REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

OBJECTIVE

The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).

SUMMARY BACKGROUND DATA

Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.

METHODS

The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.

RESULTS

Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ).

CONCLUSIONS

The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.

Practical implications of tumor proximity to landmark vessels in minimally invasive radical antegrade modular pancreatosplenectomy

Careful preoperative planning is key in minimally invasive radical antegrade modular pancreatosplenectomy (MI-RAMPS). This retrospective study aims to show the practical implications of computed tomography distance between the right margin of the tumor and either the left margin of the spleno-mesenteric confluence (d-SMC) or the gastroduodenal artery (d-GDA). Between January 2011 and June 2022, 48 minimally invasive RAMPS were performed for either pancreatic cancer or malignant intraductal mucinous papillary neoplasms. Two procedures were converted to open surgery (4.3%). Mean tumor size was 31.1 ± 14.7 mm. Mean d-SMC was 21.5 ± 18.5 mm. Mean d-GDA was 41.2 ± 23.2 mm. A vein resection was performed in 10 patients (20.8%) and the pancreatic neck could not be divided by an endoscopic stapler in 19 operations (43.1%). In patients requiring a vein resection, mean d-SMC was 10 mm (1.5-15.5) compared to 18 mm (10-37) in those without vein resection (p = 0.01). The cut-off of d-SMC to perform a vein resection was 17 mm (AUC 0.75). Mean d-GDA was 26 mm (19-39) mm when an endoscopic stapler could not be used to divide the pancreas, and 46 mm (30-65) when the neck of the pancreas was stapled (p = 0.01). The cut-off of d-GDA to safely pass an endoscopic stapler behind the neck of the pancreas was 43 mm (AUC 0.75). Computed tomography d-SMC and d-GDA are key measurements when planning for MI-RAMPS.

Metabolism of glutathione in tumour cells as evidenced by 1H MRS

1H MRS signals of glutathione and of free glutamate were examined in samples from cultured tumour cells, namely MCF-7 from mammary carcinoma and TG98 from malignant glioma, with the aim of relating signal intensities to aspects of GSH metabolism. Spectra of cells harvested at different cell densities suggest that GSH and glu signal intensities are related to cell density and proliferation and their ratio is dependent on the activity of the gamma-glutamyl cysteine synthetase. The hypothesis is confirmed by experiments performed on cells treated with buthionine sulfoximine that inhibits the enzyme activity.

1H MRS signals from glutathione may act as predictive markers of apoptosis in irradiated tumour cells

Inhibition of apoptosis in tumour cells may depend on intracellular reduced glutathione (GSH) level. In this work, GSH levels were studied by (1)H MRS in MCF-7 and HeLa cells, characterised by a different radiosensitivity. Annexin-V test showed that the fraction of apoptotic HeLa cells after irradiation is much higher than in control, although MCF-7 cells did not show a significant apoptosis. MRS signals from GSH (G) show lower intensity in HeLa with respect to MCF-7 cells; the opposite is true for free glutamic acid [glu (g)]. After irradiation, the G/g ratio decreases in MCF-7, although remaining approximately constant in HeLa cells. Buthionine sulfoximine (BSO) treated MCF-7 cells show an increase in the percentage of apoptotic cells; in parallel, G/g ratio behaves as in HeLa. This study indicates that GSH level may act as predictive marker of apoptosis by irradiation.

Ion diffusion modelling of Fricke-agarose dosemeter gels

In Fricke-agarose gels, an accurate determination of the spatial dose distribution is hindered by the diffusion of ferric ions. In this work, a model was developed to describe the diffusion process within gel samples of finite length and, thus, permit the reconstruction of the initial spatial distribution of the ferric ions. The temporal evolution of the ion concentration as a function of the initial concentration is derived by solving Fick's second law of diffusion in two dimensions with boundary reflections. The model was applied to magnetic resonance imaging data acquired at high spatial resolution (0.3 mm) and was found to describe accurately the observed diffusion effects.

