From classic motor imagery to complex movement intention decoding: The noninvasive Graz-BCI approach

In this chapter, we give an overview of the Graz-BCI research, from the classic motor imagery detection to complex movement intentions decoding. We start by describing the classic motor imagery approach, its application in tetraplegic end users, and the significant improvements achieved using coadaptive brain-computer interfaces (BCIs). These strategies have the drawback of not mirroring the way one plans a movement. To achieve a more natural control-and to reduce the training time-the movements decoded by the BCI need to be closely related to the user's intention. Within this natural control, we focus on the kinematic level, where movement direction and hand position or velocity can be decoded from noninvasive recordings. First, we review movement execution decoding studies, where we describe the decoding algorithms, their performance, and associated features. Second, we describe the major findings in movement imagination decoding, where we emphasize the importance of estimating the sources of the discriminative features. Third, we introduce movement target decoding, which could allow the determination of the target without knowing the exact movement-by-movement details. Aside from the kinematic level, we also address the goal level, which contains relevant information on the upcoming action. Focusing on hand-object interaction and action context dependency, we discuss the possible impact of some recent neurophysiological findings in the future of BCI control. Ideally, the goal and the kinematic decoding would allow an appropriate matching of the BCI to the end users' needs, overcoming the limitations of the classic motor imagery approach.

Longitudinal multimodal imaging in mild to moderate Alzheimer disease: a pilot study with memantine

OBJECTIVE

To study the feasibility of multimodal neuroimaging in mild to moderate Alzheimer disease (AD) and to estimate the size of possible treatment effects of memantine on potential functional, structural and metabolic biomarkers of disease progression.

METHODS

In this randomised, double-blind, placebo-controlled pilot study, 36 patients with moderate AD received 52 weeks of memantine (20 mg/day) or placebo. Patients were re-evaluated after 26 and 52 weeks to measure the change from baseline in several outcome measures including global and regional glucose metabolism, total brain and hippocampal volumes, as well as chemical shift imaging-derived global and regional N-acetylaspartate and myoinositol concentrations.

RESULTS

In the total population, global glucose metabolism decreased by 2.3% (p<0.01), total brain volume by 2.1% (p<0.001) and hippocampal volume by 2.7% (p<0.01) after 52 weeks. Chemical shift imaging (CSI) spectra were severely affected by patient-induced artefacts and highly variable. Patients receiving memantine showed less decline in glucose metabolism in all brain areas than patients on placebo. Their loss of hippocampal volume was substantially smaller (2.4% vs 4.0%). No between-group differences were seen for changes in total brain volume.

CONCLUSIONS

The results support the use of multimodal imaging including MRI and positron emission tomography (PET) to monitor the progression of moderate AD. CSI yielded unreliable longitudinal results. The data suggest that memantine has potentially protective effects in AD and they can be used for planning larger confirmatory studies on the cerebral effects of memantine.

Arterial oxygen tension increase 2-3 h after hyperbaric oxygen therapy: a prospective observational study

BACKGROUND

Inhalation of hyperbaric oxygen (HBO) has been reported to decrease arterial oxygen tension (PaO(2)) in the early period after exposure. The current investigation aimed at evaluating whether and to what extent arterial blood gases were affected in mechanically ventilated intensive care patients within 6 h after HBO treatment.

METHODS

Arterial blood gases were measured in 11 ventilated subjects [nine males, two females, synchronized intermittent mandatory ventilation (SIMV) mode] undergoing HBO therapy for necrotizing soft tissue infection (seven patients), burn injury (two patients), crush injury (one patient) and major abdominal surgery (one patient). Blood gases were obtained with the patients in the supine position under continuous analgesia and sedation before the hyperbaric session (baseline), during isopression, after decompression, after each transport, and 1, 2, 3 and 6 h after exposure. Heart rates and blood pressures were recorded. Intensive care unit (ICU) ventilator settings remained unchanged. Transport and chamber ventilator settings were adjusted to baseline with maintenance of tidal volumes and positive end-expiratory pressure (PEEP) levels. The hyperbaric protocol consisted of 222.9 kPa (2.2 absolute atmospheres) and a 50-min isopression phase. The paired Wilcoxon's test was used.

RESULTS

Major findings (median values, 25%/75% quartiles) as per cent change of baseline: PaO(2) values decreased by 19.7% (7.0/31.7, P < 0.01) after 1 h and were elevated over baseline by 9.3% (1.5/13.7, P < 0.05) after 3 h. SaO(2), alveolar-arterial oxygen tension difference and PaO(2)/FiO(2) ratio behaved concomitantly. Acid-base status and carbon dioxide tension were unaffected.

CONCLUSION

Arterial oxygen tension declines transiently after HBO and subsequently improves over baseline in intensive care patients on volume-controlled mechanical ventilation. The effectiveness of other ventilation modes or a standardized recruitment manoeuvre has yet to be evaluated.

Evaluation of potential risk factors for early infectious complications after autologous peripheral blood stem cell transplantation in patients with lymphoproliferative diseases

A number of risk factors for the occurrence of neutropaenic fever after haematopoietic stem cell transplantation (HSCT) have been proposed. We were interested in whether these factors remain valid for several early infection-related outcomes when applied to a homogeneous group of patients in uni- and multivariate analyses. Therefore, we analysed 144 consecutive patients with lymphoproliferative disorders receiving autologous peripheral blood HSCT. Variables tested as potential risk factors for the occurrence of fever, documented infection (DI), microbiologically documented infection (MDI) or failure of first-line antimicrobial therapy were sex, conditioning regimen, prolonged neutropaenia, low number of CD34+ cells transplanted, purging, lack of selective gut decontamination, higher age and increased body mass index. In uni- and multivariate analyses, conditioning including total body irradiation was the only risk factor for the occurrence of fever, and neutropaenia >or=10 days was the only factor associated with failure of first-line antimicrobial therapy. None of the variables tested was associated with an increased risk for DI or MDI. This analysis suggests that a number of previously proposed risk factors actually are of minor clinical relevance for early infections in the majority of patients receiving autologous HSCT.

