Association of orexin receptor antagonists with falls during hospitalization

WHAT IS KNOWN AND OBJECTIVE

The use of hypnotics, especially benzodiazepines (BZs), increases the risk of falls. Regarding the association of orexin receptor antagonists with fall risk, consistent results have not been obtained for suvorexant, and studies of lemborexant have not been reported. Therefore, this study investigated whether orexin receptor antagonists, including lemborexant, increase the risk of falls.

METHODS

Data were obtained from the medical records of patients hospitalized at Saga University Hospital in Japan between July 2020 and April 2021. Patients were retrospectively divided into the fall and non-fall groups, and the groups were compared for medication usage.

RESULTS AND DISCUSSION

The fall and non-fall groups included 132 and 6857 patients respectively. A significantly higher proportion of patients in the fall group used hypnotics (40.2% vs. 21.7%; p < 0.0001). Hypnotics remained significantly associated with a higher risk of falls after adjusting for confounders (adjusted odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.13-2.48, p = 0.01). In particular, the use of benzodiazepines was associated with a significantly higher risk of falls (adjusted OR = 2.08, 95% CI = 1.38-3.15, p = 0.0005). Meanwhile, suvorexant use was not linked to the risk of falls, and lemborexant use was associated with a significantly lower risk of falls (adjusted OR = 0.27, 95% CI = 0.09-0.84, p = 0.02).

WHAT IS NEW AND CONCLUSION

The use of hypnotics is a risk factor for falls, but orexin receptor antagonists may represent a safe option for patients requiring hypnotics. Our results provide evidence supporting the safety of these drugs.

Development of an application for management of drug holidays in perioperative periods

Before surgery and other invasive treatments, decisions must be made on whether to discontinue drugs and provide appropriate drug holidays especially for antithrombotic drugs, and this is made difficult by the large number of available drugs and associated guidelines. We have therefore developed an online application for perioperative drug discontinuation and resumption management, named Saga Application for Management of Drug Holidays in PeriOperative Periods (SAMPOP).Multidisciplinary medical staff at Saga University Hospital (SUH) worked together to build an evidence-based Perioperative Drug Discontinuation Management Database (PDDMD) and developed the user-friendly SAMPOP online application via preliminary verification at SUH. From September 2018 to February 2020, 420 medical staff at SUH, including physicians, nurses, and pharmacists, installed and tested SAMPOP.Rate per surgical procedure for forgetting to discontinue antithrombotic drugs preoperatively decreased from 0.18% to 0.09% as of August 2019, 12 months after the introduction of SAMPOP (P = .1359). In addition, six months later, it decreased further to 0.03% as of February 2020 (P = .0436). Forgetting to resume antithrombotic drugs postoperatively decreased from 0.20% to 0.02% as of August 2019, 12 months after the introduction of SAMPOP (P = .0008). There was no case of forgetting to resume the medication in the last 6 months.SAMPOP may be useful for management of drug holidays in the clinic and warrants further evaluation of its safety and efficacy.

Change of Oral to Topical Corticosteroid Therapy Exacerbated Glucose Tolerance in a Patient with Plaque Psoriasis

BACKGROUND Psoriasis is known as the most frequent disease treated by long-term topical steroids. It is also known that patients with thick, chronic plaques require the highest potency topical steroids. However, the treatment is limited to up to four weeks due to risk of systemic absorption. CASE REPORT An 80-year-old man was diagnosed with type 2 diabetes 16 years before, and was being administered insulin combined with alpha glucosidase inhibitor. He was diagnosed with plaque psoriasis and his oral steroid treatment was switched to topical steroid treatment due to lack of improvement and poorly controlled blood glucose level. The hypoglycemic events improved after the psoriatic lesions improved. CONCLUSIONS Control of blood glucose level is difficult at the very beginning of topical steroid treatment for psoriasis especially if a patient is receiving insulin treatment. Intense monitoring of blood glucose level during initiation of topical steroid treatment is necessary to prevent unfavorable complications.

