple biochemical and genetic strategies were used to downregulate early response gene NF-κB, whose activation controls squamous cell cancer-associated pathways.

STUDY DESIGN: NA cells, an oral cavity squamous cell cancer with high NF-κB activity, were cultured with biochemical NF-κB inhibitors TPCK and Calpain I inhibitor, as well as specific NF-κB antisense oligonucleotides. Cell proliferation was measured, as was NF-κB downregulation using functional luciferase reporter genes and electromobility shift assays.

RESULTS: Significant downregulation of cell proliferation and NF-κB functional activity were demonstrated with either biochemical inhibitor, as well as the antisense oligonucleotides; however, additional nonspecific toxicities were observed with control antisense oligonucleotides.

CONCLUSION AND SIGNIFICANCE: NF-κB is a potential target for squamous cancer treatment, as it is constitutively upregulated in vitro. Biochemical inhibition of NF-κB may be a viable treatment strategy for head and neck squamous cancers.

Abstract 2129: Effects of talactoferrin on lung adenoma prevention in A/J mice

Talactoferrin is a promising non-toxic solid tumor cancer agent which has met with some success in the treatment of early stage lung cancer clinically in humans. It is well tolerated and early phase clinical trials with this agent demonstrated efficacy and immune stimulation as an oral dendritic cell-mediated immunotherapy agent. We felt the nature of this agent would be suitable in the chemoprevention setting in experimental lung carcinogenesis in a B[A]P mouse model. We utilized 120 seven week old female A/J mice. All groups received Benzo[a]pyrene by oral gavage in three doses of 3mg/kg body weight over the course of one week. Animals were then randomized into 5 groups of 24 mice per group based on weight. Experimental diets, talactoferrin (Agennix Inc., Indianapolis, IN) at 1.40 and 0.42% of diet, were started one week or eight weeks after last dose of B[a]P. Animals were continued on the feeding schedule, weighed weekly, and monitored for weight loss, attenuation, rough hair coat, or other signs of ill health. The study was concluded 16 weeks after administration of B[a]P. The agent was well tolerated for the duration of the experiment and there was no observable toxicity. The average number of adenomas per animal was 14.04 ± 0.9315 (N=24) in the control group, 18.14 ± 1.448 (N=22) in the early low dose group, 16.70 ± 1.295 (N=23) in the late low dose group, 15.09 ± 1.408 (N=23) in the early high dose group and 14.46 ± 1.213 (N=24) in the late high dose group. We conclude talactoferrin is well tolerated in the A/J mouse model. We also conclude talactoferrin did not inhibit carcinogenesis in A/J mice at a dose range of 420mg/kg/day to 1400mg/kg/day.

Citation Format: Donna Seabloom, Arthur Galbraith, Anna Haynes, Jenny Antonides, Alisha Fujita, Beverly R. Wuertz, Vernon Steele, Frank Ondrey, Lee Wattenberg. Effects of talactoferrin on lung adenoma prevention in A/J mice. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2129. doi:10.1158/1538-7445.AM2014-2129

Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer

PURPOSE

Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease.

PATIENTS AND METHODS

Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS).

RESULTS

A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival.

CONCLUSION

IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN.

Randomized safety and efficacy study of fosbretabulin with paclitaxel/carboplatin against anaplastic thyroid carcinoma

BACKGROUND

Anaplastic thyroid cancer (ATC), a rare highly vascularized tumor, has a dismal outcome. We conducted an open-label study of doublet carboplatin/paclitaxel chemotherapy with or without fosbretabulin in patients with ATC.

METHODS

Patients were randomly assigned in a 2:1 ratio to 6 cycles of paclitaxel 200 mg/m(2) followed by carboplatin AUC 6 on day 1 every 3 weeks (CP), or these drugs were given on day 2 after fosbretabulin 60 mg/m(2) (CP/fosbretabulin) on days 1, 8 and 15. After 6 cycles, patients on the fosbretabulin arm without progression could continue to receive fosbretabulin on days 1 and 8 of a 3-week schedule until progression. The primary end point was overall survival (OS).