High spontaneous colony growth in chronic myelomonocytic leukemia correlates with increased disease activity and is a novel prognostic factor for predicting short survival

We have originally shown that spontaneous granulocyte/macrophage colony (CFU-GM) formation in semisolid medium is a characteristic in vitro feature of chronic myelomonocytic leukemia (CMML). However, the clinical significance of spontaneous CFU-GM growth in CMML is unknown so far. CFU-GM growth characteristics were studied in semisolid cultures in the absence of exogenous cytokines using peripheral blood mononuclear cells in 30 patients with CMML at first presentation. The median number of CFU-GM/10(5) MNC of all patients was 48.5 (range 0-622) with 18 patients having colony numbers below 100 (low CFU-GM growth) and 12 patients above 100 (high CFU-GM growth). Kaplan-Meier analysis revealed that patients with high CFU-GM growth had a significantly shorter survival than patients with low CFU-GM growth (median 6.5 vs. 44.5 months, p<0.00002). The probability of survival after 2 years was 60.5% for patients with low colony growth but 0% in those with high colony formation. Patients with CFU-GM >100 had a significantly higher WBC count, a higher LDH, and a higher number of blast cells in blood and bone marrow than patients with low colony growth. Moreover, patients with high colony growth had more often splenomegaly and lower platelet counts. In seven patients, in whom semisolid in vitro cultures were performed after transformation into RAEBT/AML, spontaneous colony growth was significantly increased as compared to CFU-GM growth in patients before transformation (median number/10(5) MNC 533, range 212-4553, p<0.005). This study demonstrates that high (>100) spontaneous CFU-GM formation in CMML at presentation correlates with increased disease activity and represents a novel and important prognostic factor predicting for short survival of CMML patients.

[Osteosarcoma and Ewing's sarcoma--The most frequent malignant bone tumors in children--therapy and outcome]

BACKGROUND

Osteosarcoma and Ewing's sarcoma are the most frequent malignant bone tumors in children and young adults with relatively poor overall survival rates.

METHODS

Between January 1980 and December 1994, 175 children with osteosarcoma and 64 children with Ewing's sarcoma were treated at the author's institution. 22 children had synchronous metastases, 19 patients had a pathologic fracture. Both groups were treated systemically with chemotherapy regimens (COSS and CESS). Local therapy was amputation or tumor resection and endoprosthetic replacement or biological reconstruction with wide or radical resection margins. In case of Ewing's sarcoma in 35 patients postoperative radiation therapy was done.

RESULTS

Five-year overall survival rate for osteosarcoma and Ewing's sarcoma patients is about 63 %, ten-year survival rate for osteosarcoma patients is 60.2 %, for Ewing's sarcoma patients 54.5 %. Prognostic factors significantly influencing overall survival rates are tumor response to chemotherapy (p values = 0.0056 and 0.013, respectively), surgical treatment with adequate resection margins (p value = 0.0001 for osteosarcoma patients) and development of postoperative metastases (p value = 0.0001 for both groups).

CONCLUSION

For both groups of malignant bone tumors systemic chemotherapy as well as adequate surgical therapy are necessary to reduce the rates of local recurrences and to achieve better survival rates.

Pre- and early postoperative risk factors for death after cardiac transplantation: a single center analysis

Due to the limited number of donor organs, death on the waiting list and waiting time for cardiac transplantation have markedly increased. A pressing need of appropriate selection criteria for patients who would benefit most from transplantation is apparent. The purpose of this study is to identify pre- and early postoperative risk factors that influence long term survival after cardiac transplantation. 702 consecutive patients who underwent cardiac transplantation between 3/1984 and 12/1997 were analyzed retrospectively for the influence of different pre- and early postoperative risk factors on early (30 days) and late death (5 years). Univariate and multivariate regression analysis revealed risk factors for early as well as late death. Predictors of early death were higher preoperative PVR, retransplantation, longer ischemic time, postoperative acute kidney failure and longer intubation time. Risk factors for late death were early transplant era, previous cardiac surgery, patients awaiting transplantation in a hospital, prolonged stay in an intensive care unit, and any rejection during the first month after transplantation. These results demonstrate that pre- and early postoperative risk factors have significant influence on early and long term survival.

Improved long-term results with thymoglobuline induction therapy after cardiac transplantation: a comparison of two different rabbit-antithymocyte globulines

BACKGROUND

The aim of this retrospective single center analysis was to compare possible long-term benefits of two different rabbit-antithymocyte globuline (ATG) induction therapies after cardiac transplantation.

PATIENTS AND METHODS

A total of 484 primary cardiac transplanted patients received induction therapy with two different rabbit-ATGs (thymoglobuline: n=342, ATG-fresenius: n=142). All patients received immunosuppressive maintenance therapy with cyclosporine, azathioprine, and prednisolone. Cardiac rejection was assessed by serial endomyocardial biopsies. Surveillance of graft arteriosclerosis was performed by angiograms 1, 3, and 5 years after transplantation.