Optical imaging of dose distributions in Fricke gels

Ferrous-sulphate infused gels, or 'Fricke gels', encounter great interest in the field of radiation dosimetry, due to their potential for 3D radiation dose mapping. Typically, magnetic resonance (MR) relaxation rates are determined in these systems in order to derive the absorbed dose. However, when large concentration gradients are present, diffusion effects before and during the MR imaging may not be negligible. In these cases, optical techniques may represent a viable alternative. This paper describes research aimed at measuring 3D dose distributions in a Fricke-xylenol orange gel by measuring optical density with a CCD camera. This method is inexpensive and fast. A series of early experiments is described, in which optical density profiles were measured with a commercial microdensitometer for film dosimetry. The light box of the device was modified to work at 567 nm, close to the maximum absorbance of the ferric ion-xylenol orange complex. Under these conditions, the gel shows linearity with dose and high sensitivity.

Radiation effects in cultured tumour cells examined by 1H MRS: mobile lipids modulation and proliferative arrest

Much attention has been devoted in the past to monitor changes of mobile lipid (ML) (1)H MRS signals in spectra of tumour cells. The purpose of this work is to exploit ML signals to provide information on cell metabolism after irradiation, comparing tumour cells characterised by different radiosensitivity and relating MRS findings to changes in cell proliferation and delays in cell cycle phases. Irradiated HeLa cells present less intense ML signals with respect to controls. The opposite is true for MCF-7 cells. A G(2) arrest is observed for both cell lines after irradiation. In HeLa cells, G(1) decreases and S phase is maintained; a sub G(1) peak is also visible. In MCF-7 cells, G(1) is decreased and S phase is strongly reduced, while no sub G(1) is present. The observed changes in ML are tentatively associated to cell cycle regulation of phospholipid synthesis. Mathematical modelling of ML variations is in progress.

Optical images of dose distributions in Gel-Fricke: dosimetric performances of the gel

The purpose of this work was to examine the dosimetric performances of the radiochromic Fricke-Agarose-Xylenol Orange gel by optical measurements in order to perform dose reconstructions, in view of a future development for 3-D maps. Optical images and dose-response curves of the gel were obtained by a CCD-based device, originally designed for reading radiochromic films, that was modified to meet the optical properties of the dosemeter. With a resolution of 0.18 x 0.18 mm the optimum range of doses in which per cent uncertainty is lower than 2% was 3-10 Gy. The minimum detectable dose, estimated as the absorbed dose corresponding to 3 SD above background, was 0.1 Gy. With a resolution of 1.98 x 1.98 mm the optimum range of doses in which per cent uncertainty is lower than 2% was 0.3-10 Gy. The minimum detectable dose, estimated as the absorbed dose corresponding to 3 SD above background, was 0.015 Gy. The comparison with alanine dosemeters in the dose range 7-10 Gy showed agreement within a few per cent and the same agreement was observed for the comparison with TLD in the range 1-3 Gy.

MRS study of the interaction of dihydropyridines with lipid molecules in phosphatidylcholine vesicles

Dihydropyridines (DHPs), synthetic molecules used as antihypertensive agents, bind to plasma membrane receptors following diffusion through the hydrophobic phase. In this study, MRS technique has been used to clarify the interactions of the dihydrophyridines Nifedipine and Lacidipine within the lipid bilayer. 1D and 2D 1H MRS at high field have been employed to examine the behavior of unilamellar dimyristoyl-phosphatidylcholine liposomes when the two drugs have been inserted in the bilayer. In particular, the study represents an innovative application of 2D 1H NOESY technique to clarify different mechanisms of interactions of small molecules inside model membranes. On the other hand, 31P measurements have been performed in multilamellar dimyristoyl-phosphatidylcholine lipsomes to detect alterations of lipid polymorphic phases. The experiments show that the two dihydropyridines interact with the lipids by different modalities. Lacidipine undergoes a very strong interaction with lipids, possibly inducing a phase segregation of lipid molecules into the bilayer, while self-association seems to be the prevalent interaction of Nifedipine inside the bilayer.

