Long-Term Outcomes and Toxicity in Esophageal Cancer Patients after Neoadjuvant or Definitive Concurrent Chemotherapy with Proton Beam Therapy

PURPOSE/OBJECTIVE(S)

Proton-beam therapy (PT) is increasingly utilized over three dimensional-conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) photon irradiation for the treatment of various malignancies due to better toxicity reduction. We investigated the long-term outcomes and toxicity in esophageal cancer (EC) patients treated with PT as part of their neoadjuvant concurrent chemoradiation followed by surgery (nCRT) or definitive concurrent chemoradiation (dCRT) treatment regimen.

MATERIALS/METHODS

All consecutively treated, American Joint Committee on Cancer 7th edition clinical stage I-IV EC patients from 2006 to 2022 were retrospectively analyzed. Standard RT dose for most patients was 50.4 Gy/28 fractions. nCRT patients had surgery within 4 months post-RT. Kaplan-Meier method was used to determine overall survival (OS), locoregional recurrence-free survival (LRRFS) and distant metastatic-free survival (DMFS). Acute and chronic RT-related toxicities were graded with Common Terminology Criteria for Adverse Events version 4.0.

RESULTS

There were 510 EC PT patients: 204 (40%) had nCRT and 306 (60%) had dCRT. Most lesions were located in the lower esophagus, of adenocarcinoma histology and treated with passive scatter PT. Overall median follow-up was 72 months. Median, 3- and 5-year OS for all patients were 43 months, 54.1% and 44.9%, respectively. Median LRRFS and DMFS were not reached. Esophagitis was the most common grade ≥3 (G3+) toxicity (59 patients; 28.9%, including a G4 and a G5 toxicity), followed by nausea (29 patients; 14.2%) and esophageal stricture (26 patients, 12.7%). With nCRT, median, 3- and 5-year OS were 80 months, 64.7% and 56.1%, respectively, while the median LRRFS and DMFS were not reached again. Their most common G3+ toxicity was esophagitis in 14 patients (6.9%) followed by nausea (8 patients; 3.9%). An nCRT patient developed G4 RT pneumonitis. Pathological complete response (pCR) was observed in 58 patients (28.4%). Surgery-related pulmonary, cardiac and gastrointestinal complications were reported in 38 (18.6%), 40 (19.6%) and 43 (21.1%) patients, respectively. dCRT patients had a median follow-up of 65 months, and median, 3- and 5-year OS of 32 months, 46.7% and 37.0%, respectively. Although the median LRRFS was not reached, the median DMFS was 74 months. The most observed dCRT G3+ toxicity was esophagitis (45 patients, 22.1%: including both G4 and G5 patients) and then esophageal stricture (23 patients, 11.3%). A dCRT patient developed G4 fistula.

CONCLUSION

To our knowledge, this is the largest single-institutional study on EC long-term outcomes and toxicity using PT. Our cohort reveals good outcomes and mostly mild CRT-related toxicities. Trimodality nCRT with protons demonstrates excellent outcomes relative to the CROSS trial (49.4 months) with identical pCR rate (29% in CROSS) and similar toxicity profile. nCRT with protons should be studied rigorously in the current randomized phase III trial NRG GI006.

Comparing 90-Day Post-Operative Mortality after Neoadjuvant Proton-Based vs. Photon-Based Chemoradiotherapy for Esophageal Cancer

PURPOSE/OBJECTIVE(S)

Standard of treatment for locally advanced esophageal cancer consists of chemoradiotherapy (CRT) followed by surgery. Evidence suggests that proton beam therapy (PBT) results in lower toxicity and fewer post-operative complications compared to photon-based radiotherapy (RT). Mortality in the first 90 days after surgery is a rare event occurring in 2-8% of patients, with higher reported rates (of up to 17%) in older patients. This 90-day mortality (90DM) rate is an important measure of post-operative (non-oncologic) mortality as a proxy of quality of care. We hypothesize that PBT could reduce the incidence of 90DM compared to photon-based RT.

MATERIALS/METHODS

From a single-center retrospectively acquired database patients with esophageal cancer treated with neoadjuvant CRT and esophagectomy in 1998-2022 were selected. Univariable logistic regression analyses were used to study the associations of RT modality and other patient- and treatment-related characteristics with 90DM. Subsequently, 3 separate methods were applied to adjust for confounding bias. These included multivariable logistic regression, 1:1 nearest-neighbor propensity score matching (PSM), and inverse probability of treatment weighting (IPTW). Finally, stratified analyses for patient groups aged ≥67 vs. <67 years were performed.

