[CART therapy followed by allo-HSCT for patients with B-cell acute lymphoblastic leukemia relapsing after the first hematopoietic stem cell transplantation]

目的

观察嵌合抗原受体T细胞（CART）序贯二次异基因造血干细胞移植（allo-HSCT）治疗移植后复发急性B淋巴细胞白血病（B-ALL）的疗效。

方法

回顾性分析2015年10月至2020年6月在河北燕达陆道培医院接受二次allo-HSCT的41例B-ALL患者的临床资料，入选患者均为移植后骨髓形态学或髓外复发且二次移植前接受CART治疗。

结果

全部41例患者中男21例、女20例，二次移植时中位年龄为16（3～46）岁。移植后骨髓复发31例（75.6％）、髓外复发5例（12.2％）、骨髓和髓外复发5例（12.2％）。复发后接受CD19-CART治疗35例（85.4％）、CD22-CART治疗2例（4.9％）、CD19-CART联合CD22-CART治疗4例（9.8％）。二次移植后预期3年总生存（OS）率为48.9％（95％ CI 23.0％～70.6％）、无白血病生存（LFS）率为41.8％（95％ CI 17.3％～64.9％），累积复发率（RI）为8.8％（95％ CI 2.9％～26.4％），非复发相关死亡率（NRM）为51.1％（95％ CI 31.2％～83.6％）。首次移植后复发时间≤6个月组（10例）二次移植后1年OS率低于复发时间>6个月组（31例）［45.0％（95％ CI 12.7％～73.5％）对75.0％（95％ CI 51.4％～88.8％），P＝0.017］。

结论

CART序贯二次allo-HSCT可使部分造血干细胞移植后复发B-ALL患者获得长生存，但NRM较高，移植方案有待进一步改进。

[Comparison of the clinical outcomes of haploidentical and matched-sibling donor stem cell transplantation for T cell acute lymphoblastic leukemia in complete remission]

目的

比较亲缘单倍型造血干细胞移植（HIDT）和同胞相合造血干细胞移植（MSDT）治疗完全缓解期（CR）急性T淋巴细胞白血病（T-ALL）的疗效。

方法

回顾性分析2012年5月至2017年5月间在河北燕达陆道培医院接受HIDT（81例）和MSDT（17例）的CR期T-ALL患者的临床特点和预后。

结果

HIDT组、MSDT组移植后100 d Ⅱ～Ⅳ度急性GVHD发生率分别为51.9％（95％CI42.0％～64.0％）、29.4％（95％CI 14.1％～61.4％）（P＝0.072），Ⅲ/Ⅳ度急性GVHD发生率分别为9.8％（95％CI 5.1％～19.1％）、11.8％（95％CI 3.2％～43.3％）（P＝1.000），巨细胞病毒（CMV）血症发生率分别为53.1％（95％CI 43.3％～65.2％）、29.4％（95％CI 14.1％～61.4％）（P＝0.115），EB病毒（EBV）血症发生率分别为35.8％（95％CI 26.8％～47.9％）、11.8％（95％CI 3.2％～43.3％）（P＝0.048）。HIDT、MSDT两组移植后5年总生存（OS）率分别为60.5％（95％CI 5.4％～49.0％）、68.8％（95％CI 11.8％～40.0％）（P＝0.315），无白血病生存（LFS）率分别为58.0％（95％CI 5.5％～46.5％）、68.8％（95％CI11.8％～40.0％）（P＝0.258），累积复发率分别为16.1％（95％ CI 9.8％～26.4％）、11.8％（95％ CI3.2％～43.3％）（P＝0.643），非复发死亡率（NRM）分别为25.9％（95％CI 17.9％～37.5％）、19.4％（95％CI6.9％～54.4％）（P＝0.386）。

结论

对于CR期T-ALL患者，当缺乏合适供者时，HIDT可作为替代选择。

[Prognostic analysis of allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia in complete remission in the era of tyrosine kinase inhibitors]

目的

探讨在酪氨酸激酶抑制剂（TKI）时代Ph染色体阳性急性淋巴细胞白血病（Ph⁺ALL）在完全缓解（CR）状态下行异基因造血干细胞移植（allo-HSCT）的预后和影响因素。

