Radioimmunoscintigraphy with a novel monoclonal antiprostate antibody (E4): an experimental study in nude mice

BACKGROUND

Prostate cancer is one of the leading causes of death among men, despite achievements in diagnosis and therapy. Radioimmunolocalization and radioimmunotherapy of malignant tumors have demonstrated increasing potential and may become useful tools in the management of prostate cancer.

METHODS

Nude mice were inoculated subcutaneously with cells from the poorly differentiated human prostate cancer cell line DU-145. The intact monoclonal antibody (MoAb) E4 and an intact anticytokeratin-8 MoAb, TS1, used for comparison were labeled with 125I and injected intraperitoneally (i.p.) in the mice. Repetitive quantitative scintigraphic recordings were performed during 1 month. The mice were killed at Day 29 after injection of the radiolabeled MoAb. The tumors and the organs were dissected and weighed. The remaining activity was measured in a gamma well counter. One part of the tumor was immediately fixed in Bouin's solution for autoradiography and the other in formaldehyde for microscopy.

RESULTS

The study demonstrated significant radioimmunolocalization of the MoAb E4 into the DU-145 prostate tumor tissue in the animal model, with an average radiation dose of 0.08 Gy/MBq in the tumor. TS1 localized preferentially in necrotic parts of the tumor, yielding a tumor dose of 0.02 Gy/MBq.

CONCLUSIONS

The MoAb E4 is a promising radiotracer for prostate cancer and may be used in radioimmunotherapy. As in earlier studies, TS1 shows significant radioimmunolocalization into necrotic tumor tissue, which also exists in prostate cancer.

Dosimetry of fractionated experimental radioimmunotargeting with idiotypic and anti-idiotypic anticytokeratin antibodies

BACKGROUND

Repeated injections of iodine-125 (125I)-labeled tumor targeting anticytokeratin monoclonal antibody (TS1) and a nonlabeled antiidiotypic monoclonal antibody against TS1 (alphaTS1) were compared with a single injection of the radiolabeled TS1 in experimental radioimmunotargeting. Anti-TS1 was used to remove nontargeting TS1.

METHODS

Nude mice were inoculated with HeLa Hep2 cells. The animals in Group A received a single injection of 13 MBq 125I-labeled TS1. The animals in Group B received four injections of 125I-labeled TS1 (8-13 MBq) followed by alphaTS1 24 hours later, at 2-week intervals. The mean absorbed doses were calculated according to the Medical Internal Radiation Dose Committee criteria based on repetitive radioimmunoscintigraphies during an observation period of 59 days.

RESULTS

A 11 gray (Gy) mean dose to the tumor and 2 Gy to the whole body was achieved in Group A. Mean peak tumor uptake of 5% of the injected dose (ID), corresponding to 14% ID/g, was observed on Day 17 after a single injection of the labeled monoclonal antibody. A mean peak tumor uptake of the same order of magnitude was seen in Group B. An absolute increase in the tumor uptake was observed in Group B during the entire observation period. The mean absorbed dose to the tumors was 11 Gy at the end of the observation period, whereas the whole body dose was only 2.5 Gy in Group B. Autoradiography of the tumors at the end of the observation period confirmed an intensive heterogeneous accumulation of activity in the entire tumor.

CONCLUSIONS

The fractionated strategy can contribute to a significant accumulation of radiolabeled TS1 in the tumors. Furthermore, the use of alphaTS1 makes it possible to increase the tumor-to-nontumor dose ratio and maintain a prolonged high activity accumulation in the tumor.

Experimental radioimmunotargeting combining nonlabeled, iodine-125-labeled, and anti-idiotypic anticytokeratin monoclonal antibodies: a dosimetric evaluation

BACKGROUND

Preinjection of a nonlabeled tumor targeting anticytokeratin monoclonal antibody (TS1) and postinjection of an anti-idiotypic anticytokeratin monoclonal antibody (alphaTS1) were evaluated separately and in combination to investigate their effects on the accumulation of iodine-125 (125I)-labeled TS1 in experimental radioimmunotargeting. TS1 targets deposited extracellular cytokeratin 8 from necrotic tumor cells.

