The effect of interfacial parameters on cup-bone relative micromotions. A finite element investigation

Achieving stability is a prerequisite for allowing bone to grow into the porous surface of non-cemented acetabular cups. The purpose of this study is to estimate the effects of interfacial characteristics on relative cyclical micromotion between cup and bone during gait in the immediate postoperative phase. The technique used is finite element analysis. Six models with different interfacial characteristics are created in order to study the effects of fixation technique. These include representation of a 1 mm press-fit, 2 mm press-fits (with and without an initial polar gap) and exact-fit conditions (with and without additional screw fixation). Although direct validation of the model has not been performed, the calculated micromotions under a static load of 1112 N are compared with appropriate experimental data. Generally, the model tends to underestimate micromotion and this underestimate is significant in the case of relative surface-normal micromotion in polar regions for models with low- and no-interference. The most likely cause of this significant underestimate is a failure of the model to accurately represent penetration of rough contacting surfaces under compression. Other types of micromotion, although low, are within standard deviations reported by Kwong et al. (1994 Journal of Arthroplasty 9, 163-170). Quasi-static joint contact and muscle forces, representative of the stance phase of gait are then applied and maximum micromotions are found to occur consistently prior to toe off: this being the point of maximum force. With regard to the press-fit simulations, good cup-bone contact in the superior region of the interface is required for stability and the greatest micromotions occur in the models with the larger interference and larger polar gaps. In contrast to the press-fit models, muscle activity in exact-fit models influences the calculations. Specifically, the early activity of m.semimembranosus modelled causes opening of the peripheral seal. Taken together it is found that polar gaps reduce the stability of the model and lack of pre-compresssion in the periphery allows this region of the interface to be opened up.

The influence of friction and interference on the seating of a hemispherical press-fit cup: a finite element investigation

The formation of gaps in the polar region of acetabular cups is seen as a drawback of press-fit fixation of non-cemented acetabular cups. Recent findings indicate a link between long-term polar gaps and the gaps present directly after implantation. In this study the process of press-fitting is simulated with a linear-elastic two-dimensional axisymmetric finite-element model. The aim of this paper is to investigate the possible importance of friction and interference on the formation of these gaps. A range of cup-bone friction coefficients (mu = 0.1-0.5) is assigned to the cup-bone interface in order to represent the unknown amount of friction occurring during press-fitting. The cup is modeled with a radius of 27 mm, whereas the radius of the cavity is varied between 26.50 and 26.75 mm, thus, creating 0.50 and 0.25 mm radial interference fits. The difference in cavity radius represents the discrepancy between the radius of the last-reamer-used and radius of the cavity it creates. The subchondral plate is considered as being completely removed during reaming. The effects of impact blows via the surgeon's mallet during surgery are modeled as a series of four load pulses, in which peak force is gradually increased from 0.5 to 4.0 kN. The effects of load removal as well as those of load application are investigated. On load application, the cup penetrates into the cavity, and on load removal, the cup rebounds. Depending on the friction, interference and load applied, the position of the cup after the load pulse is somewhere between its position at peak force and its position at the beginning of the pulse. Although the simplifications and conditions involved in the creation of the model necessitate caution when interpreting the results for all clinical cases, it is found that the seating of hemispherical cups in trabecular bone could be more satisfactory for intermediate values of friction (mu = 0.2-0.3) and smaller interference fits (0.25 mm).

The distribution of cartilage thickness within the joints of the lower limb of elderly individuals

The objective of this study was to investigate the normal distribution of cartilage thickness in the major joints of the lower limb in elderly individuals. A 12.5 MHz ultrasound transducer was used to measure the cartilage thickness in the right and left hip, knee and ankle joint of 10 individuals aged between 62 and 99 y. Distribution patterns of cartilage thickness were derived by b-spline interpolation and the average distribution computed in each surface. The maximum cartilage thickness in the hip joint was 2.6 (+/-0.36) mm and the mean thickness 1.3 (+/-0.17) mm. The CV% (a measure of thickness inhomogeneity within the joint surface) was 32%. In the knee, the maximal and mean values were 3.8 (+/-0.46) mm and 1.9 mm (+/-0.24) mm, respectively (CV% = 34%), and in the ankle 1.7 (+/-0.25) mm and 1.0 (+/-0.16) mm (CV% = 32%). Systematic differences existed between both sides in the knee, the distal femur showing a significantly greater thickness on the right. While the mean and maximal thicknesses were systematically higher in the knee than in the hip, and in the hip higher than in the ankle (P < 0.05), there were no systematic differences in the thickness inhomogeneity of the 3 joints. Only the malleolus showed a somewhat more uniform thickness than the other joint surfaces. The variability between individuals was similar for all joints for mean thickness, but the interindividual variability of the maximal thickness values was highest in the knee and lowest in the ankle. Whereas the cartilage thickness distributions in the joints of the lower limb have been suggested to reflect the pressure distribution within the articular surface, the absolute thickness is proposed to be a function of dynamic loading (range of motion) during gait, rather than being a reflection of the static articular pressure.

