Inhibition of a cutaneous nociceptive reflex by a noxious visceral stimulus is mediated by spinal cholinergic and descending serotonergic systems in the rat.

The present study examined the spinal pathway and receptors that mediate nocigenic inhibition of the tail-flick (TF) reflex produced by conditioning colorectal distension (CRD). Conditioning CRD (80 mmHg; 30 s) inhibited the TF reflex in all rats studied (n = 29). In 19 rats where intensity-dependent effects of CRD were studied, conditioning CRD in 7 rats facilitated the TF reflex at lesser, non-noxious intensities (mean 7.9 +/- 2.1 mmHg) and inhibited the TF reflex at greater, noxious intensities (40-100 mmHg); conditioning CRD at all intensities tested only inhibited the TF reflex in the other 12 rats. Inhibition of the TF reflex produced by 30 s CRD was short-lasting, repeatable and graded with the intensity of CRD. The mean threshold of CRD for inhibition of the TF reflex to cut off (10 s) was 61.4 +/- 3.3 mmHg (n = 29). Intrathecal pretreatment with atropine or methysergide significantly attenuated the inhibitory effect of CRD on the TF reflex; the effects were time- and dose-related. Intrathecal pretreatment with mecamylamine, phentolamine or naloxone was without effect. Intrathecal administration of physostigmine, an acetylcholinesterase inhibitor, significantly reduced the threshold intensity of conditioning CRD necessary to inhibit the TF reflex to cut off (mean 36.0 +/- 4.0 mmHg; n = 5). Bilateral transections of the spinal dorsolateral funiculi (DLF) did not affect the inhibitory effect of CRD in 4/7 rats and attenuated the inhibitory effect of CRD in the other 3 rats. The antagonistic effect of methysergide on CRD-produced inhibition of the TF reflex was abolished following the DLF transections, while scopolamine retained its efficacy in rats with bilateral DLF transections. These findings provide evidence for involvement of spinal cholinergic interneurons as well as a descending serotoninergic pathway traveling in the DLF in CRD-produced inhibition of the TF reflex.


Vagal afferent-mediated inhibition of a nociceptive reflex by i.v. serotonin in the rat. II. Role of 5-HT receptor subtypes.

In the rat, intravenous (i.v.) serotonin (5-HT) is a noxious stimulus which produces distinct vagal afferent-mediated pseudoaffective responses, a passive avoidance behavior, a vagal afferent-mediated inhibition of the nociceptive tail-flick (TF) reflex and a complex triad of cardiovascular responses. In the present study, we have used a variety of 5-HT receptor antagonists to characterize the receptor subtype(s) in the rat that mediate (1) inhibition of the TF reflex and (2) the cardiovascular responses produced by i.v. 5-HT. 5-HT produced a dose-dependent (3-72 micrograms/kg, i.v.) inhibition of the TF reflex (ED50 = 15.3 +/- 0.7 micrograms/kg). Following administration of the 5-HT2 receptor-selective antagonists ketanserin (50-250 micrograms/kg, i.v.) or xylamidine (10-100 micrograms/kg, i.v.), or the 5-HT3 receptor-selective antagonists ICS 205-930 (50-250 micrograms/kg, i.v.) or MDL 72222 (25-250 micrograms/kg, i.v.), there appeared to be a parallel shift of the 5-HT dose-response curve to the right. Following co-administration of xylamidine (50 micrograms/kg, i.v.) with ICS 205-930 (100 micrograms/kg, i.v.), the 5-HT-induced inhibition of the TF reflex was completely abolished at all doses of 5-HT tested (3-288 micrograms/kg, i.v.). In contrast, administration of the centrally acting 5-HT2 receptor-selective antagonist LY 53857 (10-100 micrograms/kg, i.v.) or the non-specific receptor antagonist methysergide (25-500 micrograms/kg, i.v.) resulted in a dose-dependent, but not parallel shift of the 5-HT dose-response curve to the right. The maximal doses of LY 53857 and methysergide tested (250 micrograms/kg and 500 micrograms/kg, respectively) completely abolished the effects of 5-HT (3-288 micrograms/kg, i.v.). Administration of the alpha 1-adrenoceptor antagonist prazosin (25-100 micrograms/kg, i.v.) failed to alter the 5-HT dose-response curve, indicating that the effects of ketanserin were due to blockage of 5-HT2 receptors rather than alpha 1 receptors. Administration of each of the antagonists also produced marked, but selective effects on components of the complex cardiovascular response to i.v. 5-HT. Each of the 5-HT3 receptor selective antagonists (ICS 205-930 or MDL 72222) produced a dose-dependent attenuation of the Bezold-Jarisch reflex-mediated hypotension and bradycardia, and each of the 5-HT2 receptor selective antagonists (xylamidine, ketanserin or LY 53857) produced a dose-dependent attenuation of the pressor response. The non-specific 5-HT receptor antagonist methysergide produced a dose-dependent attenuation of the 5-HT-induced pressor response.(ABSTRACT TRUNCATED AT 400 WORDS)


Transferrin receptors of rat and human brain and cerebral microvessels and their status in Alzheimer's disease.

We studied the regional distribution of specific [125I]transferrin binding to transferrin receptors in the brains and cerebral microvessels of humans and rats. We also assessed transferrin receptors in subjects with Alzheimer's disease. Human diferric [125I]transferrin bound to regional brain and cerebral microvessels with high affinity (dissociation constants of 1-10 nM), and the maximal binding densities ranged from 30 to 90 pmol/mg protein in the brain and were several-fold higher in cerebral microvessels. In Alzheimer's disease, transferrin receptor densities were significantly reduced in the hippocampus and the temporal and occipital cortex but were unchanged in the frontal and parietal cortex and the cerebellum. Although [125I]transferrin binding was higher in cerebral microvessels from subjects with Alzheimer's disease than in those of age-matched controls, this difference did not attain statistical significance. These results suggest that transferrin receptor density was decreased in some cortical areas including the hippocampus in Alzheimer's disease but relatively unchanged in cerebral microvessels.


Evidence that cholecystokinin-enhanced retention is mediated by changes in opioid activity in the amygdala.

Mice, partially trained to avoid footshock in a T-maze, showed enhanced retention relative to vehicle-injected mice when treated peripherally with arecoline, D-amphetamine, cholecystokinin octapeptide (CCK-8), epinephrine or naloxone. Both intra-amygdaloid and intraventricular injections of beta-endorphin resulted in amnesia. D-amphetamine and arecoline blocked the amnestic effect of beta-endorphin administered into the amygdala but it required higher doses for CCK-8, epinephrine and naloxone to block the amnestic effect of beta-endorphin. The effects of CCK-8, epinephrine and naloxone showed a differential ability to block amnesia induced by beta-endorphin intraventricularly with epinephrine and naloxone preventing amnesia but CCK-8 not improving retention. This data suggests that the memory enhancement produced by peripherally administered CCK-8 involves the amygdala and that both CCK-8 and epinephrine interact with opioid amnestic mechanisms within the amygdala to alter memory processing.


Evidence of alpha-N-acetyl beta-endorphin in human cerebrospinal fluid.

Alpha-N-acetyl-beta-endorphin (Ac-beta-EP) is a post-translational product of beta-endorphin (beta-EP) with no analgesic properties. Ac beta-EP is present in human fetal and adult pituitary gland and cross-reacts in all available beta-EP assays. This study evaluates levels of Ac-beta-EP in the cerebrospinal fluid (CSF) of 22 normal subjects and 15 chronic headache sufferers. Since dopamine may play a role in the acetylation process, homovanillic acid levels were also determined. After extraction and high performance liquid chromatographic (HPLC) fractionation of CSF, an immunoreactive Ac-beta-EP peak was detected coeluting with reference peptide. Ac-beta-EP was detectable in all but 5 normal subjects. In headache sufferers, Ac-beta-EP levels were always detectable and their mean value was significantly higher than that of healthy subjects (11.6 +/- 11.8 vs 3.9 +/- 3.6 fmol/ml; P less than 0.01). Conversely, CSF beta-endorphin (beta-EP) concentrations were decreased in headache patients (9.8 +/- 9.4 vs 15.7 +/- 9.7 fmol/ml; P less than 0.05), and as a consequence the beta-EP/Ac-beta-EP ratio was also markedly reduced (P less than 0.005). No difference was observed for CSF homovanillic acid concentrations. These data demonstrate that HPLC coupled to radioimmunoassay allows the identification of low but significant amounts of Ac beta-EP in human CSF. This compound represents a confounding factor when beta-EP immunoreactivity is assessed by conventional methods. In headache sufferers, Ac-beta-EP levels were higher than normal, whereas beta-EP concentrations were lower.(ABSTRACT TRUNCATED AT 250 WORDS)


Endothelin acts at the subfornical organ to influence the activity of putative vasopressin and oxytocin-secreting neurons.

Systemic endothelin-1 (ET-1) enhances the activity of subfornical organ (SFO) neurons with identified projections to the paraventricular nucleus of the hypothalamus (PVN). The present electrophysiological experiments were undertaken to examine the mechanisms through which systemic ET influences vasopressin secretion. Systemic ET-1 (50-100 pmol) was found to influence the excitability of antidromically identified vasopressin and oxytocin-secreting neurons in the PVN or supraoptic nucleus (SON) of urethane-anaesthetized rats. Long-term stable recordings from 95 antidromically identified neurons showed 56% of putative vasopressin- (n = 41), and 37% of putative oxytocin- (n = 54) secreting neurons were activated by ET-1. Such effects normally demonstrated a short latency (less than 10 s), with a duration ranging between 10 and 300 s. In contrast, unidentified neurons in the vicinity of PVN and SON (n = 27) were unaffected by ET-1. The inability of peptides to cross the normal blood-brain barrier suggested that such effects of ET-1 result from actions of this peptide at the SFO which lacks this barrier and sends efferent neural projections to both SON and PVN. This hypothesis was tested by obtaining similar recordings from animals in which this structure was destroyed prior to experimentation. In these studies recordings from 15 putative vasopressin- and 29 putative oxytocin-secreting neurons showed that only 7% and 14%, respectively, were excited by systemic ET-1 in lesioned animals. These data show that increases in circulating levels of ET have predominantly excitatory effects on vasopressin- and oxytocin-secreting neurons in SON and PVN. The modified responsiveness of these neurons to ET-1 in SFO-lesioned animals suggests this as a likely CNS site at which this peptide acts within the central nervous system to elicit such effects.


Cholinergic and noradrenergic stimulation in the rabbit flocculus have synergistic facilitatory effects on optokinetic responses.