RESULTS

Eighty patients were assigned (planned, 180) when enrollment was stopped due to rarity of disease and very low accrual. Median OS was 5.2 months [95% confidence interval (CI) 3.1, 9.0] for the CP/fosbretabulin arm (n=55; hazard ratio 0.73 [95% CI 0.44, 1.21]) and 4.0 months [95% CI 2.8, 6.2] for the CP arm (n=25; p=0.22 [log rank test]). One-year survival for CP/fosbretabulin versus CP was 26% versus 9%, respectively. There was no significant difference in progression-free survival between the two arms. Grade 1-2 hypertension and grade 3-4 neutropenia were more common with CP/fosbretabulin. There were no significant adverse cardiovascular side effects.

CONCLUSIONS

Although the study did not meet statistical significance in improvement in OS with the addition of fosbretabulin to carboplatin/paclitaxel, it represents the largest prospective randomized trial ever conducted in ATC. The regimen is well tolerated, with AEs and deaths primarily related to ATC and disease progression.

CRP as an Inflammatory Marker in Oral Rinses

Objective: 1) Learn if CRP stimulates production of IL-6 in human leukoplakia cells (MSK-Leuk1). 2) Learn if pioglitazone attenuates CRP stimulation of IL-6 in leukoplakia cells. 3) Establish an oral rinse CRP reference range in controls that can be used in an ongoing trial of leukoplakia patients treated with pioglitazone.

Method: ELISA will be used to measure IL-6 release from MSK-Leuk1 treated with varying concentrations of CRP and pioglitazone. ELISA will be used to measure CRP in oral rinses of control patients. Two-sided t test and ANOVA are used for analysis of results with significance level of 5%.

Results: When treated with CRP (0.001-10 ug/mL), MSK-Leuk1 cells increased IL-6 release in a dose-dependent manner ( P < .05). When treated with CRP (0.01-10 ug/mL) and with pioglitazone (10 uM) MSK-Leuk1 cells released a statistically significantly decrease in IL-6 as compared to CRP treatment ( P < .05) Oral rinses were easily collected and CRP was measured by ELISA to establish controls for an ongoing study of pioglitazone treatment of leukoplakia and CRP as an affective inflammatory marker.

Conclusion: CRP is now shown to play an active roll in increasing the inflammatory cascade in leukoplakia cells, and pioglitazone attenuates this stimulation as measured by IL-6. The next step is to test CRP in already collected oral rinses of leukoplakia patients before and after treatment with pioglitazone.

Exons 19 and 21 of epidermal growth factor receptor are highly conserved in squamous cell cancer of the head and neck

Objective. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibition (TKI) is a promising treatment in upper aerodigestive malignancies. EGFR inhibitors might be more effective in patients whose tumors harbor specific EGFR mutations. The presence of specific EFGR mutations is predictive of over a 75% response rate to TKI therapies as compared to 10% in wild type cases of non-small cell lung cancer. Our objective was to examine whether these mutations might occur in upper aerodigestive cancers. Design. DNA was extracted from 20 head and neck squamous cell tumors and 4 squamous cell carcinoma cell lines and sequenced the receptor using published primer pairs. We then compared the results against published mutations. Results. No exon 19 or 21 mutations were found in any of the 20 tumors and 0 of 4 cell lines. Based on the tumor data we would predict that no greater than 8% of head and neck tumors (CI 97.5%) would be likely to harbor either of these mutations. Conclusions. Our findings are comparable to results recently published of Korean, Austrian, and Spanish patient populations and we conclude that exon 19 and 21 EGFR mutations are not more common in head and neck cancer than in nonsmall-cell carcinoma.

Peroxisome proliferator-activated receptor gamma pathway targeting in carcinogenesis: implications for chemoprevention

The peroxisome proliferator-activated receptor (PPAR) gamma is one member of the nuclear receptor superfamily that contains in excess of 80 described receptors. PPARgamma activators are a diverse group of agents that range from endogenous fatty acids or derivatives (linolenic, linoleic, and 15-deoxy-Delta(12,14)-prostaglandin J(2)) to Food and Drug Administration-approved thiazolidinedione drugs [pioglitazone (Actos) and rosiglitazone (Avandia)] for the treatment of diabetes. Once activated, PPARgamma will preferentially bind with retinoid X receptor alpha and signal antiproliferative, antiangiogenic, and prodifferentiation pathways in several tissue types, thus making it a highly useful target for down-regulation of carcinogenesis. Although PPAR-gamma activators show many anticancer effects on cell lines, their advancement into human advanced cancer clinical trials has met with limited success. This article will review translational findings in PPARgamma activation and targeting in carcinogenesis prevention as they relate to the potential use of PPARgamma activators clinically as cancer chemoprevention strategies.