Radiation effects on soluble metabolites in cultured HeLa cells examined by 1H MRS: changes in concentration of glutathione and of lipid catabolites induced by gamma rays and proton beams

Cultured HeLa cells were irradiated with a single acute dose of either gamma rays (40 Gy) or low-energy proton beams (20 Gy). (1)H magnetic resonance spectra of intact cells harvested at different times after irradiation and of the correspondent perchloric acid (PCA) extracts prepared at different times after irradiation were run. Selected signals from glutathione and lactate were examined with the aim of investigating effects of irradiation on antioxidative stores and on mitochondrial activity. An increase of signal intensity of glutathione (GSH) takes place at 15 and 24 hr after irradiation, while a decrease of its signal intensity, accompanied by an increase of that of free glutamate, starts appearing 48 hr after irradiation. Lactate signal increases 48 hr after irradiation. Signals from lipid catabolites were also examined to explore their sensitivity in predicting the response to radiotherapy. Intensity ratios of signals of glycerophosphorylcholine and choline to that of phosphorylcholine increase with time after irradiation. Irradiating cells with gamma rays or proton beams at half a dose produces effects comparable to the metabolic variations presented here. The present experiments allow more insight into the complex pattern of the changes of GSH by irradiation and indicate that magnetic resonance spectroscopy signals from GSH, glutamate, lactate, and lipid catabolites are affected by irradiation. Finally, these data represent a first indication that the relative biological efficiency for some metabolic damage of low-energy proton beams with respect to gamma rays can reach a value of 2.

Changes in soluble metabolites induced in tumour cells by gamma rays and proton beams: a 1H magnetic resonance spectroscopy study

Cultured HeLa cells have been irradiated with a single acute dose of either gamma rays (40 Gy) or low energy proton beams (20 Gy). 1H magnetic resonance spectra of perchloric acid extracts (PCA) prepared at different times after irradiation show an intensity decrease of signal from glutathione and a parallel increase of lactate signal. Intensity ratios of signals of glycerophosphorylcholine to that of phosphorylcholine increase with time after irradiation. Irradiating cells with gamma rays or proton beams at half a dose obtain effects of comparable extent. The present experiments indicate that relevant metabolic alterations take place in cells damaged by irradiation. Finally, these data represent a first indication that the relative biological efficiency of low energy proton beams with respect to gamma rays can reach a value of 2 as evidenced by cell metabolic impairment.

Dose reconstruction in irradiated Fricke-agarose gels by means of MRI and optical techniques: 2D modelling of diffusion of ferric ions

Fricke-agarose gels have elicited much interest in the field of radiation dosimetry, as tissue-equivalent dosemeters. magnetic resonance (MR) relaxation rates are measured for dose reconstruction. A major problem of Fricke-agarose gels is the diffusion of the ferric ions formed after irradiation. Knowledge of the diffusion coefficient of ferric ions may be necessary. Xylene orange, a dye that specifically chelates ferric ions, was added to the Fricke gel system to reduce ion diffusion and, as the binding gives a coloured complex, to allow optical detection of ferric ions. Diffusion of ferric ions in two dimensions and time evolution of ion concentration were evaluated. MR images were obtained at different times after irradiation. Ferric ion distribution, the corresponding images and the doses at different times after irradiation were reconstructed taking into account the calculated diffusion coefficients. Diffusion was then estimated by means of two different optical methods. The agreement obtained supports the reliability of the MRI method and of the model.

Continuous quality improvement in radiotherapy: the role of the "Istituto Superiore di Sanità" in its application over the national territory

The "Laboratorio di Fisica" of the "Istituto Superiore di Sanità" has undertaken some initiatives to tackle the problem of patients' radiation protection in relation to the issues of radiotherapy, both with respect to the promulgation of new National and European laws and directives and to the extremely rapid and innovative technological developments involved in this field. First, interdisciplinary study groups were organized to identify the aspects on which recommendations to be applied at the national level could be based, and to provide for their development. Second, a national plan was launched for continuous quality improvement in radiotherapy, intended as a program of controls and correctives implemented in radiotherapy to ensure its compliance with predefined standards together with its continuous improvement. Within this plan, a group of experts coordinated by the "Istituto Superiore di Sanità" has promoted two different intercomparisons of dosimetry to evaluate the differences between the measured dose and the calculated dose 1) with reference to a water phantom and 2) during a simulated treatment of rectal cancer in a plastic phantom.

