Establishment of a novel cell line, CHO-MK, derived from Chinese hamster ovary tissues for biologics manufacturing

Chinese hamster ovary (CHO) cells are widely used as a host for producing recombinant therapeutic proteins due to advantages such as human-like post-translational modification, correct protein folding, higher productivity, and a proven track record in biopharmaceutical development. Much effort has been made to improve the process of recombinant protein production, in terms of its yield and productivity, using conventional CHO cell lines. However, to the best of our knowledge, no attempts have been made to acquire new CHO cell lines from Chinese hamster ovary. In this study, we established and characterized a novel CHO cell line, named CHO-MK, derived from freshly isolated Chinese hamster ovary tissues. Some immortalized cell lines were established via sub-culture derived from primary culture, one of which was selected for further development toward a unique expression system design. After adapting serum-free and suspension culture conditions, the resulting cell line exhibited a considerably shorter doubling time (approximately 10 h) than conventional CHO cell lines (approximately 20 h). Model monoclonal antibody (IgG1)-producing cells were generated, and the IgG1 concentration of fed-batch culture reached approximately 5 g/L on day 8 in a 200-L bioreactor. The cell bank of CHO-MK cells was prepared as a new host and assessed for contamination by adventitious agents, with the results indicating that it was free from any such contaminants, including infectious viruses. Taking these findings together, this study showed the potential of CHO-MK cells with a shorter doubling time/process time and enhanced productivity in biologics manufacturing.

Comprehensive modeling of cell culture profile using Raman spectroscopy and machine learning

Chinese hamster ovary (CHO) cells are widely utilized in the production of antibody drugs. To ensure the production of large quantities of antibodies that meet the required specifications, it is crucial to monitor and control the levels of metabolites comprehensively during CHO cell culture. In recent years, continuous analysis methods employing on-line/in-line techniques using Raman spectroscopy have attracted attention. While these analytical methods can nondestructively monitor culture data, constructing a highly accurate measurement model for numerous components is time-consuming, making it challenging to implement in the rapid research and development of pharmaceutical manufacturing processes. In this study, we developed a comprehensive, simple, and automated method for constructing a Raman model of various components measured by LC-MS and other techniques using machine learning with Python. Preprocessing and spectral-range optimization of data for model construction (partial least square (PLS) regression) were automated and accelerated using Bayes optimization. Subsequently, models were constructed for each component using various model construction techniques, including linear regression, ridge regression, XGBoost, and neural network. This enabled the model accuracy to be improved compared with PLS regression. This automated approach allows continuous monitoring of various parameters for over 100 components, facilitating process optimization and process monitoring of CHO cells.

Development of a stable antibody production system utilizing an Hspa5 promoter in CHO cells

Chinese hamster ovary (CHO) cells are widely used for manufacturing antibody drugs. We attempted to clone a novel high-expression promoter for producing monoclonal antibodies (mAbs) based on transcriptome analysis to enhance the transcriptional abundance of mAb genes. The efficacy of conventional promoters such as CMV and hEF1α decrease in the latter phase of fed-batch cell culture. To overcome this, we screened genes whose expression was maintained or increased throughout the culture period. Since CHO cells have diverse genetic expression depending on the selected clone and culture medium, transcriptome analysis was performed on multiple clones and culture media anticipated to be used in mAb manufacturing. We thus acquired the Hspa5 promoter as a novel high-expression promoter, which uniquely enables mAb productivity per cell to improve late in the culture period. Productivity also improved for various IgG subclasses under Hspa5 promoter control, indicating this promoter’s potential universal value for mAb production. Finally, it was suggested that mAb production with this promoter is correlated with the transcription levels of endoplasmic reticulum stress-related genes. Therefore, mAb production utilizing the Hspa5 promoter might be a new method for maintaining protein homeostasis and achieving stable expression of introduced mAb genes during fed-batch culture.

Multicenter phase II study of FOLFOX for metastatic colorectal cancer (mCRC) in Japan; SWIFT-1 and 2 study

BACKGROUND/AIMS

This study assessed the efficacy and toxicity of the FOLFOX4 (SWIFT1) and mFOLFOX6 (SWIFT2) regimens in Japanese patients with metastatic colorectal cancer (mCRC).

METHODOLOGY

Patients with mCRC were required to have ECOG performance status of 0 to 1, and to have adequate organ function. Two multicenter Phase II studies (SWIFT1/SWIFT2) were conducted in chemotherapy naive patients with mCRC.

RESULTS

112 patients were enrolled in these studies (SWIFT1: 54 patients / SWIFT2: 58 patients). The disease sites for each study were the colon in 27 patients and 28 patients, and the rectum in 27 patients and 30 patients, respectively. All patients received a median of 8 courses. After a median follow-up period of 35 months, 54 patients and 58 patients were evaluable in the respective studies, and the overall response rate was 50.0% (CR:31 PR:53). The response rate according to the sites of metastasis were as follows: liver, 54.1% (46/85); lung, 17.4% (4/23); and lymph node, 23.3% (7/30). Grade 3/4 neutropenia occurred in 14 patients (12.5%), while Grade 3/4 non-hematological toxicities were observed in 16 patients (31.0%) and Grade 3 neurotoxicity was observed in 6patients (5.4%) and 5 patients (4.5%), respectively.

CONCLUSIONS

FOLFOX4 (SWIFT1) and mFOLFOX6 (SWIFT2) regimens complying with the international standard dosage and schedule can also be administered safely and effectively in Japan.