Th1/Th2 cytokine ratio in tissue transudates from patients with oral lichen planus

OBJECTIVE

The characteristics of oral lichen planus (OLP) provoke investigators to explore possible biomarkers by which to monitor disease activity and therapeutic efficacy. Oral fluids may provide an accessible medium for analysis of such biomarkers. Previous studies have shown that activation of nuclear factor-kappa B (NF-kappa B) plays an important role in the pathogenesis of oral lichen planus (OLP), which is a chronic inflammatory disorder mediated by T cells. Prior to the present investigation, reports of the levels of NF-kappa B and its dependent cytokines in oral fluids have not been forthcoming. The purpose of this study was to detect the level of NF-kappa B dependent cytokines, TNF-alpha, IL-1-alpha, IL-6, and IL-8 in tissue transudates directly from lesions of OLP, and explore the feasibility of the data for clinical application.

STUDY DESIGN

Thirteen definitively diagnosed OLP subjects were enrolled in the study as were 13 age-sex matched controls. In each subject, lesion tissue transudates (TTs) were collected by a novel collection technique with a filter paper. The level of cytokines, TNF-alpha, IL-1-alpha, IL-6, and IL-8 in three types of oral fluids were determined by ELISA.

RESULTS

In the tissue transudate(TT), there were significantly higher level of cytokines TNF-alpha, IL-1-alpha, IL-6, and IL-8 detected in OLP patients than in controls: (TT: 40.0 +/- 9.8 versus 4.5 +/- 0.7, 710 +/- 114 versus 305 +/- 78, 150 +/- 25 versus 1.7 +/- 0.5, 2800 +/- 260 versus 1450 +/- 130, P < .0001; unit: pg/mL).

CONCLUSIONS

These results indicate that NF-kappa B dependent inflammatory cytokines may be detected at increased levels in oral lesion tissue transudates which may have diagnostic and prognostic potentials for monitoring disease activity and making therapeutic decisions in patients with OLP.

Proinflammatory cytokine levels in saliva before and after treatment of (erosive) oral lichen planus with dexamethasone

OBJECTIVE

To explore the potential of detecting the level of proinflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin-1-alpha (IL-1-alpha), IL-6, and IL-8 in whole unstimulated saliva (WUS) in monitoring the therapeutic effects of topical dexamethasone on these salivary cytokines in subjects with erosive oral lichen planus (OLP).

STUDY DESIGN

Thirteen definitively diagnosed OLP subjects were enrolled in the study as were 13 age- and sex-matched controls. The OLP subjects were treated with 0.1% dexamethasone oral rinse for 6 weeks. Prior to treatment and at the end of clinical trial, the visual analog scale (VAS) for symptoms was recorded, WUS was collected and these proinflammatory cytokines were analyzed by ELISA.

RESULTS

Following the dexamethasone treatment, the levels of TNF-alpha, IL-1-alpha, IL-6, and IL-8 were decreased significantly, and IL-1-alpha and IL-8 were detected at a level without a statistically significant difference from controls. VAS value was decreased significantly and was found to significantly correlate with the decrease in IL-1-alpha and IL-8 levels.

CONCLUSIONS

These preliminary results indicate that salivary analysis of NF-kappaB-dependent cytokines may be applied to monitoring the therapeutic response of OLP.