Changes in cell volume and internal sodium concentration in HeLa cells during exponential growth and following lonidamine treatment

Cell volumes decreased in HeLa cells as a function of time after seeding during exponential growth. Cell volume distributions revealed the presence of two cell populations in all stages of growth. When cells approached confluence, the ratio of the two populations abruptly shifted towards that characterised by the smallest volume. Percentages of G1-, S- and G2 + M-phase cells were also measured and it was found that G1 frequency increased as a function of cell density during exponential growth. Intracellular sodium concentration, [Na]i was monitored by 23Na NMR in the presence of 5 mM dysprosium (III) tripolyphosphate. [Na]i increased from 22.8 to 59.0 mM in cells from the second to the seventh day after seeding. Treatment with lonidamine, an antitumoral drug that it is known to slow down cell growth by affecting aerobic glycolysis, produced a complete block of cell progression after a few days of treatment. The progression of cell volume distributions towards smaller volumes and the increase in internal sodium concentration as a function of time after seeding were also affected by the drug. These phenomena were related to the existence of a subpopulation of mitotically inactive G1-phase cells during exponential growth, pointing out that a density-dependent cellular mechanism regulates the cell cycling in HeLa cells.

Characterization of a phospholipid adduct formed in Sprague Dawley rats by chloroform metabolism: NMR studies

The formation of a covalent adduct to a single phospholipid by the oxidative chloroform metabolite, phosgene, is demonstrated in liver mitochondria of phenobarbital-pretreated Sprague Dawley (SD) rats treated with CHCl3. The densitometric analysis of the phosphorus stained extracted phospholipids showed that the formation of this adduct in liver mitochondria is accompanied by a decrease of phosphatidylethanolamine and cardiolipin. The characterization of this adduct was performed with a multinuclear NMR approach by comparison with the decreased phospholipids. Treatment of rats with [13C]chloroform resulted in an intense 13C NMR peak from either an esteric or amidic carbonyl. Very strong similarities in fatty acid composition were found between phosphatidylethanolamine and the phosgene-modified PL, using 13C and 1H NMR spectroscopy. A multiplet at 3.91 ppm coupled to a signal at 3.41 ppm was shown by two-dimensional 1H NMR in the adduct spectrum. This cross peak was interpreted as arising from the shifted resonances of the two PE head group methylene groups, due to the binding with phosgene. 31P spectrum of the adduct was identical to that of phosphatidylethanolamine. We concluded that the chloroform adduct is a modified phosphatidylethanolamine, with the phosgene-derived carbonyl bound to the amine of the head group.

Bayesian estimation of relaxation times T(1) in MR images of irradiated Fricke-agarose gels

The authors present a novel method for processing T(1)-weighted images acquired with Inversion-Recovery (IR) sequence. The method, developed within the Bayesian framework, takes into account a priori knowledge about the spatial regularity of the parameters to be estimated. Inference is drawn by means of Markov Chains Monte Carlo algorithms. The method has been applied to the processing of IR images from irradiated Fricke-agarose gels, proposed in the past as relative dosimeter to verify radiotherapeutic treatment planning systems. Comparison with results obtained from a standard approach shows that signal-to noise ratio (SNR) is strongly enhanced when the estimation of the longitudinal relaxation rate (R1) is performed with the newly proposed statistical approach. Furthermore, the method allows the use of more complex models of the signal. Finally, an appreciable reduction of total acquisition time can be obtained due to the possibility of using a reduced number of images. The method can also be applied to T(1) mapping of other systems.

1H-MRS lipid signal modulation and morphological and ultrastructural changes related to tumor cell proliferation

Changes in signal intensity of (1)H-MRS mobile lipids, mostly triglycerides, have been observed in cultured HeLa cells during exponential growth. Signals were intense in the first days after seeding and almost disappeared after a few days in culture. Choline-based metabolites were not affected by growth. Treatment with the antitumor drug lonidamine, which blocks cell proliferation and cell progression through cycle, increased lipid signal intensity. Morphological changes in the organization of the cell surface were detected by scanning electron microscopy during exponential growth, and were confirmed by freeze fracture analysis. The observed metabolic and structural modifications during cell growth were correlated to cell cycle progression of HeLa cells, as high-intensity lipid signals were typical of cells with a high percentage of S- and( )G(2) + M-phases, while cells with a high frequency in G(1)-phase were characterized by mobile lipid signals of very low intensity. Magn Reson Med 42:248-257, 1999.