A phase II study of preoperative chemotherapy (CX) with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancer: JCOG 0210

4609

Background: Prognosis of both linitis plastica (type 4) and large ulcero-invasive type (type 3) gastric cancer is poor even after curative resection. We conducted a phase II study to evaluate the safety and efficacy of preoperative CX with S-1 and cisplatin followed by gastrectomy in patients (pts) with these tumors. Methods: Eligibility criteria included histologically proven adenocarcinoma of the stomach; clinically resectable gastric cancer of type 4 or type 3 of =8 cm; cN0–2; cM0; PS 0–1; 20–75 years old. Pts received two 28-day cycles of induction CX of S-1 (80–120 mg/body, po, day 1–21) and cisplatin (60mg/m2, iv, day 8). Gastrectomy with D2/3 dissection was performed within 3 to 5 weeks after CX. No adjuvant therapy was added until recurrence after the curative gastrectomy. Primary endpoints were the proportion of protocol achievement and incidence of treatment related death (TRD). Sample size was determined to reject the rate of 45% under the expectation of 60% with power of 80% and alpha of 10%. Results: Fifty pts, 29 males and 21 females with a median age of 61 years (range: 32–75), were entered in this study between 03/2003 and 12/2003. Type 3/4 ratio was 20/30. Surgical exploration was carried out in 48 pts (96%). Among 49 eligible pts, 36 pts (73%; 95% CI, 59–85%) received two cycles of induction CX and R0 resection. One TRD was observed during the first course of CX due to uncontrollable hemorrhage from the primary tumor. Median survival time and the 3- year OS were 1.44 years (95% CI, 1.26–1.98) and 26.0% (95% CI, 14.9–38.6%), respectively. Pathological response, defined as disappearance of more than one third of the primary tumor, was confirmed in 24 pts (48%) and pathological complete response was seen in 1 pts (2%). During the CX, grade 3/4 neutropenia and anorexia occurred in 7 pts (14%), respectively. Postoperative morbidity included pneumonia in 2 pts, pancreatic leakage in 4, and intraperitoneal abscess in 3, without any mortality. Conclusions: Preoperative CX with S-1 and cisplatin followed by gastrectomy was safe and promising for type 4 and large type 3 gastric cancer. The results of ongoing phase III study to evaluate this treatment are awaited.

No significant financial relationships to disclose.

Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow

BACKGROUND AND PURPOSE

Distal embolism during carotid angioplasty with stent (CAS) can be protected by a flow-reversal device. Diffusion-weighted MR imaging was used to evaluate this protective procedure and perform a comparison with the control.

METHODS

Cases of CAS with protection procedures were included in this study. Sixty-five men (68 procedures) and 5 women (5 procedures), with an average age of 68.8 years, having severe carotid stenosis were treated in our department between 2002 and 2004. Eleven cases were treated with the Parodi Anti-Emboli System, with which the internal carotid blood flow is reversed by simultaneous occlusion of the proximal common carotid artery and external carotid artery. Diffusion-weighted MR imaging was performed within 1-3 days after CAS. As controls, data from diffusion-weighted MR imaging in 26 patients who had diagnostic angiography were included.

RESULTS

Diffusion-weighted MR imaging in diagnostic angiography showed 11.5% appearance of ischemic spots after procedures. In the Parodi Anti-Emboli System, this value was 18.2%. In the CAS group, ischemic lesions appeared only in the hemisphere ipsilateral to carotid stenosis. There were no ischemic lesions in the opposite carotid or vertebrobasilar territory. The appearance rate of new ischemic spots was not significantly different between the control group and the group of CAS with Parodi Anti-Emboli System (chi2 test, P = .6227, Fisher exact method).

CONCLUSIONS

Protection results obtained with the Parodi system were excellent and comparable with conventional angiography.

[A case of multiple liver metastases from sigmoid colon cancer effectively treated by hepatic intra-arterial administration of levoforinate and 5-fluorouracil]

A 62-year-old female patient, who was diagnosed with sigmoid colon cancer with multiple liver metastases, was admitted to our hospital. She underwent sigmoidectomy with D3 lymph node dissection on January 31, 2000. In addition to that, she received hepatic intra-arterial infusion of levoforinate (l-LV) 250 mg and 5-fluorouracil (5-FU) 500 mg for combined multiple hepatic metastases starting on postoperative day 14, and these medications were administered over 48 hours once weekly by infuser pump. The tumor diminished by 59% 2 months after the start of administration and further diminished at 4 months. PR was achieved. Cancer metastasis to the cerebellum and metastasis to the lung were detected at month 9 and month 11, respectively, but the liver metastatic tumor continued to diminish in size, ultimately becoming undetectable by CT scan at month 10. Surgery and radiotherapy were performed for the cerebellar metastasis, and intravenous administration of a combination of l-LV and 5-FU was performed systemically for the pulmonary metastatic tumor. At present, the patient receives regular outpatient treatment continuously. To our knowledge, there has been no report on the combination therapy with l-LV and 5-FU through the hepatic artery. Since good antitumor efficacy was demonstrated in the present patient, this case is described in this report together with four other cases of hepatic metastasis from colorectal cancer.

[A case report: disappearance of cancer cells confirmed by surgical resection after transcatheter hepatic artery embolization (TAE) for ruptured hepatocellular carcinoma]

The patient was a 74-year-old man. He had received medical treatment for liver cirrhosis (C types) and elevated AFP. Abdominal ultrasonography (US) revealed a 150 mm size tumor in the right lobe of the liver. After admission, anemia progressed rapidly, and we recognized bloody ascites by abdominal punction. Thus, diagnosis was a tumor rupture. Emergency angiography was performed. Farmorubicin and Lipiodol were injected, and complete TAE was added. After two TAE treatments CT-scan showed a remarkable decrement of the tumor and hypertrophy of the left lobe in the liver. Right lobectomy of the liver was then done because reserve function of the liver was good. Cancer cells changed into hyaline body and mecrotic focus. In the pathological examination of the extirpated sample, no viable tumor cells were detected.