The feasibility of monitoring NF-kappaB associated cytokines: TNF-alpha, IL-1alpha, IL-6, and IL-8 in whole saliva for the malignant transformation of oral lichen planus

Previous investigations have demonstrated that immune activation and chronic inflammation may be one of the causes of oncogenesis. A previous study from our lab has shown significant increases of NF-kappaB dependent cytokines, TNF-alpha, IL-1alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus (OLP) patients. The aim of this analysis was to explore the potential of detecting these cytokines in whole unstimulated saliva (WUS) in monitoring the malignant transformation of OLP. Thirteen patients with OLP (with epithelial dysplasia), 13 cases with oral squamous cell carcinoma (OSCC), and 13 age-sex matched controls were enrolled in the study. The WUS samples were collected and the level of TNF-alpha, IL-1alpha, IL-6, and IL-8 in WUS was determined by ELISA. In moderate and severe dysplasia, the level of each cytokine was significantly higher than in control. In moderate dysplasia, TNF-alpha and IL-1alpha were significantly increased at a level without difference from OSCC, but IL-6 and IL-8 was detected at a concentration significantly lower than OSCC. In severe dysplasia, the level of TNF-alpha was also not significantly different from that of OSCC, and the level of IL-1alpha, IL-6, and IL-8 was still significantly lower than that of OSCC. The level of four cytokines between smokers and non-smokers in each group did not show a significant difference. These results indicate that the change of NF-kappaB dependent cytokines in WUS may in part reflect the malignant transformation of OLP and the analysis of these cytokines and may provide a useful, non-invasive surrogate endpoint for monitoring malignant transformation as well as the therapeutic response of OLP. This is the first in vivo study utilizing saliva to confirm preclinical data that NF-kappaB is upregulated in oral carcinogenesis.

Inhibitors of the Arachidonic Acid Pathway and Peroxisome Proliferator–Activated Receptor Ligands Have Superadditive Effects on Lung Cancer Growth Inhibition

Arachidonic acid (AA) metabolizing enzymes and peroxisome proliferator-activated receptors (PPARs) have been shown to regulate the growth of epithelial cells. We have previously reported that exposure to the 5-lipoxygenase activating protein-directed inhibitor MK886 but not the cyclooxygenase inhibitor, indomethacin, reduced growth, increased apoptosis, and up-regulated PPARalpha and gamma expression in breast cancer cell lines. In the present study, we explore approaches to maximizing the proapoptotic effects of PPARgamma on lung cancer cell lines. Non-small-cell cancer cell line A549 revealed dose-dependent PPARgamma reporter activity after treatment with MK886. The addition of indomethacin in combination with MK886 further increases reporter activity. We also show increased growth inhibition and up-regulation of apoptosis after exposure to MK886 alone, or in combination with indomethacin and the PPAR ligand, 15-deoxy-Delta12,14-prostaglandin J2 compared with single drug exposures on the adenocarcinoma cell line A549 and small-cell cancer cell lines H345, N417, and H510. Real-time PCR analyses showed increased PPAR mRNA and retinoid X receptor (RXR)alpha mRNA expression after exposure to MK886 and indomethacin in a time-dependent fashion. The results suggest that the principal proapoptotic effect of these drugs may be mediated through the known antiproliferative effects of the PPARgamma-RXR interaction. We therefore explored a three-drug approach to attempt to maximize this effect. The combination of low-dose MK886, ciglitazone, and 13-cis-retinoic acid interacted at least in a superadditive fashion to inhibit the growth of lung cancer cell lines A549 and H1299, suggesting that targeting PPARgamma and AA action is a promising approach to lung cancer growth with a favorable therapeutic index.

A comparison of the pro-inflammatory, NF-kappaB-dependent cytokines: TNF-alpha, IL-1-alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus patients

To explore the feasibility of detection of the level of NF-kappaB-dependent cytokines in oral fluids from patient with oral lichen planus (OLP) for clinical application, 13 OLP subjects were enrolled in the study as were 13 age-sex-matched controls. In each subject, the whole unstimulated saliva (WUS), mixture of saliva and isotonic saline oral rinse (Saliva-NaCl), and lesion tissue transudates (TT) were collected by standard techniques. The level of cytokines, TNF-alpha, IL-1-alpha, IL-6, and IL-8 in three types of oral fluids was determined by ELISA. In the three types of oral fluids, a significantly higher level of these cytokines was detected in OLP patients than in normal controls. These results indicate that NF-kappaB-dependent inflammatory cytokines may be detected at increased levels in certain oral fluids which may have diagnostic and prognostic potential for monitoring disease activity and making therapeutic decisions in patients with OLP.