Long-term results of the pelvic floor muscle training for female urinary incontinence: An 8-year transition tree and predictive parameters

AIMS

The pelvic floor muscle (PFM) training is effective in alleviating the symptoms of urinary incontinence, but there are very few reports available on its long-term effectiveness. Therefore, 8-year follow-up data have been prospectively analyzed.

MATERIALS AND METHODS

Originally 123 women with stress or mixed urinary incontinence participated in an 8-week intensive PFM training program. The training comprised repeated muscle contractions of the pelvic floor and the timely locking of the perineum. An average of 8 years (6-10) had elapsed between the time of present assessment and the completion of the original training. Seventy-nine women were subjected to the present analysis. Self-reported responses of "completely cured" and "more than 50% improved" were regarded as treatment success (TS). An 8-year transition tree and predictive parameters were analyzed.

RESULTS

The success rate of the training was 39% at the 8-year follow-up. The transition tree demonstrated that the continence/incontinence status has been varying in 42% of the women, while it was stable in 58% throughout the follow-up period. The 6-year incidence and remission rates of incontinence were 34% and 18%, respectively. The higher pressure difference in the vaginal contraction strength between the baseline and strength at the end of the training is a predictive parameter of the long-term TS.

CONCLUSIONS

The results suggest that the 8-year TS rate was 39% and that the altered patterns of the continence status and incidence and remission rates of incontinence were similar to those observed in the general population.

Novel heat shock protein HspQ stimulates the degradation of mutant DnaA protein in Escherichia coli

Escherichia coli DnaA protein initiates chromosomal replication and is an important regulatory target during the replication cycle. In this study, a suppressor mutation isolated by transposon mutagenesis was found to allow growth of the temperature-sensitive dnaA508 and dnaA167 mutants at 40 degrees C. The suppressor consists of a transposon insertion in a previously annotated ORF, here termed hspQ, a novel heat shock gene whose promoter is recognized by the major heat shock sigma factor sigma32. Expression of hspQ on a pBR322 derivative inhibits growth of the dnaA508 and dnaA167 mutants at 30 degrees C, whereas growth of dnaA46 and other dnaA mutants is insensitive to changes in the level of hspQ. Cellular DnaA508 protein is degraded rapidly at elevated temperature, but hspQ disruption impedes this process. In contrast, DnaA46 protein is rapidly degraded in an hspQ-independent manner. Gel-filtration and chemical cross-linking experiments suggest that HspQ forms a stable homodimer in solution and can form homomultimers consisting of about four monomers. Heat-shock induced proteases such as Clp contain homomultimers of subunit proteins. We propose that HspQ is a new factor involved in the quality control of proteins and that it functions by excluding denatured proteins.

Transcriptional control for initiation of chromosomal replication in Escherichia coli: fluctuation of the level of origin transcription ensures timely initiation

BACKGROUND

During the cell cycle, the initiation of chromosomal replication is strictly controlled. In Escherichia coli, the initiator DnaA and the replication origin oriC are major targets for this regulation. Here, we assessed the role of transcription of the mioC gene, which reads through the adjacent oriC region. This mioC-oriC transcription is regulated in coordination with the replication cycle so that it is activated after initiation and repressed before initiation.

RESULTS

We isolated a strain bearing a mioC promoter mutation that causes constitutive mioC-oriC transcription from the chromosome. A quantitative S1 nuclease assay indicated that in this mutant, the level of transcription does not fluctuate. Introduction of this mutation suppressed the growth defect of an overinitiation-type dnaAcos mutant, and severely inhibited the growth of initiation-defective dnaA mutants at semipermissive temperatures in a dnaA allele-specific manner. These results suggest that mioC-oriC transcription inhibits initiation at oriC. Indeed, flow cytometry analysis and quantification of DNA replication in synchronized cultures revealed that the mioC promoter mutation alters the control of the initiation of chromosomal replication, for instance by delaying replication within the cell cycle.

CONCLUSIONS

These results suggest that the transcriptional regulation of the mioC gene is required for cell cycle-coordinated initiation of chromosomal replication.