METHODS

Nude mice were inoculated with HeLa Hep 2 cells. Four different groups were followed with 504 repetitive quantitative radioimmunoscintigraphic recordings during a 78-day observation period. The absorbed doses were calculated according to criteria of the Medical International Radiation Dose Committee.

RESULTS

As much as 2% of the injected dose (ID) of 125I-labeled TS1 accumulated in the tumor, and the peak tumor uptake was recorded as late as Day 30 after the injection of 125I-labeled TS1. Anti-TS1 caused a rapid decrease in the whole body activity. The highest tumor-to-nontumor activity ratios were obtained when a pre-injection of nonlabeled TS1 was combined with a postinjection of alphaTS1. The mean absorbed dose in tumor per unit activity administered was 0.44 gray/megabecquerel (Gy/MBq) and in nontumor tissues 0.15 Gy/MBq after a single injection of 125I-TS1. The efficacy was 0.34 Gy/MBq in tumor and 0.1 Gy/MBq in nontumor tissues after a combination of preinjection of nonlabeled TS1 and postinjection of nonlabeled alphaTS1. This indicates a 20% increase in tumor doses compared with a single injection of labeled TS1.

CONCLUSIONS

This study confirms an extensive accumulation of TS1 in the tumor, with peak values as late as 30 days after injection of labeled TS1. Furthermore, both preinjection of nonlabeled TS1 and postinjection of alphaTS1 can improve radioimmunotargeting.

Unintentional fatal paraquat poisonings among agricultural workers in Costa Rica: report of 15 cases

This study analyzes the exposure circumstances of 15 fatal occupational paraquat poisonings. To evaluate the potential danger of dermal absorption and the amount needed to produce a fatal outcome in the event of oral intake, we reviewed the medical records and autopsy protocols and interviewed relatives. Five fatalities were due to ingestion of a mouthful of paraquat concentrate, and five to intake of a smaller amount; three cases were associated with dermal exposure, and in two, there was no evidence of either oral or dermal exposure. Several cases concerned diluted paraquat spray. The clinical and pathomorphological findings, including a "blinded" evaluation of lung slides, were consistent with paraquat poisoning in all cases. Difficulties in establishing the diagnosis and recognizing the exposure were identified, as well as classification of unintentional poisonings as suicides at autopsy. The findings suggest that paraquat may cause fatal poisonings by ingestion of small amounts, by dermal absorption of diluted paraquat, and possibly by inhalation. More conclusive studies are warranted.

Serial Gadolinium-Enhanced Magnetic Resonance Imaging and Assessment of Facial Nerve Function in Bell's Palsy

Eleven patients with mild or moderate acute idiopathic peripheral facial palsy, so-called Bell's palsy, were serially examined by gadolinium-DTPA-enhanced MRI on mean days 11, 40, and 97 (third examination, n = 10) after the onset of palsy. Results of the clinical and neurophysiologic assessment of facial nerve function were compared with the gadolinium-enhanced MRI findings. Eight of the 11 patients demonstrated contrast enhancement of the facial nerve at the initial examination, but in 7 of them, the enhancement had disappeared by the time of the serial follow-up gadolinium-enhanced MRI scans. The disappearance of facial nerve enhancement was found to be related to clinical and neurophysiologic improvements in facial nerve function during recovery from Bell's palsy. The three patients whose scans were negative at the initial gadolinium-enhanced MRI examination had the same clinical severity of palsy, but initially they had milder neurophysiologic involvement than those who demonstrated enhancement; these three patients did not exhibit enhancement at serial follow-up scans. These findings indicate that the presence of enhancement at the initial MRI scan is not necessarily indicative of a poor prognosis for recovery.