Pseudomonas aeruginosa Lipopolysaccharide Induction of Keratinocyte Proliferation, NF-κB, and Cyclin D1 Is Inhibited by Indomethacin

NF-kappaB is activated during acute inflammatory states as well as in other injury response disease states. Several pathologic states in squamous tissue injury response are characterized by increased squamous proliferation. This study was performed to investigate the hypothesis that Pseudomonas aeruginosa LPS is able to activate a proliferative phenotype in squamous cells via NF-kappaB induction and that this NF-kappaB-mediated response may be abrogated with the classic anti-inflammatory agent indomethacin. EMSA, luciferase reporter gene experiments, Western blots, and cellular proliferation assays were performed in normal and transformed human keratinocytes after stimulation with P. aeruginosa LPS. EMSA and luciferase reporter gene assays showed a 3- to 5-fold induction of active NF-kappaB in human keratinocyte cell lines after stimulation with P. aeruginosa LPS. The stimulation correlated with significantly increased cellular proliferation. As one potential mechanism for this increase in proliferation, an NF-kappaB-specific activation of cyclin D1 was observed. Both the NF-kappaB induction and proliferation response were inhibited with indomethacin and in dominant negative stable transfection clones. P. aeruginosa LPS activates proliferation of human keratinocytes, potentially through the induction of NF-kappaB and cyclin D1. These findings suggest that bacterial components can contribute to proliferative disease states in squamous epithelium through NF-kappaB activation.

NF-kappaB dependent cytokine levels in saliva of patients with oral preneoplastic lesions and oral squamous cell carcinoma

Previous investigations in our laboratory and others (Chen et al., 1998) have shown that the levels of certain inflammatory, proangiogenic cytokines in saliva and tissue specimens of patients with oral premalignant lesions (OPML) are elevated. We have also shown that these cytokines are elevated in tissue culture of oral squamous cell carcinoma (OSCC) cell lines. The purpose of this pilot study was to determine the level of several inflammatory, NF-kappaB-dependent cytokines in whole unstimulated saliva (WUS), in subjects with OPML as compared to those with diagnosed OSCC. Subjects (n=13) with OMPL, OSCC (n=13), and age-sex matched controls without oral lesions (C) (n=13) were enrolled. The mean age was 58.7 years. WUS was collected by standard techniques for 5 min (Navazesh, 1993). WUS samples were centrifuged and the cytokine analysis was performed on the supernatants by ELISA as previously described by Ondrey et al. (1991). The cytokines analyzed were: TNF-alpha, interleukin-1, interleukin-6, and interleukin-8 (TNF-alpha, IL-1, IL-6, and IL-8). The results as analyzed by Pairwise t-tests revealed significant differences in the salivary levels of: (1) TNF-alpha: (mean+/-S.E.M.: TNF-alpha-OSSC=28.9+/-14.6* pcg/ml versus OPML=10.5+/-7.4* pcg/ml versus controls=3.0+/-1.0 pcg/ml; *p<0.01); (2) IL-1: (IL-1-OSSC=454.4+/-215.8* pcg/ml versus OPML=255.1+/-124.8* pcg/ml versus controls=173.2+/-66.9 pcg/ml; *p<0.01); (3) IL-6: (mean+/-S.E.M.: IL-6-OSSC=88.2+/-43.2* pcg/ml versus OPML=70.8+/-24.3* pcg/ml versus controls=1.4+/-1.0 pcg/ml; *p<0.001) and (4) IL-8 in saliva: (mean+/-S.E.M.: IL-8-OSSC=3154.1+/-1023.2* pcg/ml versus OPML=1918.2+/-899.1* pcg/ml versus controls=1580.7+/-789.0 pcg/ml; *p<0.001). There was a significant increase in the levels of all cytokines in the saliva of the OPML as compared to controls, and a significant difference in the cytokines of OSSC saliva compared to the OPML and controls. These results suggest that these proangiogenic, proinflammatory cytokines are elevated in the saliva of patients with OSSC and OPML as compared to controls, which may have diagnostic and/or prognostic significance.