RESULTS

Five-year survival was significantly better in the thymoglobuline group (76 vs. 60%). Thymoglobuline patients had a lower rate of death from rejection (2.3 vs. 10%; P<0.01) and graft arteriosclerosis (0.88 vs. 5.6%; P<0.01). After 5 years, freedom from rejection was 72% in the thymoglobuline group compared to 42% in the ATG-fresenius group (P<0.01). Graft arteriosclerosis appeared in 14% of thymoglobuline patients and in 28% of ATG-fresenius patients (P<0.01). Viral infections occurred more often in thymoglobuline patients (53 vs. 39%, P<0.05) although there was no difference in appearance of cytomegalovirus disease (17 vs. 13%). Freedom from posttransplant malignant disease was comparable between the two groups.

CONCLUSION

These results suggest that there are differences between rabbit ATG products. The superior prevention of rejection with thymoglobuline may be the reason for the lower rate of graft arteriosclerosis.

Combined heart and kidney transplantation using a single donor: a single center's experience with nine cases

BACKGROUND

Simultaneous double-organ transplants comprising various organ combinations have become frequent. The purpose of this article is to report on a single center's experience of simultaneous heart and kidney transplantation (HNTX) with particular emphasis on selection criteria and patient outcome.

METHODS

From September 1990 to January 1997, nine patients underwent HNTX, receiving both grafts from a single donor selected on ABO blood group compatibility and a negative lymphocytotoxic crossmatch, but without regard to HLA-antigen matching.

RESULTS

One patient died of acute humoral rejection of the cardiac graft shortly after surgery. Eight patients are alive and well and have normal cardiac and renal function at a mean follow-up of 44+/-28 months.

CONCLUSION

HNTX offers a compelling therapeutic solution in the treatment of advanced cardiac and renal failure in carefully selected patients. Because the heart and kidney rejection episodes were independent of each other, rejection surveillance should be carried out separately for each transplanted organ.

Simultaneous heart and kidney transplantation as treatment for end-stage heart and kidney failure

BACKGROUND

The aim of the present analysis was to define the role of simultaneous heart and kidney transplantation (HNTX) using organs from the same donor by evaluation of clinical strategy and achieved outcome compared with a reference group of concurrently single heart transplant (HTX) and kidney transplant (NTX) recipients. Compared with other organ combinations (pancreas-kidney, heart-lung), HNTX has been performed infrequently and is reported mainly as case records in the literature. Because of expansion of recipient selection criteria for HTX and NTX, the number of patients requiring simultaneous replacement of both organs is increasing.

METHODS

Six HNTX recipients, three of them suffering from long-standing type I diabetes, received transplants between September 1990 and March 1996 and were analyzed in terms of clinical and immunological demographics and outcome. They were compared with 379 HTX and 769 NTX recipients operated upon within this period.

RESULTS

Survival for HNTX is 100% with a mean follow-up of 32.7+/-21.1 months. Cold ischemic time of the kidney was significantly shorter for HNTX than for NTX (6.5+/-1.0 hr vs. 22.1+/-6.8 hr, P<0.005). Although HNTX patients received HLA-unmatched grafts, no rejection of the kidney has been observed to date. There was no difference for rejection of the heart in HNTX compared to HTX recipients.

CONCLUSIONS

Satisfying results are obtained by HNTX and justify the use of two organs for one recipient. The favorable immunological behavior of the kidney despite use of HLA-unmatched grafts is most probably explained by higher immunosuppression and short cold ischemic time, although a combination effect cannot be excluded.

[Effect of betaxolol on blood pressure and heart rate in mild to moderate hypertension]

The efficacy and safety of daily 20 mg betaxolol monotherapy was investigated in mild-moderate essential hypertension in a four week long, open label, single blind trial (with a placebo run-in). Twenty one patients of both sexes were enrolled. The systolic blood pressure in the supine position decreased from 158 to 142 mmHg, the diastolic blood pressure from 101 to 89 mmHg. The mean systolic values of the 24 hours ambulatory blood pressure monitoring decreased from 136 to 126 mmHg, the mean diastolic values from 87 to 80 mmHg. All decreases in blood pressure were significant. The reduction of the heart rate (80/min vs 63/min) was also significant. The decrease in blood pressure during daytime was significant, during night it was moderate. The blood pressure- and heart rate reducing effect of betaxolol was detectable however in the second half of the night, before wake-up. No side effect was recorded.

[Myocardial infarct and diabetes mellitus: incidence, management and prognosis]

The authors analyse the data of the Myocardial and Diabetes Register, where 2436 diabetic patients (pts) and 1448 pts with acute myocardial infarction (AMI) were registered between 1st of January, 1992 and 31st of December 1994. In the history of diabetic patients previous AMI was present in 14.4% of the cases. The 21.6% of the AMI pts had diabetes mellitus as well. According to the type of diabetes (IDDM and NIDDM) the prevalence of AMI in the history of the registered persons was significantly different: among pts with NIDDM the previous AMI was found 14.8% of the pts and only 2% of pts with IDDM (p = 0.012). The clinical picture of AMI was also different of AMI pts with and without diabetes: chest pain suggesting AMI was present 10.9% of pts with proved AMI and diabetes mellitus, and 86.2% of pts with AMI without diabetes (p < 0.0001). The Streptokinase treatment was more common among AMI pts without diabetes (18.2% versus 12.5% p = 0.022). The hospital lethality was significantly higher among AMI pts with diabetes (42.8% versus 29.4% (p < 0.0001). The poorer prognosis was independent of age.

