Optimal oxygen tension conditions for functioning cultured hepatocytes in vitro

With a view toward furthering the development of artificial liver systems, we have been culturing hepatocytes in vitro. The object of this research was to investigate the ideal conditions of oxygen tension for the efficient functioning of hepatocytes. Viable hepatocytes isolated from rat livers were cultured under five different oxygen tensions: 5, 10, 20, 50 and 90% O2. DNA contents, gluconeogenesis, urea synthesis, adenosine triphosphate (ATP) levels, and lipid peroxidation of hepatocytes were evaluated. Under the 5% oxygen conditions, the function of hepatocytes was very inferior and was accompanied by a low ATP level. However, hepatocytes cultured under 90% oxygen tension functioned less effectively than the control (20% O2) with elevated lipid peroxidation. The data in this study suggest that the optimum oxygen condition for cultured hepatocytes is 10 approximately 50%, and that especially under conditions of 20% oxygen tension, i.e., that of the ordinary atmosphere, hepatocytes can function most effectively.

Water jet scalpel for liver resection in hepatocellular carcinoma with or without cirrhosis

Patients with hepatocellular carcinoma were subjected to hepatic resection by using a water jet scalpel which is a device developed recently. Seventy-two patients who underwent hepatic resection were divided into two groups: group A included patients with HCC associated with liver cirrhosis and group B included patients without cirrhosis. Patient characteristics and liver function tests did not differ significantly between the groups. Resected a specimens weighed lighter in group A than in group B. No significant difference in total blood loss, time of operation and postoperative complications were noted. Physiologic saline employed in the machine to create a fine jet stream was projected through the nozzle on the liver at a pressure of 15-20 kg/cm2. The parenchyma of the cirrhotic liver was divided but the intrahepatic vessels were spared. It was therefore concluded that hepatic resection by water jet is safe and useful in case of HCC associated with cirrhosis of the liver.

Treatment of hepatocellular carcinoma associated with extrahepatic primary cancer

Association of extrahepatic primary cancers (EPC) were studied in 533 consecutive hepatocellular carcinoma (HCC) cases. EPCs were found in 30 cases (5.6%). Three patients had two EPCs. The most frequent sites of EPC were the stomach (n=10, 30.3%), the colon (n=8, 24.2%), otolarynx (n=5, 15.2%), and the lung (n=2, 6.1%). Twenty-nine of 33 EPCs were treated by resection. EPCs did not affect the survival rate, however, the survival of the 20 patients who underwent resection of HCC was better than the 10 patients who did not. Liver cirrhosis was present in 8 of the 30 cases. Advanced stages of HCC were more frequently seen (P<0.05) in cases without cirrhosis.

Serum levels of the type IV collagen 7s domain in patients with chronic viral liver diseases

The serum levels of type IV collagen 7s domain (7s collagen) were determined in 80 patients with hepatocellular carcinoma (HCC) and in 105 with chronic liver disease without HCC. Among 86 patients with HCV infection, serum levels of the 7s collagen were significantly higher in those with HCC than-in those without HCC (p<0.05). In contrast, no significant differences were recognized between these two groups in 84 patients with HBV infection. Patients with HCV infection having high serum levels of the 7s collagen exceeding 7.0 ng/ml, were diagnosed as HCC with a sensitivity of 71.8%, a specificity of 74.5%, and a reliability of 77.9%. It was concluded that the progression of hepatic fibrosis plays an important role in the hepatocarcinogenesis of HCV, and that serum levels of the 7s collagen appeared to be useful as a risk factor of the development of HCV-related HCC.

Pyrimidine nucleoside phosphorylase-activity and biological characteristics of breast-cancer

We investigated whether Pyrimidine nucleoside phosphorylase (PyNPase) activity in breast cancer tissue correlated with biological characteristics of breast cancer. PyNPase activity, ER, PgR, EGFR, DNA ploidy pattern, PCNA positive cells and amplification of the c-erbB-2 gene were determined in specimens from 138 patients. PyNPase activity was significantly higher in ER negative than ER positive carcinomas (p<0.05), in PgR negative than PgR positive carcinomas (p<0.05) and significantly higher in tumors with c-erbB-2 gene amplification compared with tumors with no amplification (p<0.05). The results suggest that PyNPase activity in breast cancer tissue may be a new biological characteristic of breast cancer.