Asymptomatic laryngeal malformations are common in patients with Pallister-Hall syndrome

Pallister-Hall syndrome (PHS) comprises hypothalamic hamartoma, polydactyly, pituitary dysfunction, laryngotracheal cleft, imperforate anus, and other anomalies. Some patients with PHS have a bifid epiglottis, a rare malformation. Greig cephalopolysyndactyly syndrome (GCPS) comprises polydactyly with craniofacial malformations without the PHS malformations. Both disorders are caused by mutations in the GLI3 gene. Laryngoscopy on 26 subjects with PHS showed that 15 had a bifid or cleft epiglottis (58%) and none of 14 subjects with GCPS had a cleft epiglottis. The malformed epiglottis was asymptomatic in all of the prospectively evaluated subjects. One additional PHS subject was found to have bifid epiglottis and a posterior laryngeal cleft on autopsy. We conclude that bifid epiglottis is common in PHS but not GCPS. Posterior laryngeal clefts are an uncommon manifestation of PHS and are identified only in severely affected patients. The diagnosis of a bifid epiglottis should prompt a thorough search for other sometimes asymptomatic anomalies of PHS to provide better medical care and recurrence risk assessment for affected individuals and families.

Do lipoxygenases modulate normal or aberrant lympho-hematopoiesis?

Whether 5- (and the 12- or 15-) lipoxygenases participate in normal or malignantly transformed hematopoietic cell proliferation and differentiation, or contribute to programmed or necrotic cell death has been difficult to decide. Recent evidence concerning these questions is reviewed and some reasons for these difficulties are considered.

Linkage mapping and phenotypic analysis of autosomal dominant Pallister-Hall syndrome

Pallister-Hall syndrome is a human developmental disorder that is inherited in an autosomal dominant pattern. The phenotypic features of the syndrome include hypothalamic hamartoma, polydactyly, imperforate anus, laryngeal clefting, and other anomalies. Here we describe the clinical characterisation of a family with 22 affected members and the genetic mapping of the corresponding locus. Clinical, radiographic, and endoscopic evaluations showed that this disorder is a fully penetrant trait with variable expressivity and low morbidity. By analysing 60 subjects in two families using anonymous STRP markers, we have established linkage to 7p13 by two point analysis with D7S691 resulting in a lod score of 7.0 at theta = 0, near the GLI3 locus. Deletions and translocations in GLI3 are associated with the Greig cephalopolysyndactyly syndrome. Although Greig cephalopolysyndactyly syndrome has some phenotypic overlap with Pallister-Hall syndrome, these two disorders are clinically distinct. The colocalisation of loci for these distinct phenotypes led us to analyse GLI3 for mutations in patients with Pallister-Hall syndrome. We have previously shown GLI3 mutations in two other small, moderately affected families with Pallister-Hall syndrome. The linkage data reported here suggest that these larger, mildly affected families may also have mutations in GLI3.

Effect of lipoxygenase inhibition on mucous glycoprotein secretion from chinchilla middle ear epithelial cells in vitro

Lipoxygenase is an enzyme that metabolizes arachidonic acid down to leukotrienes. Recent studies have shown that the enzyme is implicated in mucous glycoprotein (MGP) secretion stimulated by inflammatory mediators in the airways, suggesting its possible role in secretion of MGP from middle ear epithelial cells. To investigate a correlation between MGP secretion and the arachidonic acid metabolites, we examined the effects of nordihydroguaretic acid (NDGA, both a cyclooxygenase and lipoxygenase inhibitor), low-dose indomethacin (an inhibitor of cyclooxygenase), and A63162 (an inhibitor of lipoxygenase) on MGP secretion in cultured chinchilla middle ear epithelial cells. It was found that lipoxygenase inhibition led to reduction of MGP secretion from cultured chinchilla middle ear epithelial cells, while cyclooxygenase inhibition did not. Both cyclooxygenase and lipoxygenase inhibition resulted in profound blockage of MGP secretion in baseline and platelet activating factor-stimulated MGP secretion. It was concluded, therefore, that MGP secretion was linked to arachidonic acid metabolites, especially lipoxygenase products.