Hormonally induced modulation in the phosphate metabolites of breast cancer: analysis of in vivo 31P MRS signals with a modified prony method

A modified Prony method (MPM) was applied to analyze the main signals present in spatially resolved 31P NMR spectra of MCF7 breast tumors implanted in nude mice. First, the method was tested on synthetic data to establish its limits of reliability. Its performance with respect to peak identification and quantification of signal intensities was then exploited on data from three implanted tumors during hormonal manipulation with estrogen and the antiestrogenic drug tamoxifen. The phosphomonoester peak was resolved into phosphocholine (PC) and phosphoethanolamine (PE). Treatment with tamoxifen led to a significant reduction in the PE to PE+PC peak amplitude ratio in the tumors under consideration. MPM analysis also revealed the presence of two different inorganic phosphate pools: a larger acidic pool and a smaller alkaline pool during estrogen-induced growth and the reverse during tumor regression.

Dose distribution of proton beams with NMR measurements of Fricke-agarose gels

Fricke-agarose gels have been irradiated with a proton beam. Then samples have been extracted at different depths with respect to the beam penetration distance, corresponding to different irradiation doses. Relaxation times T1 and T2, measured at 17 MHz, appear sensitive to this kind of radiation. In particular, T2 exhibits three components T2a, T2b and T2c, the first two being sensitive to proton irradiation. At 1% agarose concentration, the relaxation rates R1 = 1/T1, R2a = 1/T2a and R2b = 1/T2b of samples irradiated with both modulated and unmodulated beams, increase with the dose, irrespective of the beam energy. The yield G of Fe3+ ions per 100 eV of absorbed energy is always higher than that obtained for gamma irradiated samples.

Multiexponential T2 relaxation in Fricke agarose gels: implications for NMR dosimetry

NMR relaxation times T1 and T2 of agarose and Fricke agarose gels have been measured in the range 17-51 MHz. The analysis of the spin echo curves indicates a multiexponential behaviour, characterized by three components, at all the examined frequencies. The relative T2 values, ranging from a few to a hundred milliseconds, can be attributed to different species of water molecules present in the gel. Two of these components are characterized by relaxation rates R2a and R2b, more sensitive than R1 to gamma irradiation, the sensitivity S being S(R1) = 0.066 s-1 Gy-1, S(R2a) = 0.088 s-1 Gy-1, S(R2b) = 0.17 s-1 Gy-1. The three T2 values decrease as a function of frequency, but no gain in dose sensitivity is obtained by changing the working frequency in the examined range. The relaxivity of agarose gels containing ferrous or ferric ions has also been measured and found to be different from those of the corresponding solutions in the absence of agarose. Thus it was possible to estimate the irradiation yield from three independent parameters, R1, R2a and R2b. No effect of the dose rate or of the source energy has been observed for any of these parameters.

Erythrocyte Na-K-Cl cotransport activity in low renin essential hypertensive patients. A 23Na nuclear magnetic resonance study

The Na-K-Cl cotransport activity in red blood cells from essential hypertensive men with low (n = 8, mean age 42 +/- 4 years) or normal renin activity (n = 4, mean age 43 +/- 3 years), and in normotensive men with normal renin activity (n = 7, mean age 38 +/- 4 years) has been evaluated by means of a recently developed 23Na nuclear magnetic resonance (NMR) method. Sodium efflux was determined by relating the resonating frequency of the NMR signal from extracellular sodium to sodium concentration in the presence of the shift reagent Dy(PPP)2(7-). The maximum Na+ efflux driven by cotransport (Vmax) was measured in Na(+)-loaded erythrocytes in the presence of ouabain to block the Na-K-Cl pump activity. A significant difference (P < 0.05) was found in Vmax values of low renin patients (0.70 mmol/h/L cells, range 0.40 to 0.90 mmol/h/L cells) as compared with normotensive controls (0.39 +/- 0.08 mmol/h/L cells) and normal renin hypertensives (mean 0.49 +/- 0.04 mmol/h/L cells). In conclusion, this study showed an increased activity of the Na-K-Cl cotransport in red blood cells from low renin hypertensive men as compared with normal renin hypertensives and normotensives.