方法

回顾性分析2012年5月至2017年5月河北燕达陆道培医院收治的116例在CR状态下行allo-HSCT的Ph⁺ALL患者的预后及其影响因素。

结果

116例患者中男72例，女44例。中位年龄20（4～64）岁。同胞全相合移植21例，亲缘单倍型移植77例，非血缘移植18例。5年总生存（OS）率为73.2％（95％CI 63.8％～80.5％），其中诊断至移植间隔时间<180 d的亚组5年OS率为87.5％。5年无病生存（DFS）率为61.4％（95％CI 51.8％～69.7％）。5年细胞形态及分子学水平复发累积发生率为18.5％（95％CI 12.6％～27.3％）。5年移植相关死亡率（TRM）为19.9％（95％CI 13.8％～28.7％）。多因素分析显示，15～39岁（HR＝2.730，P＝0.044）、诊断至移植间隔时间≥180 d（HR＝4.534，P＝0.010）、发生Ⅲ～Ⅳ度急性移植物抗宿主病（aGVHD）（HR＝7.558，P＝0.000）是影响患者OS的不利因素；发生局限型慢性移植物抗宿主病（cGVHD）是影响患者OS的有利因素（HR＝0.300，P＝0.034）。而性别、起病时WBC（<30×10⁹/L，≥30×10⁹/L）、BCR-ABL融合基因类型、体细胞突变类型、移植前状态（CR₁，>CR₁）、移植前微小残留病（MRD）水平（MRD阴性，MRD阳性）、预处理方案（全身照射方案，白消安为基础方案）、预处理方案强度、移植类型、GVHD预防方案（环孢素A，他克莫司）、抗胸腺细胞免疫球蛋白的种类、巨细胞病毒和EB病毒血症的有无对OS的影响无统计学意义。

结论

TKI时代Ph⁺ALL在CR状态下行allo-HSCT时，影响生存的因素有年龄、诊断至移植间隔时间和发生重度aGVHD。

[Predictive value of STOP-Bang questionnaire combined with Epworth sleepiness scale for OSA]

Objective:To explore the predictive value of STOP-Bang questionnaire(SBQ) combined with Epworth sleepiness scale(ESS) for OSA. Method: Both SBQ and ESS were conducted to assess 356 potential OSA patients. ROC curve was drawn in comparison with the gold standard of PSG. The values were obtained after the sensitivity, specificity, positive predictive values and negative predictive values were calculated. Result:When combined, the sensitivity(89.31%), specificity(78.95%), positive predictive value(97.26%), negative predictive value(46.88%) and the area under ROC curve(AUC=0.821) were higher. Conclusion:SBQ and ESS have certain predictive value in OSA screening. When combined, the accuracy of prediction OSA can be improved, which can help medical staff to identify patients with high risk of OSA early.

[Clinical characteristics and prognosis of 34 cases of acute myeloid leukemia with FLT3 internal tandem duplication and MLL gene rearrangement]

目的

探讨同时伴FLT3-ITD突变及MLL基因异常的急性髓系白血病（AML）患者的临床特征及转归。

方法

回顾性分析34例同时伴FLT3-ITD突变及MLL基因异常的AML患者的临床资料，比较化疗、化疗加靶向药物治疗及allo-HSCT的疗效及影响因素。

结果

34例同时伴FLT3-ITD突变及MLL基因异常的AML患者占同期住院AML患者的2.02%。入院时WBC>30×10⁹/L的患者占63.6%，其中WBC>50×10⁹/L者占39.4%。FAB亚型中以M₅比例最高，占35.3%，染色体核型异常者达63.6%，其中复杂异常占12.1%。34例患者中仅有FLT3-ITD及MLL基因异常（双基因异常）者11例（32.4%），具FLT3及MLL以外的1种及1种以上的基因异常（多基因异常）者23例（67.6%）。34例患者2个疗程完全缓解（CR）率为29.4%，7例（20.6%）化疗≥3个疗程后CR，CR患者的早期复发率为52.9%。WBC>50×10⁹/L以及多基因异常的患者2个疗程CR率较低（7.7%、5.4%），其中具有3种以上基因异常的患者无一例CR。34例患者2年总生存（OS）率为28.8%（95%CI 13.5%~46.0%），2年无病生存（DFS）率为27.1%（95% CI 12.5%~44.0%）。18例仅使用化疗或化疗加靶向药物治疗的患者，17例在2年内死亡，1例放弃治疗后失访。接受allo-HSCT治疗的患者3年OS率为43.4%（95%CI 13.7%~70.4%），3年DFS率为42.7%（95% CI 13.4%~69.7%）。