The growth inhibiting effect of docetaxel (Taxotere) in head and neck squamous cell carcinoma xenografts

Docetaxel (Taxotere) is a new antitumor agent with activity in patients with ovarian, lung and breast cancer. In this study, docetaxel was tested for its antitumor effect in human tumor xenografts derived from head and neck squamous cell carcinoma (HNSCC). A significant growth inhibiting effect was observed in the two tested lines, at the well tolerated dose of 20 m/kg docetaxel. Two intravenous injections were given with a week interval. Both lines were less sensitive to treatment with cisplatin, indicating that no cross-reactivity exists between these drugs. Docetaxel has a promising outlook in the treatment of patients with head and neck squamous cell carcinoma (HNSCC).

EO9: a novel bioreductive alkylating indoloquinone with preferential solid tumour activity and lack of bone marrow toxicity in preclinical models

EO9 is a novel and fully synthetic bioreductive alkylating indoloquinone. Although structurally-related to mitomycin C, EO9 exhibits a distinct preclinical antitumour profile and there are also differences in its biochemical activation. In this study, EO9 was found to demonstrate preferential cytotoxicity against solid tumours in vitro as compared to leukaemia cell lines both in the Corbett two-tumour assay and in the disease-oriented human tumour cell line panel of the U.S. National Cancer Institute. In the latter system activity was particularly apparent in colon, melanoma and central nervous system lines, together with some renal and non-small cell lung lines. Preferential cytotoxicity towards hypoxic versus aerobic EMT6 mouse mammary tumour cells was observed. In vivo, EO9 was inactive against the P388 murine leukaemia, while exerting significant antiproliferative effects against several murine and human solid tumours, including the generally resistant MAC mouse colon tumours and gastric, ovarian and breast xenografts. These results confirmed in vitro observations of preferential solid tumour activity. In animal toxicology studies, EO9 induced vascular congestion in the gastrointestinal tract, but no significant bone marrow toxicity. The LD10 value of EO9 after a single intravenous injection into mice was 9 mg/kg (27 mg/m2). A dose of one-tenth of the mouse equivalent LD10 (2.7 mg/m2), the recommended starting dose for clinical phase I studies, was found to be safe in rats. Considering its distinct mechanism of bioactivation as compared to mitomycin C, its preferential solid tumour activity, its excellent activity against hypoxic cells, and lack of significant bone marrow toxicity in animals studies, EO9 has been selected for clinical evaluation within the framework of the EORTC.

Expression of the proliferation-associated Ki-67 antigen of transferrin receptors and of DNA polymerase alpha in human tumour lines: implications for in vitro chemoresistance

To compare the time course of in vitro expression of various proliferation-associated markers including Ki-67 antigen, transferrin receptors (TfR), and DNA polymerase alpha, six human tumour cell lines of different histological origin were studied under defined conditions. Proliferation markers were demonstrated by peroxidase/anti-peroxidase staining using specific monoclonal antibodies, and their expression was compared to results obtained from [3H]-thymidine incorporation assays and cell counting. Expression of all proliferation markers began to increase during the lag phase, and occurred earlier than elevations of [3H]dT incorporation and cell numbers were recorded. Maximum expression was observed before cell growth reached plateau phase. The time courses of expression of DNA polymerase and Ki-67 were almost identical. The closest correlation of [3H]dT incorporation with time course of expression of proliferation-associated markers was observed, when intranuclear staining of DNA polymerase was analysed. TfR were expressed earlier than the polymerase and Ki-67. Since TfR were also found at remarkable levels in resting cells, they seem less proliferation-specific than Ki-67 and DNA polymerase. While in rapidly growing cell lines more than 95% of the cells expressed Ki-67, TfR, and more than 75% DNA polymerase in cell nuclei, a malignant melanoma and a pleural mesothelioma line displayed fewer than 35% of cells stained for DNA polymerase in cell nuclei during log phase. Determination of growth fractions by monoclonal antibodies may thus contribute to the prediction of chemoresistance by identifying quiescent cells that are not sensitive to S-phase-specific drugs.