Prony-Householder method applied to 31P NMR signals: II. Study of conjugates of ara-AMP with lactosaminated albumin

Conjugates of 9-beta-D-arabinofuranosyladenine 5'-monophosphate (ara-AMP) with lactosaminated albumin (L-SA), obtained by using two different coupling procedures, produce antibodies in rats and mice which display only a small cross-reactivity. 31P NMR signals from the two conjugates have been examined to clarify whether different lysine and histidine residues are involved in the two reaction pathways. The occurrence of different chemical shifts and linewidths between the two conjugates, as evidenced by processing the signals with the Prony-Householder method, indicates the formation of two different complexes.

23Na-NMR study of cation cotransport in human red blood cells

Na(+)-K+ cotransport in human erythrocytes from healthy subjects has been studied by means of 23Na-nuclear magnetic resonance (NMR) in the presence of the anionic paramagnetic shift reagent dysprosium (III) tripolyphosphate [Dy(PPP)2(7-)]. The intra- and extracellular 23Na-NMR signals were well separated, giving values of 6 +/- 1 mM for internal sodium concentration. Determination of the furosemide-sensitive Na+ efflux, in the presence of ouabain, was obtained by correlating the chemical shift variation of the external signal with changes in external Na+ concentration. For this purpose, calibration curves were generated. The values of the maximum efflux velocity (Vmax; 0.29-1 mmol.h-1.l cells-1) measured in 10 healthy adult male subjects were found to be within the range of values obtained by other authors. The NMR method proposed for the study of Na(+)-K+ cotransport is relatively simple and allows quick evaluation of cotransport Vmax values for a number of samples, being a good candidate for the study of this transport mechanism in the presence of different pathologies.

Interaction of HIV-1 with susceptible lymphoblastoid cells. 1H NMR studies

Different strains of HIV susceptible lymphoblastoid cells have been infected by HIV-1 and examined by means of 1H NMR spectroscopy at different times after infection, taking advantage of the presence of high resolution lipid signals from the plasma membrane of tumor cells. A transient decrease in intensity of fatty acid signals, originated by changes in membrane structure, has been observed early after viral infection. Marked alterations in membrane-dependent steps of phospholipid synthesis can also be inferred by the observed transient depression in peaks from choline-based metabolites. Spectral modifications deriving from changes in lipid metabolism are also produced both in infected cells a few days after infection and in permanently infected cells. 1H NMR can, therefore, monitor structural and metabolic effects induced by HIV infection.

A new glucose-clamp algorithm--theoretical considerations and computer simulations

The commonly used setup of an automatic glucose-clamp was analyzed as a control system, modeling the measuring device and the patient in a simple but effective way. Strict limits in response time, parasitic oscillation amplitude, and accuracy were defined in order to approach the physician's requirements. We developed a new control algorithm and defined the gain coefficients which can lead the system within these limits. Computer simulations with model parameters from literature (patient) and from experimental data (measuring device) are presented. Preliminary in vivo trials are also presented.

Effects of decreased pH on membrane structural organization of Escherichia coli grown in different fatty acid-supplemented media: a 31P NMR study

Total membranes from Escherichia coli cells grown in different fatty acid-supplemented media have been examined by 31P NMR at different pH values. The isolated inner and outer membranes were also studied and compared to the liposomes formed with the corresponding extracted lipids. While the liposomes show structures that are correlated with lipid composition, degree of fatty acid unsaturation, and pH, the membrane structure is mainly bilayer. The presence of two bilayer phases characterized by different chemical shift anisotropy values (delta nu csa) is detectable at neutral pH; a perturbation of the bilayer phase characterized by the smallest delta nu csa is produced by low pH. Moreover, an isotropic peak is always present in the membrane NMR spectra: its attribution to cardiolipin molecules is discussed on the basis of digestion experiments with phospholipase C.

Biochemical and NMR studies on structure and release conditions of RNA-containing vesicles shed by human colon adenocarcinoma cells

Large amounts of particulate material, mostly lipid vesicles, are released by human colon adenocarcinoma HCT-8R cells when they are packed at high density in saline solution. RNA is also present in the released structures. Vesicle sheding is displayed only by healthy and viable cells. The process, in our experimental conditions, lasts up to 40 min, and can be restored by supplementing cells with nutrients and oxygen. RNA and lipids give rise to IH and 3IP NMR signals. The process is somehow related to a thermotropic transition observed by means of IH NMR spectroscopy for peculiar lipid domains in the plasma membrane. Analysis of 3IP NMR spectra of the phosphodiester groups, upon pH variation, indicates strong interaction between RNA and proteins in an assembled structure. A constant amount of polyA+ RNA can be recovered from the vesicles. The electrophoretic pattern and in vitro protein synthesis indicate that mRNA can be isolated as a functionally active molecule with a major 5 Kb fraction.