A recent study (Exp. Brain Res., 85 (1991) 475-481) showed that injection of the cholinergic agonist carbachol into the cerebellar flocculi had a pronounced facilitatory effect on the gains of the optokinetic (OKR) and vestibulo-ocular (VOR) reflexes, suggesting a positive modulatory role of the cholinergic system in the flocculus. Because many behavioral and electrophysiological studies throughout the brain have revealed a functional relationship between acetylcholine (ACh) and noradrenaline (NA), the present study was undertaken to compare the effects of floccular injection of the ACh agonist carbachol, the beta-adrenergic agonist isoproterenol and the conjoint injection of both of these substances on the basic gain of the VOR and the OKR. Carbachol and isoproterenol both significantly raised the gain of the OKR, by 0.14 and 0.11 respectively. Neither of the two substances significantly affected the gain of the VOR in light or darkness. Conjoint injection of the same amounts of carbachol and isoproterenol resulted in an increase in the gain of the OKR by 0.29 without significant changes in the gains of the VOR in the light or in darkness. These results suggest a synergistic and positive modulatory role of ACh and NA in the flocculus.


Increased locomotor response to novelty and propensity to intravenous amphetamine self-administration in adult offspring of stressed mothers.

It is suggested that drug addiction is more likely to develop in individuals who are particularly sensitive to the reinforcing effects of drugs. Animal studies of intravenous drug self-administration (SA) have shown that rats display a large range of individual differences in the propensity to develop drug-seeking. Predisposed animals are characterized by a higher locomotor reactivity to both novelty and psychostimulants. In this report, we show that prenatal stress (restraint of the mother during the last week of pregnancy) may contribute to an individual's vulnerability to develop amphetamine self-administration. The adult offspring of stressed mothers exhibited: (i) a higher locomotor response to novelty and to an injection of amphetamine (0.3 mg/kg, i.v.); (ii) a higher level of amphetamine self-administration. The data indicate that individual predisposition to drug-seeking in the adult may be induced by prenatal events.


1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) reduces norepinephrine concentrations in the olfactory bulbs of male mice.

Male retired breeder C57/Bl and CD-1 mice were treated with either MPTP or its vehicle. At 7-10 days post-treatment, catecholamine concentrations within the olfactory bulbs (OB) and hypothalamus were determined. Norepinephrine concentrations within the OB were significantly decreased in MPTP-treated mice. These effects were more pronounced in the CD-1 (50% reduction) compared to the C57/Bl (20% reduction) strain. No effects of MPTP were observed on norepinephrine concentrations within the hypothalamus. Dopamine concentrations in the OB and hypothalamus did not differ between MPTP- and vehicle-treated mice in either strain. Overall, catecholamine concentrations within the OB, but not the hypothalamus, were significantly greater in C57/Bl compared to CD-1 mice. The reduction in OB norepinephrine concentration in the MPTP-treated animals may be related to the olfactory deficits which accompany Parkinson's disease.


Differential long-term effect of AF64A on [3H]ACh synthesis and release in rat hippocampal synaptosomes.

The activities of various presynaptic cholinergic parameters were determined in hippocampal synaptosomes of rats 29 weeks after intracerebroventricular injection of ethylcholine aziridinium (AF64A) (3 nmol/2 microliters/side) or vehicle (saline). Synaptosomes were preloaded with [3H]choline ([3H]Ch), treated with diisopropyl fluorophosphate to inhibit cholinesterase activity and then were assayed for their content of [3H]Ch and [3H]acetylcholine ([3H]ACh) and for their ability to synthesize and release [3H]ACh. In synaptosomes from AF64A-treated rats compared with synaptosomes from vehicle-treated rats we observed that: (i) specific uptake of [3H]Ch was reduced to 60% of control; (ii) residing [3H]ACh levels were 43% of control while residing [3H]Ch levels were 72% of control; (iii) basal and K(+)-induced [3H]ACh release were 77% and 73% of control, respectively; (iv) high K(+)-induced synthesis of [3H]ACh was only 9% of control; (v) but, choline acetyltransferase activity remained relatively high, being 80% of control. These results suggest that AF64A-induced cholinergic hypofunction is expressed by both loss of some cholinergic neurons and impairment in the functioning of the spared neurons.


The effects of prenatal cocaine exposure on spontaneously active midbrain dopamine neurons in adult male offspring: an electrophysiological study.

In this study, the technique of extracellular single unit recording was used to examine the effect of prenatal cocaine exposure on the number of spontaneously active dopamine (DA) cells in the substantia nigra pars compacta (SNC or A9) and the ventral tegmental area (VTA or A10) of male Sprague-Dawley rats on postnatal days 56-68. In addition, the effect of the direct DA receptor agonist (+/-)-apomorphine (APO) on the basal firing rate of A10 DA cells was also determined. A significant decrease in the number of spontaneously active A10 DA cells was observed in offspring whose dams were treated with 40 mg/kg/day of cocaine s.c. from gestational days 8-20 when compared with offspring of pair-fed and non-treated control dams. The number of spontaneously active A9 DA cells was significantly decreased in the offspring of cocaine-exposed dams when compared to pair-fed offspring. In contrast, there were no significant differences among the three prenatal groups regarding the sensitivity of spontaneously active A10 DA cells to APO (2-64 micrograms/kg, i.v.). Overall, our results suggest that in utero cocaine exposure may alter presynaptic DA activity in offspring long after their exposure has been terminated.


Zebrin II distinguishes the ampullary organ receptive map from the tuberous organ receptive maps during development in the teleost electrosensory lateral line lobe.

In weakly electric gymnotiform teleosts, monoclonal antibody anti-zebrin II recognizes developing pyramidal cells in the ampullary organ-receptive medial segment of the medullary electrosensory lateral line lobe (ELL) and in the mechanoreceptive nucleus medialis. Developing pyramidal cells in the remaining three tuberous organ-receptive lateral ELL segments are unreactive. These results suggest that certain biochemical features of the ELL ampullary organ-receptive medial segment are more similar to the nucleus medialis than to the tuberous organ-receptive ELL segments, and support the hypothesis that the ampullary system evolved from mechanosensory precursors.


c-fos expression in noradrenergic A2 neurons of the rat during the estrous cycle and after steroid hormone treatments.

The expression of the proto-oncogene product fos in noradrenergic neurons of the A2 cell group was studied with immunohistochemistry during the estrous cycle of the rat and after ovariectomy and estrogen treatments. During the estrous cycle the percentage of fos-positive norepinephrine containing neurons was highest at proestrus (39%), followed by estrus (36%) while during diestrus only 4% of the A2 neurons contained immunoreactive fos protein in their nuclei. Ovariectomy caused a further decrease in the number of fos-positive A2 neurons (2%) while long-term estradiol administration partially reversed the effects of ovarian steroid removal (19%). However, 3 h after a single subcutaneous injection of estradiol into ovariectomised rats, 79% of the noradrenergic neurons in the A2 area showed fos immunoreactivity in their nuclei. The results indicate that fos-expression in the noradrenergic neurons in the A2 region varies depending upon the circulating estradiol levels. Since norepinephrine stimulates gonadotropin releasing hormone (GnRH) secretion from the median eminence during proestrus and the GnRH neurons do not contain estrogen receptors, it is suggested that the A2 region is, at least in part, responsible for conveying the estrogen signal to the GnRH neurons.


A role for acetylcholine in conditioning-related responses of rat frontal cortex neurons: microiontophoretic evidence.

In an associative conditioning paradigm, an auditory stimulus (CS+) was paired with rewarding medial forebrain bundle stimulation or a tone of different frequency (CS-) was presented without pairing. After training, slow potential (SP) and single neuron responses were recorded from rat frontal cortex. When cortical SP responses indicated the development of discrimination between CS+ and CS- tones, single neurons could be isolated that exhibited a discriminative response to CS+. Seventy-three percent of the 56 neurons which discriminated between CS+ and CS- were excited by the paired tone while the remainder were inhibited. Iontophoretically applied acetylcholine increased spontaneous firing rate in 90% of the excited cells and 87% of the inhibited cells. Iontophoretic administration of a muscarinic receptor antagonist, either atropine or tropicamide, during trial presentation attenuated the conditioning-related response to CS+ as well as the response to acetylcholine in the majority of neurons. The largest group of discriminating neurons were excited by both CS+ and acetylcholine, and both responses were suppressed by the antagonists. The results provide evidence that conditioning-related responses of a major population of frontal cortex neurons are modulated by cholinergic input, a portion of which may originate in the basal forebrain area. There also may be a significant non-cholinergic influence on these neuronal responses.


Nerve growth factor promotes collateral sprouting of cholinergic fibers in the septohippocampal cholinergic system of aged rats with fimbria transection.

Nerve growth factor (NGF) was injected intraventricularly into aged (24 months) rats with unilateral fimbria transection. Controls received intraventricular injections of cytochrome c. A quantitative analysis of acetylcholinesterase (AChE)-positive fibers was used to evaluate whether the NGF treatment can stimulate regeneration and reinnervation of the cholinergic axons in the septohippocampal system of aged rats with fimbria transection. A marked increase in the density of AChE-positive fibers was observed in the lateral septum, the dorsal fornix and the dorsal hippocampus of the NGF-treated animals, as compared to the controls. In the lateral septum, the increase was observed in the 2-month NGF-treated animals but not in the 15-day NGF-treated animals. In the dorsal fornix at the level of the dorsal hippocampus, the increase was observed on both the lesioned and unlesioned sides of both the 15-day and 2-month NGF-treated animals. In the denervated (lesioned side) hippocampus, the increase took place in the dorsal hippocampus but not in the ventral hippocampus of both the 15-day and 2-month NGF-treated animals. There was no recovery of AChE-positive fibers on the lesioned side of the fimbria distal to the lesion site even in the 2-month NGF-treated animals. These results demonstrate that intraventricular injections of NGF can stimulate collateral sprouting of intact cholinergic axons in the septohippocampal system and promote cholinergic reinnervation of the denervated hippocampus of aged rats with fimbria transection.


Polyamines inhibit N-methyl-D-aspartate antagonist-induced darting behavior in the rat prefrontal cortex.