结论

同时伴FLT3-ITD突变及MLL基因异常的AML患者FAB分型以M₅多见，常伴高白细胞血症、细胞遗传学异常及多基因异常。患者化疗缓解率低，早期复发率高，长期生存率低。高白细胞血症、多基因异常可能是此类患者疗效差的重要原因，allo-HSCT可改善患者的转归。

[Comparison of three different types of donor hematopoietic stem cell transplantation for intermediate and high-risk myelodysplastic syndrome]

目的

比较半相合移植（Haplo-HSCT）、无关供者移植（MUD-HSCT）及同胞相合移植（MSD-HSCT）治疗中高危骨髓增生异常综合征（MDS）的疗效及其预后影响因素。

方法

回顾性分析2001年8月至2015年5月接受异基因造血干细胞移植（allo-HSCT）治疗的167例中高危MDS患者病例资料，比较不同移植方式下患者的预后特征及预后影响因素。

结果

存活患者中位随访60（12~177）个月。5年实际累积无病生存（DFS）率为67.8%（95% CI 60.0%~75.6%），其中MSD-HSCT组为68.0%（95% CI 54.1%~81.9%），MUD-HSCT组为77.4%（95% CI 62.1%~92.7%），Haplo-HSCT组为64.0%（95% CI 52.4%~75.6%），三组比较差异无统计学意义（P=0.632）。单因素分析结果显示移植前病程>12个月者累积DFS率明显低于≤12个月者（P=0.018）。5年累积复发死亡率和移植相关死亡率（TRM）与上面危险因素均无明显相关性。

结论

Haplo-HSCT治疗MDS疗效显著，可以作为重要的替代供者，特别是在缺乏MSD而病情紧急没有时间去等待搜索MUD的情况下，可以主动选择；移植前病程是影响DFS的重要因素。

[Effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion: Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

[Effect of minimal residual disease monitoring by multiparameter flow cytometry pre-conditioning on prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

目的

分析预处理前多参数流式细胞术（MFC）监测的骨髓微小残留病（MRD）对急性髓系白血病（AML）异基因造血干细胞移植（allo-HSCT）预后的影响，探讨MFC监测MRD在AML allo-HSCT预后评估中的价值。

方法

回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者，预处理前骨髓细胞形态学均达第1次完全缓解（CR₁）。采用8色MFC对预处理前骨髓进行MRD检测，任何水平异常均定义为MRD阳性。

结果

①186例AML患者中151例MRD阴性；35例MRD阳性，其中25例MRD<1%，10例MRD为1%~3%。②2年总体无病生存（DFS）率为80.0%（95% CI 68.5%~92.3%）。与MRD阴性组比较，MRD阳性组DFS率低[62.9%（95% CI 50.6%~75.2%）对88.9%（95%CI 76.6%~100.0%），P<0.001]、复发率高[11.4%（95%CI 4.1%~29.0%）对3.3%（95%CI 0.6%~20.9%），P=0.003]、非复发死亡率（NRM）高[25.7%（95%CI 8.1%~43.3%）对7.9%（95%CI 1.3%~26.5%），P=0.001]。继发性AML组DFS率低（P=0.004），NRM高（P=0.003）。③多因素分析结果显示预处理前MFC检测的MRD阳性是DFS[HR=4.565（95%CI 2.918~9.482），P<0.001]、复发[HR=5.854（95% CI 1.538~22.288），P=0.010]及非复发死亡[HR=3.379（95%CI 1.361~8.391），P=0.009]的独立危险因素。

结论

预处理前MFC监测的MRD阳性是影响allo-HSCT治疗CR₁-AML独立危险因素，MFC监测MRD可用于AML allo-HSCT的预后评估。

A study for maternal thyroid hormone deficiency during the first half of pregnancy in China

BACKGROUND

Maternal thyroid hormone deficiency is the most common disorder of thyroid function during pregnancy and can influence the outcome for mother and foetus. The purpose of this study was to investigate the prevalence of thyroid hormone deficiency during the first half of pregnancy in iodine sufficient areas of China.