Transport and uptake of nateglinide in Caco-2 cells and its inhibitory effect on human monocarboxylate transporter MCT1

1 Nateglinide, a novel oral hypoglycemic agent, rapidly reaches the maximum serum concentration after oral administration, suggesting that it is rapidly absorbed in the gastrointestinal tract. The aim of this work is to clarify the intestinal absorption mechanism of nateglinide by means of in vitro studies. 2 We examined the transcellular transport and the apical uptake of [(14)C]nateglinide in a human colon carcinoma cell line (Caco-2). We also examined whether nateglinide is transported via monocarboxylate transport-1 (MCT1) by means of an uptake study using MCT1-expressing Xenopus laevis oocytes. 3 In Caco-2 cells, the transcellular transport of [(14)C]nateglinide from the apical to basolateral side was greater than that in the opposite direction. The uptake of [(14)C]nateglinide from the apical side was concentration-dependent, H(+)-dependent, and Na(+)-independent. Kinetic analysis revealed that the Kt and Jmax values of the initial uptake rate of [(14)C]nateglinide were 448 micro M and 43.2 nmol mg protein(-1) 5 min(-1), respectively. Various monocarboxylates, including salicylic acid and valproic acid, and glibenclamide significantly inhibited the uptake of [(14)C]nateglinide. 4 The uptake study using MCT1-expressing oocytes showed that nateglinide inhibits the MCT1-mediated uptake of [(14)C]L-lactic acid, though nateglinide itself is not transported by MCT1. 5 Taken together, these results suggest that the uptake of nateglinide from the apical membranes of Caco-2 cells is, at least in part, mediated by a proton-dependent transport system(s) distinct from MCT1.

Characteristics of L-lactic acid transport in basal membrane vesicles of human placental syncytiotrophoblast

The characteristics of L-lactic acid transport across the trophoblast basal membrane were investigated and compared with those across the brush-border membrane by using membrane vesicles isolated from human placenta. The uptake of L-[(14)C]lactic acid into basal membrane vesicles was Na(+) independent, and an uphill transport was observed in the presence of a pH gradient ([H(+)](out) > [H(+)](in)). L-[(14)C]lactic acid uptake exhibited saturation kinetics with a K(m) value of 5.89 +/- 0.68 mM in the presence of a pH gradient. p-Chloromercuribenzenesulfonate and alpha-cyano-4-hydroxycinnamate inhibited the initial uptake, whereas phloretin or 4,4'-diisothiocyanostilbene-2,2'-disulfonate did not. Mono- and dicarboxylic acids suppressed the initial uptake. In conclusion, L-lactic acid transport in the basal membrane is H(+) dependent and Na(+) independent, as is also the case for the brush-border membrane transport, and its characteristics resemble those of monocarboxylic acid transporters. However, there were several differences in the effects of inhibitors between basal and brush-border membrane vesicles, suggesting that the transporter(s) involved in L-lactic acid transport in the basal membrane of placental trophoblast may differ from those in the brush-border membrane.

H(+)-linked transport of salicylic acid, an NSAID, in the human trophoblast cell line BeWo

We investigated the transport of salicylic acid and L-lactic acid across the placenta using the human trophoblast cell line BeWo. We performed uptake experiments and measured the change in intracellular pH (pH(i)). The uptakes of [(14)C]salicylic acid and L-[(14)C]lactic acid were temperature- and extracellular pH-dependent and saturable at higher concentrations. Both uptakes were also reduced by FCCP, nigericin, and NaN(3). Various nonsteroidal anti-inflammatory drugs (NSAIDs) strongly inhibited the uptake of L-[(14)C]lactic acid. Salicylic acid and ibuprofen noncompetitively inhibited the uptake of L-[(14)C]lactic acid. alpha-Cyano-4-hydroxycinnamate (CHC), a monocarboxylate transporter inhibitor, suppressed the uptake of L-[(14)C]lactic acid but not that of [(14)C]salicylic acid. CHC also suppressed the decrease of pH(i) induced by L-lactic acid but had little effect on that induced by salicylic acid or diclofenac. These results suggest that NSAIDs are potent inhibitors of lactate transporters, although they are transported mainly by a transport system distinct from that for L-lactic acid.