[Long partial response (PR) in a case of multiple liver metastasis from colon cancer effectively treated by continuous hepatic intra-arterial infusion chemotherapy]

The patient was a 69-year-old man who had undergone a sigmoidectomy for cancer of the sigmoid colon on March 25, 1993. We detected the elevation of CEA after the operation. Computed tomography revealed multiple metastasis of the liver on September 3, 1996. After beginning 48-hour continuous hepatic arterial infusion using 5-FU 1,000 mg and Leucovorin 30 mg, we recognized a decrement of metastatic liver tumor. We could not detect cancer cells by needle biopsy for liver tumors on February 19, 1998. This case is maintaining good quality of life by hepatic artery infusion using 5-FU and Leucovorin, showing a long PR for about two years. We think that this case shows ideal clinical progress from chemotherapy for cancer of the digestive organs.

Mechanism of oxidative DNA damage induced by quercetin in the presence of Cu(II)

Quercetin, one of flavonoids, has been reported to be carcinogenic. There have been no report concerning carcinogenicity of kaempferol and luteolin which have structure similar to quercetin. DNA damage was examined by using DNA fragments obtained from the human p53 tumor suppressor gene. Quercetin induced extensive DNA damage via reacting with Cu(II), but kaempferol and luteolin induced little DNA damage even in the presence of Cu(II). Excessive quercetin inhibited copper-dependent DNA damage induced by quercetin. Bathocuproine, a Cu(I)-specific chelator, catalase and methional inhibited the DNA damage by quercetin, whereas free hydroxyl radical scavengers did not. Site specificity of the DNA damage was thymine and cytosine residues. The site specificity and the inhibitory effects suggested that DNA-copper-oxygen complex rather than free hydroxyl radical induced the DNA damage. Formation of 8-oxodG by quercetin increased extensively in the presence of Cu(II), whereas 8-oxodG formation by kaempferol or luteolin increased only slightly. This study suggests a good relationship between carcinogenicity and oxidative DNA damage of three flavonoids. The mechanism of DNA damage by quercetin was discussed in relation to the safety in cancer chemoprevention by flavonoids.

Somatic alterations of the SMAD-2 gene in human colorectal cancers

The SMAD-2 gene, which is located at 18q21, has been identified as a candidate tumour-suppressor gene from work on colorectal cancers. The aim of the present study was to determine the clinical alterations and the significance of its mutations in a series of colorectal cancers previously examined for SMAD-4/DPC-4 gene. Mutation analyses of the SMAD-2 gene were carried out on cDNA samples from 36 primary colorectal cancer specimens using a combination of the polymerase chain reaction (PCR), single-strand conformation polymorphism (SSCP) and DNA sequencing. Only one missense mutation (2.8%), producing an amino acid substitution in the highly conserved region, and two homozygous deletions (5.5%) of the total coding region of the SMAD-2 gene were detected in the 36 cancers. The SMAD-2 gene may play a role as a candidate tumour-suppressor gene in a small fraction of colorectal cancers. However, allelic loss at 18q21 is very often seen in this type of tumour. Even in combination with changes in SMAD-4, the observed frequency was not sufficient to account for all 18q21 deletions in colorectal cancers. Thus, another tumour-suppressor gene, such as DCC, discovered as the first tumour-suppressor candidate in the region may also exist in this chromosome region.

[Results of combination therapy of UFT-E with low-dose CDDP for patients with advanced recurrent breast cancer]

CDDP, as a modulator for 5-FU, has already been described as a very effective treatment for gastrointestinal tract cancer. We administered a dose of 400 mg of UFT-E orally every day, and 10 mg of CDDP by drip infusion twice weekly, for more than 10 weeks to 12 outpatients with metastatic local, pulmonary, hepatic, osteal or multiple-organ cancer which showed a poor response to the pretreatment, and assessed its efficacy and drug toxicity. In terms of the clinical efficacy of this therapy, CR was noted in one patient and PR in 2 patients with a response rate of 25%. The incidence of drug toxicity was low. Complications included temporal transient nausea and anorexia in two patients and leukopenia grade 2 as bone marrow suppression in 3 patients. From the standpoint of QOL, as well as in terms of both antitumor effect and drug toxicity, the therapy mentioned above was believed to be effective for outpatients with advanced recurrent breast cancer.

[A randomized controlled trial with methotrexate (MTX), 5-fluorouracil (5-FU) and pirarubicin (THP) vs 5-FU alone in advanced or recurrent gastric carcinoma. Tokai Hokuriku THP Study Group]

A randomized controlled trial was designed to investigate the therapeutic benefit of a combination chemotherapy consisting of MTX, 5-FU and THP in patients with advanced or recurrent gastric carcinoma. The patients were randomized into two groups; Group A patients (n = 37) underwent our combined chemotherapy, whereas Group B (n = 34) underwent chemotherapy with 5-FU alone as a control. There were no significant differences in various background factors between the groups. The median survival time was roughly 170 days after the randomization for the patients with advanced cancer (n = 26 for Group A and n = 25 for Group B), with no significant difference between the groups. Two long survivors, however, belonged to Group A. The median survival time of 161 days for Group A (n = 11) was longer than that of Group B (84 days, n = 9), but the difference was not statistically significant. The incidence of toxicities (leukopenia in particular) exceeding JCOG grade 3 was significantly higher for Group A, but no morbidity was observed. These results imply that patients with advanced or recurrent gastric carcinoma may benefit from a regimen of MTX, 5-FU and THP.

Spread of colorectal cancer micrometastases in regional lymph nodes by reverse transcriptase-polymerase chain reactions for carcinoembryonic antigen and cytokeratin 20

BACKGROUND AND OBJECTIVES

Lymph node metastasis is known as a significant predictor of prognosis in colorectal cancer patients. Recently, reverse transcriptase polymerase chain reaction (RT-PCR) has been applied to detecting micrometastasis. To assess the risk of recurrence and accurately determine the spread of tumor cells, we examined lymph node micrometastases in a series of colorectal cancer patients.