Serial gadolinium-enhanced magnetic resonance imaging and assessment of facial nerve function in Bell's palsy

Eleven patients with mild or moderate acute idiopathic peripheral facial palsy, so-called Bell's palsy, were serially examined by gadolinium-DTPA-enhanced MRI on mean days 11, 40, and 97 (third examination, n = 10) after the onset of palsy. Results of the clinical and neurophysiologic assessment of facial nerve function were compared with the gadolinium-enhanced MRI findings. Eight of the 11 patients demonstrated contrast enhancement of the facial nerve at the initial examination, but in 7 of them, the enhancement had disappeared by the time of the serial follow-up gadolinium-enhanced MRI scans. The disappearance of facial nerve enhancement was found to be related to clinical and neurophysiologic improvements in facial nerve function during recovery from Bell's palsy. The three patients whose scans were negative at the initial gadolinium-enhanced MRI examination had the same clinical severity of palsy, but initially they had milder neurophysiologic involvement than those who demonstrated enhancement; these three patients did not exhibit enhancement at serial follow-up scans. These findings indicate that the presence of enhancement at the initial MRI scan is not necessarily indicative of a poor prognosis for recovery.

The pharmacological characterization of a novel selective 5-hydroxytryptamine1A receptor antagonist, NAD-299

The pharmacological properties of a novel selective 5-hydroxytryptamine1A (5-HT1A) receptor antagonist, NAD-299 [(R)-3-N,N-dicyclobutylamino-8-fluoro-3,4-dihydro-2H-1-benzopyran-5-carboxamide hydrogen (2R,3R)-tartrate monohydrate] were examined in vitro and in vivo and compared with the reference 5-HT1A receptor antagonist, WAY-100635 [N-(2-(1-(4-(2-methoxyphenyl)piperazin-yl))ethyl)-N-(2-pyridinyl) cyclohexanecarboxamide trihydrochloride]. The new compound had high affinity for 5-HT1A receptors in vitro with a Ki value of 0.6 nM. The only other receptors for which NAD-299 had affinity less than 1 microM were alpha-1 and beta adrenoceptors with Ki values of 260 and 340 nM, respectively. Thus, the selectivity of NAD-299 for 5-HT1A receptors was more than 400 times. WAY-100635 had considerably higher affinity than NAD-299 for alpha-1 adrenoceptors (Ki = 45 nM) and dopamine D2 and D3 receptors (Ki = 79 and 67 nM, respectively). Like WAY-100635, NAD-299 competitively blocked 5-HT-induced inhibition of vasoactive intestinal peptide-stimulated cAMP production in GH4ZD10 cells and had no intrinsic activity. Both compounds were therefore 5-HT1A receptor antagonists in vitro and also behaved as such in in vivo experiments. Thus, they competitively antagonized the 8-hydroxy-2-(di-n-propylamino)tetralin-induced 5-HT behavioral effects, hypothermia, corticosterone secretion and inhibition of passive avoidance behavior without causing any actions of their own. The effective dose of NAD-299 varied between 0.03 and 0.35 micromol/kg s.c., depending on the test and the dose of 8-hydroxy-2-(di-n-propylamino)tetralin.

Hydration does not influence the image quality in bone scintigraphy: an investigation using 99Tcm-HDP

We investigated the possibility that the increased diuresis caused by hydration leads to enhanced renal excretion of radiotracer and thereby increases the target-to-background activity ratio and improves the image quality in bone scintigraphy. The study was carried out using paired comparisons in 10 healthy volunteers. Whole-body antero-posterior and postero-anterior acquisitions were obtained for 4 h after the administration of 99Tcm-hydroxymethylene diphosphonate with and without hydration. The bone-to-soft tissue activity ratio was semi-quantified by comparing regions of interest acquired from geometrical means of the acquisitions. Hydration was performed by slowly drinking 1.5 litres of water after administration of the tracer. Hydration induced a slight enhancement of excretion of the activity, but it had no effect on the bone-to-soft tissue activity ratio, nor did it influence image quality. We conclude that hydration could be avoided when it is cumbersome for the patient. However, as hydration reduces the radiation dose to the urinary bladder wall, which is the critical organ, hydration should be maintained in younger patients.