Effect of prostaglandin E1 on hepatic function after hepatectomy in patients with chronic liver disease

We designed a clinical study to determine the effect of prostaglandin E1 (PGE1) on functional recovery of the liver after hepatectomy. Thirty-five patients with primary hepatic neoplasms accompanied by chronic liver disease were randomly divided into two groups: 13 patients received intravenous PGE1 at 0.06 micro g/kg per minute for 3 postoperative days (PGE1[+] group) and 22 patients did not (PGE1[-] group). All postoperative values of hepatic function tests were calculated as a ratio to each preoperative value. Significantly higher cholinesterase ratios were observed in the PGE1[+] group than in the PGE1[-] group 2 weeks postsurgery (P < 0.05). The alanine aminotransferase (ALT) ratios at 1 and 2 weeks postsurgery were 118% and 123% in the PGE1[+] group and 207% and 175% in the PGE1[-] group, respectively. The ratio of the maximum postoperative ALT level was 503% in the PGE1[+] group and 792% in the PGE1[-] group (P < 0.05). We concluded that PGE1 would have the effect of conditioning the postoperative ALT elevation and cholinesterase deterioration and that the patient's postoperative course might be more favorable with the use of PGE1.

[Chemosensitivity test for thyroid cancer by in vitro MTT assay]

In vitro MTT assay was applied for examining chemosensitivity with 50 thyroid cancers; 47 papillary cancers, 1 follicular cancer, 1 anaplastic cancers, and 1 medullary cancer. Anticancer drugs examined were 5-fluorouracil (5-FU), cisplatin (CDDP), adriamycin (ADM), etoposide (VP-16) and ifosfamide (IFO) (active type). Their efficacy was as follows: 5-FU 0%, CDDP 40.9%, ADM 0%, VP-16 5.3%, IFO 48.5%. Anaplastic cancer and medullary cancer showed no sensitivity to all tested drugs. We compared the chemosensitivity between cancer tissue and normal tissue. CDDP was more effective in cancer tissue than in normal tissue. Chemosensitivity of CDDP depended on the drug concentration but 5-FU did not. CDDP and IFO might be useful against human differentiated thyroid cancer.

[Calcium metabolism in porcine liver transplantation]

The influence of warm ischemia on calcium metabolism in liver transplantation (LTX) was investigated using temporary portal vein arterialization (PA) technique. Group I pigs were added no warm ischemia (n = 6). In group II, donors were killed by KCl, and the livers were left in situ for 60 min (n = 6). After anastomosing the suprahepatic vena cava, revascularization was carried out employing PA. Initial reperfused blood was collected through the infrahepatic vena cava. All pigs survived more than 4 days in group I, whereas all died within 2 days in group II. In group II, Ca2+ levels of initial reperfused blood were significantly lower than those of arterial blood. Ca2+ levels of initial reperfused blood in group II were significantly lower than those in group I. Within 90 min after revascularization, biliary output and biliary calcium content and excretion in group I recovered to 30%, 100% and 40% of normal, respectively, but in group II only 2 animals could excrete bile. In conclusion, in the liver with 60 min warm ischemia, Ca2+ influx occurred immediately after revascularization followed by decreased calcium excretion in bile, which suggested that accumulation of calcium might be one of the causes of warm ischemic injury.

Encephalitozoon-like organisms in patients with alveolar hydatid disease: cell culture, ultrastructure, histoimmunochemical localization and seroprevalence

We found Encephalitozoon-like organisms in an in vitro culture of a human liver lesion which was due to larval Echinococcus multilocularis. The organisms developed in the same fashion as an Encephalitozoon cuniculi. The spores that developed in parasitophorous vacuoles were 2.0-2.6 x 1.1-1.5 microns; each contained a single nucleus and 4-5 polar tubule coils, closely resembling E. cuniculi in its ultrastructure. Mature spores were collected from the supernatants by the use of Percoll centrifugation resulting in the banding of the spores on continuous gradients. We prepared three sorts of spores which were different in buoyant density in 0.15 M NaCl: 1.05-1.07 g/ml spores, 1.12 g/ml spores, and spores of over 1.14 g/ml. Polyclonal antibodies to a pool of each spore preparation were produced in a rabbit and applied to the detection of microsporidian antigen in situ. The histoimmunoperoxidase (HIP) procedure was used to detect the microsporidian antigen in echinococcal liver lesions from patients with alveolar hydatid disease (AHD). Ten echinococcal liver lesions from different AHD patients were examined and four were found to be positive in the HIP test. The Percoll-separated spores were also used as an antigen to detect for antibodies in the sera from the patients with AHD by Western blotting. Antibodies were detected in 62 (52%) of the 119 AHD patients and in only 8 (5%) of the 159 normal healthy individuals.