METHODS

We examined 202 lymph nodes obtained from 13 colorectal cancer patients who underwent curative operation and were histologically diagnosed to be node-negative, using RT-PCR to amplify mRNAs for two epithelial markers, carcinoembryonic antigen (CEA) and cytokeratin 20 (CK-20).

RESULTS

All the cases, including early stage patients, had micrometastases. A total of 102 among 202 lymph nodes (50.5%) were positive for either CEA or CK-20, or both (47.0, 40.1, and 36.6% respectively). Positive lymph nodes were spread along the courses of vascular trunks as well as being located in more distant regions.

CONCLUSIONS

Even in histologically negative lymph nodes, there is a considerable possibility that micrometastases may exist. Their detection by RT-PCR may improve clinical staging and indications for cancer therapy. We should also take care in the choice of surgical approach.

Spread of colorectal cancer micrometastases in regional lymph nodes by reverse transcriptase-polymerase chain reactions for carcinoembryonic antigen and cytokeratin 20

BACKGROUND AND OBJECTIVES

Lymph node metastasis is known as a significant predictor of prognosis in colorectal cancer patients. Recently, reverse transcriptase polymerase chain reaction (RT-PCR) has been applied to detecting micrometastasis. To assess the risk of recurrence and accurately determine the spread of tumor cells, we examined lymph node micrometastases in a series of colorectal cancer patients.

METHODS

We examined 202 lymph nodes obtained from 13 colorectal cancer patients who underwent curative operation and were histologically diagnosed to be node-negative, using RT-PCR to amplify mRNAs for two epithelial markers, carcinoembryonic antigen (CEA) and cytokeratin 20 (CK-20).

RESULTS

All the cases, including early stage patients, had micrometastases. A total of 102 among 202 lymph nodes (50.5%) were positive for either CEA or CK-20, or both (47.0, 40.1, and 36.6% respectively). Positive lymph nodes were spread along the courses of vascular trunks as well as being located in more distant regions.

CONCLUSIONS

Even in histologically negative lymph nodes, there is a considerable possibility that micrometastases may exist. Their detection by RT-PCR may improve clinical staging and indications for cancer therapy. We should also take care in the choice of surgical approach.

Somatic alterations of the DPC4 gene in human colorectal cancers in vivo

BACKGROUND & AIMS

The chromosome region 18q21 has been shown to be frequently deleted in colorectal cancers, and such frequent allelic loss is a hallmark of the presence of a tumor-suppressor gene. The DPC4 gene, which is located at 18q21, has been identified as a tumor-suppressor gene from examination of pancreatic cancers. The aim of the present study was to determine if it might also be altered in colorectal cancers.

METHODS

Mutation analyses of the DPC4 gene were performed on complementary DNA samples from 31 primary colorectal cancer specimens using a combination of polymerase chain reaction, single-strand conformation polymorphism, and DNA sequencing.

RESULTS

Four missense mutations producing amino acid substitutions and a somatic 12-base pair deletion in the coding region of the DPC4 gene were detected in the 31 cancers (16%; 5 of 31).

CONCLUSIONS

The DPC4 gene may play a role as a tumor-suppressor gene in a fraction of colorectal cancers; however, while allelic loss at 18q21 is very often seen in colorectal cancers, only a minority show DPC4 mutations, suggesting that there might be another tumor-suppressor gene in this chromosome region.

[Effect of leucovorin and 5-FU for advanced colorectal cancer patients]

In 17 cases of advanced colorectal carcinoma with accessible metastatic lesions, a low dose of leucovorin (LV, 30 mg/body) + 5-fluorouracil (5-FU 500 - 750 mg/body) was administered intravenously as a bolus injection, or by injection into the hepatic artery from a reservoir. Two of the 12 patients (16.7%) who received intravenous injection, and one of the five cases who received intra-hepatic artery injection showed partial response (PR). The side effect of this treatment was mild, and the performance status of the patients was excellent. This article deals with 3 PR cases. Case 1 had a bipulmonary multiple metastasis. When LV + 5-FU was administered intravenously, a reduction rate of 87% was obtained, and the patient survived for 27 more months. Case 2 had paraaortic lymph node metastasis. When LV + 5-FU was administered intravenously, a reduction rate of 59% was obtained, but the patient died after 9 months. Case 3 had a multiple liver metastasis. LV + 5-FU was administered intravenously in the liver, and a reduction rate of 69% was achieved. The patient survived for 30 months from the administration. LV + 5-FU is an effective treatment for advanced colorectal cancer. In the future, more research should be conducted to study the amount and method of administration, and combined treatment, to increase the response rate and to extend the period of good health.

[A case of postoperative pulmonary metastasis of colon cancer which responded to treatment with leucovorin and 5-FU]

A 72-year-old man underwent a radical operation for sigmoid colon cancer (well-differentiated adenocarcinoma, stage III) in 1989. Chest X-ray examination performed in September 1992 showed multiple nodular shadows in the lungs. A diagnosis of pulmonary metastasis was made from abnormally increased CEA and CA 19-9 and findings by chest tomography and CT scanning. There was no evidence of metastasis or recurrence in the liver, bone, brain or large intestine. He received three courses of bolus injections of leucovorin (30 mg/body) and 5-FU (500 mg/body), each over five consecutive days with a two-week rest period, and subsequently weekly at the same doses. CEA and CA 19-9 levels started to decrease after completion of the second course of consecutive treatment. In week 18 of chemotherapy, CEA and CA 19-9 levels dropped to 5.6 ng/ml and 32 U/ml from 66 ng/ml and 130 U/ml, respectively. Chest tomography and chest CT showed the disappearance or reduction in size of the nodules, with a reduction rate of 87.1%. Twenty-two weeks later, at this writing, there was no evidence of disease progression, and the patient was thus judged to be PR. He continues to receive chemotherapy at our outpatient clinic.