The competitive NMDA (N-methyl-D-aspartate) receptor antagonist, CPP (3(2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid), microinjected into the medial prefrontal cortex of rats, induces a unique behavioral syndrome termed 'darting', characterized by rapid leaping across an open field arena. In addition, CPP induces generalized hyperactivity when microinjected into the medial prefrontal cortex, nucleus accumbens, and caudate nucleus. Polyamine modulation of the NMDA receptor was tested at the medial prefrontal cortex microinjection site in this behavioral paradigm. The polyamine spermidine, and its diamine precursor, putrescine, blocked CPP-induced darting behavior, as well as CPP-induced hyperactivity, at doses which did not decrease locomotor activity when administered alone. The putative polyamine antagonists, ifenprodil and diethylenetriamine, did not prevent spermidine from inhibiting CPP-induced darting. These results suggest that polyamines, presumably by acting as positive allosteric modulators of the NMDA receptor, can inhibit the CPP-induced behavioral syndrome at the prefrontal cortex site.


Regional differences in brain norepinephrine and dopamine uptake kinetics in inbred rat strains with hypertension and/or hyperactivity.

High-affinity uptake of norepinephrine (NE) and dopamine (DA) were determined in synaptosomes of brain regions from four genetically related inbred rat strains, all derived from the Wistar-Kyoto rat: SHR, WKY, WKHA and WKHT strains. SHRs express hypertension and hyperactivity, WKHAs express hyperactivity alone, WKHTs express hypertension alone, and WKYs are neither hypertensive nor hyperactive. Significant increases in NE uptake, primarily in Vmax, in cerebral cortical areas and the cerebellum, were associated with the hypertensive trait. Significant increases in DA uptake Vmax in the frontal cortex were associated with the inheritance of hyperactivity among these strains. A limited study in SHRs indicated that DA uptake in the frontal cortex increased with age, and that males did not differ from females. No changes in DA uptake in the neostriatum were found with respect to either strain, or age or sex. These findings revealed changes in brain catecholamine neuronal function that are of relevance to both hypertension and hyperactivity. This was made possible by the availability of WKHA and WKHT, in addition to WKYs, as appropriate controls for the SHR.


Neurons in the median preoptic nucleus of the rat with collateral branches to the subfornical organ and supraoptic nucleus.

A novel pathway between the subfornical organ and the supraoptic nucleus involving the collateral branches of cell bodies situated in the lamina terminalis has been studied. Fluorogold was injected into the supraoptic nucleus and rhodamine-labelled microspheres into the subfornical organ of rats. Nineteen % of neurons in the median preoptic nucleus and 30% of neurons in the OVLT projecting to the subfornical organ also had axons extending to the supraoptic nucleus. These pathways may represent a novel trajectory for the rely of information from the lamina terminalis to the supraoptic nucleus.


Treatment of anterior cross-bites in the early mixed dentition.

The diagnosis and treatment of anterior cross-bites are described by categorizing anterior cross-bites into three groups. Appropriate appliance therapy is described in sufficient detail to enable the general dental practitioner to provide interventional treatment.


Dental anxiety: differentiation, identification and behavioral management.

Dental anxiety has always been and still is a major impediment to regular dental care for a significant proportion of the general public. In years past, dental professionals could afford, by and large, to ignore this problem. Practices could flourish based on their technical virtuosity, and fearful or anxious patients might be considered a burden rather than a concern. Today, however, the laws of supply and demand are causing dentists to pay increased attention to aspects of the profession that extend beyond the science of clinical technique. A successful practice now depends on interpersonal as well as technical skills, particularly the ability to manage dental anxiety. Despite this, most dentists admit to a surprising lack of confidence when it comes to understanding the nature of anxiety and the modern methods advocated for its everyday management, which generally rely on behavioral modes of intervention. This paper is designed to familiarize practitioners with some of the basic elements of dental fear and anxiety, and their day to day management.


Colon cancer overview.

The scope of current prevention research support by the National Cancer Institute includes the clinical assessment of dietary modifications and cancer screening trials, epidemiologic studies, development of new chemopreventive therapies, and the use of advanced molecular biologic technologies to probe the genetic determinants of colorectal adenomas. Colorectal cancer frequently has been associated with high-fat low-fiber diets in epidemiologic and experimental studies. A recently initiated Phase III Dietary Intervention Study of Recurrence of Large Bowel Adenomatous Polyps will investigate the potential benefits of a low-fat high-fiber fruit-and-vegetable-enriched eating pattern to decrease the polyp recurrence rate. The Chemoprevention Program currently is supporting four Phase III controlled clinical intervention trials investigating the cancer-inhibiting effects on colorectal cancer of beta-carotene, piroxicam, calcium, and calcium plus fiber in persons with previous adenomas. A proposed early detection trial will screen for colorectal, prostate, lung, and ovarian cancers. A comparison of incidence and mortality trends indicates progress in colorectal cancer detection and therapy.


Molecular genetics of colorectal carcinoma.

The molecular genetics of colorectal carcinoma are among the best understood of any common human cancer. Reported molecular genetic abnormalities involve tumor-suppressor genes that undergo inactivation (e.g., apc, mcc, dcc, p53, and possibly genes on chromosomes 8p, 1p, and 22q) and dominant-acting oncogenes (e.g., ras, src, and myc). Multiple clonal genetic abnormalities accumulate during the development of colorectal carcinoma in adenomas. Altered DNA methylation is an early event, and the specific genetic alterations occur in a preferential order. However, the clinical application of molecular genetics in patients who are at risk for or have colorectal carcinoma is in its infancy. Patients with a predisposition to colorectal carcinoma caused by inheritance of familial adenomatous polyposis can be identified by genetic analysis of the apc gene on chromosome 5q21. In patients who undergo curative resection of colorectal cancer, deletion of the p53 gene on chromosome 17p, deletion of the dcc gene on 18q, and high fractional allelic loss (fraction of nonacrocentric autosomal arms with deletion) in the primary tumor appear to indicate an increased likelihood of occult disseminated disease and thus a poor prognosis. Additional studies are needed to establish the role of the molecular genetics of colorectal carcinoma in the management of patients who are at risk for or already have neoplasia of the large bowel.


The National Polyp Study. Design, methods, and characteristics of patients with newly diagnosed polyps. The National Polyp Study Workgroup.

The National Polyp Study (NPS) is a multicenter prospective randomized trial designed to evaluate follow-up surveillance strategies in patients who have undergone polypectomy for the control of large bowel cancer. The study design was developed by a joint research committee from American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the American College of Gastroenterology. Subjects who met the eligibility criteria were randomized into two different treatment arms. Eligibility criteria included: removal of one or more adenomas; complete colonoscopy; no prior polypectomy, inflammatory bowel disease, or familial polyposis; and no history of colon cancer. The treatment arms consisted of a frequent follow-up (1 and 3 years after initial polypectomy) and a less frequent follow-up (3 years). Follow-up examinations included fecal occult blood tests, air-contrast barium enema, and colonoscopy. The latter was done on 9112 referred patients at the seven participating centers from November 1980 until February 1990 who had no history of polypectomy, colon cancer, familial polyposis, or inflammatory bowel disease. Of these patients, 4763 (52.3%) had no polyps; 549 (6.0%) had an invasive cancer; 776 (8.5%) had nonadenomatous polyps; 208 (2.3%) had incomplete examinations; 184 (2.0%) had other findings; and 2632 (28.9%) had one or more adenomas, of which 1418 (53.9%) were randomized to one of the two treatment arms. This article reports the background, rationale, objectives, methods, and organization of this study and includes patient characteristics on initial presentation. Future data provided by the NPS may help in the development of recommendations for surveillance guidelines for such patients. This study also provides a framework to address questions regarding the natural history of adenomas and their relationship with colorectal cancer.


Screening and early diagnosis.

Although colorectal cancer is the second leading cause of death in the US, the majority of diagnoses are made at an advanced stage, and screening detects 70% at an early stage, controversy has existed because of a lack of experimental controlled trial evidence showing a decrease in mortality. Indirect and now direct evidence supports the current screening guidelines of the American Cancer Society and the National Cancer Institute as reasonable and should be continued.


Goals of screening.

Colorectal cancer is a major target of inquiry into the effectiveness of screening in the control of the disease by earlier detection and possibly reduced incidence after removal of polyps. Four randomized clinical trials are in process to determine the efficacy of fecal occult blood tests (FOBT) in reducing mortality from colorectal cancer. General issues that affect decisions to initiate screening, benefits and risks, and precision of screening are discussed. Trends in incidence, mortality, stage at detection, and survival are reviewed. Colorectal cancer retains a relatively high incidence and mortality; improvements are occurring in stage of detection and survival. Definitive results from randomized clinical trials on efficacy of screening with FOBT are not yet available. Guidelines for colorectal screening of asymptomatic subjects in the general population have been adopted by the American Cancer Society and the National Cancer Institute. Other organizations have concluded there is insufficient evidence to recommend for or against FOBT.


Flexible sigmoidoscopy and the despecialization of gastrointestinal endoscopy. An environmental impact report.

Gastrointestinal endoscopy is a diagnostic and therapeutic tool for the prevention of premature death from cancer. Flexible equipment innovations during the 1970s increased the power of this technique dramatically. For family physicians and general internists, dissemination of these techniques started around 1979 and continued during the 1980s. In this report, data describing the gradual reformation of primary-care cancer screening are discussed. For example, one longitudinal study revealed a sustained improvement in physician compliance with American Cancer Society guidelines associated with the advent of flexible sigmoidoscopy and short colonoscopy skills. For symptomatic patients, compliance increased from 2% to 79% over 5 years. Flexible sigmoidoscopy is now well accepted. Endoscopic biopsy, full colonoscopy, and polypectomy skills are now available to many primary-care physicians. This represents a technical advance, and it is a small part of a larger medical-care revolution in which technology is decentralized. This holds great promise for the eradication of premature death from colorectal cancer.


The role of the barium enema in the detection of colonic neoplasms.

The variability in the published results for colonoscopy and barium enema examinations is confusing. With both, optimum studies depend on meticulous preparation, technical excellence, and operator proficiency. The equivalency of results and the lower cost of the radiologic study indicate that the double-contrast barium enema is the technique of choice for the examination of asymptomatic patients or symptomatic individuals without known antecedent disease. The relatively small difference between the cost of the double-contrast enema examination and sigmoidoscopy ($193 versus $135) suggests that it should replace the latter on the 3-5-year screening schedule because, on average, 50% more of the colon is examined by the barium study. It is a mistake to place colonoscopy and barium enema in competitive positions; the two methods ideally complement one another. The exclusion of significant pathologic findings by the double-contrast enema can be accepted, but the detection of abnormalities should be followed, when necessary, by colonoscopic verification and/or biopsy. The number of times both will be required are few. Radiologically demonstrated colon carcinomas seldom require biopsy verification, and 90% of all polyps are smaller than 5 mm in diameter with a negligible incidence of malignant transformation. When the examinations are used in the proper sequence, they provide a cost-effective approach to the early detection and control of cancer of the large bowel.