D-CECaT as preoperative chemotherapy for unresectable neuroblastoma in children over one year of age

The role of intensive pre- and postoperative chemotherapy in unresectable nonmetastatic neuroblastoma is still controversial. A preoperative regimen that included deferoxamine, cyclophosphamide, etoposide, carboplatin and thiotepa (D-CECaT) was evaluated in 10 children over one year of age at diagnosis, and this was followed by surgery and postoperative chemotherapy. After four courses of D-CECaT, the response rate was 9/10 with 3 complete responses, 6 partial responses and 1 minor response. Severe but transitory myelosuppression was the major toxic effect. Complete remission by combined D-CECaT chemotherapy and surgery was obtained in 9/10 patients, while 1 case achieved complete remission only with postoperative chemotherapy. All children are disease-free with a median follow-up of 30.5 months (range: 1+ to 50+). This intensive treatment was effective in both standard- and high-risk unresectable NB. However, whether a less intensive approach and fewer courses can also give similar results in standard-risk cases warrants further study.

[The study of chemotherapy via the reservoir to colo-rectal cancer patients with liver metastases]

From January 1986 to December 1994, we administered intra-arterial chemotherapy via the reservoir to 26 colo-rectal cancer patients with liver metastases. The protocol of this chemotherapy was administration of ADM 30 mg/body/4 wks, MMC 10 mg/body/2 wks and 5-FU 500 mg/body/2 wks. Responses to this chemotherapy were PR in 8 cases, NC 3 cases, PD 14 cases and unknown 1 case. The rate of response was 32.0%. Side effects were shown in 12 cases (46.2%), and trouble with the reservoir in 5 cases (20.8%). Survival times of patients were from 5 months to 42 months (average 13.6). We think that this intra-arterial chemotherapy via the reservoir was effective for patients with liver metastases from colo-rectal cancer.

[Effects of intraarterial chemotherapy after hepatectomy in hepatic cancer patients]

We conducted a retrospective study on the effects of intra-hepatic arterial chemotherapy in patients with liver cancer, and 118 patients with stage II hepatocellular carcinoma (HCC) who had undergone hepatectomy were enrolled. Patients were divided into three groups: group R (n = 41) was treated by intraarterial infusion of Epi-adriamycin 30-40 mg/body and CDDP 100 mg/body via reservoir every two weeks post-operatively; group O (n = 57) was given one-shot infusion of Epi-adriamycin or adriamycin, and group N (n = 20) served as the control. No significant differences were observed among the three groups in postoperative disease-free survival rates. The better prognosis of survival rates found in group R suggested the influence of treatment on the recurrent lesions. Six of 14 long-term survivors were in group N. The selection of the patients group should be studied more in order to obtain the full potential of postoperative intraarterial chemotherapy in stage II HCC.

Adjuvant chemoimmunotherapy for hepatocellular carcinoma patients. Adriamycin, interleukin-2, and lymphokine-activated killer cells versus adriamycin alone