[A male case of primary bilateral breast cancers during estrogen therapy for prostate cancer]

An 82-year old man received total androgen blockade therapy (bilateral orchiectomy and 375 mg/day flutamide) for the treatment of stage C prostate cancer. Serum PSA levels were undetectable for 13 months and thereafter increased gradually. We administered estramustine phosphate sodium (EPS) instead of flutamide under the diagnosis of hormone refractory prostate cancer. EPS therapy was discontinued after 9 months because serum PSA levels increased again. Then, the patient complained of bilateral breast nodules and pain. Bilateral mammectomies were performed due to bilateral breast cancers which had been diagnosed by aspiration biopsies and radiographic examinations, but he died four months after the operations. Final pathological diagnosis was ductal adenocarcinoma of the breasts. Immunohistochemical study revealed expressions of PSA in the breast cancers. We diagnosed double cancers of the prostate and the breast because of the different expression patterns of progesterone receptor between them. We review the literatures and discuss the differential diagnosis of prostate cancer and PSA-producing breast cancer.

[Laparoscopy-assisted total nephroureterectomy for renal pelvic and/or lower ureteral cancer]

PURPOSE

The usefulness of laparoscopy-assisted total nephroureterectomy for patients with renal pelvic and lower ureteral cancer is evaluated.

MATERIAL

Seven patients with renal pelvic cancer and four with lower ureteral cancer performed laparoscopy-assisted total nephroureterectomy from May 1997 to December 2000 (Ten males and one female, mean age 68.5 year-old).

METHOD

Of the 11 patients, the initial one received preoperative embolization of the renal artery. Under general anesthesia laparoscopy-assisted total nephroureterectomy underwent via transperitoneal approach in three patients and retroperitoneal approach in eight. After the kidney was completely dissected under laparoscopic procedure, it was delivered en bloc with ureter from the skin incision in the lower abdomen.

RESULT

Two patients needed conversion to open surgery. The mean operating time of nine patients except for conversion cases was 272 minutes and the mean blood loss was 313 ml. There was no major complication associated with laparoscopic procedure. There was no significant difference in both complication and recurrence rate between laparoscopy-assisted total nephroureterectomy and open surgery.

CONCLUSION

Laparoscopy-assisted total nephroureterectomy is an useful procedure for the treatment of patients with renal pelvic and lower ureteral cancer because it enables us to remove out the kidney and ureter from one small lower abdominal incision.

Medicinal foodstuffs. XXI. Structures of new cucurbitane-type triterpene glycosides, goyaglycosides-a, -b, -c, -d, -e, -f, -g, and -h, and new oleanane-type triterpene saponins, goyasaponins I, II, and III, from the fresh fruit of Japanese Momordica charantia L

Eight cucurbitane-type triterpene glycosides called goyaglycosides-a, -b, -c, -d, -e, -f, -g, and -h and three oleanane-type triterpene saponins termed goyasaponins I, II, and III were isolated from the fresh fruit of Japanese Momordica charantia L. (Cucurbitaceae) together with five known cucurbitane-type triterpene glycosides momordicosides A, C, F1, I, and K. The structures of goyaglycosides and goyasaponins were elucidated on the basis of chemical and physicochemical evidence.

Prognostic value of tumor-associated macrophage count in human bladder cancer

BACKGROUND

We determined the tumor-associated macrophage (TAM) count to investigate its importance in predicting clinical outcome or prognosis in patients with bladder cancer.

METHODS

The TAM count and microvessel count (MVC) were determined immunohistochemically in 63 patients with bladder cancer, including 40 superficial bladder cancers and 23 invasive bladder cancers. To examine the relationship between TAM count and clinical outcome or prognosis in bladder cancer, cystectomy rates, distant metastasis rates, vascular invasion rates and 5 year survival rates were compared between patients with low (< 67) and high (> or = 67) TAM counts.