[Effect of lovastatin on serum lipids and lipoproteins. Hungarian multicenter, open-label study]

The authors studied the effects of lovastatin on the parameters of serum and lipoprotein lipids in an open multicenter trial. 160 patients with hypercholesterolemia participated in the study, 151 of whom completed the trial. After a 4 week period of dietary measures, the patients were treated with lovastatin for 12 weeks while combining standard lipid lowering diet. The initial dose of the drug was 20 mg, this was increased until serum cholesterol level decreased under 5.2 mmol/l, or to a maximal daily dose of 80 mg. By the end of the 12th week, serum cholesterol level was reduced by an average of 33% (p < 0.001), LDL-cholesterol by an average of 45% (p < 0.001), serum triglyceride concentration by an average of 22% (p < 0.001) and HDL-cholesterol increased by an average of 13% (p < 0.001). Lovastatin showed a very good safety profile, therapy had to be cancelled due to the occurrence of adverse events only in 4 cases.

Differential effects of diethylstilbestrol and estradiol-17 beta in combination with testosterone on rat prostate lobes

Treatment of Noble rats with separate silastic implants containing testosterone (T) and estradiol-17 beta (E2) for 16 weeks has previously been shown to induce multifocal epithelial dysplasia, a putative preneoplastic lesion, consistently in the dorsolateral prostate (DLP) but not in the ventral prostate (VP). We now studied effects of diethylstilbestrol (DES) substituted for E2 on these prostate lobes under the same conditions of exogenous androgen support. Three-week treatments with one 1-cm-long silastic implant of E2 or DES were approximately equipotent in changing target-organ weights and plasma prolactin. Accordingly, rats received for 16 weeks one 1-cm-long E2 or DES implant and two 2-cm-long T implants. In contrast to T + E2, T + DES induced widespread multifocal VP dysplasia and less or no DLP dysplasia. A serum-free explant-culture assay was used to determine uptake and metabolic disposition of 3H-labeled 5 alpha-dihydrotestosterone (DHT), T, and E2. Dysplastic VP explants incubated with 1.7 microM 1 beta-3H-labeled DHT and T accumulated more 3H-labeled steroid, metabolized 69 and 50% less substrate to terminal hydroxylated metabolites, and thereby formed and retained up to eight times as much estrogenic metabolite 5 alpha-androstane-3 beta,17 beta-diol (3 beta-androstanediol) and its lipoidal derivative than control VP. Experimental DLP explants did not form or retain more 3 beta-[3H]androstanediol than control DLP irrespective of treatments. Control VP metabolized [2-3H]E2 more actively to estrone than DLP. Dysplastic VP, however, metabolized one-half and accumulated five times as much E2 as VP and did not release more 3H as a marker of the 2,3-catechol estrogen pathway. These data suggest that differential target-tissue bioavailability of the estrogen component of the protracted dual-hormone stimulus determines in which prostate lobe dysplasia develops.

Metabolism of estradiol and estrone in organ cultures of dorsolateral and ventral prostate of untreated and sex hormone-implanted rats

Since dorsolateral but not ventral prostate undergoes estrogen-induced dysplasia in the androgen-supported Noble rat in 16 weeks, we studied estrogen metabolism by these tissues from untreated and sex hormone-implanted animals. We incubated 8.5 nM [6,7-3H]-labeled estradiol (E2) and estrone (E1) for 21 hours in serum-free, prostate-lobe cultures and 8.5 nM [2-3H]E2 with explants from untreated rats and animals treated with testosterone, 5 alpha-dihydrotestosterone, or E2 plus testosterone. Untreated rat ventral prostate metabolized 3.7 times as much E2 to E1 as dorsolateral prostate, whereas the latter tissue converted 2.5 times as much E1 to E2 as the former. After dorsolateral prostate culture with 8.5 nM [6,7-3H]-labeled E2 or E1, 0.6 M KCl-extracted, Sephadex G25-excluded nuclear protein bound preponderantly E2, whereas the counterpart nuclear protein fraction from ventral prostate explants incubated with E2 bound substrate and E1 almost equally. The combination sex hormone treatment decreased E2 metabolism and increased its uptake by the dysplastic dorsolateral prostate. Implantation of 5 alpha-dihydrotestosterone, but not of testosterone, also decreased E2 metabolism to E1 by dorsolateral prostate cultures. Treatments with E2 plus testosterone and with 5 alpha-dihydrotestosterone changed E2 uptake/E1 retention in dorsolateral prostate explants from 2.4 to 7.4 and 8.5, respectively. C-2 tritium release marking the 2,3-catechol estrogen pathway was greater for ventral than dorsolateral prostate, but was unaffected by the sex hormone treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical alterations in sex hormone-induced hyperplasia and dysplasia of the dorsolateral prostates of Noble rats

Simultaneous implantation of intact Noble (Nb) rats with testosterone and 17 beta-estradiol (E2)-filled silastic capsules for 16 weeks caused atypical hyperplasia (dysplasia) and striking enlargement exclusively in the dorsolateral prostates (DLPs) of all animals. The dysplastic lesion may be preneoplastic since long-term administration of these steroids to Nb rats is known to induce a high incidence of adenocarcinoma in the DLP. Treatment of rats with nonaromatizable 5 alpha-dihydrotestosterone (DHT) for 16 weeks caused enlargement but not dysplasia, implicating estrogen as a key factor in the genesis of the proliferative lesion. Compared with controls, the testosterone plus E2 treatment caused a 2.5-fold increase in nuclear type II estrogen binding sites which were confined to the DLP. Neither treatment significantly altered androgen content or levels of androgen receptor in the ventral prostate or DLP. Organ cultures of enlarged DLP containing foci of dysplasia metabolized more [3H]DHT than control tissue, which resulted in increased formation of the 5 alpha-androstane-3 beta, 17 beta-diol (3 beta-androstanediol) metabolite by these explants. Because 3 beta-androstanediol has previously been shown to displace [3H]E2 from cytosolic type I estrogen binding sites, the dysplasia may be caused by hyperstimulation of the DLP by the hormones and their normal metabolites produced in abnormal amounts.