The selective 5-lipoxygenase inhibitor A63162 reduces PC3 proliferation and initiates morphologic changes consistent with secretion

We examined the effect of A63162 (Abbott), a selective inhibitor of 5-lipoxygenase on human prostate (PC3) cell proliferation. Within 5 min DNA synthesis was reversibly inhibited by 40 microM A63162, without altered cellular attachment or uptake of trypan blue. After 72 Hr, cells continued to be attached and exclude dye, were reduced in number and their histology was altered. Many treated cells were larger, more pleomorphic, with nuclear and cytoplasmic ultrastructural changes consistent with preparation for secretion. Some cells contained moderately swollen, distorted mitochondria. ETYA, a less selective inhibitor of 5-lipoxygenase that also inhibits cell replication, acutely reduced O2 uptake by 40%, but A63162 did not. The retention of the supravital mitochondrial dye, rhodamine 123 was increased by ETYA at 4 hr, but not after 24 hr; retention was not altered by A63162. Although the mechanism by which A63162 reversibly inhibits PC3 proliferation and initiates preparation for secretion is not identified, additional studies should further define its role in these events.

ETYA, a pleotropic membrane-active arachidonic acid analogue affects multiple signal transduction pathways in cultured transformed mammalian cells

ETYA (5,8,11,14-eicosatetraynoic acid), an arachidonic acid analogue, inhibited DNA synthesis in human transformed U937 (monoblastoid), PC3 (prostate) and A172 (glioblastoma) cells, and partially differentiated the U937 and A172 lines. The agent is not primarily cytotoxic at the concentrations employed, based upon exclusion of trypan blue, continued attachment of PC3 and A172 cells, unchanged release of Cr51, and reversibility of inhibited thymidine incorporation after removal of ETYA. Leukotriene C4 partially reversed the suppression of U937 DNA synthesis, suggesting its modulation by leukotrienes. U937 and A172 cells partially differentiated, as judged by a number of criteria. ETYA increased whole cell and microsomal membrane fluidity, increased intracellular Ca2+ in PC3 and U937 cells, altered the distribution and activity of protein kinase C in U937 cells, and rapidly downregulated the transcription of U937 c-myc. Evidence from transmission electron microscopy consistent with oxidative stress including putative lipofuscin bodies, myelin figures and disordered mitochondrial cristae and matrices was especially evident in PC3 cells, less so in A172 and essentially absent in U937 cells. A specific 5'-lipoxygenase inhibitor, A63162 inhibited PC3 and U937 proliferation. Some of these events are believed to represent components of "signal" transduction pathways responsible for reversible inhibition of DNA synthesis and the induction of partial phenotypic differentiation in competent cells. Arachidonic acid analogues which exert selective effects on physical and functional properties of cell membranes may represent an additional class of membrane-active agents with potential anticancer activity. A subset of their activities can be duplicated by inhibitors of 5' lipoxygenase.

Tumor cell mitochondrial matrix/cristae complexes as potential sites for anticancer therapy with polyunsaturated fatty acid analogues

The consequences of incubating human cancer cells with ETYA, a competitive analogue of arachidonic acid, and the reported responses of cells cultured with polyunsaturated fatty acids indicate that polyunsaturated fatty acid analogues or their modified congeners could represent potential cytotoxic anticancer agents. The inner mitochondrial membrane and matrix may represent important targets for such agents, since they seem unusually susceptible to ETYA-induced oxidative stress.

Inhibition of U937 eicosanoid and DNA synthesis by 5,8,11,14-eicosatetraynoic acid, an inhibitor of arachidonic acid metabolism and its partial reversal by leukotriene C4

When replicating U937 cells were incubated with up to 80 microM concentrations of the in vitro inhibitor of eicosanoid biosynthesis, 5,8,11,14-eicosatetraynoic acid (ETYA), DNA synthesis measured by labeling with [3H]thymidine was inhibited in a concentration-dependent manner. No reduction in cellular viability occurred, as judged by exclusion of trypan blue, unaltered release of 51Cr-labeled proteins, and the reversibility of inhibition after incubation for 72 h with ETYA. Neither indomethacin nor acetylsalicylic acid, inhibitors of cyclooxygenase, altered DNA synthesis in control or ETYA-inhibited cells, excluding participation of the products of this enzyme in the inhibition of DNA synthesis. Incubation of inhibited cells with extracts prepared from log-phase media partially reversed the inhibition of DNA synthesis. Addition of leukotriene B4 or D4 at 10(-7) to 10(-8) M did not reverse ETYA-induced inhibition of DNA synthesis, nor did the addition of a series of long chain fatty acids, including arachidonic acid. However, leukotriene C4 at 10(-7) M partially reversed the inhibition of DNA synthesis. Extracts of media from log-phase cells were shown by high-pressure liquid chromatography to contain leukotriene C4, and synthesis of this compound was inhibited by ETYA, as judged by measurement of UV absorbance and radioactivity. Additional inhibitors of eicosanoid metabolism including nordihydroguaiaretic acid and esculetin also suppressed DNA synthesis in U937, K562, and prostate PC3 cells, without altered cellular viability; the effect is not limited to lymphohematopoietic cells or to a single inhibitor of arachidonic acid metabolism. Suppression of U937 DNA and eicosanoid synthesis by ETYA and the partial reversal of DNA synthesis by leukotriene C4 suggest that in these cells eicosanoids may modulate DNA synthesis. Other possible consequences of incubating cells with ETYA including creation of arachidonic acid-deficient membranes, and even incorporation of the agent into membrane phospholipids, may also contribute to the reversible inhibition of DNA synthesis.