RESULTS

The TAM count in invasive bladder cancers (154.22+/-11.98) was significantly higher than in superficial bladder cancers (49.05+/-7.76; P<0.0001). The MVC in invasive bladder cancers (71.55+/-10.44) was also significantly higher than in superficial bladder cancers (47.02+/-5.57; P<0.05). There was a positive correlation between TAM count and MVC (r=0.30; P=0.02). Immunohistochemical staining using CD68/horseradish peroxidase monoclonal antibody showed more infiltrating cells in invasive than superficial bladder cancers. Patients with a high TAM count (> or =67) showed significantly higher rates of cystectomy, distant metastasis and vascular invasion than those with a lower TAM count (<67). The 5 year survival rate estimated using the Kaplan-Meier method was significantly lower in patients with a high TAM count than in those with a low TAM count (P<0.0001).

CONCLUSIONS

Our results suggest that determination of TAM count in bladder cancer tissues is of value to predict the clinical outcome or prognosis and to select appropriate treatment strategies in patients with bladder cancer.

Calcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy

BACKGROUND

Prediction of the extent of calcium supplement will facilitate safe and efficient management of hypocalcemia in the early postoperative stage of total parathyroidectomy with autotransplantation (PTXa) in patients with renal osteodystrophy.

METHODS

The correlation between the extent of calcium deficiency, estimated by the amount of calcium supplement over 48 h after PTXa and using various parameters such as carboxy terminal parathyroid hormone (c-PTH), intact PTH (i-PTH), alkaline phosphatase (ALP), serum calcium, serum phosphorus, duration of hemodialysis, total weight of resected parathyroid glands and degree of subperiosteal resorption of the middle phalanx was examined in 49 patients who underwent PTX with subcutaneous autotransplantation. Bone mineral density (BMD) was also determined before, 3 months and 1 year after PTXa with dual energy X-ray absorptiometry (DEXA) in 13 patients.

RESULTS

There was a positive correlation between pre-operative i-PTH level (r=0.56, P<0.0005) or ALP level (r=0.50, P<0.0005) and the amount of calcium supplement over 48 h after PTXa in these patients. Furthermore, the degree of subperiosteal resorption, determined by Jensen's classification, was significantly correlated with the amount of calcium supplement after PTX (P<0.05). Bone mineral density 3 months after (P<0.0005) and 1 year after PTXa (P<0.001) significantly increased compared with BMD before PTXa in all patients examined.

CONCLUSION

These findings suggest that the pre-operative determination of i-PTH, ALP levels and degree of subperiosteal resorption allow the management of hypocalcemia safely and efficiently in renal osteodystrophy patients after PTXa.

[Laparoscopic radical nephrectomy for renal cell carcinoma--transperitoneal anterior approach]

PURPOSE

To evaluate the usefulness of transperitoneal anterior approach in laparoscopic radical nephrectomy for patients with renal cell carcinoma.

MATERIAL

Ten patients (Eight males and two females) with small renal cell carcinoma less than 7 cm in diameter were treated with laparoscopic radical nephrectomy between June 1997 and May 1999. Clinical stage was T1aN0M0 in 6 cases and T1bN0M0 in 4 cases.

METHOD

Of the 10 patients, the initial four received preoperative embolization of the renal artery. Under general anesthesia laparoscopic radical nephrectomy via transperitoneal anterior approach was performed in all patients. This procedure facilitates initiated early access to the renal vessels as does open radical nephrectomy. The kidney was dissected en bloc with Gerota's fascia and delivered from the small skin incision without morcellation.

RESULT

Two patients needed conversion to open surgery. The mean operating time of eight patients except for conversion cases was 247 minutes and the mean blood loss was 258 ml. There was no major complication associated with laparoscopic procedure.

CONCLUSION

Transperitoneal anterior approach in laparoscopic radical nephrectomy is a suitable and useful procedure for the treatment of small renal cell carcinoma because it enables us to avoid possible tumor manipulation by early access to the renal vessels as open radical nephrectomy.