Reductive metabolism of 5 alpha-dihydrotestosterone by rat ventral and dorsolateral prostate: kinetic parameters of the enzymes

In male sex accessory organs the active androgen 5 alpha-dihydrotestosterone (DHT) is metabolized to 5 alpha-androstane-3 alpha, 17 beta-diol (3 alpha-diol) and 5 alpha-androstane-3 beta, 17 beta-diol (3 beta-diol) by the reductase activities of 3 alpha-hydroxysteroid oxidoreductase (3 alpha-HSOR; EC 1.1.1.50) and 3 beta-hydroxysteroid oxidoreductase (3 beta-HSOR; EC 1.1.1.51). After separation of radiosubstrate and products by HPLC, these enzymes activities in subcellular preparations of rat ventral and dorsolateral prostate were determined from the conversion of [3H]DHT to the radiometabolites 3 alpha-diol and 3 beta-diol and 3 beta-triols (5 alpha-androstane-3 beta, 6 alpha, 17 beta-triol plus 5 alpha-androstane-3 beta, 7 alpha, 17 beta-triol). Whereas both enzymes were found in the dorsolateral prostate, 3 beta-HSOR reductase activity was near the limit of detection in ventral prostate. Unlike the equal distribution of 3 alpha-HSOR reductase between the microsomal and cytosol fractions of the ventral prostate, both 3 alpha- and 3 beta-HSOR reductase activities of the dorsolateral prostate are mainly confined to its cytosol fraction. Km and Vmax of the 3 alpha- and 3 beta-HSOR reductases in dorsolateral prostate cytosol were 1.8 microM, 24.6 pmol.mg-1 min-1 and 25.4 microM, 45.7 pmol.mg-1 min-1, respectively. We surmise from these and earlier studies that 3 beta-HSOR reductase is the rate-limiting prostatic enzyme in the catabolic disposition of intracellular DHT.

C19-radiosteroid disposition in organ cultures of transplanted prostatic adenocarcinomas of the Noble rat

This study compares the disposition of 8.5-nM C19-radiosteroids in 21-h cultures of Noble rat dorsolateral prostate (DLP) and transplanted adenocarcinomas derived from the DLP. Our purpose was to determine whether differences in androgen activation could be detected between the androgen-stimulated tumor (AST) line, an androgen-independent tumor line carried in intact (AIT-I) and castrated (AIT-C) rats and their DLP tissue of origin. No differences were found between DLP, AST, AIT-I, and AIT-C for the following parameters: 5 alpha-reduction of [3H]testosterone to dihydrotestosterone (DHT); however, conversion to total 5 alpha-reduced metabolites was lower in AIT-C than DLP cultures; explant retention of [3H]testosterone-derived DHT; tissue capacity to hydroxylate [3H]5 alpha-androstane-3 beta,17 beta-diol; total and nuclear high-affinity binding of [3H]DHT to salt-extractable explant protein, except for one AIT-C which yielded half the number of binding sites. Since AIT carried in either intact or castrated hosts is competent as regards formation, retention and high-affinity binding of [3H]DHT in organ culture, we conclude that the neoplasm possesses some of the characteristics considered essential for the expression of androgen responsiveness in vivo.

Multiple phenotypes of prostatic glandular cells in castrated dogs after individual or combined treatment with androgen and estrogen. Morphometric, ultrastructural, and cytochemical distinctions

To demonstrate a potential for multidirectional differentiation in mature prostatic epithelium, 17 beta-estradiol 17-cyclopentylpropionate (ECP) and 5 alpha-androstane-3 alpha, 17 beta-diol dipropionate (3 alpha-diol DP) were administered individually and in combination to castrated dogs. Quantitative ultrastructural and cytochemical methods were used to distinguish phenotypes of glandular cells in the various hormonal environments. Castration-induced glandular cell regression was accompanied by an increased nuclear to cytoplasmic ratio; by enhanced keratin positivity, expressed as dispersed immunolabeled tonofilaments; and by an absence of peanut agglutinin (PNA) binding sites on luminal membranes. Administration of ECP resulted in squamous metaplasia as well as hypertrophy of the glandular epithelium. The hypertrophied estrogen-modified glandular (EMG) cells were characterized by a new population of small (0.29 micron in diameter) secretory granules, bundles of tonofilaments, and PNA-positive luminal membranes. Treatment of castrated dogs with 3 alpha-diol DP produced a greater epithelial hypertrophy than ECP. These cells were characterized by larger (0.49 micron in diameter) secretory granules, dispersed tonofilaments, and no detectable PNA receptors. Joint administration of ECP and 3 alpha-diol DP caused a florid response including squamous metaplasia and hypertrophy of the glandular epithelium which was associated with the emergence of a novel phenotype in androgen-estrogen modified glandular (A-EMG) cells. In A-EMG cells, secretory granules were similar in size to those found in 3 alpha-diol DP-dominated epithelium whereas tonofilaments often appeared in bundles and luminal membranes were PNA positive, i.e., features found in EMG cells. Our results indicate that atrophic canine prostatic glandular cells possess pluripotentiality of response to sex hormones.