Cystatin C, and inhibitor of bone resorption produced by osteoblasts

The effects of human cystatin C on bone resorption, enzyme release, osteoclast generation, bone cell proliferation and bone matrix protein biosynthesis have been examined in different in vitro systems. The effects of cystatin C were compared with those of calcitonin and E 64 (trans-Epoxysuccinyl-L-leucyl-amido-(4-guanidino)butane). Recombinant human cystatin C and E 64 dose dependently inhibited the mobilization of 45Ca and the release of 3H (from [3H]-proline-labelled bones) in mouse calvariae stimulated to resorb by parathyroid hormone (PTH) or 1,25(OH)2-vitamin D3. Cystatin C and E 64 also inhibited the release of 45Ca from bones stimulated by thrombin, interleukin-1 and prostaglandin E2. In PTH-stimulated bones, the inhibitory action of cystatin C and E 64 on 45Ca release was observed after 6-9 h, whereas the inhibitory effect on 3H release was seen after just 2 h. In contrast, calcitonin caused an inhibition of both 45Ca and 3H release which was seen after 2 h. The PTH-stimulated release of the lysosomal enzymes was not affected by cystatin C and E 64, whereas calcitonin caused a significant inhibition. In contrast to calcitonin, cystatin C did not affect PTH-stimulated enhancement of osteoclast generation in the mouse calvariae. Using Western blot analysis and radioimmunoassay, we demonstrated that mouse calvarial bones and MC3T3-E1 cells produce cystatin C. These data show that cystatin C is synthesized by bone cells and that recombinant human cystatin C inhibits bone resorption in vitro without affecting bone cell proliferation, bone matrix formation or osteoclast generation. The mechanism seems to be due primarily to inhibition of the activity of osteoclastic proteolytic enzymes released into the resorption lacunae.

Decentralisation from acute to home care settings in Sweden

Sweden has a regionally based, publicly operated and financed, national health care system. Implementation of policy and the provision of health care has been the responsibility of the county council. In 1992, the major responsibility and resources for care of the elderly was transferred to the municipalities. The start of this reform, unintentionally, coincided with an economic recession which caused additional difficulties for the financing of the present level of public services generally. This development, in combination with innovations in health care technology, resulted in a rapid decentralisation of certain elderly care services from acute care settings.

Response rates with different distribution methods and reward, and reproducibility of a quantitative food frequency questionnaire

OBJECTIVES

To evaluate the use of a self-administered quantitative food frequency questionnaire (QFFQ) in a national dietary survey concerning (a) response rates with different distribution methods and reward; (b) degree of underreporting of energy intake; (c) reproducibility of the QFFQ; and (d) seasonal variation on reported intake.

DESIGN AND SUBJECTS

A pilot study was performed in 1992 to test response rates to the QFFQ with three different distribution methods, with and without reward, in a random sample of 1200 adults aged 16-79 y. In another study, the QFFQ was distributed to a nation-wide, representative random sample of 5008 adults aged 16-79 y during June, September, November 1993 and March 1994. Reproducibility was evaluated among 90 responders to the survey who answered another QFFQ six weeks later.

RESULTS

The distribution method combining postal distribution and collecting the QFFQ by interviewer as well as an offer to participate in a lottery, gave the highest response rate (72%). The possibility to get a reward increased the response rate by 9, 14 and 57%, respectively, depending on the distribution method used. The mean daily energy intake and the percentage of subjects claiming to have unlikely low energy intake did not differ significantly between the different ways of distribution. In the main survey the mean ratio between energy intake and estimated basal metabolic rate was 1.58 among men and 1.47 among women, and 37% of men and 45% of women had a ratio below 1.35. Spearman rank correlations between the two QFFQ ranged from 0.48 (edible fats) to 0.91 (coffee) with a median coefficient of 0.70. For nutrients correlations ranged from 0.55 (carbohydrate E%) to 0.81 (alcohol), with a median coefficient of 0.72. The season of questionnaire administration was of minor importance for the reported intake of the main foods and nutrients.

CONCLUSIONS

The QFFQ-method is suitable for use in a Norwegian nutritional surveillance system.

SPONSORSHIP

National Nutrition Council, Ministry for Agriculture, Ministry for Health and Social Affairs and Norwegian Research Council.