Physiopathology of the knee joint after distal iliotibial band transfer

In an experimental study of 14 cadaver knee joints, the pressure load on the joint surface after distal iliotibial band transfer was measured using Fuji Prescale foils. With an intact anterior cruciate ligament, increases of up to 153% for the average pressure load and of 225% for the total pressure in the lateral compartment were found in relation to the fixation point chosen. At point P3--slightly dorsal to the insertion of the lateral collateral ligament--the area loaded with maximum pressure increased to six-fold. Fixation at the transition of the lateral femoral condyle to the femoral shaft at the start of the linea aspera was associated with the least pressure increases in both the lateral and the medial compartments. Under all experimental conditions, lateral extra-articular stabilization with fixation at the insertion of the fibular collateral ligament was shown to be associated with significantly higher load increases. While a shift of pressure load to the dorsal third was seen in the lateral compartment, the mid-third remained the focus of the pressure load in the medial compartment. After transection of the anterior cruciate ligament and iliotibial band transfer at the "over-the-top" point, a significant shift of pressure towards the medial compartment was seen, while the lateral pressure load decreased. Medially, the area loaded with peak pressure remained constant, while the corresponding area in the lateral joint space showed a highly significant decrease to nearly one-third of normal. After additional bilateral meniscectomy this tendency was even more pronounced.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth of xenografted head and neck cancer in nude mice pre-treated with whole body irradiation

In an attempt to enhance the primary acceptance rate of human squamous cell carcinoma of the head and neck (HNSCC), nude mice (BALB/c) were given whole body irradiation (WBI) prior to heterotransplantation of tumour specimens. A total of 27 fresh HNSCC biopsies were transplanted, with a take rate of 15%. No difference in primary tumour acceptance rate was found between irradiated and non-irradiated mice. Only one of the accepted tumours established growth both in irradiated and non-irradiated mice. In a second experiment, three previously established tumour lines of HNSCC were re-transplanted to irradiated and non-irradiated mice. As compared with non-irradiated mice, the growth rate was lower in all tumours transplanted to irradiated mice, the difference being statistically significant in two out of the three tumour lines. The results of the study show that attempted immunosuppression by WBI of nude mice prior to tumour implantation does not improve the growth conditions of HNSCC. These findings further emphasise the complexity of the transplantation barrier against human tumour xenografts in nude mice.

In vitro and in vivo anticancer activity of mitozolomide and sparsomycin in human tumor xenografts, murine tumors and human bone marrow

The colony formation in agar of human tumor xenografts, of murine tumors and of human bone marrow was used as a test system to determine the in vitro activity of the two novel cytostatic agents, mitozolamide and sparsomycin. Mitozolomide was additionally studied in vivo in nine human tumor xenografts. The comparison of in vitro/in vivo activity allows an assessment of the relevant in vitro dose based on in vivo pharmacological behavior of a compound. Both compounds showed clear dose/response effects in vitro. A dose of 3 micrograms/ml mitozolomide, given by continuous exposure, was active (colony number of test less than 30% of the control group) in 12/42 (29%) human tumor xenografts as well as in the four murine tumors, P388, L1210, B16 melanoma and colon carcinoma 38, whereas the two human bone marrows showed no significant suppression of the ability to form colonies in culture. The comparison of in vitro with in vivo activity suggests that the in vitro dose of 3 micrograms/ml corresponds best to the activity observed in animal experiments. The highest activity was observed in small-cell cancer of the lung (4/5), followed by melanomas (2/7) and non-small-cell cancer of the lung (2/9). Furthermore, activity was found in a cancer of the large bowel, stomach, breast and in one sarcoma. In the treatment of nine human tumor xenografts growing subcutaneously in nude mice, mitozolomide effected a complete or partial remission in 6 out of 9 tumors. In comparison to standard drugs mitozolomide is one of the most effective compounds in these tumors. These data indicate that mitozolomide possesses potent broad-spectrum activity in human tumor xenografts. Sparsomycin (0.1 micrograms/ml, continuous exposure) was active in 11/46 (24%) human tumor xenografts and in 4/5 of the murine tumors, whereas the colony-forming capacity of four human bone-marrows showed no inhibition, suggesting that this dose level may be the relevant in vitro dose. However, the high in vitro activity in murine tumors is incompatible with the in vivo activity. In mice the only responsive tumor was leukemia P388, whereas the L1210, B16 melanoma and colon carcinoma 38 were resistant. At the dose level of 0.03 microgram/ml only 3/30 (10%) of the human tumor xenografts were sensitive. In an earlier clinical phase I study the dose-limiting adverse effect was eye toxicity and not bone-marrow suppression.(ABSTRACT TRUNCATED AT 400 WORDS)