Prostatic cytosol binding of 5 alpha-androstane-3 beta, 17 beta-diol and estradiol-17 beta

The goal of the present research was characterization of the interaction of 5 alpha-androstane-3 beta, 17 beta-diol (3 beta-diol) with prostatic estradiol-17 beta(E2) binding sites to address the role of this 5 alpha-dihydrotestosterone(DHT)a metabolite in prostatic regulation. Using dextran-charcoal assay we demonstrated specific 3 beta-diol and E2 binding sites in rat ventral prostate cytosol (RVPC) and dog prostate cytosol (DPC). In both cytosols, E2 binding is of high affinity (Ka congruent to 10(9) M-1; RVPC:68 fmol/mg protein), DPC:170 fmol/mg protein), and 3 beta-diol binding is of moderate affinity (Ka congruent to 10(8) M-1; RVPC:62 fmol/mg protein, DPC:165 fmol/mg protein). Unlabeled 3 beta-diol competes effectively for cytosolic 3H-E2 binding sites, whereas unlabeled DHT, 5 alpha-androstane-3 alpha, 17 beta-diol (3 alpha-diol) and testosterone (T) are poor competitors for 3H-E2 binding sites. Using DNA-cellulose column chromatography, we separated prostatic androgen and estrogen binding activities. The E2 binding activity which adhered to DNA-cellulose was displaced by 100-fold excess 3 beta-diol but not by DHT. Thus data from two assay procedures show competition of 3 beta-diol for 3H-E2 binding sites in rat and dog prostate.

Hydroxylation of [3H]5 alpha-androstane-3 beta,17 beta-diol by whole tissue, epithelial cells and fibroblasts from the same hyperplastic human prostate

Hydroxylations of 3 beta-hydroxy 5 alpha-dihydro C19-steroids are terminal reactions by which male accessory sex organs dispose of intracellular androgens. Cellular androgen egress is of particular interest in benign prostatic hyperplasia (BPH) where the elevated nuclear 5 alpha-dihydrotestosterone-receptor content may be implicated in the etiology of the disease. We here report substitution of hydroxyl groups at C-6 alpha, C-7 beta and predominantly at C-7 alpha of [3H]5 alpha-androstane-3 beta,17 beta-diol on incubation of 3 and 8.5 nM substrate concentrations with minced and explanted human BPH tissue. Fibroblasts isolated from the same prostatectomy specimen hydroxylated 3 nM radiosubstrate mainly at C-6 alpha, with extensive metabolism to 17-oxosteroids. Epithelial cells from the same tissue source substituted to the same extent at the three positions. Competing 3 beta-hydroxysteroid dehydrogenase exceeded hydroxylase activity only in epithelial-cell cultures. Our findings support previous evidence that prostatic epithelial and stromal cells make different contributions to androgen disposition by the 3 beta-hydroxysteroid pathway.

Metabolism of radiotestosterone to 3 beta,6 alpha- and 3 beta,7 alpha-dihydroxy 5 alpha-steroids by rat ventral, canine and human prostate in organ culture

We report here the structural assignment for the hydroxylated 5 alpha-reduced metabolites in the culture medium following incubation of radiolabelled testosterone with explants of rat ventral prostate, canine cauda epididymidis and prostate, and benign hyperplastic canine and human prostate. Explants were incubated for 21 h at 37 degrees C in surface contact with serum-free Trowell's T8 medium containing 1.7 microM or 8.5 nM substrate. After uptake determination, radiosteroid patterns in explants and media were obtained by t.l.c. The C19O3-metabolites released into the culture medium were resolved by h.p.l.c. and fractions migrating with appropriate reference compounds were crystallized to constant SA with carriers synthesized for this purpose. 5 alpha-Androstane-3 beta,6 alpha,17 beta-triol and 3 beta,6 alpha-dihydroxy-5 alpha-androstan-17-one were identified as the major C19O3-radiometabolites of rat ventral prostate. In the culture medium of canine prostate and epididymis and human prostate, 5 alpha-androstane-3 beta,7 alpha,17 beta-triol and 3 beta,7 alpha-dihydroxy 5 alpha-androstan-17-one were the principal hydroxylation products, with 6 alpha-hydroxy epimers as significant minor products of the canine prostate and epididymis and 5 alpha-androstane-3 beta,7 beta,17 beta-triol as a significant minor radiometabolite of human prostate tissue. Treatment of the castrated dog with androgen and estrogen causes an oxidative shift to striking predominance of 3 beta,7 alpha-dihydroxy 5 alpha-androstan-17-one. The 3 beta-hydroxy-5 alpha-androstane configuration of the identified C19O3-metabolites supports a pathway of prostatic and epididymal testosterone disposition which effects activation by 5 alpha-reductase and inactivation and egress by the coupled 5 alpha-3-oxosteroid reductase/3 beta-hydroxysteroid hydroxylase reactions.

Ultrastructural and biochemical expressions of divergent differentiation in prostates of castrated dogs treated with estrogen and androgen