[A case of secondary leukemia induced by chemotherapy with a CDDP-based regimen for gastric cancer 5 years following radical resection]

Cisplatin, mitomycin C and 5-fluorouracil were given a 55-year-old woman for an unresectable gastric cancer, and successful radical gastrectomy was performed. Postoperative adjuvant immunochemotherapy using UFT and PSK was continued for about 4 years and 4 months. Pancytopenia was observed at 5 years after the treatment and then marked leucocytosis was noted. She also showed complications of general fatigue, appetite loss etc. A secondary acute leukemia associated with eosinophilia was diagnosed by peripheral blood examinations, showing WBC, 122,400: blast, 37.5 % and eosinophil, 41%. Results also showed atypia and pseudo-Pelger nuclear abnormality of eosinophil, high positive stain of cell myelogenic cell surface marker, many numeral and structural abnormalities of chromosomal analysis, etc. From the above results, it was suggested that the leukemia might be induced by previously performed chemotherapy. The patient died about 2 months following its onset.

[Recent advance and its problem of postoperative immunotherapy on gastric cancer--with references to effects and host dependent factors]

The effects of immunotherapy such as PSK, Bestatine and OK-432 (oral administration) in combination with various chemotherapy were reviewed in the patients who underwent gastrectomy for gastric cancer from the Japanese references. The immunotherapy might lead to better prognosis about 10% or more, however, if it is administered for such a selected patient who show a lower preoperative serum IAP value (580 micrograms/ml), higher total protein (6.5g/dl), better performance status (0, 1 or 2) and etc, the survival rate could be increased. The usefulness of immunotherapy was also noted in such a case which showed severe side effects of chemotherapy and bad performance status. Moreover, the pre- and post-operative immunotherapy was advisable for prevention of surgical stress and enhancement of tumor metastases.

[Therapeutic effect of transarterial infusion immunochemotherapy for metastatic liver cancer]

In order to improve therapeutic efficacy for metastatic liver cancer, intermittent transarterial administration of BRM in combination with anticancer drugs was performed by use of reservoir apparatus. A total of 22 patients (12 cases of gastric cancer, 6 of colon cancer, 2 of pancreas cancer, 1 of gall bladder cancer and 1 of biliary tract carcinoid) were treated according to the following schedule: both 10 mg of ADM (or MMC) and 0.5 KE (or 1.0 KE) of OK-432 were administered on day 1 and 40 x 10(4) JRU of recombinant interleukin 2 (r-IL 2) on day 4, 7 and 11. The treatment was repeated as many times as possible. In terms of direct antitumor effect and decrease of tumor marker, the response rate was 43% (6 cases out of 14) and 75% (9 cases out of 12), respectively. As for performance status, improvement, no change and deterioration were seen in 4 cases, 8 cases and 3 cases, respectively. Even though 13 patients died, 8 of them survived more than 300 days. In the case of gastric cancer patients with liver metastasis, 50% survival time of 12 cases was 334 days, while that of 30 cases, who were administered anticancer drugs only systemically, was 144 days. In 3 cases the decrease in the size of tumors located in both liver and the other metastases also was seen. Every case developed high grade fever, but an antifebrile was effective. Otherwise severe side effects were not seen. These results indicated that intermittent arterial infusion immunochemotherapy was feasible for the treatment of metastatic liver cancer.

[A long-term survival case of advanced gastric cancer undergoing radical gastrectomy by second-look operation after successful chemotherapy (CDDP, MMC, 5-FU)]

A 55-year-old woman with gastric cancer underwent laparotomy and was found to have an unresectable tumor characterized by S3 (invasion of the pancreas), N3, P0 and H0. She was then treated by combined administration of cisplatinum, mitomycin C and 5-fluorouracil. A remarkable response (CR) was confirmed by upper gastrointestinal roentgenography and endoscopy. Upon reoperation about 8 weeks after chemotherapy, a successful radical total gastrectomy with R2 (partially R3) lymphnode dissection was performed. Histological examination of the specimens, including the stomach and lymphnodes, revealed no cancer cells in any region (pCR). She had been given UFT and PSK for 4 years 4 months after reoperation. She has lived for 5 years 2 months after reoperation without any signs of recurrence or metastases.

[Relationship between the prognosis and nuclear DNA histograms in gastric cancer patients with a synchronous liver metastases who were given a combined gastrectomy and hepatectomy]

Out of 127 gastric cancer cases with a synchronous liver metastases, the relationship between the prognosis and the nuclear DNA contents in the primary and liver metastatic foci has been investigated in 10 relatively noncurative patients who had received a combined gastrectomy and hepatectomy. In 3 out of 5 long-term survival cases, low ploidy patterns were seen in both foci, whereas in 1 out of 5 short-term survival cases, a multiplicity was observed, i.e., a low ploidy in the primary focus and a high ploidy in the liver. In the other 4 short-term survival cases, high ploidy patterns were noted in both foci.

[Intraoperative intraperitoneal administration of mitomycin C and OK-432 for peritoneal dissemination of gastric cancer]

In order to improve the prognosis, intraoperative intraperitoneal administration of both mitomycin C and OK-432 was performed for the peritoneal dissemination of gastric cancer. Some 74 of 469 patients of gastric cancer, who underwent surgical treatment over the last 7 years in our department, had peritoneal dissemination and 24 of them were treated with the drugs described above. However, there was no significant difference between treated group and controlled untreated group. No severe side effects were noted except for moderate pyrexia. It is still too early to determine the effect of this treatment because of both the short duration of follow-up and the small number of analyzed cases. In the future, we are planning to apply this treatment to selected cases, for which a histological diagnosis will be made intraoperatively by use of irrigation cytology and/or stamp biopsy.