Hereditary aspects of colorectal adenomas.

Inheritance is important to the development of colonic adenomatous polyps and colon cancer. Current knowledge of inherited susceptibility to colonic neoplasms suggests that colon cancer screening strategies should consider familial and genetic risk. This report reviews the literature pertinent to adenomatous polyp and colon cancer inheritance and suggests polyp-cancer screening procedures based on inherited or familial risk. Colorectal adenomas and cancer occur in several rare inherited syndromes and more commonly as sporadic cases. Intensive screening protocols have been suggested for the inherited syndromes because of the high associated cancer risk. Recent evidence suggests that inherited susceptibility also may be important in a large fraction of the so-called sporadic cases. Preliminary screening guidelines are suggested for this category based on the number of first-degree relatives affected with colon cancer. Inherited susceptibility appears to be more important to the pathogenesis of colorectal adenomas and cancer than previously recognized. Screening strategies which consider inherited risk may increase the effectiveness of cancer detection and prevention.


Colon cancer genetics.

The terms "hereditary," "sporadic," and "familial" colorectal cancer (CRC) suggest a knowledge of causation; however, current understanding of CRC does not permit categorization of differing CRC risks in accord with their cause per se. Despite these serious shortcomings, these terms are defined operationally on the basis of a family history of cancer, and when available, additional phenotypic information. The sporadic type occurs in the absence of a family history of CRC in a first-degree relative. The familial type occurs when at least one first-degree relative has CRC. Both these categories require the exclusion of hereditary CRC. In the case of hereditary CRC, this type is defined as a family history of CRC occurring in a pattern that indicates autosomal-dominant inheritance, which also may involve certain phenotypic signs (depending on the specific disorder, i.e., florid adenomatous polyps, benign and malignant extracolonic lesions, cancer of unusually early onset, and multiple primary cancer, particularly synchronous and metachronous CRC). Although this operational classification does not produce etiologically homogeneous groups, it is believed to have pragmatic utility with respect to planning targeted surveillance and management strategies. Because of the distinctive natural history of CRC in hereditary syndromes, it is of paramount clinical importance to identify hereditary CRC when it does occur. Even in patients with no evidence of hereditary CRC syndrome, their family history may be second only to age in determining the best CRC screening program for those who are asymptomatic. In an attempt to provide a perspective on the clinical evaluation of CRC risk, research was reviewed on pathologic features and biomarkers that may be related to CRC causes, especially the genetic basis of CRC susceptibility. The long-term objective of studies on the genetic epidemiology of CRC is primary and secondary prevention through development of targeted management and surveillance recommendations (based on an understanding of CRC causation) that is relevant to hereditary, familial, and sporadic CRC.


Inflammatory bowel disease and colon cancer.

Patients who have had extensive colitis for more than 10 years are at increased risk for colorectal cancer. The risk may be greatest for those whose onset of illness is in childhood. Management options for patients at increased risk include prophylactic colectomy or endoscopic surveillance. The object of surveillance is prevention of cancer by detecting premalignant lesions that predispose to cancer. A less desirable objective is the diagnosis of cancer at an early curable stage. Patients must be well informed about their risk for cancer, the limitations of endoscopic surveillance, and the availability of surgical alternatives. Current endoscopic and pathologic techniques focus on the detection of dysplasia, but newer biomarkers may offer greater sensitivity and specificity in the future.


Preoperative evaluation of patients with primary colorectal cancer.

Preoperative evaluation should focus on techniques that either preclude surgery entirely, alter the planned operation either preoperatively or intraoperatively, or suggest the need for preoperative adjuvant therapy. The presence of a synchronous colonic neoplasia should be excluded by colonoscopy or air-contrast barium enema combined with sigmoidoscopy. A preoperative carcinoembryonic antigen level provides useful prognostic information. Abdominal computed tomography (CT) or hepatic ultrasonography should be done in patients with hepatomegaly or abdominal liver function tests. Those with rectal cancer should undergo a careful digital palpation done by an experienced observer combined with rigid proctosigmoidoscopy. Intrarectal ultrasonography may provide more objective data in regard to the extent of the local disease. If preoperative radiation therapy is planned, abdominal CT is appropriate to exclude extrapelvic disease that would preclude such a strategy. The benefit of routine preoperative CT in patients with otherwise resectable colonic or rectal cancer remains unclear.


Precursors of colorectal carcinoma. Biopsy and biologic markers.

The term biologic marker (biomarker) of colorectal cancer refers in this article to an early preclinical phenotypic characteristic that relates to the risk for developing this cancer. Putative biologic markers in the normal colorectal mucosa of patients at risk include abnormal cell proliferation as determined by kinetic studies, ornithine decarboxylase activity, and polyamine synthesis. Alterations of mucin synthesis have been studied using both histochemical stains and lectin-binding techniques. Blood group and related carbohydrate antigens also have been evaluated as potential biomarkers in the normal mucosa. Biopsy small (less than 5 mm) polyps encountered at endoscopy has become a standard practice. Although a small polyp found to be an adenoma has a low likelihood of harboring high-grade dysplasia or invasive carcinoma, it represents an indicator of risk for colorectal neoplasia. Hyperplastic polyps, however, even though they have certain epidemiologic associations with colorectal neoplasia, are controversial as putative biomarkers of clinical relevance. Current research supports a concept of a field defect of the colorectal mucosa at risk for neoplasia, which may be identified by phenotypic abnormalities of the normal mucosa and the development of small adenomas.


Preoperative evaluation. Medical obstacles to surgery.

The primary curative therapy for colorectal cancer is surgical resection. In addition, surgery is the mainstay for palliative therapy in most patients with more advanced colorectal cancer. Medical problems may have an impact on the decisions of when to operate and what procedure to do. Postoperative morbidity and mortality are affected by preoperative medical conditions. These medical problems may be secondary to the carcinoma, such as obstruction, perforation with sepsis, or malnutrition, or may be a result of underlying disorders, especially cardiopulmonary diseases. Adequate evaluation and indicated therapeutic intervention before surgical procedures will improve the patient's outcome.


Treatment options for the patient with colorectal cancer.

Treatment decisions for patients with colorectal cancer depend on the site and extent of the cancer. Medical factors rarely preclude appropriate treatment. For colonic and upper rectal cancer, curative treatment is almost entirely operative. Even patients with disseminated colon cancer merit a limited palliative resection to abort bleeding and prevent obstruction. When surgery is elective, colostomy is rarely necessary, although it may be required in patients who have obstructed or perforated colon cancer. For distal rectal cancer, various treatment options, including radiation therapy, have reduced the need for a colostomy, although maintaining comparable cure rates. Currently, only about one in seven patients with rectal cancer requires a permanent colostomy.


Perioperative teaching and counseling.

Patients who undergo surgery for colorectal cancer resulting in an abdominal stoma need extensive teaching and counseling to fully recover and enjoy a satisfactory quality of life. The economics of health care, changes in length of hospital stay, what and how patients are taught, and ways in which adults learn were reviewed. Each of these influences on acquisition of self-care skills and knowledge were considered as they apply to the specific needs of stoma patients. Common misconceptions about ostomies should be dispelled to clear the way for adults to learn what they need to know to care for their ostomy. Postoperative teaching must wait until patients are alert and comfortable enough to attend to instruction. Educational material should be prepared at the patient's level of understanding. An adequate budget for education and dedicated patient education personnel are necessary for effective perioperative teaching and counseling of ostomy patients. In today's health-care system, patients who require a stoma need access to outpatient preoperative and postoperative training and emotional support.


Operative treatment of colorectal cancer.

Principles of radical surgery for curative treatment of colon and rectal cancer are based on 5-year survival and 2-year local recurrence rates. Depth of invasion, cellular differentiation, vascular invasion, and the location and number of lymph node metastasis influence the 5-year survival rate. Age, type of resection, obstruction or perforation of the primary tumor, and the surgeon's technique influence the 2-year local recurrence rate. Accordingly, high ligation of major vascular pedicle, tumor-free margins, resection of contiguous organs, and oophorectomy should improve survival and an additional benefit may be derived from complete excision of distal mesorectum and the "no-touch isolation technique."


Conservative treatment of rectal cancer. Extending the indications.

Rectal cancer often in the past was believed to require abdominoperineal resection with permanent colostomy to achieve a cure. Several surgical alternatives to colostomy currently are available for selected patients. Understanding of the methods of preoperative staging is increasing, and new techniques, such as intrarectal ultrasound, have provided improved accuracy. By applying this and other methods of preoperative staging, selection of a surgical approach appropriate to the tumor stage increasingly is possible. Curative treatment for rectal cancer often can be achieved while preserving anorectal function.


Accomplishments in surgical adjuvant therapy for large bowel cancer.

In the past, effective surgical adjuvant therapy has been an elusive goal with little or no evidence of benefit from chemotherapy, immunotherapy, or radiation therapy. During the last 2 years, however, randomized trials have produced strong evidence of substantive progress. In colon cancer with regional nodal metastasis, therapy with combined 5-fluorouracil (5-FU) and levamisole has resulted in a 41% reduction in the recurrence rate (P less than 0.00005) and a 33% reduction in the death rate (P = 0.0052). In rectal cancer, combined technique adjuvant therapy using radiation (50.4 Gy) given in combination with 5-FU and preceded and followed by full-dose systemic chemotherapy with a 5-FU-based regimen was evaluated. In comparison with the same dose of radiation used alone, this combined regimen reduced the recurrence rate by 33% (P = 0.0016) and the death rate by 29% (P = 0.025). Of almost equal importance, there was a major reduction in local recurrence from 25% to 13%. Both these regimens would seem sufficiently well established to justify offering them as standard treatment. Of greater potential value to the patient, however, is entry into the currently available clinical trials that are pursuing hopeful avenues of research and offer the prospect of still greater accomplishments in the years to come.


Adjuvant radiation therapy for colorectal cancer.