To investigate the role of estrogen and androgen in prostatic differentiation and induction of epithelial hyperplasia, we studied ultrastructural and biochemical responses to estradiol-17 beta 17-cyclopentylpropionate (ECP) and 5 alpha-androstane-3 alpha, 17 beta-diol dipropionate (3 alpha-diol DP) in glands of castrated dogs. The hormones were injected individually or in combination. Organ cultures, incubated with 1.7 microM radioisotope-labeled testosterone in serum-free Trowell T8 medium, were used to compare capacities of key transforming enzymes in hormone-modified glands. High-affinity binding of labeled 8.5 nM estradiol-17 beta and 5 alpha-dihydrotestosterone (5 alpha-DHT) to 0.4 M KCl-extractable explant protein was also determined. Treatment with 1 mg. of ECP per week for 2 weeks produced basal cell mitosis and early squamous metaplasia. The glandular epithelium hypertrophied but was not repopulated. When compared with radiotestosterone disposition by explanted prostate from untreated castrates, increased formation and egress of 17-oxo C19O2 steroids, predominantly 4-androstene-3,17-dione, occurred at the expense of 5 alpha-reduced 17 beta-hydroxy C19O2-steroids and hydroxylated metabolites. Administration of 2 x 50 mg. of 3 alpha-diol DP per week for 2 weeks also induced basal cell proliferation. The glandular epithelium was repopulated, and atrophic glandular cells were partially restored. This treatment increased accumulation of radiotestosterone-derived 5 alpha-reduced C19O2-metabolites and C19O3-steroids in the explants. Joint administration of ECP and 3 alpha-diol DP yielded proliferating squamous and glandular cells within the same acinus. Each type of proliferating cell was identified by specific cytologic markers. Chromosomes were observed with tonofilament bundles in squamous cells and with secretory granules in glandular cells. However, most glandular cells were not dividing. They were characterized by co-existing tonofilament bundles and secretory granules. The dual hormone administration increased radiotestosterone metabolism. The separate effect of each hormone was notable since estrogen increased the ratio of 17-oxo C19O2 to 5 alpha-reduced 17 beta-hydroxy C19O2-metabolites, whereas androgen restored both terminal hydroxylations and high-affinity binding of 5 alpha-DHT. The levels of saturable binding of estradiol-17 beta were high but variable in explants of each treatment group. We conclude that estrogen and androgen act cooperatively and synergistically on basal cells of regressed canine prostate to induce divergently differentiated epithelial cells. Together with stromal components, these glandular and squamous cells express distinctive pathways of androgen disposition.

Estrogen-mediated exocytosis in the glandular epithelium of prostates in castrated and hypophysectomized dogs

Glandular cells in the prostate of the intact, adult dog contain numerous, large secretory granules that are released by exocytosis. Following hypophysectomy or castration, the glandular epithelium atrophies and the secretory granules degenerate and eventually disappear. Pharmacologic doses of estradiol-17 beta 17-cyclopentylpropionate cause the regressed glandular cells to synthesize a new population of smaller granules that are also released by exocytosis, even though estrogen is known to inhibit fluid secretion by the canine prostate. Thus, the mechanisms involved in prostatic synthesis and exocytosis of secretory granules are independent of those regulating fluid secretion and are operative in the absence of androgen or pituitary hormones.

Primary epithelial cell cultures derived from canine prostate: isolation, culture, and characterization

Epithelial-cell-enriched primary cultures were established from canine prostate. Minced tissue was dissociated with 750 units/ml of collagenase in F12K tissue culture medium containing 1% fetal bovine serum. This treatment resulted in the gradual removal of stromal elements from the base of the epithelial cells. After 30 minutes of digestion, aggregates of epithelial cells free of stroma were dislodged from the minced pieces of prostate. These aggregates were washed and plated at high density in F12K plus 10% fetal bovine serum. After 12-16 hours in vitro the unattached cellular aggregates were removed from the culture dishes, washed, and reinoculated into new culture vessels containing fresh medium. After 48 hours in vitro, the aggregates had attached to the culture vessels and spread out to yield discrete patches of epithelial cells. By 120 hours in vitro the patches of cells had grown and coalesced to form a confluent monolayer of epithelial cells. Ultrastructural examination of these cultures indicated that adjacent cells were joined by desmosomes and tight junctions and had tonofilaments and microvilli, giving the cells an epithelial appearance. The cells contained rough endoplasmic reticulum, Golgi apparatus, and secretory granules similar to those of the epithelial cells in the intact organ. In addition, intracellular "blebs" containing acid phosphatase were observed in the monolayers and were found to increase in size and number with time in vitro. Differentiated function of the cultures was demonstrated by the presence of ornithine decarboxylase and acid phosphatase and the ability of the cultures to metabolize testosterone to primarily 5 alpha-reduced metabolites.

C19-Steroid metabolism by canine prostate, epididymis and perianal glands. Application of the twin-ion technique of gas chromatography/mass spectrometry to establish 7 alpha-hydroxylation

The present study applied the twin-ion technique of gas chromatography/mass spectrometry to establish 7 alpha-hydroxylation of 5 alpha-androstane-3 beta, 17 beta-diol by canine prostate, epididymis and perianal glands. 5 alpha-[4-14C, 7 beta-2H0.52]Androstane-3 beta, 17 beta-diol (0.5 microM) was incubated for 60 min at 37 degrees C with minced canine prostate and epididymis in 50 ml 0.067 M phosphate buffer (pH 7.4) containing NADPH (0.2 mM). The principal radioactive metabolite fraction was isopolar in thin-layer chromatography with 5 alpha-androstane-3 beta, 7 alpha, 17 beta-triol and contained 24% (prostate incubation) and 23% (epididymis incubation) of the radioactivity added. Following gas chromatography of the trimethylsilyl ether derivative of these metabolites, the peak with the retention time of the derivative of 5 alpha-androstane-3 beta, 7 alpah, 17 beta-triol yielded a mass spectrum consistent with that of the authentic standard triol and gave the characteristic twin-ion, though with some loss of deuterium. Incubation of 5 alpha-[4-14C, 7 beta-2H0.46]dihydrotestosterone (7 microM) and minced canine perianal glands and NADPH (0.2 mM) gave in 5% yield a transformation product with an RF-value of 5 alpha-androstane-3 beta, 7 alpha, 17 beta-triol. One half of the chromatographic fraction was subjected to gas chromatography/mass spectrometry as the free steroid, the other as the CrO3-oxidation product. The site of hydroxylation was identified as 7 alpha from the gas chromatography retention time of the free 7 beta-deuterated (twin-ion) triol and mass-spectrometry loss of deuterium in the 3,7,17-trione produced by mild CrO3 oxidation. Results of a comparative study of the metabolism of [4-14C]testosterone and 5 alpha-dihydro[4-14C]-testosterone with minced canine perianal glands and shoulder skin showed that, whereas both tissues contain a high level of 3 beta-hydroxysteroid oxidoreductase, only the perianal glands were able to transform radioactive testosterone to the 5 alpha-reduced derivatives and thence to the 7 alpha-hydroxylated product.