[A case of metastatic malignant melanoma of the stomach treated by a surgical operation]

A metastatic malignant melanoma of the stomach is not a disease of rate occurrence, but reports of melanomas that were clinically diagnosed and were treated by a surgical operation are rare. The case presented is a 73-year-old woman, who underwent an excision of a malignant melanoma of the left sole in 1981. Subsequently, she had a subcutaneous metastasis of a melanoma three times and was treated by a resection and immunochemotherapy. In January, 1988, an X-ray examination of stomach revealed a giant elevated lesion, and an endoscopic examination of the stomach revealed a black pigmented tumor with ulceration. A biopsy taken from the tumor confirmed the diagnosis of a malignant melanoma. Thus, she was given a total gastrectomy. Reports in the Japanese literature of metastatic malignant melanomas of the stomach diagnosed while the patient was still living amount to 11 cases. Of this number, 3 patients were given a surgical operation. Further, these 3 patients lived longer than the non-surgically treated cases and had a better quality of remaining life.

[Relationship between the effectiveness of CDDP therapy and the nuclear DNA content in advanced-recurrent gastric cancer cases]

A microspectrophotometric analysis of the DNA content has been performed on 9 advanced recurrent gastric cancer patients with measurable lesions, who has either been treated by CDDP alone or with other chemotherapeutics during a three-year period since, 1984. Histograms of the DNA content were classified into four ploidy patterns. All of the 4 responder cases (CR, PR, MR) showed type, IV, although only one of 5 non-responder cases revealed the same typing. In one of the two CR cases the DNA ploidy pattern, which was examined before and after the therapy, changed from type IV to type II. Thus it appears that an analysis of the DNA content may be useful in evaluating the effectiveness of different chemotherapies.

[In vivo antitumor effect of LAK cells induced from various lymphocytes--experimental study in rats]

A MRMT-1 was inoculated in the thigh of SD rats. On day 7, regional lymph node lymphocytes (TB-LN), thymus cells (TB-TC) and spleen cells (TB-SC) or non-tumor bearing spleen cells (NB-SC), were obtained. LAK were induced with lug/ml of R-IL2 (TGP-3) using above lymphocytes, and were examined as for their in vivo and in vitro cytotoxic activities. In vitro: Against MRMT-1, cytotoxic activity of LAK increased with lapse of culturing time. Thus on day 4 of culture, it was the highest (46.5%) in TB-SC-LAK, while that of TB-LN-LAK was the lowest (5.8%). Against YAC-1, they also increased except TB-LN-LAK. In vivo: When the mixture of MRMT-1 and LAK was sc inoculation, diameter of the tumor were the smallest in TB-LN-LAK and the largest in TB-SC-LAK. When it was injected intraperitoneally, in non-irradiated rats, the survival prolongation was the best in TB-LN-LAK and the worst in TB-SC-LAK. In pre-irradiated rats; the cytotoxicity was almost the same as the results of in vitro. When it was injected intravenously, number of lung metastatic nodes were the smallest in TB-LN-LAK and the largest in TB-SC-LAK. R-IL2 substitution therapy was also effective. In conclusion, the effectiveness of LAK-AIT was estimated more accurately by in vivo cytotoxic assay. TB-LN was most useful as a source of LAK cells.

Cure of advanced gastric cancer by combined chemotherapy with cisplatinum, mitomycin C, and 5-fluorouracil

A 55-year-old female, in which an unresectable Borrmann II-type gastric cancer (moderately differentiated adenocarcinoma) extending from vicinity of the cardia to the lower portion of the corpus, with direct invasion into the pancreas and extensive lymph node metastases, confirmed by laparotomy, was treated postoperatively by 3 courses of chemotherapy with cisplatinum in combination with mitomycin C and 5-fluorouracil. A complete response was confirmed by roentgenography and endoscopy, and, at 4 months after the first operation, a total gastrectomy with radical lymphadenectomy was performed successfully. Cancer cells were not detectable histologically in the stomach specimen and in all the lymph nodes removed. One year and 5 months after the second operation she is well, showing no sign of recurrence.

[Experience with CDDP therapy in advanced and recurrent gastric cancer cases]

For 3 years beginning in 1984, 14 advanced and recurrent gastric cancer cases with measurable lesions (8 unresected cases, 3 cases of recurrence, 2 cases with non-curative resection, 1 case of no operation) were treated by CDDP therapy alone or in combination with other chemotherapies. CR was obtained in 2 of the 8 non-resected cases, radical gastrectomy being feasible in these 2 cases by second-look operation. Five of the 8 cases showed PD, and in 1 case the effect was rather obscure. One of the 2 non-curative resection cases achieved PR, and the other case was MR. One of the 3 recurrent cases was NC, the remaining cases being PD. The one case given no operation showed PD. Overall effectiveness of CDDP therapy for advanced and recurrent gastric cancer cases was seen in 3 (21.4%) of the 14 cases. All of these 3 cases showing effective CDDP therapy was elevated serum CEA values before the therapy, which was markedly reduced after starting the therapy, the reduction rate being very remarkable.

Advanced gastric cancer successfully resected following cisplatin therapy: report of a case

A case of unresectable advanced gastric cancer was treated with cis-dichlorodiammine platinum (CDDP) at a dosage of 30 mg/day for 5 days every month after operation. After three courses of administration, examinations revealed that the tumor had disappeared, and an evaluation of complete response was made. Four months later, a second-look operation was performed; and it was found that the cancer was smaller than a thumb and could be resected radically. No significant side effects were observed during CDDP therapy.