Motility stimulant effects of prostasome inclusion in swim-up medium on cryopreserved human spermatozoa

The chance of obtaining a fertilization and establishing a pregnancy increases with the number of motile spermatozoa that can reach and interact with the oocyte after the time of insemination. In an attempt to increase the recovery of freeze-thawed and motile spermatozoa, the swim-up medium was supplemented with prostasomes and some other effectors. Swim-up media supplemented with prostasomes were superior in comparison to the other effectors investigated in the recovery of motile spermatozoa for insemination. These results suggest that prostasome inclusion in swim-up medium might be of benefit in improving results in assisted reproductive technologies using freeze-thawed spermatozoa.

Expression pattern of glutamate decarboxylase (GAD) in the developing cortex of the embryonic chick brain

The development of the GABAergic system in the chick embryo telencephalon has been studied. Special emphasis was placed on the development of glutamate decarboxylase (GAD) between embryonic day 8 (E8) and E17. The GABA immunoreactivity and neuron-specific enolase expression was detected simultaneously in glutardialdehyde fixed sections, which confirmed that GABAergic cells exhibit neuronal phenotype. The GAD expression was studied by means of immunohistochemistry on cryo-sectioned material both at the light and electron microscopic levels. Furthermore, the presence and localization of GAD65 and GAD67 mRNAs were studied with an in situ hybridization technique with digoxigenin-labeled RNA probes. Protein expression as well as mRNA appearance mostly coincided both temporally and spatially. In the parahippocampal area, as well as in other regions of the developing cortex, GAD staining was seen from E8 onwards. The number of positive cells increased as did the intensity of staining up to E14. As observed in the electron microscope, the GAD protein was co-localized with GABA in most cases, although some GAD-positive cells devoid of GABA-staining also were observed. The pattern of GAD mRNA expression was in general similar to that of GAD immunostaining. Both GAD65 and GAD67 mRNA were detected during the entire period. Furthermore, GAD67 mRNA localization spatially was more correlated with GAD protein expression. The study provides evidence for the notion that development of the GABAergic system occurs rapidly during embryogenesis and, as suggested from mRNA data, that two forms of GAD with slight difference in distribution can contribute to this.

Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study

In order to assess the value of radiotherapy in the treatment of pleural mesotheliomas, we studied tumour response and survival after hemithorax irradiation alone (RT), or radiotherapy combined with doxorubicin and cyclophosphamide chemotherapy (RTCT). Forty seven patients with pleural mesotheliomas received irradiation of the diseased hemithorax at 8 MV (megavolt) photons to a total dose of 40 Gy, administered in 20 daily fractions of 2 Gy for 5 days a week. One month after RT, patients aged < or = 70 yrs with a good performance status were offered supplementary chemotherapy (CT) with doxorubicin 30 mg.m-2 body surface on Day 1 and Day 8, combined with cyclophosphamide 600 mg.m-2 on Day 1, in cycles of 21 days. Tumour response was evaluated by computed axial tomography (CAT) before and 1 month after RT and/or CT. Only 3 of the 47 (95% confidence interval (95% CI)-0.6-13%) irradiated tumours responded with a partial response (PR). In 31 patients treated with RT alone, one PR was observed; whereas, in the combined treatment group, 2 out of 16 responded with PR to RT. CT with doxorubicin and cyclophosphamide induced only 2 out of 16 PRs (95% CI -3.4-28.4%), and the combined treatment consisting of RT followed by CT induced 2 out of 16 PRs. The median survival following the initiation of RT was 7 months in all patients (n = 47), 6 months in the RT group (n = 31), and 13 months in the combined RTCT group (n = 16). Chest pain, performance status and body weight were not favourably affected by the radiotherapy. We conclude that hemithorax irradiation of pleural mesotheliomas with a moderately high dose is not useful, since it produces no improvement in chest pain, few objective tumour responses and no prolongation of survival.