Replication cycle-coordinated change of the adenine nucleotide-bound forms of DnaA protein in Escherichia coli

The ATP-bound but not the ADP-bound form of DnaA protein is active for replication initiation at the Escherichia coli chromosomal origin. The hydrolysis of ATP bound to DnaA is accelerated by the sliding clamp of DNA polymerase III loaded on DNA. Using a culture of randomly dividing cells, we now have evidence that the cellular level of ATP-DnaA is repressed to only approximately 20% of the total DnaA molecules, in a manner depending on DNA replication. In a synchronized culture, the ATP-DnaA level showed oscillation that has a temporal increase around the time of initiation, and decreases rapidly after initiation. Production of ATP-DnaA depended on concomitant protein synthesis, but not on SOS response, Dam or SeqA. Regeneration of ATP-DnaA from ADP-DnaA was also observed. These results indicate that the nucleotide form shifts of DnaA are tightly linked with an epistatic cell cycle event and with the chromosomal replication system.

Prediction of alpha-blocker response in men with benign prostatic hyperplasia by magnetic resonance imaging

OBJECTIVES

To assess the value of magnetic resonance imaging (MRI) for predicting the alpha-blocker response in men with symptomatic benign prostatic hyperplasia (BPH) and to examine the relationship between MRI and the area density of smooth muscle cells in BPH.

METHODS

Twenty-eight men were consecutively enrolled in this study and received tamsulosin 0.2 mg once daily for 4 to 6 weeks. The efficacy of tamsulosin was determined by measuring improvements in the maximum urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS). The patients underwent T2-weighted MRI and were separated into a high (H) or iso-low (IL) group according to the signal intensity of the inner gland of the prostate compared with that of bone marrow of the proximal femur head. The area density of smooth muscle cells was determined using immunostaining with antiactin antibody in 16 prostate specimens.

RESULTS

IPSS significantly decreased after the administration of tamsulosin from 16 +/- 1 to 8 +/- 1 (n = 28, P <0.0001 ), and 76.7% of the patients had an improved IPSS of 25% or greater. Qmax was significantly increased in group IL (P = 0.03) but not in group H. Of the patients in group IL, 53.3% had a Qmax response (an increase of Qmax of 30% or more); 15.4% did so in group H (P = 0.04). The area density of smooth muscle cells was 48.1 +/- 3.7% in group IL (n = 9) and 36.7 +/- 3.2% in group H (n = 7, P = 0.04).

CONCLUSIONS

MRI is useful in estimating the area density of smooth muscle cells in the prostate and in predicting Qmax response for alpha-blocker therapy in patients with symptomatic BPH.

Muscarinic receptor subtypes and receptor-coupled phosphatidylinositol hydrolysis in rat bladder smooth muscle

BACKGROUND

The purpose of this study was to evaluate the muscarinic receptor subtypes expressed in rat bladder smooth muscle and characterize the muscarinic receptor-coupled phosphatidylinositol (PI) hydrolysis in order to clarify the first step of bladder smooth muscle contraction.

METHODS

Expressions of mRNAs of muscarinic receptor subtypes were examined by Northern blot analysis. Changes in the mass of inositol 1,4,5-trisphosphate (IP3) and the inhibitory effects of muscarinic subtype specific antagonists on PI hydrolysis were determined after carbachol stimulation.

RESULTS

mRNAs of m2 and m3 genes, encoding M2 and M3 receptors, were expressed in rat bladder smooth muscle. Carbachol produced a rapid increase of IP3, which returned to the basal level within 30 seconds. 4-Diphenylacetoxyl-N-methylpiperidine methiodide (4-DAMP; M1 and M3 antagonist) strongly inhibited the PI hydrolysis, but methoctramine (M2 antagonist) partially inhibited it at 10(-4) mol/L. The IC50 value for atropine was 9.5 x 10(-9) mol/L, for pirenzepine 6.4 x 10(-6) mol/L, and for 4-DAMP 1.5 x 10(-7) mol/L.

CONCLUSION

M2 and M3 receptors are expressed in rat urinary bladder. Only M3 receptor was involved in the production of IP3, which might induce the initial phase of contractile response in rat bladder smooth muscle after carbachol stimulation.