Effects of estrogen and androgen on the ultrastructure of secretory granules and intercellular junctions in regressed canine prostate

Epithelial cells in the prostate of the castrated or hypophysectomized dog were studied by thin-section and freeze-fracture electron microscopy to determine in vivo responses to estradiol-17 beta 17-cyclopentylpropionate (ECP) and testosterone cyclopentylpropionate (TCP). Particular attention was given to changes in specific organelles and intercellular junctions that might reflect hormone action. The few secretory granules that remain in the regressed epithelium (vestigial granules) serve as markers of prior androgen responsiveness. Pharmacologic doses of ECP caused regressed glandular cells to acquire a novel phenotype. Characteristic features of these estrogen-modified glandular (EMG) cells are newly formed secretory granules and tonofilament bundles that coexist with vestigial granules, thus demonstrating bipotentiality of response. Glandular cell-tight junctions appear unaltered by the endocrine manipulations. Although EMG cells have squamous cell features, tight junctions remain intact. Desmosomes in the canine prostate are dimorphic and are classified 70F and 100F according to the width of the filaments that converge on the dense plaques. In intact dogs, 100F desmosomes are associated with basal-reserve cells, whereas only the 70F variety is found between glandular cells. TCP treatment does not alter this distribution. Following ECP administration, both 70F and 100F desmosomes are present between EMG cells. The coexistence of newly formed secretory granules and tonofilaments of 100F desmosomes in the same EMG cell represents estrogen-induced bidirectional differentiation. Our findings indicate that androgens and estrogens are individually capable of controlling the expression of secretory granules and desmosomes. In intact animals, male and female sex hormones may act in concert to direct epithelial cell differentiation of the prostate.

Bipotentiality of response to sex hormones by the prostate of castrated or hypophysectomized dogs. Direct effects of estrogen

Prostatic response to administered estradiol-17beta 17-cyclopentylpropionate (ECP) was studied in castrated or hypophysectomized dogs. Ultrastructural investigation identified two types of epithelial cells, squamous and modified glandular, that resulted from estrogen action. Squamous cells, which predominated, appeared to evolve from basal reserve cells. Estrogen-modified glandular cells have features attributable to estrogen and previous androgen stimulation. Thaw-mount autoradiography of explants located radiolabeled estrogen in prostatic epithelium and stroma of normal and ECP-treated animals, suggesting a role of estrogen in prostatic homeostasis. Epithelium from ECP-treated dogs incorporated 3H-thymidine, indicating that estrogen promotes DNA synthesis in these cells. Greatly enhanced conversion of radiotestosterone to 4-androstene-3,17-dione, with sharply decreased formation of 5alpha-reduced hydroxylation products, and attendant elevation in estradiol-17beta oxidoreductase activity are metabolic markers attributable to the induced squamous and responding stromal cells. The duality of prostatic response to sex hormones is apparent from observations that estrogen stimulates regressed glandular epithelium which had undergone androgen-mediated differentiation before ablation.

Correlative study of the morphology and C19-steroid metabolism of benign and cancerous human prostatic tissue

Perineal punch biopsy specimens of human prostate with benign hyperplasia (BPH), well- and poorly-differentiated adenocarcinoma and transitional-cell carcinoma were incubated with testosterone-1,2-3H and 5alpha-dihydrotestosterone-1,2-3H. Incubations were carried out using a single tissue-radiosubstrate ratio and time point. Resulting radiosteroid patterns were related to histologic and ultrastructural features of these tissues. Well differentiated neoplasms had ultrastructural characteristics closely resembling hyperplastic epithelia. Both in BPH and in well differentiated carcinomas the C19-steroids were mainly metabolized by the 17beta-hydroxysteroid pathway. In contrast, cells in poorly-differentiated adenocarcinoma and transitional-cell carcinoma lacked the cytoplasmic organelles responsible for secretion; formation of 5alpha-reduced 17beta-hydroxysteroids was decreased in these carcinomas, while conversion to 17-oxosteroid radiometabolites remained unchanged or was greatly increased. These results indicate that loss of prostatic differentiation is attended by a trend from reductive toward oxidative radiotestosterone metabolism. Even in NAPDH-supplemented preparations of the majority of poorly-differentiated tumors, there was diminished transformation to 5alpha-dihydrotestosterone, the key intracellular hormone in the expression of androgenic activity in the prostate. These findings may explain why poorly-differentiated prostatic neoplasms are frequently unresponsive to anti-androgenic therapy.

In vitro metabolism of testosterone-4-14 C by canine salivary glands

Testosterone-4-14C (2430 pmol, 0.48 muM) was incubated aerobically in 67 mM phosphate buffer pH 7.4 with homogenates and minces of salivary glands from male dogs. Extracted radiosteroids were resolved by thin-layer chromatography on silica gel, removed and quantitated. Substantially higher NAD+-dependent 17beta-hydroxy-C19-steroid oxidoreductase activity was found in submaxillary gland homogenates than in similar parotid-gland preparations. Preliminary evidence is presented that the enzyme activity per unit wet weight of the minced submaxillary gland is decreased in the 2-week male castrate, in the absence of any recognizable histologic changes in the gland. Testosterone metabolism by canine salivary glands is thus oxidative, contrasting with the reductive 17 beta-hydroxysteroid pathway characteristic of androgen-dependent organs such as the prostate, and is more extensive than in this accessory sex tissue. Our findings suggest that the canine salivary glands are not target organs for circulating male hormone.