Differentiation of U937 cells induced by 5,8,11,14-eicosatetraynoic acid, a competitive inhibitor of arachidonic acid metabolism

5,8,11,14-Eicosatetraynoic acid, a competitive inhibitor of arachidonic acid metabolism, rapidly and reversibly inhibited DNA synthesis in U937 cells. This inhibition was not due to cytotoxicity, as judged by studies with trypan blue, release of 51Cr-labeled proteins, and its reversibility. When cells were cultured in the presence of ETYA for several days, morphologic, enzymatic, and functional changes consistent with differentiation occurred. Morphologic evidence of differentiation was evident by light microscopy. The cells enlarged, the ratio of cytoplasm to nuclei increased, secretory granules and vacuoles developed, the apparent activity of nonspecific esterase rose, and ingestion of latex particles increased. A morphology consistent with that of an immature monocyte was evident by electron microscopy. These features included the development of lobulated nuclei, a reduced nuclear to cytoplasmic ratio, increased complexity and development of the cytoplasmic components, and the disappearance of fimbriated plasma membrane structures. In addition, putative polyribosomes were less evident. When cells differentiated by ETYA were cultured in media free of the inhibitor, DNA synthesis reinitiated and the cell number increased; differentiation was phenotypic and not genotypic. To examine whether ETYA-induced differentiation was obligatorily related to its suppression of DNA synthesis, cells were incubated in 50 microM hydroxyurea and DNA synthesis was inhibited for 24 to 36 h without morphologic evidence of cellular differentiation. However, addition of ETYA to cells prevented from dividing by hydroxyurea and subsequent culture for 72 h induced morphologic evidence of differentiation. The effects of ETYA on cell division and cell differentiation are closely related but can be dissociated. The molecular events underlying these results remain to be established.

Human PC-3 prostate cell line DNA synthesis is suppressed by eicosatetraynoic acid, an in vitro inhibitor of arachidonic acid metabolism

When human PC-3 cells derived from a metastatic prostatic adenocarcinoma were incubated for 15 min to 4 h with the in vitro inhibitor of eicosanoid biosynthesis, eicosatetraynoic acid (ETYA) at 10-80 microM, DNA synthesis was suppressed. No reduction in cellular viability occurred, as judged by exclusion of trypan blue or unaltered release of 51Cr-labeled proteins, and the inhibition was partially reversible. Indomethacin (to 12.5 micrograms/ml) did not inhibit DNA synthesis or alter the suppression of DNA synthesis by ETYA, suggesting a role for a lipoxygenase product in this effect. Addition of leukotriene B4 (LTB4) at 10(-8) M did not reverse the inhibition of DNA synthesis produced by ETYA, nor did arachidonic acid (10(-5) - 10(-9) M) incubated with control cells mimic the effect of that agent. 3H-arachidonic acid incubated with PC-3 cells was rapidly incorporated into phospholipids and this labeling was differentially inhibited by ETYA. Positive modulation of PC-3 cellular DNA synthesis by lipoxygenase products and inhibition of their synthesis by ETYA is one attractive hypothesis with which to account for these results. Other consequences of producing a selective deficiency of arachidonic acid in cellular membrane phospholipids and even the probable substitution of ETYA for arachidonic acid could also contribute to the inhibition of DNA synthesis by ETYA.