The clonogenic assay with human tumor xenografts: evaluation, predictive value and application for drug screening

The feasibility, evaluation and predictive value of the colony-forming assay with human tumor xenografts for screening anticancer drugs have been studied. Using human tumors grown in serial passage in nude mice, adequate colony formation was observed in 215 of 251 (86%) different solid human tumors of various histologies. Based on in vitro growth characteristics, a quality-controlled assay protocol was developed. With the proposed criteria for standardized evaluation of individual experiments a substantial increase in assay reliability was achieved. The five clinically established agents, cisplatin, doxorubicin, etoposide, mitomycin-C and vindesine, were studied for anticancer activity in the clonogenic assay. Drugs were applied over a wide dose range by continuous exposure, yielding clear dose-response effects with coefficients of correlation between r = 0.946 and 0.995. Relevant dose levels predicting correctly for the clinical efficacy of the agents were determined by comparison of in vitro anticancer activity to in vitro toxicity on human bone marrow as follows: cisplatin 0.1 micrograms/ml, doxorubicin 0.01 micrograms/ml, etoposide 0.1 micrograms/ml, mitomycin-C 0.005 micrograms/ml, vindesine 0.01 micrograms/ml. At these concentrations, clinically sensitive tumor types showed inhibition of colony formation in 99 of 240 cases (41%), whereas 11% (19/176) of clinically resistant tumors were responsive. The relevant dose levels used equal between 0.3% and 4.0% of the achievable peak plasma concentrations in man. The predictive value of the clonogenic assay was determined by treatment of the same tumors in vitro and in vivo in tumor-bearing nude mice. In 174/220 comparisons (79%), in vitro data predicted correctly for the in vivo sensitivity of the xenografted malignancies.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitumor activity of brequinar sodium (Dup-785) against human head and neck squamous cell carcinoma xenografts

The effect of Brequinar sodium on the growth of xenografts established from head and neck squamous cell carcinomas (HNSCC) was assessed. Brequinar sodium is a novel drug, known to inhibit dihydroorotic acid dehydrogenase (DHO-DH), resulting in a decrease of the pyrimidine de novo synthesis. The drug was administered i.p. to tumor-bearing nude mice, once a day, during 5 days at a maximum tolerated dose of 50 mg/kg/day. Statistically significant growth delaying effects were observed in 4 out of 5 lines tested. In 3 of these lines the effect was moderate and short lasting, whereas in one line (HNX-LP) tumor growth rate was totally inhibited for a 17-day period. In this line, Brequinar sodium was superior to 5 drugs known to be active in HNSCC patients. In two tumor lines DHO-DH activity could be measured and the results are in agreement with the concept that there is a relation between Brequinar sodium sensitivity and enzyme activity.

Preclinical chemotherapy on human head and neck cancer xenografts grown in athymic nude mice

This study was undertaken to investigate the potential role of xenografts established from human head and neck squamous cell carcinoma (HNSCC) in the selection of new anticancer agents for phase II clinical trials. Eight HNSCC tumor lines were established in NMRI nude mice. The tumor-bearing animals were then treated with drugs at the maximum tolerated dose level. Treatment with drugs known for their activity in 15%-30% of HNSCC patients [cisplatin (CDDP), bleomycin (BLEO), 5-fluorouracil (5-Fu), cyclophosphamide (CY), and doxorubicin (DOX)] caused strong responses in up to 38% and moderate responses in 50%-67% of the HNSCC tumor lines. Methotrexate (MTX), known to cause remissions in about 40% of HNSCC patients, was only minimally active in this model system. A clinically ineffective drug, amsacrine (m-AMSA), was included as a negative control and showed no or minimal activity in all four HNSCC lines tested. A number of experimental drugs that have promising preclinical activity were also tested. Brequinar sodium (Dup 785) and 10-ethyl, 10-deaza-aminopterin (10-EdAM) showed activity in three of five, and two of the four tested tumor lines respectively. N,N-dimethylformamide (DMF) and 5-aza-2'-deoxycytidine (5-aza-dCyd), agents with the capacity to induce differentiation in in vitro systems, showed moderate activity in 43% and 40%, and strong activity in 14% and 40% of the lines, respectively. Our results indicate that the nude mouse xenograft model may play a role in the screening of new drugs, and in particular, it could be of help in the selection of drugs to be tested in phase II HNSCC clinical trials.