Characterization of vesicles, containing an acylated oligopeptide, released by human colon adenocarcinoma cells. NMR and biochemical studies

RNA-containing vesicles, recovered from the supernatant of high-density cell samples of human colon carcinoma, produce a high-resolution 1H NMR spectrum of lipids characterized by isotropic tumbling; these vesicles contain large amounts of triglycerides and cholesterol esters. Both findings have strict analogies to what is displayed by the proteolipid complexes isolated from the sera of tumor-bearing patients [(1985) Proc. Natl. Acad. Sci. USA 82, 3455-3459; (1986) FEBS Lett. 203, 164-168]. Lipid analysis and enzymatic tests indicate that these vesicles are selected micromaps of plasma membranes, analogous to those that can be recovered from culture media in which tumor cells are grown [(1985) Dev. Biol. 3, 33-57]. Peculiar lipids, an acylated oligopeptide and a modified phospholipid, are also present in the vesicles.

RNA-lipid complexes released from the plasma membrane of human colon carcinoma cells

Cultured cells from human colon adenocarcinoma spontaneously release structures which display an intense 31P NMR signal from RNA and mobile phospholipids. Furthermore, the DPH probe in the cell supernatant shows an intense fluorescence, thus indicating its insertion in lipid vesicles. The total membranes, prepared from the same cells, also release similar structures. The fatty acid chain signals from the mobile lipids, observable in the H NMR spectrum, and the fluorescence polarization of the DPH probe are strongly affected by RNAase digestion, thus indicating an association between RNA molecules and lipids. The enzymatic marker cytochrome c reductase was assayed to rule out possible contamination from endoplasmatic reticulum. A high alkaline phosphatase activity was instead found in the supernatant samples, thus indicating that the shed material is released by the plasma membrane.

Mobile phospholipid signals in NMR spectra of cultured human adenocarcinoma cells

An intense peak is visible in the phosphodiester region of the 31P NMR spectra of human colon adenocarcinoma HCT-8R cells. A signal at the same frequency, partially deriving from mobile phospholipids, is also observable in the spectra of total membranes and of perchloric acid extracts prepared from the same cells. The phosphodiester signals of glycerophosphorylcholine, glycerophosphorylethanolamine, and glycerophosphorylserine resonate at lower fields with respect to this broader peak and appear only in aged samples. Enzymatic treatments of the extracts would indicate that ribonucleic acid also contributes to the broad phosphodiester signal. Moreover, 1H NMR spectra show the presence of lipid structures, characterized by high mobility, in the cell and in the membrane samples, similar to what was already observed in other tumor cells and tissues.

Studies of structural modifications induced by gamma-irradiation in distearoylphosphatidylcholine liposomes

An investigation of the structural and thermodynamical modifications induced by gamma-irradiation in model membranes is reported. Differential scanning calorimetry and X-ray diffraction were used to study the different phases and associated transitions of distearoylphosphatidylcholine multilamellar liposomes after 60Co gamma-irradiation. Changes were observed in the shape of the calorimetric peaks and in the corresponding phase transition temperatures. In particular a shoulder was observed at about 20 kGy. The three phases characteristic of lecithins with identical acyl chains were detected also for the highest radiation dose. The formation of lysolecithin and stearic acid upon phospholipid degradation was observed. The lysolecithin concentration increases as a function of irradiation dose, until a saturation value is reached at 40 kGy. These results correlate quite well with those obtained for interlayer and interchain distances and for the width of the main phase transition calorimetric peak. At the highest dose (approximately equal to 80 kGy) cross-linked adjacent radicals and other molecular species are also formed. Appreciable differences, and some similarities, in the behaviour of DSPC and DPPC liposomes under gamma-irradiation were observed.