Despite apparently complete resection of cancers of the rectum or colon, many patients have recurrences in the area from which their primary cancer was excised and in more distant organs. Radiation therapy has been used either alone or in combination with chemotherapy as an adjuvant to surgery to reduce the risk of recurrence. The literature describing the results of adjuvant radiation treatment for colorectal cancer was reviewed. In randomized studies in patients with moderately advanced rectal cancers (T2-4 N0, M0 or N1-3, M0) adjuvant radiation therapy has often reduced the risk of pelvic recurrence, but has had little effect on survival rates or the risk of extrapelvic metastases. Recent reports show that combined radiation and chemotherapy can improve both disease-free survival and survival rates. Such treatment has caused only moderate toxicity in most studies. Nonrandomized studies in patients in whom small superficial rectal cancers are treated by local excision suggest that adjuvant radiation therapy reduces the risk of pelvic recurrence after this limited surgery and allows anorectal function to be preserved. Strategies similar to those developed for the treatment of rectal cancer are being studied in patients with colon cancer. In moderately advanced rectal cancers, the combination of chemotherapy and radiation is more effective than radiation alone in reducing local recurrence and increasing survival rates. Additional trials are needed to improve results and to refine drug and radiation schedules. Radiation alone may be sufficient as an adjuvant treatment when combined with local excision of small rectal cancers. The role of radiation in the adjuvant treatment of colon cancer is investigational. There is a need to more accurately delineate the patients with colorectal cancer most likely to benefit from adjuvant therapy.


Anal cancers. Squamous and melanoma.

The total experience at Memorial Sloan-Kettering Cancer Center with two types of anal cancers--squamous and malignant melanoma--is reviewed. The squamous type is much more common, and its anatomic distinction between that of the anal margin and the anal canal is important in its respective clinical and surgical management. The historical, purely surgical management of canal lesions has evolved into the current chemoirradiation management, followed by the surgical approach with improvement of the 5-year survival rate and salvage of rectums. Malignant melanoma, which is the much rarer anal cancer, is still occasionally salvageable, with the use of standard abdominoperineal resection.


Role of the enterostomal therapy nurse in ostomy patient rehabilitation.

Enterostomal therapy (ET) nurses specialize in the management of patients with urinary and fecal diversions, draining wounds and fistulas, fecal and urinary incontinence, and chronic wounds such as pressure ulcers and vascular ulcers. ET nurses have much to offer in the management of patients with cancer. Such nurses play a major role in the rehabilitation of patients undergoing fecal or urinary diversions. Preoperative services include: counseling regarding planned surgical procedure, the impact of an ostomy on the patient's life, and the basics of ostomy management; sexual counseling; and stoma site selection. Postoperatively, the ET nurse instructs the patient and family in ostomy care, dietary and fluid alterations, and ways to incorporate ostomy management into the patient's life. The ET nurse also provides long-term follow-up care in outpatient settings; such care includes ongoing counseling, education, and surveillance for complications requiring medical intervention. ET nurses can recommend appropriate measures to prevent and manage skin breakdown that is related to immobility, friable skin, incontinence, and/or radiation therapy. They also can assist in correcting or containing fecal or urinary incontinence and in cost-effective management of draining wounds and fistulas.


Colorectal cancer. Principles of postoperative follow-up.

Monitoring patients after primary large bowel surgery for malignancy is predicated on the concept that early detection of recurrence may provide salvage treatment for cure. Knowledge of the pathologic site and stage provides important information as to the probability of recurrence and the patterns of failure that are likely to occur. Available methods to detect recurrence include clinical, roentgenographic, and serum tests that are done more frequently during the first 2 years after surgery. Monitoring plasma carcinoembryonic antigen levels can lead to identification of asymptomatic recurrences, but there is controversy about the curability of recurrences outside the liver. Newer techniques (such as computed tomographic portography, intraoperative ultrasonography, and radioimmunoguided surgery) provide greater diagnostic accuracy and lead to more appropriate procedures during "second-look" operations. For example, hepatic resection in properly selected patients offers up to a 30% chance of cure and should be pursued aggressively. A search for metachronous cancers by endoscopy also should be done. Knowledge of the potential and patterns of failure can provide a useful guide during the postoperative follow-up care of the patient with large bowel cancer.


Patterns of recurrent colorectal cancer and recovery surgery.

In only two areas of colorectal cancer recurrence does surgery provide benefit. For a minority of patients with liver metastases that can be resected completely, cure is possible. Recent data from a prospective liver surgery protocol provide a perspective on the outcome, morbidity, and mortality of the procedure and confirm many of the suggestions in previous retrospective reviews. For patients with isolated pelvic or perineal recurrence, surgical removal of recurrent tumor provides palliation, but only if in-hospital convalescence is minimal and if recently introduced reconstructive techniques allow early rehabilitation.


Chemotherapy for metastatic colorectal cancer.

The systemic management of patients with colorectal cancer continues to focus on the use of 5-fluorouracil (5-FU). In the setting of metastatic disease, parenteral 5-FU has been shown to be superior to oral 5-FU; however, survival duration seems similar whether such parenteral 5-FU is administered in a "loading," weekly, or continuous infusion manner. The addition of other cytotoxic agents such as semustine, mitomycin C, or cisplatin to 5-FU does not appear to increase the response rate or prolong survival. The results of five randomized trials assessing the value of intraarterial hepatic infusions of 5-FU or floxuridine show that such regional chemotherapy increases the likelihood of hepatic response compared with systemic treatment but has little effect on survival and is associated with significant toxicity. Recent efforts in the management of patients with advanced disease have been directed at optimizing the activity of 5-FU by (1) enhancing the inhibition of DNA synthesis through the concomitant administration of folinic acid; (2) increasing drug incorporation into RNA through pretreatment with methotrexate or phosphonacetyl-L-aspartate; and (3) improving the drug's activity through the synergistic action of alpha-2a-interferon. Although the results of some of these investigations have been promising, only the 5-FU and folinic acid combination consistently has appeared to be superior to single-agent 5-FU. These different approaches to biochemical modulation are being compared in ongoing cooperative group trials.


Immunotherapy of colorectal cancer.

Specific and nonspecific stimulation of the host immune system to reject cancer is an attractive concept that is just beginning to mature. Results with crude extracts and nonspecific immune stimulation have been variable. However, the recent observations of improved survival after administration of levamisole plus 5-fluorouracil in the adjuvant setting have made an impact on the treatment of colorectal cancer. Animal studies consistently show that immune therapies are most effective for disease that is not advanced. Thus, the small benefit seen with levamisole, a low toxicity immunomodulator, suggests that much more impressive results can be anticipated with more potent and specific agents. Postsurgical autologous tumor cell vaccine has been effective in some prospective randomized trials; in others, no benefit was found. The identification and purification of allogeneic tumor-associated antigens has lead to enhanced antigen-specific host cell-mediated immunity; this may result in more consistent antitumor effects. The current development of chemically defined immune adjuvants of low toxicity allows tumor-specific immune stimulation to be tested in high-risk apparently healthy patients after resection of colorectal cancer (Stages II and III). The influx of information regarding immune cell populations, cell-surface markers, and cytokines has fostered extensive exploration of lymphocyte stimulation, in vitro cell growth and expansion, and in vivo evaluation in patients with advanced cancer. Modest tumor response rates have been documented with adoptive transfer of lymphokine-activated killer cells and interleukin-2. Improved results are anticipated with the more potent tumor-infiltrating lymphocytes and specific in vitro sensitization of draining lymph node cells to autologous and allogeneic tumor antigens. Murine monoclonal antibodies specific for cell-surface markers, such as carcinoembryonic antigen, have been tested for their value in the diagnosis and therapy of colorectal cancer. A small response rate has been seen with single and multiple injections of C017-1A, a monoclonal antibody specific for colonic and pancreatic cancer. The development of antiidiotypic antibodies in these patients may have been important in those that responded to this type of therapy. However, laboratory evidence suggests that monoclonal antibody conjugated to a cytotoxic agent (i.e., radionuclide, drug, or toxin) should be much more effective. Radioimmunotherapy trials in the nude mouse model bearing human colon cancer xenografts showed good tumor incorporation of the radionuclide (yttrium 90 or iodine 131), inhibition of tumor growth, and long-term survival.(ABSTRACT TRUNCATED AT 400 WORDS)


Radiation therapy for advanced colorectal cancer.

Locally advanced, inoperable, and recurrent colorectal cancer requires multitechnique therapy to achieve optimal control and palliation. The role of radiation therapy as an adjuvant in resectable rectal cancer has been studied extensively in clinical trials, but its role in more advanced disease has not been explored to the same extent. The use of radiation in colonic rather than rectal cancer is more problematic because of natural tissue tolerance constraints in the abdomen versus the pelvis. The current and past role of radiation in advanced colorectal cancer will be reviewed, and avenues of ongoing and future investigation will be outlined. The role of radiation for palliation also will be discussed.


Health quality of life and colorectal cancer.

Quality of life associated with cancer and radiation treatment includes the dimensions of psychologic and physical well-being, nutrition concerns/side effects, and radiation treatment-related anxiety/adjustment. An understanding of the impact of colorectal cancer and radiation treatment on these aspects of health quality of life can be reached by comparing this diagnostic group to others undergoing similar treatment. Thirty-six patients with colorectal cancers, 41 with uterocervical cancers, 43 with genitourinary tumors, 13 with leukemia or bone metastasis, and 129 with head and neck cancers undergoing radiation therapy provided complete health quality of life index (QLI-RT) data during weeks 1 and 3 of treatment and at the first follow-up visit after treatment completion. The QLI-RT was found to be reliable and valid. Those with colorectal cancer had similar QLI-RT summary scores as the other groups at the beginning of treatment and during the follow-up period. QLI-RT scores tended to range from 62 to 84 for the summary score and individual-item scores; this was a narrow span considering the QLI-RT uses a 0-100-mm linear analog-response scale. The exceptions were strength, which elicited scores in the 46-68 range and a couple of responses to worrying about radiation therapy. The largest change in QLI-RT score in relation to the treatment trajectory was 11 mm. These findings tend to support the notion that patients with cancer try to maintain health quality of life at an acceptable level despite the occurrence of stressful negative events. Future research should explore the stable versus dynamic attributes of health quality of life to learn more about the factors that contribute to the adaptive process that maintains such quality of life at an acceptable level.


Interactive display of volumetric data by Fast Fourier Projection.

This article describes a new algorithm for reprojection of volumetric data, called Fast Fourier Projection (FFP), which is one to two orders of magnitude faster than conventional methods such as ray casting. The theoretical basis of the new method is developed in a unified mathematical framework encompassing slice imaging and conventional volumetric reprojection methods. Software implementation is discussed in detail. The article closes with an account of experience with a prototype FFP implementation, and applications of the technique in medical visualization.


Correction of aberration in image-intensifier systems.

A mathematical model describing spatial distortions caused by an image intensifier has been developed. These distortions originate from projecting a flat plane onto a curved input phosphor surface. Considering the source of these distortions and their magnification along the radial distance, it is possible to describe them in terms of the geometrical relations between a point on a physical object and its projection onto an input phosphor screen's spherical surface. On the basis of these relations, the correction of pixel coordinates and pixel values has been performed. Parameters included in the derived formula consider the radius of curvature of the input screen, the view angle, the distance from the focal spot to the object, and the distance from the focal spot to the input phosphor screen. These parameters make the correction formula system independent and permit its application to any image projected under different view angle and/or acquired with different image-intensifier system. The correction leads to a nearly distortion-free image.