MATERIALS AND METHODS

Four thousand eight hundred pregnant women from 10 hospitals during the first 20 weeks of gestation were enrolled in this study. All sera obtained from pregnant women were measured for thyrotropin, free thyroxine and thyroid peroxidase antibody. Screening for thyroid hormone deficiency was performed on pregnant women using gestational age-specific reference intervals or non-pregnant population reference intervals.

RESULTS

With gestational age-specific reference intervals as the criterion, the prevalence of subclinical hypothyroidism at 4, 8, 12,16 and 20 weeks of gestation was 4.59%, 6.15%, 4.68%, 4.53% and 5.96%, respectively, and the prevalence of hypothyroxinaemia was 3.69%, 1.11%, 2.92%, 1.29% and 2.29%, respectively. Different prevalence was obtained when non-pregnant population reference intervals was used as the criterion. If non-pregnant population reference intervals were used, the percentage of potentially misclassified cases of subclinical hypothyroidism were 0.18%, 2.85%, 4.1%, 3.24%, and 3.21%, respectively, and 3.45%, 0.66%, 2.34%, 1.29%, and 1.83%, respectively, in potentially misclassified cases of hypothyroxinaemia.

CONCLUSIONS

The percentage of potentially misclassified cases of subclinical hypothyroidism and hypothyroxinaemia in pregnant women decreased by using the gestational age-specific reference intervals as a diagnostic criteria during the first half of pregnancy.

Beta-carotene modulates human prostate cancer cell growth and may undergo intracellular metabolism to retinol

Epidemiologic and animal studies provide support for a relationship between high intakes of carotenoids from fruits and vegetables with reduced risk of several malignancies including prostate cancer. The highly controlled environments of in vitro systems provide an opportunity to investigate the cellular and molecular effects of carotenoids. The effects of beta-carotene (BC) on in vitro growth rates, p21(WAF1) and p53 gene expression, as well as the conversion of BC to retinol were investigated in three human prostate adenocarcinoma cell lines: PC-3, DU 145 and LNCaP. In these experiments, media concentrations of 30 micromol BC/L for 72 h significantly (P < 0.05) slowed in vitro growth rates in all three cell lines, independently of p53 or p21(WAF1) status or expression. (14)C-labeled retinol was detected in prostate tumor cells incubated with (14)C-labeled BC, suggesting metabolic conversion of BC to retinol. Conversely, no (14)C-labeled retinol was detected in media incubated without prostate cancer cells. These studies support a hypothesis that in vitro biological effects of BC on prostate cells may result in part from the conversion of BC to retinol or other metabolites. The possibility that prostate cancer cells in vivo locally metabolize provitamin A carotenoids to retinol and other related metabolites may have implications for our understanding of prostate cancer etiology and the design of future prevention studies.

Soybean phytochemicals inhibit the growth of transplantable human prostate carcinoma and tumor angiogenesis in mice