To determine improved postresection survival in patients with hepatocellular carcinoma, two postoperative protocols were compared: adoptive chemoimmunotherapy versus chemotherapy. Following resection, 24 patients were allocated at random to receive (1) arterial infusion of Adriamycin, recombinant interleukin-2 and lymphokine-activated killer cells or (2) arterial infusion of Adriamycin alone. The spleen was removed at operation and used to prepare lymphokine-activated killer cells. Each group had 12 patients. They were followed until signs of recurrence appeared. The overall survival rates of the patients were 91.7%, 82.9%, and 72.5% at 1, 2, and 3 years, respectively, and slightly higher than would be expected with surgery alone. No statistically significant difference was found between the two groups either in the survival rate (generalized Wilcoxon test, P = .936) or in the cumulative disease free rate (P = .182). However, when patients who had had hepatic resection with negative margin (> or = 1 cm) were separated, the 2-year cumulative disease-free rate in the adoptive chemoimmunotherapy was higher (83.3%, n = 6) than that in chemotherapy (37.5%, n = 8). Toxicity to adoptive chemoimmunotherapy was moderate; no severe side effects were observed. Totally no statistical difference between the two groups was found. Although only one of six patients in adoptive chemoimmunotherapy experienced recurrence after hepatic resection with negative margin, it was not feasible to determine the role of interleukin-2 and lymphokine-activated killer cells. We conclude that the adoptive chemoimmunotherapy in this study is not an ideal adjuvant protocol after hepatic resection.

[DNA ploidy pattern, p53 immunohistochemical overexpression and PCNA labeling index in "single nodular" human hepatocellular carcinomas from the viewpoint of biological malignant potential]

Nuclear DNA ploidy analysis, p53 immunohistochemical overexpression and PCNA Labeling Index (PCNA LI) were studied in 80 cases of resected "single nodular" human hepatocellular carcinoma (HCC) tissue sections. Aneuploid pattern was found in forty-six cases (57.7%) and p53 overexpression in fifteen cases (18.8%). The rate of aneuploid pattern was significantly higher in patients with carcinomas more than 2 cm in diameter, fc-inf positive growth and more than Stage II. p53 overexpression was not found in patients with well-differentiated HCCs and Stage I. Positive rate of p53 overexpression was significantly higher in patients with HCV-Ab positive and PCNA LI > or = 40%. It was high in patients with vp-positive, vv-positive and aneuploid pattern. PCNA LI of HCCs were significantly higher in patients with HBs-Ag positive, high serum AFP level, massive type and single nodular type with proliferation into surrounding area, fc-inf positive, im-positive, Stage III + IV, aneuploid pattern and p53 overexpression. The postoperative prognoses of patients with aneuploid pattern and PCNA LI > or = 40% were significantly poorer than those of the diploid one and PCNA LI < 40% in cumulative survival rates. Those prognoses were remarkably poorer in the early postoperative period. Patients with p53 overexpression had poorer prognosis than those with no p53 overexpression in the early postoperative period. These results suggest that nuclear DNA ploidy analysis, p53 immunohistochemical overexpression and PCNA LI were useful markers of biological malignant potentials in "single nodular" human HCCs.

[Primary hyperparathyroidism in young patients]

Five young patients with primary hyperparathyroidism were treated in our hospital. Male to female ratio was 3 to 2 and the mean age was 12.2 years old. Hypercalcemia due to a single adenoma of the parathyroid gland was found in all cases. They showed various clinical symptoms, such as abdominal pain, nausea, convulsions and disturbance of walking. Parathyroid tumors usually could be easily identified with ultrasonography or CT scan or thyroid subtraction scintigraphy. But in two cases parathyroid tumor was not found during operation. Angiography and/or venous sampling were performed and they showed the right localization.

Relationship between mdr-1 messenger-RNA expression and anticancer drug-sensitivity in human hepatocellular-carcinoma cell-lines

We examined the relationship between chemosensitivity and the expression of mdr-1 and P-gp in ten human HCC cell lines. Expression of P-gp was detected immunohistochemically and the expression of mdr-1 mRNA by the reverse transcriptase polymerase chain reaction (RT-PCR). Chemosensitivity was determined by the MTT assay. P-gp was positive in nine of the ten lines. mdr-1 mRNA expression was found in five. All cells lines positive for mdr-1 mRNA expression expressed P-gp. We could not demonstrate a correlation between mdr-1 or P-gp expression and drug resistance. We conclude that drug-resistance in HCC cells depends not only on mdr-1 but also on other factor(s).