Heterotopic gastric mucosa accompanied by aberrant pancreas in the duodenum

An operated case of a heterotopic gastric mucosa, accompanied by an aberrant pancreas tissue, in the bulb of the duodenum was reported. A 40-yr-old man complained of epigastralgia and was diagnosed to have a protruding lesion in the duodenum by roentgenological and endoscopic examinations. Partial excision of the duodenal wall including the mass was performed. Cut surface of the specimen showed a yellowish-whitish mass in the submucosal through the subserosal layers, which was covered by a papillary elevated mucous membrane. Histologically the mass was an aberrant pancreas of the Heinrich I-type and the mucous membrane covering the mass was a heterotopic gastric mucosa, consisting of completely developed fundic glands.

[Successful treatment of advanced gastric cancer by combined cisplatinum, mitomycin C and 5-FU administration. A case report]

A 55-year-old woman with gastric cancer underwent laparotomy and was found to have an unresectable tumor at the MC region, characterized by S3 (invasion into the pancreas), N3, P0, H0, Borrmann-II and moderately differentiated tubular adenocarcinoma. She was then treated by combined administration of cis-dichlorodiammine platinum (CDDP), mitomycin C and 5-fluorouracil (5-FU). A complete response was confirmed by upper gastrointestinal roentgenography and endoscopy. Upon reoperation 4 months after the initial laparotomy, a successful total radical gastrectomy with R2 (partially R3) lymph node dissection was performed. Histological examination of the specimens, including the stomach and lymph nodes, revealed no cancer cells in any region.

Clinical studies on serum immunosuppressive acidic protein (IAP) and ferritin in gastric cancer patients: with special reference to preoperative value and influence of surgical stress

Serum IAP and ferritin values were measured preoperatively in 83 resectable gastric cancer patients. IAP was significantly higher in them than in normal subjects, and increased gradually with progression of cancer, and the values at stages III and IV were significantly higher than that at stage I. It was significantly higher in the cases of n(+) than in those of n(-), and in the cases of noncurative resection than in those of curative resection. Ferritin was significantly higher in them than in normal subjects and mammary cancer patients, and in males than in females, and the values at stages I and IV were significantly higher than that at stage III. OK-432 was serially administered pre- and postoperatively in 83 cases and only postoperatively in 33 cases. IAP increased markedly at 1 week postoperatively and was reduced gradually at 2 and 4 weeks. Ferritin increased markedly at 1 week after operation and reached the maximum value at 2 weeks and was reduced toward the value of 1 week at 4 weeks. However, these changes showed no significant difference between the both groups.

[Advanced gastric cancer successfully resected following cisplatin therapy. A case report]

A case of unresectable advanced gastric cancer (portion A, Min, S3 infiltrating into pancreas, N3, por., Borrmann III-type, hen's egg size) was treated with cis-dichlorodiammine platinum (CDDP) at a dosage of 30 mg/day for five days every month following surgery. After three courses of administration, examinations revealed that the tumor had disappeared and an evaluation of complete response was made. Four months later, a second-look operation was performed. It was found that the cancer was less than thumbsize and was able to be resected radically. No significant side effects were observed during CDDP therapy.

[Observation on natural killer cell activity in gastric cancer patients and effect of nonspecific immunopotentiator administration on its postoperative reduction]

Natural killer cell (NK) activity, together with various nonspecific immunologic parameters, was measured preoperatively, and its changes induced by operative stress were examined in gastric cancer patients. Effect of administration of a nonspecific immunopotentiator, OK-432, was evaluated by postoperative changes in NK activity. Peripheral blood NK activity was measured by 51Cr-release assay against K-562 target cells. It was found that NK activity in the gastric cancer patients was significantly lower than that in healthy subjects. The reduction was specially marked in the cases of cancer at stages I and IV. NK activity in the cases with hepatic or peritoneal metastasis was significantly lower than that in the cases without such metastasis. NK activity in the cases of noncurative gastric resection or non-resection was significantly lower than that in the cases of curative gastric resection. NK activity in the cases of stage IV and "por" in histology was significantly lower than that in the cases of stage IV and "tub1" in histology. In the cases at stages I + II, there was a positive correlation between NK activity and IgG FcR(+) T cell ratio. There was a negative correlation between NK activity and alpha 2-globulin ratio and the correlation was especially significant in the cases at stages III + IV. In the cases at stages III + IV, receiving administration of OK-432 only postoperatively, NK activity was significantly reduced or tended to be reduced at 1 through 4 week(s) postoperatively, while such a reduction was not seen in the cases receiving administration of OK-432 pre- and postoperatively. This phenomenon was more marked in the cases showing a serum albumin level lower than 3.5 g/dl or in the cases undergoing operations longer than 4 hours in duration.

Relationship between lymphocytic cytotoxicity and phytohemagglutinin-induced lymphoblastogenesis before and after surgical tumor excision: an experimental study

Experimental study was performed on changes in lymphocytic cytotoxicity and phytohemagglutinin (PHA)-lymphoblastogenesis after surgical tumor excision and on a possibility of estimating antitumor immunocompetence based on the latter parameter, using 3-methyl-cholanthrene-induced mammary cancer, MRMT-1, of SD rats. When the tumor was excised at 2 weeks after inoculation, cytotoxicity showed, after a transient rise, a marked reduction at 4 weeks postoperatively in the cases of postoperative negative metastasis, while it showed a high peak at 3 weeks postoperatively, followed by a sharp descent, in the cases of postoperative positive metastasis. On the other hand, PHA-lymphoblastogenesis was found to recover a relatively high level postoperatively, in the cases of both negative and positive metastases. It appears to be difficult to estimate specific cytotoxicity from PHA-blastogenesis, but both are useful, in complementary fashion, to estimate the antitumor immunocompetence.