The objectives of our studies are to characterize the ability of dietary soybean components to inhibit the growth of prostate cancer in mice and alter tumor biomarkers associated with angiogenesis. Soy isoflavones (genistein or daidzein) or soy phytochemical concentrate inhibit the growth of prostate cancer cells LNCaP, DU 145 and PC-3 in vitro, but only at supraphysiologic concentrations, i.e., 50% inhibitory concentration (IC(50)) > 50 micromol/L. G2-M arrest and DNA fragmentation consistent with apoptosis of prostate cancer cells are also observed at concentrations causing growth inhibition. In contrast, the in vitro proliferation of vascular endothelial cells was inhibited by soy phytochemcials at much lower concentrations. We evaluated the ability of dietary soy phytochemical concentrate and soy protein isolate to inhibit the growth of the LNCaP human prostate cancer in severe combined immune-deficient mice. Mice inoculated subcutaneously with LNCaP cells (2 x 10(6)) were randomly assigned to one of the six dietary groups based on the AIN-76A formulation for 3 wk. A 2 x 3 factorial design was employed with two protein sources (20%, casein vs. soy protein) and three levels of soy phytochemical concentrate (0, 0.2 and 1.0% of the diet). Soy components did not alter body weight gain or food intake. Compared with casein-fed controls, the tumor volumes after 3 wk were reduced by 11% (P = 0.45) by soy protein, 19% (P = 0.17) by 0.2% soy phytochemical concentrate, 28% by soy protein with 0.2% soy phytochemical concentrate (P < 0.05), 30% by 1.0% soy phytochemical concentrate (P < 0.05) and 40% by soy protein with 1.0% soy phytochemical concentrate (P < 0.005). Histologic examination of tumor tissue showed that consumption of soy products significantly reduced tumor cell proliferation, increased apoptosis and reduced microvessel density. The angiogenic protein insulin-like growth factor-I was reduced in the circulation of mice fed soy protein and phytochemical concentrate. Our data suggest that dietary soy products may inhibit experimental prostate tumor growth through a combination of direct effects on tumor cells and indirect effects on tumor neovasculature.

Energy intake and prostate tumor growth, angiogenesis, and vascular endothelial growth factor expression

BACKGROUND

A sedentary lifestyle coupled with excessive energy intake is speculated to be a factor associated with increased incidence of prostate cancer. We have investigated the effects of energy intake on prostate tumor growth in experimental animals.

METHODS

Two transplantable prostate tumor models, i.e., the androgen-dependent Dunning R3327-H adenocarcinoma in rats and the androgen-sensitive LNCaP human carcinoma in severe combined immunodeficient mice, were studied. R3327-H tumor growth and relevant tumor biomarkers (proliferation index, apoptosis [programmed cell death], microvessel density, and vascular endothelial growth factor [VEGF] expression) were compared in ad libitum fed control rats, ad libitum fed castrated rats, and groups restricted in energy intake by 20% or 40%. A second set of experiments involving both tumor models examined tumor growth in ad libitum fed rats or in animals whose energy intake was restricted by 30% using three different methods, i.e., total diet restriction, carbohydrate restriction, or lipid restriction. All P values are two-sided.

RESULTS

R3327-H tumors were smaller in energy-restricted or castrated rats than in control rats (P<.001). Tumors from energy-restricted rats exhibited changes in tumor architecture characterized by increased stroma and more homogeneous and smaller glands. In castrated rats, the tumor proliferation index was reduced (P<.0001), whereas apoptosis was increased in both energy-restricted (P<.001) and castrated (P<.001) rats. Tumor microvessel density and VEGF expression were reduced by energy restriction and castration (P<.003 versus control). Restriction of energy intake by reduction of carbohydrate intake, lipid intake, or total diet produced a similar inhibition of growth of R3327-H or LNCaP tumors. These effects were associated with reduced circulating insulin-like growth factor-I.

CONCLUSIONS

Our observations are consistent with the hypothesis that energy restriction reduces prostate tumor growth by inhibiting tumor angiogenesis. Furthermore, dietary fat concentration does not influence prostate tumor growth when energy intake is reduced.

Inhibition of murine bladder tumorigenesis by soy isoflavones via alterations in the cell cycle, apoptosis, and angiogenesis