Projection domain compensation of missing angles for fan-beam CT reconstruction.

An improved method is proposed for fan-beam computed tomographic (CT) reconstruction from data with limited views. Compensation for the missing projections for fan-beam CT can be partially accomplished by using the coincident ray or by an interpolation technique using circular sample theory. In this article, the authors propose a more accurate compensation method for the missing projections whether the coincident ray pairs exist or not. The fan-beam reprojection algorithm, which is the inverse operator of the convolution filter, was extended from the projection space iteration reconstruction-reprojection (PSIRR) in parallel beam geometry. In addition, this algorithm was validated by applying the Shepp-Logan phantom for a computer simulation in the equi-angular fan-beam CT geometry.


Modification of tumor promotion in the mouse skin by exposure to an alternating magnetic field.

Some epidemiological studies have suggested that exposure to an alternating magnetic field may increase the incidence of some cancers. Our earlier study of carcinogenesis in mouse skin, indicated that exposure to a magnetic field (MF) alone did not promote the growth of tumors. In the present experiment, the ability of a MF to act as a tumor copromoter was investigated. The dorsal skins of female SENCAR mice (6-7-weeks-old) were treated with 10 nmol of 7,12-dimethylbenzanthracene (DMBA) to initiate the carcinogenic process and then tumor development was promoted, for 23 weeks, by weekly applications of 4.9 nmol (0.3 microgram) of 12-0-tetradecanoylphorbal-13-acetate (TPA). One group of 48 mice were exposed to a 60-Hz magnetic field of 2 mT (20 Gauss) for 6 h/day 5 days/week, while a similar group (48 mice) were sham exposed. After week 12, the percentage of mice with tumors and the mean number of tumors per mouse, were higher for the group exposed to MF. At week 18, for example, where the differences between field and sham groups were statistically significant, the percentage of mice with tumors were, respectively, 25% and 8% (P less than 0.05, Fisher exact) and, the mean yield of tumors 1.9 +/- 0.69 and 0.65 +/- 0.46 (mean +/- S.E.M.) (P less than 0.05, Wilcoxon). At week 23 these differences were no longer statistically significant.


Ammonia: a possible promotor in Helicobacter pylori-related gastric carcinogenesis.

Helicobacter pylori (HP) has been shown to possibly be a pathogen of gastric carcinoma. HP has urease activity and produces ammonia in the stomach. In this study, the role of ammonia on gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) were investigated in rats. After 24 weeks pretreatment with MNNG (83 mg/l), 0.01% ammonia or tap water as a drinking water was administered for 24 weeks. The ammonia-treated rats showed a significantly higher incidence of gastric cancer (percent of animals with tumors and number of tumors per rat). Ammonia would thus appear to have an important role in HP-related human gastric carcinogenesis.


Analysis of the Harvey ras gene in cisplatin-initiated mouse skin tumors by polymerase chain reaction and direct DNA sequencing.

Cisplatin (cis-dichlorodiammineplatinum (II)) acts as a tumor initiator in the mouse skin model of carcinogenesis. DNA transfection studies suggested that skin tumors initiated by cisplatin contained dominant transforming activity. Since the Harvey-ras (H-ras) gene is known to be activated by point mutations in chemically initiated mouse skin tumors, we used polymerase chain reaction (PCR) and direct DNA sequencing to analyze the DNA sequence of the H-ras gene in twelve different cisplatin-initiated skin tumors. The results of these studies indicated that cisplatin-initiated skin tumors were normal (wild-type) at codons 12, 13, 61 and 117. Thus the transforming activity associated with cisplatin initiated mouse skin tumors was not due to a mutant H-ras gene and this suggests the involvement of other transforming genes during initiation of the mouse skin with cisplatin.


Epithelioid hemangioendothelioma of spleen with intrasplenic metastasis: ultrasound and computed-tomography appearance.

The US and CT appearances of epithelioid hemangioendothelioma of the spleen with intrasplenic metastasis have not been previously reported. We described a 29-yr-old female with such a disease. Abdominal US study revealed a large mass in the upper pole and multiple small nodules in the rest of the spleen. CT scan also showed similar lesions of hypodensity which were not apparently enhanced by contrast medium.


Intracanalicular arachnoid cyst mimicking acoustic neuroma: CT and MRI.

A patient with a surgically proven intracanalicular arachnoid cyst was studied using computed tomography, magnetic resonance imaging, and air CT cisternography. The lesion had a similar radiographic appearance to acoustic neuroma and therefore, although rare, must be considered in the differential diagnosis of intracanalicular mass lesions. We report a case in which examination was performed, in evaluating the lesion, utilizing high-resolution air CT cisternography and magnetic resonance imaging (MRI).


Acute pyelonephritis after transrectal ultrasonographically guided biopsy of the prostate: diagnosis by computed tomography.

Acute pyelonephritis developed in a 67-yr-old man after transrectal ultrasonographically guided biopsy of the prostate. The clinical presentation and results of excretory urography were nondiagnostic. Diagnosis was made by computed tomography, which was delayed 12 h after i.v. administration of contrast medium.


Detection of PAH:DNA adducts from auto-oxidation using 32P-postlabeling.

The binding of benzo[a]pyrene, 7,12-dimethylbenz[a]anthracene, 3-methylcholanthrene, benz[a]anthracene, dibenz[a,c]anthracene and phenanthrene to calf thymus DNA in vitro in the absence of enzymatic or chemical activation was investigated using the 32P-postlabeling assay. Reactions were performed in the dark or under white light in 1 ml of Tris-HCl buffer (pH 7.5), containing 150 mM KCl, 250 micrograms of DNA and 0.12 nmol-600 nmol of hydrocarbon. Reactions were incubated for 1 h at 37 degrees C and the extent of hydrocarbon:DNA adduct formation was determined. With the exception of phenanthrene, all of the hydrocarbons investigated formed DNA adducts that were easily detected with the 32P-postlabeling assay. The multiplicity and level of hydrocarbon:DNA adducts varied for each hydrocarbon. A dose related increase in adduct formation was observed. Adduct levels ranged from 0.07 to 15.28 adducts per 10(7) nucleotides. Highest adduct levels were detected with 7,12-dimethylbenz[a]anthracene (DMBA) and benzo[a]-pyrene (B[a]P). Hydrocarbon: DNA adduct formation was enhanced when reactions were performed under white light. A comparison of the adduct levels formed from auto-oxidation and enzymatic activation suggests that 0.05 and 0.26% of the adducts detected in the enzymatic activation of B[a]P and DMBA, can be attributed to auto-oxidation, respectively. These data demonstrate that in the absence of enzymatic or chemical activation, polycyclic aromatic hydrocarbons can undergo auto-oxidation in vitro and form hydrocarbon:DNA adducts that are detectable with the 32P-postlabeling assay.


Inhibition by selenium of DNA and RNA synthesis in normal and malignant human cells in vitro.

Several studies have demonstrated differences between normal and malignant cells in their sensitivity to various effects of selenite. We have compared the effect of selenite on DNA and RNA synthesis in two pairs of normal and malignant human cell lines. One pair of cells, CCL-210 (normal lung fibroblasts) and A549 (lung adenocarcinoma cells), exhibited a large difference in their sensitivity to selenite but no significant difference in their sensitivity to selenodiglutathione. They also had a large difference in the level of intracellular sulfhydryl (SH) compounds. In contrast the other pair of cells, WI-38 (normal fetal lung fibroblasts) and WI-38VA (SV-40 transformed WI-38 cells) both had low levels of intracellular SH compounds and exhibited similar (low) sensitivity to selenite. Our results indicate that differences between normal and malignant cells in their sensitivity to selenite could be due to a difference in the reaction of selenite with intracellular sulfhydryl compounds to form selenotrisulfides.


Effect of (-)-epigallocatechin gallate, the main constituent of green tea, on lung metastasis with mouse B16 melanoma cell lines.

(-)-Epigallocatechin gallate (EGCG), the main polyphenolic constituent of green tea, inhibits tumor promotion and chemical carcinogenesis in animal experimental systems. Here we report that the peroral administration of EGCG inhibited metastasis of B16 melanoma cell lines, such as B16-F10 and BL6, in both experimental and spontaneous systems.


Fluorescence photograph of stomach cancer tumors in Wistar rats: computerized analysis.

Detection of cancer in early stages with hematoporphyrin derivatives (HpD) is highly limited by the low fluorescence quantum yield, the strong autofluorescent components of the tissue, and the low contrast between normal and tumoral tissue when fluorescent photographs are taken. A new computer analysis based on digital subtraction of photographs before and after the administration of HpD, allows a total autofluorescence extraction, resulting in a remarkable increase of contrast between tumors and normal tissue. Experiments, with this computerized imaging system in adenocarcinoma of the stomach in Wistar rats, confirms the reliability of this method.


Comparative reduction of 1-nitro-3-nitrosopyrene and 1-nitro-6-nitrosopyrene: implications for the tumorigenicity of dinitropyrenes.

Dinitropyrenes are mutagenic environmental pollutants. Of these compounds, 1,6-dinitropyrene is a potent tumorigen while 1,3-dinitropyrene appears to be weakly or non-tumorigenic. Two-electron reduction of dinitropyrenes yields nitro-nitrosopyrenes, which have been shown previously to be the major aerobic metabolites of these compounds in vitro. Further reduction of nitrosopyrenes is required for their activation to a DNA-reactive N-hydroxylamines. In this work, 1-nitro-3-nitrosopyrene was synthesized and the electrochemical and enzyme-catalyzed reduction of 1-nitro-3-nitrosopyrene has been compared with that of 1-nitro-6-nitrosopyrene. As determined by cyclic voltammetry, the reduction potentials of 1-nitro-3-nitrosopyrene, 1-nitro-6-nitrosopyrene and their parent dinitropyrenes were similar, although 1-nitro-3-nitrosopyrene did have a slightly more negative cathodic peak potential than the other three compounds. The NADPH-mediated reduction of 1-nitro-6-nitrosopyrene to intermediates which reduce succinoylated cytochrome c was faster than that of 1-nitro-3-nitrosopyrene. In the presence of rat liver microsomes or cytosol, the reduction of 1-nitro-6-nitrosopyrene was faster than that of 1-nitro-3-nitrosopyrene. These differences in the rates of nitro-nitrosopyrene reduction may be one factor contributing to the lower tumorigenic potential of 1,3-dinitropyrene relative to 1,6-dinitropyrene.