Effects of gamma-irradiation on the erythrocyte membrane: ESR, NMR and biochemical studies

The effects of gamma-irradiation on resealed erythrocyte ghosts have been examined with different techniques. Phospholipid analysis reveals peroxidative damage on the polyunsaturated chains of phosphatidylethanolamine. Gel electrophoresis and ESR measurements indicate modifications of the cytoskeletal proteins. 31P Nuclear magnetic resonance data show bilayer modifications that can be interpreted as changes in lipid-protein interactions. The overall picture from the present results favours interaction between lipids and proteins in the inner monolayer of the membrane.

X-ray diffractometry and calorimetry studies of structural modifications induced by gamma-irradiation in phosphatidylcholine multilamellar liposomes

Experimental results are reported on structural and thermodynamic modifications induced by gamma-irradiation in model membranes. Differential scanning calorimetry (DSC) and X-ray diffraction were used to study the different phases and associated transitions of dipalmitoylphosphatidylcholine after 60Co gamma-irradiation. Changes were observed in the shape of calorimetric peaks and in the corresponding enthalpy. The repetition distance of the layers increases while the distances related to the aliphatic chains decrease as a function of gamma-irradiation time. Moreover, an increase in the hexagonal symmetry with increasing dose was detected. No disappearance of a pre-transition was detected even at high doses.

1H- and 2H-n.m.r. studies of water in gamma-irradiated phosphatidylcholine multilamellar liposomes

1H- and 2H-n.m.r. studies of gamma-irradiation-induced variations in the dynamic structure and proportional amounts of free, trapped and bound water species in multilamellar liposomes are reported and discussed. Bound water is shown to increase with dose and to be present in two different structural states. A dose-dependent decrease in the 1H-n.m.r. relaxation times of bound water following gamma-irradiation is reported. Variations are suggested as being due to large scale changes at the bilayer surface.

Effects of vitamin A in the presence of vitamins D3, E, K1 on red cell membrane structure

The incubation of erythrocyte ghosts with mixtures of vitamins A+D3, A+E, A+K1 produces decrease or increase of fluorescence anisotropy r of the DPH probe, depending on the vitamin/vitamin ratio. We found a correlation between the order parameter S and cell fusion phenomena observed by phase contrast microscopy.

Gamma-irradiation effects on phosphatidylcholine multilayer liposomes: calorimetric, NMR, and spectrofluorimetric studies

Chemical and structural modifications in multilayer liposomes of synthetic phosphatidylcholine induced by gamma irradiation are investigated with different techniques. Fluorescence anisotropy of the DPH probe and differential scanning calorimetry reveal a broadening of the main lipid transition and the disappearance of pretransition. Fluorescence anisotropy is shown to be higher in the irradiated sample and particularly so at low temperatures. NMR and TLC results show that lysolecithin and palmitic acid are formed with a consequent change in bilayer organization. The possibility that these modifications may account for the permeability variations observed in irradiated natural membranes is discussed.

Effect of lipophilic vitamins on the erythrocyte membrane. 31P NMR and fluorescence studies

Structural changes induced by the fat-soluble vitamins A, D3, E and K1 in natural membranes were studied by 31P NMR and fluorescence anisotropy on erythrocyte ghosts; the occurrence of cell fusion following vitamin addition was detected by optical microscopy of intact cells. Vitamins A, E and K1, which produce cell fusion, also induce the formation of configurational phases other than the bilayer and increase, at a different extent for the different vitamins, membrane fluidity. Vitamin D3, on the contrary, induces aggregation without fusion, paralleled by bilayer phase stabilization and microviscosity increase. A correlation between fusion phenomena and structural variations in the bilayer organization is therefore suggested.

1H NMR study on the interaction of cupric ion with ribonuclease A

The reassignment of the 1H NMR C-2 histidine signals of the bovine pancreatic ribonuclease A has required a revision of the 1H NMR data on the role of the different histidines in their interaction with the Cu2+. The results of our measurements carried out at p2H 5.5 and 7.0 reduce the importance of His-12 as main site of interaction. At p2H 5.5 a very strong binding site involves His-119, while a weaker one contains certainly His-105. On the contrary, at p2H 7.0 the histidines 105 and 119 seem to possess binding constants of the same order of magnitude and in addition they provide stronger ligands for the Cu2+ than His-12. The comparison with X-ray data in the crystal shows numerous analogies. Finally, preliminary results on the competitive inhibition effect between the Cu2+ and 2',3'-cytidine monophosphoric acid are discussed.