Tubulogenesis by microvascular endothelial cells is mediated by vascular endothelial growth factor (VEGF) in renal cell carcinoma

OBJECTIVE

To investigate the role of vascular endothelial growth factor (VEGF) in tumour angiogenesis in renal cell carcinoma (RCC).

MATERIALS AND METHODS

The expression of VEGF was examined in tissue samples from 25 patients with RCC using the reverse-transcriptase polymerase chain reaction (RT-PCR). Cellular localization of VEGF was studied in normal kidney and RCC tissues. Tube formation by human omental microvascular endothelial (HOME) cells co-cultured with A498 RCC cells was quantified in a three-dimensional collagen gel using computer-image analysis.

RESULTS

RT-PCR detected VEGF m-RNA in tissue from 20 of 25 patients with RCC. An immunohistochemical study revealed that VEGF was primarily localized in the cytosol of normal renal tubule cells and RCC cells. Tube formation by HOME cells was increased in the presence of A498 cells overexpressing VEGF mRNA, induced by exogenous VEGF in a dose-dependent manner and completely inhibited by an anti-VEGF antibody.

CONCLUSION

VEGF, which is produced and released from RCC cells, may elicit tumour angiogenesis by inducing microvessel tubulogenesis in patients with RCC. The co-culture system may be useful for screening inhibitors of tumour angiogenesis in RCC.

Clinical significance of multi-drug resistance associated protein and P-glycoprotein in patients with bladder cancer

PURPOSE

The clinical significance of multi-drug resistant proteins, such as multi-drug resistance associated protein and P-glycoprotein, in terms of prognostic value was determined in patients with bladder cancer.

MATERIALS AND METHODS

The expression of multi-drug resistance associated protein and P-glycoprotein was investigated immunohistochemically before and after chemotherapy. The relationship between expression of these multi-drug resistant proteins and clinical outcome assessed by tumor recurrence rate, cystectomy rate and 5-year survival rate was also investigated in 33 patients with bladder cancer.

RESULTS

Before chemotherapy multi-drug resistance associated protein expression was observed in 1 of 28 patients (4%) while P-glycoprotein expression was observed in 22 of 33 (67%). Multi-drug resistance associated protein induction by chemotherapy was observed in 6 of 28 patients (21%), whereas P-glycoprotein induction was noted in 4 (14%). Multi-drug resistance associated protein in this disease is induced more frequently by high dose (more than 300 mg.) than low dose (less than 300 mg.) anthracyclines (p < 0.01). Immunohistochemical analysis also revealed co-expression of multi-drug resistance associated protein and P-glycoprotein in 5 of 28 patients (18%) after chemotherapy. However, there was no significant correlation between positive P-glycoprotein expression before chemotherapy and clinical outcome.

CONCLUSIONS

Multi-drug resistance associated protein as well as P-glycoprotein mediated multi-drug resistance may be induced after chemotherapy for bladder tumors. However, the presence of P-glycoprotein before chemotherapy does not predict clinical outcome in patients with bladder cancer.

Induction of tubulogenesis of microvascular endothelial cells by basic fibroblast growth factor from human SN12C renal cancer cells

PURPOSE

To investigate the role of basic fibroblast growth factor (b-FGF) in angiogenesis in renal cell carcinoma.

MATERIALS AND METHODS

We examined b-FGF expression in 25 patients with renal cell carcinoma (RCC) by reverse transcriptase polymerase chain reaction (RT-PCR). We measured the tube formation by human omental microvascular endothelial (HOME) cells induced by b-FGF in a three-dimensional collagen gel in the absence or presence of SN12C human renal cancer cells by means of computer-image analysis.

RESULTS

RT-PCR analysis detected b-FGF m-RNA in 20 (80%) of 25 patients with RCC. The tube formation of HOME cells was increased in the presence of SN12C cells overexpressing b-FGF mRNA, induced by exogenous b-FGF in a dose dependent manner and completely inhibited by anti-b-FGF antibody.

CONCLUSIONS

Basic-FGF may develop tumor angiogenesis by inducing microvessel tubulogenesis in patients with RCC.