[Clinical studies on preoperative nonspecific immunological parameters and radical operation in stomach cancer]

Ratio of IgG Fc receptor positive T (Fc R(+) T) cell, PHA-induced blastogenesis and serum alpha 2-globulin ratio were examined in 90 preoperative cases with gastric cancer and were analyzed according to various stages of cancer and compared with normal controls. Moreover, on the basis of correlations among these parameters, operative radicality and prognosis were discussed. Fc R(+) T cell ratio was significantly elevated. PHA- blastogenesis was significantly reduced. Alpha 2-globulin ratio tended to increase as the stage progressed. A significant negative correlation was found between Fc R(+) T cell ratio and PHA- blastogenesis. In a scattergram indicating this correlation, the group of noncurative resection or exploratory laparotomy was divided into two areas, B1 and B2. The group of curative resection (A1) was located between B1 and B2, and the normal control group was located in the area common to B1 and A1, Cases succumbing to cancer within one year postoperatively were found to accumulate either in the area B2 or in the area B1 minus the area common with A1. No significant correlation was found between Fc R(+) T cell ratio and alpha 2-globulin ratio. However in a scatter gram, the almost same relationship between these three groups was noted. Thus it has suggested that postoperative prognosis (at least for two years) is good in cases which an immunological harmony among these parameters is maintained preoperatively.

Facilitation of tumor metastasis by operative stress and participation of cell-mediated immunity. Experimental study

5-week-old syngeneic female SD rats were inoculated subcutaneously at the dorsal flank with 200 mg of a metastasizing rat's mammary tumor, MRMT-1. A significantly higher incidence of lung metastasis was observed in the cases in which tumor excision on day 14 was accompanied by 30 min laparotomy than in the cases of simple tumor excision. PHA lymphoblastogenesis on day 17 was significantly lower in the cases of tumor excision plus laparotomy on day 14 than in the cases of simple tumor excision. Winn's assay using splenocytes revealed a postoperative enhanced suppressor activity in the cases undergoing laparotomy stress. Possible participation of the raised suppressor activity to facilitation of metastasis was discussed.

[Experimental study on immunological effect of splenectomy on tumor-bearers]

In view of popularity of splenectomy in combination with gastrectomy for gastric cancer, immunological effect of splenectomy was studied experimentally, using SD rats and 3-methylcholanthrene-induced mammary cancer, MRMT -1. Splenectomy was performed on day -14, 2, 7, 14 or 21 of sc inoculation of 200 mg (about 4 X 10(6) cells) of MRMT -1 at the back of 4-week-old female rats. Tumor growth and immunocompetence of peripheral lymphocytes, spleen cells and thymus cells were examined. Tumor growth on day 35 tended to be inhibited in rats splenectomized on day -14, 2, or 14, while it tended to be promoted in rats splenectomized on day 7. PHA-induced blastogenesis and NK activity of spleen cells were reduced on day 2, rose on day 7 and gradually decreased on days 14 and 21. Winn's neutralization assay revealed that spleen cells on days 2, 14 and 21 of tumor inoculation had suppressor activities. In conclusion, spleen cells of tumor-bearing rats showed a reduced immunocompetence on day 2 (the early tumor-bearing stage) and on day 14 and later (the late tumor-bearing stage), while they showed a raised immunocompetence on day 7 (the middle tumor-bearing period).

Influences of operative stress on cell-mediated immunity and on tumor metastasis and their prevention by nonspecific immunotherapy: experimental studies in rats

Influences of operative stress on nonspecific cell-mediated immunity and on liability to tumor metastasis and preventive effects thereon of a nonspecific immunopotentiator OK-432 were examined. Syngeneic female SD rats were inoculated SC with 200 mg of a transplantable mammary carcinoma MRMT-1 at the dorsal flank. After 2 weeks the tumor was surgically excised simply or combined with 30-min laparotomy. It was revealed by follow-up examination that the laparotomy stress significantly increased incidence of postoperative lung metastasis. It was found that PHA-induced blastogenesis of peripheral lymphocytes was markedly reduced in the early period following laparotomy. Preoperative or post-operative (especially the former) administration of OK-432 was effective for preventing both the postlaparotomy facilitation of lung metastasis and the postlaparotomy reduction in PHA lymphoblastogenesis.

[Intracranial mycotic aneurysm--report of a case (author's transl)]

A case of intracranial mycotic aneurysm has been reported. The case was a 26-year-old female and was admitted to our hospital on November 11, 1975. She was semicomatous and showed right hemiplegia. On auscultation systolic murmur radiating from the mitral area to the left axilla was found. Left carotid angiogram showed a saccular aneurysm 5 mm in diameter, arising from peripheral portion of the percentral cerebral artery and accompanied by intracerebral hematoma. Emergency craniotomy was performed. A thin subdural hematoma, coated with pus, was found and microabcesses were seen to be scattered in the nearby subarachnoid space. After aneurysmectomy and removal of intracranial hematoma, the patient improved without complications. On histological examination of the aneurysmal wall, moderate degree of neutrophilic infiltration was found. It was especially marked around the vasa vasorum. Heretofore only eight cases of intracranial mycotic aneurysm have been reported in the domestic literature.

[Calcified epidural hematoma-report of a case incidentally found 16 years after head injury (author's transl)]

A calcified epidural hydroma, or old hematoma, was incidentally found in the left parietal region of a 55-year-old man presenting status epilepticus due to uremia after a lapse of 16 years following head injury. The hydroma (10x7x1.2 cm) was extirpated operatirelly. There was an extensive calcificantion in the wall, and the outer wall showed bone-like metaplasia and hemosiderin deposit. No skull fracture was discernible. The dura and the brain surface neighboring the hydroma were gloslsly normal. The patient eventually died of uremia.