CGP 6809, a sugar-containing nitrosourea derivative: pharmacological and physicochemical properties

CGP 6809 is a water-soluble nitrosourea derivative with quite distinct chemical and biological properties as compared with the well-known representatives of this class of compounds. It is related to the antibiotic streptozotocin, from which it is distinguished in the structure of the sugar moiety and the position of the methylnitrosourea residue. CGP 6809 possesses practically the same alkylating potential as streptozotocin; however, its carbamoylating activity is comparable with that of CCNU. In contrast to other nitrosourea derivatives, CGP 6809 showed relatively little activity in murine leukemias but was markedly active in solid transplantable melanomas (Harding-Passay, B16), in the 11095 prostate carcinoma, and in a substrain of Yoshida hepatoma (AH 7974) resistant to BCNU and CCNU. In the Ehrlich and Yoshida ascitic tumors complete responses were seen with no toxic death. Dose-dependent activity was found in the human lung carcinoma MBA 9812 and almost complete growth inhibition was achieved in the human melanoma WM 47 by both the oral and parenteral routes of administration. However, mammary tumor lines (Ca 755, 2661/61, R-3230AC), the Guerin-T8 uterus epithelioma, and the Rous sarcoma/S-R proved to be relatively refractory to this drug. This was also the case for the Lewis lung carcinoma implanted i.m. or s.c. However, development of lung metastases was markedly inhibited. Combination therapy using CGP 6809 with cyclophosphamide, 5-fluorouracil, or chlorambucil in the same model led to partial responses of the primary tumor as well as almost total eradication of lung metastases.

Human tumor xenografts as model for drug testing

This paper reviews the history of xenografts, the endpoints commonly used to evaluate response and chemotherapeutic results obtained with serially maintained human tumor xenografts from different laboratories, and discusses the potential clinical relevance of the heterotransplant model for cancer chemotherapy. Specifically, an attempt is made to correlate the published xenograft data with the clinical data. Drug testing with different types of xenotransplanted tumors has shown that the response of xenografts obtained in immune-deficient animals is comparable to that in clinical practice. In addition, xenografts of a particular tumor type are able to identify agents of known clinical activity against that disease.

Preclinical phase II studies in human tumor lines: a European multicenter study

In an attempt to increase the predictability and to extend the differential capacity of the anticancer drug development program the American National Cancer Institute has recently proposed the introduction of a screening system consisting of human tumor cell lines to select drugs in a disease-oriented fashion rather than by the previously applied drug-oriented strategy. Although this new approach offers great advantages, assay limitations can be identified in testing unknown compounds for antitumor activity in vitro. Human tumor xenografts grown in nude mice may play an additional role in the prediction of clinical activity and the assessment of the spectrum of activity of potential anticancer drugs, because they have a better relationship with the clinical situation of cancer treatment. In a European multicenter collaboration it has been proposed to use panels of human tumor lines from solid tumor types to study: the antitumor activity of three different drugs per tumor type; the reliability of 'preclinical' phase II studies by comparison of the obtained data with results of phase II clinical trials; the feasibility of this joint project, such as the methodology, the reproducibility of experimental data and the introduction of uniform activity criteria. If preclinical phase II studies in human tumor lines generate reliable results, this in vivo screening system will create a unique possibility to better identify promising clinical candidate compounds or analogs of conventional cytostatic agents as well as those tumor types likely to respond to the selected investigational drugs.

In vitro and in vivo cytotoxicity of alkyl lysophospholipid ET-18-OCH3 and thioether lipid BM 41.440

Screening for cytotoxicity in the clonogenic assay in human tumor xenografts and L1210 mouse leukemia revealed comparable dose-dependent effects of the alkyl lysophospholipid ET-18-OCH3 and the thioether lipid BM 41.440. The efficacy in human tumors only was marginal at low doses. In vivo tests of both agents were carried out in nude mice bearing two of the tumors that proved most sensitive in vitro and in mice inoculated with L1210 leukemia. Only small effects on the growth of the human tumors and no effects on L1210 leukemia were observed. In view of clinical rules for definition of remission, no convincing antitumor effects were obtained.