Soy isoflavones exhibit a number of biological effects, suggesting that they may have a role in cancer prevention. Our objectives are to determine whether components of soy products or purified soy isoflavones can inhibit the progression of bladder cancer. We compared the in vitro effects of pure soy isoflavones and soy phytochemical concentrate on growth curves, cell cycle progression, and apoptosis in murine and human bladder cancer cell lines. Pure soy isoflavones (genistein, genistin, daidzein, and biochanin A) and soy phytochemical concentrate exhibit dose-dependent growth inhibition of murine (MB49 and MBT-2) and human (HT-1376, UM-UC-3, RT-4, J82, and TCCSUP) bladder cancer cell lines, although the degree of inhibition varies among lines. Soy isoflavones induce a G2-M cell cycle arrest in all human and murine lines evaluated by flow cytometry. In addition, some bladder cancer lines show DNA fragmentation consistent with apoptosis. We next evaluated the ability of genistein, soy phytochemical concentrate, and soy protein isolate, respectively, to inhibit the growth of transplantable murine bladder cancer in vivo. C57BL/6 mice were randomly assigned to treatment groups (n = 12/group): (a) AIN-76A diet; (b) AIN-76A diet plus genistein, i.p., 50 mg/kg body weight/day; (c) AIN-76 diet with soy phytochemical concentrate at 0.2% of the diet; (d) AIN-76 diet with soy phytochemical concentrate at 1.0% of the diet; and (e) AIN-76A diet with soy protein isolate, 20% by weight. Mice were inoculated s.c. with 5 x 10(4) syngeneic MB49 bladder carcinoma cells, and tumor growth was quantitated. Neither genistein nor soy products reduced body weight gain. Tumor volumes from mice treated with genistein, dietary soy phytochemical concentrate at 1%, or dietary soy protein isolate were reduced by 40% (P < 0.007), 48% (P < 0.001), or 37% (P < 0.01), respectively, compared with controls. We characterized the effects of treatment on several biomarkers in tumor tissue: proliferation index by proliferating cell nuclear antigen staining, apoptotic index by terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling staining, and angiogenesis by microvessel quantitation. Soy products reduced angiogenesis, increased apoptosis, and slightly reduced proliferation while showing no histopathological effects on the normal bladder mucosa. Our data suggest that soy isoflavones can inhibit bladder tumor growth through a combination of direct effects on tumor cells and indirect effects on the tumor neovasculature. Soy products warrant further investigation in bladder cancer prevention and treatment programs or as antiangiogenic agents.

Bridging animal and human studies: what are the missing segments in dietary fat and prostate cancer?

Epidemiologic investigations have suggested an association of dietary fat intake with prostate cancer risk, especially risk of advanced prostate cancer. However, supporting evidence from animal studies is limited. Segments that would bridge animal and human studies on dietary fat and prostate cancer--which would determine the future directions of research--are missing. Such segments include 1) well-designed animal studies to evaluate whether dietary fat or fatty acid modulation, particularly by reducing dietary fat and supplementing n-3 fatty acids, reduces the progression of prostate cancer; 2) in vivo identification of intermediate biomarkers that are responsive to dietary fat and fatty acid treatment and may serve as surrogate endpoints in future clinical studies; 3) elucidation of mechanisms by which dietary fat or fatty acid modulation could prevent prostate cancer progression; 4) further epidemiologic studies to estimate dietary exposure more precisely to establish the correlation between dietary fat and risk of prostate cancer; 5) randomized clinical intervention trials evaluating whether dietary fat reduction combined with dietary n-3 fatty acid supplementation delays the recurrence of prostate cancer and improves survival in patients with clinical disease after therapeutic treatment, and whether it prevents or reduces the progression to clinically significant disease in men with latent disease; and 6) studies validating intermediate biomarkers as surrogate endpoints.

The crystalline form of carotenes and the food matrix in carrot root decrease the relative bioavailability of beta- and alpha-carotene in the ferret model

OBJECTIVE

The objective of this study was to investigate the relative bioavailability (BV) of beta-carotene (BC) and alpha-carotene (AC) from different extracts of carrots utilizing the ferret model.

METHODS

Five groups of animals (n = 6) were provided free access to a carotenoid-free, vitamin A-adequate diet and tap water for 2 weeks, then for 3 consecutive days 10 mg of BC was provided in 30--40 mL of one of the following fluids as partial replacement for tap water along with diet: 1) commercial BC beadlets dispersed in distilled water (control), 2) non-heated carrot juice, 3) heated carrot juice, 4) non-heated isolated carrot chromoplasts, or 5) heated carrot chromoplasts. The animals were killed and samples of blood and tissues (liver, adrenal, lung, kidney, spleen) were collected and analyzed for AC and BC concentrations.

RESULTS

The tissue analysis of BC concentrations indicated that BC-beadlet-supplemented animals had significantly higher BC concentrations than other groups (p<0.01). Carrot chromoplast-supplemented animals had significantly higher tissue BC and AC concentrations than carrot juice-supplemented animals. Heat treatment tended to reduce the relative BV of carotenoids but the differences between heated and non-heated juices or isolated carrot chromoplasts were not significantly different.