Antitumor activity of polysaccharide from a Chinese medicinal herb, Acanthopanax giraldii Harms.

The results of experiments with Acanthopanax giraldii polysaccharide (AGP) demonstrated that it inhibited the growth of solid Sarcoma 180 and prolonged the survival time significantly. In tumor-bearing mice, AGP enhanced the phagocytosis and chemiluminescence of macrophages. By the immunofluorescent method, binding of the third component of complement (C3) cleavage product to macrophages and proportion of C3 positive cells were increased. In crossed immunoelectrophoresis, human serum C3 was converted by AGP and appeared as the 3rd peak. The height of the 3rd peak was directly proportional to doses of AGP. The residual CH50 units of human serum decreased dose-dependently. These results suggest that the antitumor activity of AGP is related to the enhancement of immune responses.


Endocrine mediation of psychosocial stressor effects on mouse mammary tumor growth.

We have demonstrated that differential housing alters the growth rate of the androgen-responsive Shionogi mouse mammary carcinoma (SC115). In the present study we wished to determine if changes in plasma levels of hormones or a shift in the responsiveness of the tumor cells to hormones was responsible for the differential tumor growth rates observed. Plasma testosterone and corticosterone levels were assayed 24 h, 3 days and 1 week post tumor cell/vehicle injection. Also 3 weeks post injection androgen and glucocorticoid receptor binding capacity (Bmax) and binding affinity (Kd) and the in vitro responsiveness of tumor cells to dihydrotestosterone and hydrocortisone were measured. At 24 h post injection, plasma testosterone levels were significantly increased in mice with large tumors, but remained low in mice with small tumors. Plasma corticosterone levels were significantly elevated in mice with small tumors compared to those of mice with large tumors at all time points measured. Androgen and glucocorticoid receptor binding capacity and binding affinity of tumor cells did not differ among groups. Further, all groups tested had the ability to respond to dihydrotestosterone and hydrocortisone in vitro. These data indicate that an effect of housing condition on plasma levels of steroid hormones may, in part, mediate the differential tumor growth rates observed in this model.


Antitumor activity of phytic acid (inositol hexaphosphate) in murine transplanted and metastatic fibrosarcoma, a pilot study.

We have previously reported that phytic acid (inositol hexaphosphate or InsP6), a natural constituent of cereal diet, when administered in drinking water exerts a consistent antitumor effect on experimental colon cancer in vivo. The objective of this study was to determine whether InsP6 has similar anti-neoplastic effect on other tumor models, such as murine fibrosarcoma. We report that intraperitoneal injection of InsP6 reduces growth of subcutaneously transplanted fibrosarcoma (FSA-1) in mice, prolongs survival of tumor-bearing mice and reduces the number of pulmonary metastases. Since InsP6 is a common constituent of our diet and has very little or no toxic effects, in addition to being chemopreventive, it could have potential use in therapy of cancer as well.


A study of tobacco carcinogenesis. XLVII. Bioassays of vinylpyridines for genotoxicity and for tumorigenicity in A/J mice.

3-Vinylpyridine is formed from nicotine during the smoking of tobacco products. Consequently it is found in mainstream and side-stream smoke of cigarettes and cigars and in environmental tobacco smoke. In this study, 3-vinylpyridine and its isomers 2- and 4-vinylpyridine as well as styrene (vinylbenzene) were bioassayed for mutagenicity in Salmonella typhimurium strains TA 1535, TA 1538, TA 98 and TA 100 and for their genotoxicity in the rat hepatocyte DNA-repair test. In both in vitro assays-all three vinylpyridines and styrene were inactive. In a test for tumorigenicity in which the test compounds were injected intraperitoneally into A/J mice (total dose 200 mumol/animal) there was no significant incidence of lung adenoma nor of any other type of tumors.


Parallel changes in the blood levels of abnormally-fucosylated haptoglobin and alpha 1,3 fucosyltransferase in relationship to tumour burden: more evidence for a disturbance of fucose metabolism in cancer.

Levels of an abnormally-fucosylated form of the serum glycoprotein, haptoglobin (FHp) and an enzyme, alpha 1,3 fucosyltransferase (FT) have been measured in blood specimens from women with carcinoma of the ovary or breast who are undergoing chemotherapy. The levels of FHp and FT increased if the women had progressive disease and decreased if they showed complete response to therapy. The statistical correlation between the blood concentrations of these two substances is very strong (P less than 0.0001, chi 2 test). These results and recent studies of fucosyltransferases and cell adhesion molecules from other laboratories, suggest that there are important changes in fucose metabolism in cancer which are worthy of further investigation.


The effect of EDTA and serum on endogenous porphyrin accumulation and photodynamic sensitization of human K562 leukemic cells.

The interrelationship between the effect of serum on the induction of porphyrin synthesis, intracellular porphyrin accumulation and photodynamic sensitization of human K562 cells is described. Endogenous porphyrins, synthesized from supplemented 5-amino levulinic acid (5-ALA), were shown to accumulate in the cells, while an addition of serum triggered porphyrin translocation from the cell to the serum. In order to enhance porphyrin accumulation in the cells themselves, they were further stimulated by EDTA, which in combination with 5-ALA reduces Fe++ cellular content. The higher porphyrin cellular content under EDTA and 5-ALA induction was exploited to photoinactivate the human leukemic cells by more then 3 orders of magnitude.


Inhibitory effect of geniposide on aflatoxin B1-induced DNA repair synthesis in primary cultured rat hepatocytes.

We have previously demonstrated that geniposide (GP) inhibits the aflatoxin B1 (AFB1) induced-hepatotoxicity and hepatic DNA binding in rats. To address the mechanism of action, the effects of GP on AFB1-induced DNA repair synthesis and AFB1 biotransformation in cultured rat hepatocytes were investigated. By evaluation of unscheduled DNA synthesis (UDS), GP reduced AFB1-induced DNA repair synthesis in a dose-dependent manner in hepatocyte cultures. GP elevates the metabolism of AFB1 and decreases the formation of AFM1. The enzyme activities of glutathione S-transferase (GST) and GSH-peroxidase (GSH-Px) in AFB1-treated hepatocyte cultures are enhanced in the presence of GP. GP reduces AFB1-induced DNA repair synthesis through an increased AFB1 detoxication metabolism. It provides one possible mechanism for the chemopreventive activity of GP.


Effect of dietary nitrate on endogenous nitrosation of piperazine in humans.

The effect of dietary nitrate on endogenous nitrosation of a therapeutic dose of piperazine has been described in five human volunteers who acted as their own controls. The urinary excretion of endogenously formed N-nitro-somonopiperazine (MNPz) ranged between 9.2 and 80.1 micrograms/24 h on a normal uncontrolled diet which increased from 25.7 to 163.7 micrograms/24 h when the diet was supplemented with 250 mg nitrate. The corresponding urinary nitrate was 63.0-122.7 mg/24 h and 119.2-322.0 mg/24 h, respectively. The dinitroso derivative of piperazine was detected only in trace amounts and no detectable increase in its excretion was observed during high nitrate exposure. The unchanged piperazine (range 294-784 mg/24 h) in urine showed a decrease under high nitrate regimen (range 185-399 mg/24 h).


Si(IV)-naphthalocyanine: modulation of its pharmacokinetic properties through the use of hydrophilic axial ligands.

A water-soluble derivative of the highly hydrophobic molecule Si(IV)-naphthalocyanine was synthesized by the addition of two polyethyleneglycol ligands in axial positions to the centrally coordinated Si(IV) ion. The compound can be intravenously injected in homogeneous aqueous solution, where it is largely aggregated and remains mostly in an unbound state. While the naphthalocyanine is accumulated in significant amounts by an intramuscularly transplanted MS-2 fibrosarcoma in Balb/c mice, the dye shows little tumour selectivity and essentially no phototherapeutic activity. The situation is not improved by association of the naphthalocyanine with dipalmitoyl-phosphatidylcholine liposomes, probably owing to a lack of incorporation of the bulky dye molecule into the phospholipid bilayer.


Promotion pattern and tumour types in two-stage rat skin carcinogenesis.

Carcinogenic studies were performed on the skin of inbred male Lister rats using 7,12-dimethylbenz[alpha]anthracene (DMBA) in low doses (2.5 mg and 5.0 mg), followed by promotion with croton oil (CO) in one half of the animals. The clinically observed tumour rate did not differ after the two carcinogen doses and was practically unaffected by promotion, only a marginal increase in effect being noted after DMBA 2.5 mg. Also the latency periods were alike. The total tumour crop was increased by promotion, but histologically the predominant clinical skin tumour was a sebaceous proliferation with or without associated papillomatous squamous cell hyperplasia. This lesion did not in microscopic structure or cellular characteristics fulfil the criteria of a neoplastic tumour. Basal cell carcinomas, adnexal tumours and pure squamous cell tumours were rare and were not promoted by CO. CO had a marked promotion effect, but only on the mixed sebaceous-papillomatous hyperplasias, which were more than doubled in number. In conclusion, carcinogenesis was weak after the low DMBA-doses, and promotion by CO of neoplastic tumours was not seen.


HPLC separation of 32P-postlabelled benzo[b]fluoranthene-DNA adducts.

Analysis using 32P-postlabelling and a recently developed HPLC method resolved the adduct formed by reaction of the benzo[b]fluoranthene (BbF) anti-bay-region diol-epoxide with DNA from the more polar major adduct produced by the hydrocarbon in three different biological systems. In each case, the adduct formed from the anti-bay-region diol-epoxide constituted only a minor proportion of the total DNA modification. Comparisons of the DNA adducts formed from the hydrocarbon with those formed in microsomal incubations from the putative metabolites BbF-9,10-diol, anti-BbF-9,10-diol-11,12-oxide and the 5,9,10- and 6,9,10-BbF-triols indicate that the predominant pathway for BbF activation in skin probably involves a bay-region triol-epoxide possessing a phenolic OH-group on the peninsula ring.


Tissue lipid composition of human gliomas and meningiomas.

This study is a comparative analysis of some lipid fractions in human brain tumors and normal brain tissue. Gliomas and meningiomas were studied and in these tumors while total lipid, total and free cholesterol and total phosphoglyceride levels were found to be significantly lower than in normal controls, the difference in esterified cholesterol levels was found to be insignificant. No significant differences in lipid fractions existed between gliomas and meningiomas except total and esterified cholesterol values.


Variable expression of the interleukin-2 receptor alpha chain and MYC genes in lymphocytes from renal cell carcinoma patients treated with interleukin-2.