Treatment combined with bone marrow transplantation for advanced neuroblastoma: an analysis of patients who were pretreated intensively with the protocol of the Study Group of Japan

One hundred and ten patients with advanced neuroblastoma were treated with the protocol of the Study Group of Japan between January 1985 and March 1991. Patients received six cyclic courses of regimen A1, consisting of cyclophosphamide (1,200 mg/m2), vincristine (1.5 mg/m2), tetrahydropyranyl adriamycin (40 mg/m2), and cisplatin (90 mg/m2). Primary tumors and regional lymph node metastases were removed some time during the first six cycles of regimen A1. After six cycles of A1, the patients were divided into three groups. Patients in group 1 received alternating treatment with regimen B (cyclophosphamide and ACNU) and intensified A1, and those in group 2 were treated with alternating administration of regimen C (cyclophosphamide and DTIC) and intensified A1. Patients in group 3 were treated with supralethal therapy and bone marrow transplantation (BMT). Event-free survival rates at five years were 38.8% in the chemotherapy group (groups 1 and 2) and 50.0% in the transplant group (group 3). Because of the study design that was not in truly randomized fashion and because of the small number of patients in each risk group, it is indicated, though not concluded, that the transplant group had a better prognosis than the chemotherapy group in the cases with stage III disease or with amplified N-myc oncogene, based on the statistical calculations. Differences in survival rates for patients who underwent BMT when complete remission (CR) was achieved and for those who achieved CR but who did not undergo marrow transplant were statistically insignificant. BMT-related death occurred in 3 of 31 cases (9.7%) undergoing marrow transplant, and the causes of the death included hemorrhagic pneumonia, myocardial disturbance and hemorrhagic uremia.

Age-related, different clinicopathologic features of hepatocellular carcinoma patients

OBJECTIVE

The authors attempted to clarify the clinicopathologic differences of hepatocellular carcinoma (HCC) patients, according to age distribution, and to investigate whether these differences contribute a certain hepatocarcinogenesis.

SUMMARY BACKGROUND DATA

Hepatitis-associated viruses causing HCC have been investigated, and the infection of the viruses and etiologically, the peak age of the disease vary according to geographic barriers. However, a correlation between clinicopathologic differences and the age distribution of the patients is not well understood.

METHODS

The authors reviewed their institutional experience from 1978 to 1990 in treating 428 patients with HCC. The carrier rate for hepatitis B surface antigen (HBsAg), the frequency of occurrence of high serum alpha-fetoprotein (AFP) of 2000 ng/mL, the degree of liver damage represented by the retention rate of indocyanine green dye at 15 minutes (ICGR15), and the incidence of accompanying liver cirrhosis were investigated and compared in each decade of age.

RESULTS

The HBsAg carrier rate and the frequency of high serum AFP values were significantly prominent in the younger patients (20-49 yrs). The degree of liver damage and the incidence of liver cirrhosis were prominent in the elderly patients (older than 70 yrs) or the middle-aged patients (50-69 yrs); however, these four values in the middle-aged patients were intermediate with respect to those observed in the other two age groups. In addition, there was a positive correlation between the HBsAg carrier rate and the frequency of high serum AFP values or between the degree of liver damage represented by ICGR15 and the incidence of liver cirrhosis, showing that the former correlation was inversely related to the latter.

CONCLUSIONS

The authors' study indicates that there are age-related differences of clinicopathologic features in HCC patients, suggesting that there are different steps or mechanisms of hepatocarcinogenesis according to the patient's age-distribution.

The significance of measuring liver volume using computed tomographic images before and after hepatectomy

The authors have developed a system to measure the volume of the liver parenchyma and tumors using computed tomographic images printed on film. The present study was carried out to clarify the usefulness of this method to assess both liver volume and the relationship between the volume increase and the functional recovery. We investigated 55 patients who underwent a hepatic resection of more than one segment. We calculated the effective resection of ratio and the liver volume increase at the 4th postoperative week to evaluate postoperative hepatic insufficiency. The liver volume increase 4 weeks after surgery correlated significantly with the effective resection ratio and also showed an inverse correlation with the severity of chronic changes in the liver. The liver volume increase also inversely correlated with the preoperative retention of indocyanine green at 15 min. Patients with postoperative hepatic insufficiency tended to show a smaller liver volume increase than expected for their resection ratio. In contrast, noncirrhotic patients had no such particular tendency. In conclusion, measurement of the liver volume using this technique appears to be a simple and useful method to evaluate liver volume after resection; as such, it may also be used to evaluate hepatic regeneration after resection.