CONCLUSIONS

These results suggest that the food matrix, probably pectin-like fibers, and the crystalline form of carotenoids in carrot chromoplast are the primary factors that reduce the relative BV of carotenoids from carrot juice.

Phytic acid in health and disease

Phytic acid (PA), a major phosphorus storage compound of most seeds and cereal grains, contributes about 1 to 7% of their dry weight. It may account for more than 70% of the total kernel phosphorus. PA has the strong ability to chelate multivalent metal ions, especially zinc, calcium, and iron. The binding can result in very insoluble salts that are poorly absorbed from the gastrointestinal tract, which results in poor bioavailability (BV) of minerals. Alternatively, the ability of PA to chelate minerals has been reported to have some protective effects, such as decreasing iron-mediated colon cancer risk and lowering serum cholesterol and triglycerides in experimental animals. Data from human studies are still lacking. PA is also considered to be a natural antioxidant and is suggested to have potential functions of reducing lipid peroxidation and as a preservative in foods. Finally, certain inositol phosphates, which may be derived from PA, have been noted to have a function in second messenger transduction systems. The potential nutritional significance of PA is discussed in this review.

Bone zinc is poorly released in young, growing rats fed marginally zinc-restricted diet

The effect of marginal zinc restriction on bone zinc release was studied. Male weanling rats were fed zinc-adequate diet (12 mg zinc/kg diet) for 1 wk, intubated with 65Zn, refed the zinc-adequate diet for an additional week, and divided into one baseline group and five marginally zinc-restricted groups (6 mg/kg) and five corresponding zinc-adequate pair-fed groups. Significantly lower (P < 0.05) 65Zn radioactivity (10-20%) in the first week was observed in femurs of rats fed the marginally zinc-restricted diet without further change in the following weeks. Pair-fed rats showed higher 65Zn radioactivity in femurs in the second week, and the level was maintained. Similar results were found in tibia 65Zn radioactivity. Muscle zinc concentration was higher in the first week (P < 0.05) but subsequently returned to baseline levels in the second week through the fifth week. The results support the existence of two zinc pools in the skeleton, one a small, rapidly turning-over pool (10-20% in size), and the other a slowly turning-over pool. When rats suffer marginal zinc restriction, zinc from the readily turning-over bone pool is utilized for soft tissue needs, followed by decreased growth rate to maintain zinc homeostasis.

[Effect of auriculo-acupuncture plus needle embedding in heart point on left cardiac, humoral and endocrine function]

Twelve patients with dilating cardiomyopathy complicated heart failure were divided randomly into auriculo-acupuncture group (n = 7) and controls (n = 5). Left cardiac function and plasma levels of PRA, ALD, EDLS, ANF were measured. Results showed that CO, CI, ANF, EDLS, ALD were decreased in test group (P < 0.05), which indicated that auriculo-acupuncture plus needle-embedding in Heart acupoint could improve the left cardiac function in patients with dilating cardiomyopathy complicated heart failure and that the function of acupoints is distinctly different from that of non-point.

Reduction of phytic acid in soybean products improves zinc bioavailability in rats

The inhibitory effect of phytic acid in soybean products on zinc bioavailability was evaluated in two experiments in rats. In Experiment 1, soybean flours containing different natural phytic acid levels produced by sand culture techniques that limited phosphorus during growth of the soybean plants were formulated into diets. The rats fed a higher phytic acid level diet had lower food intake, depressed weight gain, and lower tibia zinc gain (P < 0.05). A negative, linear relationship between tibia zinc gain and dietary phytic acid level was found. In Experiment 2, two commercially produced soybean isolates containing either normal phytic acid level or a reduced level were formulated into diets. Slope ratio analysis revealed that relative zinc bioavailability from phytic acid-containing soybean isolate-based diets was significantly reduced (P < 0.05) compared with control diets. Reduced phytic acid soybean isolate-containing diets resulted in a significant increase of zinc bioavailability compared with normal phytic acid diets (P < 0.01). These results coupled with other reports indicate that phytic acid is the primary inhibitory factor in soybean products that results in reduced zinc bioavailability and that phytate reduction in soybean protein increases zinc bioavailability.