The contribution of secondary heavy particles to the absorbed dose from high-energy photon beams

High-energy photon radiotherapy sources produce non-negligible numbers of secondary heavy particles (neutrons, protons and alphas) which contribute to the dose in a patient. They also present a radiation protection problem. The contribution of such particles to the absorbed dose in a tissue-like medium and to the equivalent dose is considered in this study experimentally. Track etch detectors were chosen as a basic type of measuring instrument: cellulose nitrate Kodak LR115 and polyallyldiglycol carbonate CR39 were used as detectors. Several methods of directly read datum (track density, track parameter, LET spectrum etc) interpretation have been analysed. It has been ascertained that the contribution of secondary heavy particles represents approximately 0.002 of the photon dose and 0.02 of the equivalent dose, both at 50 MeV as maximum photon energy. The contribution of a 20 MV bremsstrahlung beam is roughly one-fifth of that at 50 MV.

The Norwegian diet during the last hundred years in relation to coronary heart disease

OBJECTIVE

The influence of dietary changes on serum cholesterol and CHD during the last century in Norway has been evaluated.

DESIGN

Data on food consumption are based on national food supply and household consumption surveys. To be able to calculate comparable series of the dietary content of energy, fat, saturated, monounsaturated and polyunsaturated fatty acids and dietary cholesterol, we compiled food composition data covering this century. The dietary effect on serum cholesterol was estimated by Keys equation.

RESULTS

Changes in dietary lipids precede the increase and the decrease in mortality of CHD. The estimated serum cholesterol level in the population increased by approximately 1 mmol/l during 1900-1960, and decreased by approximately 0.6 mmol/l during 1960-1992. These changes correspond to a 60% increase and a 30% decrease in risk for CHD. However, the observed change in mortality of CHD was greater. During 1951-1955 and 1971-1975 it increased by 120% in men and 80% in women aged 50-59 years and during 1971-1975 and 1991-1993 it decreased by 43% and 29%, respectively.

CONCLUSIONS

Change in dietary lipids have the potential to explain a great deal of the changes in mortality of CHD in Norway during this century. A reduced consumption of boiled coffee and an increase in the consumption of antioxidants may also have contributed to the reduced mortality of CHD the last 20 years.

Electrocortical responses to ecologically relevant visual stimuli among professional drivers with and without cardiovascular disease

Electrocortical responses were assessed using two simulated aspects of visual signals encountered in traffic: the Glare Pressor Test (GPT) and Event-Related Potential Avoidance Task (ERPAT) among four groups of male professional drivers: 12 with ischemic heart disease (IHD), 12 hypertensives, 10 borderline hypertensives, 34 who were apparently healthy and 23 nonprofessional driver healthy control subjects. The blood pressure (BP) responses immediately after the ERPAT were also measured. There was a significant between groups effect for the amplitude of the target N2 component in the ERPAT (p = 0.02), with the lowest means among the drivers with IHD and the highest among those with hypertension. Drivers with IHD also showed the highest diastolic BP reactivity to the ERPAT. Significantly more than the expected number of drivers with IHD failed to recover alpha activity after the first glare impulse of the GPT. Professional drivers who failed to recover baseline levels of alpha activity after the GPT showed a significantly smaller N2 amplitude compared to those who recovered (p = 0.01). There was a positive correlation between abundance of alpha activity at rest with P300 amplitude (p = 0.02). An inverse relation was found between number of work hours behind the wheel and the amplitude of the target P300 (p = 0.04). Results are interpreted in light of recent advances concerning integrative mechanisms of defence versus vigilance response patterns. The findings in this study justify further applications of these psychophysiologic methods to assess the relationship between simulated signals of the work environment and mechanisms of cardiac risk in this occupational group.

Three cases of dental technician's pneumoconiosis related to cobalt-chromium-molybdenum dust exposure

Dental technician's pneumoconiosis (DTP) is a rather recent finding in subjects exposed to the dust generated in dental laboratories producing metal-framed removable partial dentures from alloys based on cobalt, chromium, and molybdenum. This study presents details of the first three Swedish cases of DTP with some emphasis on the diagnostic procedures and the dust exposure. A follow-up of at least 5 years from diagnosis is included.