We have studied the expression of the interleukin-2 receptor alpha chain, c-MYC and L-MYC genes in lymphocytes obtained from four renal cell carcinoma patients undergoing an interleukin-2 clinical trial. Two of these patients exhibited stable disease after the interleukin-2 therapy and two exhibited progressive disease. Analysis of mRNA levels by dot blot hybridization indicated that changes in the expression of both the interleukin-2 receptor alpha chain and c-MYC genes were erratic and varied widely between patients. L-MYC expression was not observed in any sample. There appeared to be little correlation between the changes in gene expression and parameters such as thymidine incorporation, the proportion of CD25 positive cells present or cytotoxic activity. The situation in vivo therefore appears to be more complex than would be predicted from in vitro studies.


Effect of verapamil on the class I major histocompatibility complex antigen expression in K562 chronic myelogenous leukemia cells treated with recombinant human interferon-gamma.

The effects of various compounds which modulated the intracellular signal transduction on the induction of class I major histocompatibility complex (MHC) antigens by recombinant human interferon-gamma (rIFN-gamma) were investigated using K562, chronic myelogenous leukemia cells. Class I or class II MHC antigens were not expressed in untreated K562 cells and rIFN-gamma (600 units/ml) weakly induced class I antigens on the cells. Among the compounds tested, verapamil but not the calcium ionophore A23187 enhanced the rIFN-gamma-induced class I antigen expression at both the surface molecule and mRNA levels and enhancement by verapamil occurred in a dose-dependent manner at non-toxic concentrations examined (approximately 50 microM). Verapamil alone had no inducible effect on MHC antigen expression. Deprivation of Ca2+ in culture medium by ethylene glycol-bis(beta-aminoethyl ether) N,N,N',N'-tetraacetic acid (EGTA) could not cause an enhancement of class I antigen induction by rIFN-gamma. Simultaneous exposure of K562 cells to rIFN-gamma (600 units/ml) and recombinant human tumor necrosis factor (rTNF; 1000 units/ml) in combination with verapamil (50 microM) resulted in a further increase of class I antigens in the cells. The expressions of c-myc oncogene in K562 cells were not changed when the cells were treated with rIFN-gamma (600 units/ml) or verapamil (50 microM), either alone or in combination. These results indicate that verapamil synergistically interacts with rIFN-gamma on the class I antigen induction in K562 cells irrespective of c-myc gene expression and that class I antigen induction in this cell line may not be relevant to calcium influx triggered by IFN-gamma.


In vivo and in vitro growth-inhibitory effect of bovine seminal ribonuclease on a system of rat thyroid epithelial transformed cells and tumors.

We investigated the antitumoral effect of bovine seminal RNase (BS-RNase) in vivo and in vitro on a model system of epithelial tumor- and metastasis-derived cells as well as on epithelial tumors derived from the same system. We found that while BS-RNase significantly inhibited the growth in vitro of the epithelial tumor-derived cells, its inhibitory effect was even more dramatic on the growth of metastasis-derived cells. BS-RNase exerted no appreciable growth inhibition on normal thyroid epithelial cells. When administered in vivo to rats bearing solid carcinomas, having the same thyroid origin, BS-RNase induced a drastic reduction in the tumor weight, with no detectable toxic effects on the treated animals. These data show, for the first time on a system of neoplastically transformed epithelial cells, that BS-RNase has a potent specific antitumoral activity.


Clinical implications of decreased retinoblastoma protein expression in acute myelogenous leukemia.

The retinoblastoma (RB) protein levels in blast-enriched mononuclear fractions from the peripheral blood of 33 newly diagnosed patients with acute myelogenous leukemia were studied. Ten patients who had previously been treated were also analyzed, nine of whom had achieved prior complete remission. Low RB protein expression was found in 13 of 43 (30%) of the acute myelogenous leukemia patients as determined by Western blotting and immunochemical analysis. Of particular interest among the 20 newly diagnosed patients treated with the same therapeutic regimen, the median survival was 39 days for those with low RB protein expression compared to 333 days for those with high levels of RB protein expression in their leukemic cells (P less than or equal to 0.02). This preliminary study suggests that decreases of RB protein expression in peripheral blood of myeloid leukemic cells occur frequently and may be associated with shortened survival of acute myelogenous leukemia patients.


Cell cycle synchronization and growth inhibition by 3-hydroxypyridin-4-one iron chelators in leukemia cell lines.

The effect of bidentate 3-hydroxypyridin-4-one (HPO) iron chelators on cell cycle arrest with subsequent cycle synchronization has been compared with that of the hexadentate desferrioxamine (DFO) in K562 and Daudi cells. The relationships between chelator concentration and inhibition of growth, DNA synthesis and ribonucleotide reductase, and phase of cell cycle arrest have also been explored. HPOs and DFO arrest the cell cycle in a dose-dependent manner causing a blockade at the G1-S border after 24 h at concentrations above 30 microM iron-binding equivalents. This is associated with reduced ribonucleotide reductase activity and concomitant cessation of DNA synthesis and growth. When the chelator is subsequently removed, HPO-treated cells synchronously cascade into S phase, unlike DFO-treated cells which resume cycling in a nonsynchronous manner. Chelator concentrations of approximately 25 microM and 3 microM iron-binding equivalents inhibited growth, DNA synthesis, and ribonucleotide reductase activity by 50% in K562 and Daudi cells, respectively. Concentrations less than 10 microM iron-binding equivalents inhibited K562 cell growth without an effect on DNA synthesis but with accumulation of cells in G2 and M phases. These results suggest that HPOs have advantages over DFO as cell cycle synchronization agents and may be useful adjuncts in cell cycle-specific treatment regimens.


Effect of treatment duration and glutathione depletion on mitomycin C cytotoxicity in vitro.

Glutathione (GSH) has been shown to modulate the cytotoxicity of a variety of chemotherapeutic agents. The effect of mitomycin C (MMC) treatment duration and the effect of GSH depletion on in vitro cytotoxicity against the human colon cancer cell line HT-29 was studied under aerobic conditions. Continuous-exposure experiments revealed that the cytotoxicity of 0.1 microM MMC, as measured by clonogenic cell survival, exhibited a shoulder until exposure time was at least 12 h, after which time exponential cytotoxicity was observed. Lowering GSH levels to less than 3% of control using buthionine sulfoximine (BSO) did not enhance cytotoxicity of MMC given for 1 h or continuously for less than 12 h. However, GSH depletion did enhance cytotoxicity of MMC given continuously for at least 12 h, with a dose-modifying factor at 1% survival of 1.4 for a 24-h treatment. GSH depletion under these conditions enhanced cytotoxicity of even minimally cytotoxic MMC concentrations (0.02 microM). Absolute levels of GSH-related enzymes, including glutathione-S-transferase, and the MMC-metabolizing enzyme DT-diaphorase did not change appreciably. A tetrazolium [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay was used to verify the results further and to determine the optimal sequence of BSO administration with a 24-h MMC treatment. BSO added simultaneously with MMC did not increase cytotoxicity, compared to MMC alone. BSO added and then removed prior to MMC was effective (dose-modifying factor at 50% survival = 1.3), but the greatest cytotoxicity was noted when BSO was present before and during MMC treatment (dose-modifying factor = 1.5). GSH depletion in another cell line (SW480) showed similar enhancement of 24-h MMC cytotoxicity. These studies show that aerobic cytotoxicity of MMC is improved by administration of the drug in continuous fashion for at least 12 h, as opposed to continuous administration for shorter periods or 1-h bolus administration. Cytotoxicity of continuous (at least 12-h) MMC treatment can be modestly enhanced by GSH depletion, which must precede MMC exposure in order to be effective.


Rat prostate adenocarcinoma cells disseminate to bone and adhere preferentially to bone marrow-derived endothelial cells.

Approximately 70% of patients with prostatic cancer develop bone metastases. Metastatic prostate adenocarcinomas are associated with high mortality rates and represent a leading cause of cancer-related deaths among males. To study the host-tumor interactions underlying the predilection of prostate cancer cells for skeletal bone, an experimental model was developed using rat Dunning carcinoma Mat-LyLu cells. Inoculations of these cells into the left ventricle of the heart led to the development of spinal metastases in 100% of inoculated animals. A subline of Mat-LyLu (Mat-LyLu-B5) was subsequently selected through the sequential inoculation of bone marrow-derived carcinoma cells into the left ventricle and was found to have an increased metastatic potential compared to the parental line. The possible role of tumor cell adhesion to host cells in the process of bone marrow colonization was then investigated in vitro using the metastatic line and primary cultures of rat bone marrow-derived stromal cells. It was found that the adhesion of the metastatic Mat-LyLu cells to a bone marrow stromal cell culture highly enriched for endothelial cells was significantly higher than the adhesion to other bone-derived cells, including nonendothelial bone marrow stromal cells (3.5x) and osteoblasts (1.7x). It was also significantly higher than the adhesion to rat fibroblasts (7x) and to hepatic endothelial cells (7.5x). The results suggest that the adhesion of prostate carcinoma cells to the bone marrow endothelium may play a role in their metastasis to bone.


Quantitative changes in tumor metabolism, partial pressure of oxygen, and radiobiological oxygenation status postradiation.

Hypoxia is considered to be a major cause of tumor radioresistance. Reoxygenation of previously hypoxic areas after a priming dose of radiation is associated with an increase in tumor radiosensitivity. In a study of a hypoxic mammary carcinoma, 31P nuclear magnetic resonance spectra showed statistically significant increases in metabolite ratios (phosphocreatine/Pi and nucleotide triphosphate/Pi) after 65 and 32 Gy. The maximum changes in metabolite ratios after 32 Gy occurred at 48 h, although significant changes were detected at 24 h. A corresponding increase in the mean tumor pO2 (polarographic microelectrode measurements) and a decrease in hypoxic cell fraction [changes in paired (clamped versus unclamped) tumor control dose for 50% of tumors] were also shown to occur 48 h after a priming dose of 32 Gy. A significant increase in the mean tumor pO2, phosphocreatine/Pi, and nucleotide triphosphate/Pi, compared to initial values, was noted at 24, 48, and 96 h post 65-Gy radiation. An increase in the downfield component of the phosphomonoester peak relative to the upfield component (phosphoethanolamine), is also noted after doses of 65 and 32 Gy. These are likely to be due to cell kill and/or decreased cell proliferation. In this tumor model, 31P nuclear magnetic resonance spectroscopic changes postradiation are temporally coincident with and may be indicative of tumor reoxygenation as measured by the tumor control dose for 50% of tumors and oxygen-sensitive microelectrodes.