RESULTS

A total of 894 eligible patients were included (PBT, n = 202; photon-based RT, n = 692). PBT patients had a significantly higher age, better performance score, and a higher number of comorbidities. The 90DM rate was 5 (2.5%) in the PBT group and 29 (4.2%) in the photon-based RT group (p = 0.262). Significant univariable predictors of 90DM included higher age and tumor location. After multivariable adjustment, PBT vs. photon therapy was not significantly associated with 90DM (OR 0.49, 95% CI 0.18-1.31). The 90DM rates in the PSM cohort (n = 181 vs. n = 181) were 2.8% for PBT and 3.3% for photon-based RT (p = 0.379). The 90DM rates in the IPTW cohort were 2.8% for PBT and 4.1% for photon-based RT (p = 0.427). In the full cohort, stratified analysis for age groups revealed that in patients aged ≥67 years, PBT was associated with a decreased risk of 90DM compared to photon-based RT (1.3% vs. 8.8%; p = 0.046), which was not the case in patients aged <67 years. In the PSM cohort, a comparable (but non-significant) difference was observed in favor of PBT in patients aged ≥67 years (i.e., 1.5% vs. 7.5%; p = 0.099). Within-group analyses in the original cohort demonstrated that a higher age significantly increased the risk of 90DM within the photon-based RT group (8.8% vs. 2.7% for age ≥67 vs. <67 years; p = 0.001), but not within the PBT group (1.3% vs. 3.2%; p = 0.398).

CONCLUSION

Post-operative 90DM after esophagectomy for cancer was not significantly different between PBT and photon-based neoadjuvant CRT. However, among older patients we observed a signal that PBT may reduce the risk of 90DM. Higher age increased the risk of 90DM in patients who underwent photon-based RT, but not in patients who underwent PBT.

Prospective Trial of Using Imaging to Predict Pathologic Response and Clinical Outcomes in Locally Advanced Esophageal Cancer

PURPOSE/OBJECTIVE(S)

Trimodality therapy with chemoradiation (CRT) followed by esophagectomy is the standard of care for locally advanced esophageal cancer. An unresolved question is whether pathologic complete response (pCR) can be assessed non-invasively for patients post-CRT. In this study, we assessed whether diffusion-weighted imaging (DWI) with MRI or PET can be used as predictors of pCR and other clinical outcomes after CRT.

MATERIALS/METHODS

Patients were enrolled on a single-arm institutional trial (PA13-0380) assessing the role of imaging in predicting outcomes in potentially resectable esophageal patients undergoing trimodality therapy. All patients received neoadjuvant CRT, and 29 patients had subsequent surgery. DWI MRI and PET scans were obtained at baseline, 2 weeks after the start of CRT (interim) and 4 to 6 weeks after completion of CRT (follow up). Apparent diffusion coefficients (ADCs) were calculated based on DWI images. Circulating tumor DNA was obtained for 27 patients post-radiation using CAPP-Seq. Mann-Whitney tests compared imaging changes associated with pCR. Discrimination of pCR by imaging changes was quantified by received operating characteristics. Youden's index was applied to select optimal thresholds. Kaplan-Meier analysis was performed to assess differences in overall survival (OS) and progression-free survival (PFS) by changes in DWI, PET, and ctDNA parameters.

RESULTS

Our cohort of 60 patients had a median follow up of 42.7 months, age of 65.4 yrs, and ECOG of 1 at completion of CRT. 90% were male, 58% had a history of smoking, and 85% were white. 83% had adenocarcinoma with the rest squamous cell carcinoma. Stages of the patients ranged from IIA to IIIB. All had moderately (47%) or poorly (53%) differentiated disease. All received 41.4-50.4 Gy in 1.8 Gy fractions with the majority receiving 50.4 Gy (95%). 29 patients underwent surgery after CRT of which 8 (27.6%) had pCR. Mean ΔADC from baseline to mid-treatment was most associated with pCR (AUC = 0.98, p<0.001) for patients undergoing surgery. Max ΔADC from baseline to first follow-up was most associated with OS (p = 0.002) and PFS (p<0.001) for the whole cohort. 27 patients had ctDNA analyzed after RT with the presence of ctDNA significantly associated with worse OS (HR = 0.12, p = 0.05) and PFS (HR = 0.10, p = 0.002). Combining ctDNA and max ΔADC generated a model that was more predictive of OS and PFS than either alone. We found that neither the PET parameters of TLG or SUV max at baseline or changes in these parameters from baseline to mid-treatment or first follow-up were as predictive as DWI.

CONCLUSION

We show that changes in DWI is associated with pCR, OS, and PFS in resectable esophageal cancer patients undergoing CRT. DWI was more predictive than PET and a model combining DWI and ctDNA was the most predictive of clinical outcomes. This study shows the significant promise of using DWI in potentially guiding treatment decisions in esophageal cancer patients and will require validation in a larger cohort.

Effect of minor amounts of β-calcium pyrophosphate and hydroxyapatite on the physico-chemical properties and osteoclastic resorption of β-tricalcium phosphate cylinders

β-Tricalcium Phosphate (β-TCP), one of the most used bone graft substitutes, may contain up to 5 wt% foreign phase according to standards. Typical foreign phases include β-calcium pyrophosphate (β-CPP) and hydroxyapatite (HA). Currently, the effect of small amounts of impurities on β-TCP resorption is unknown. This is surprising since pyrophosphate is a very potent osteoclast inhibitor. The main aim of this study was to assess the effect of small β-CPP fractions (<1 wt%) on the in vitro osteoclastic resorption of β-TCP. A minor aim was to examine the effect of β-CPP and HA impurities on the physico-chemical properties of β-TCP powders and sintered cylinders. Twenty-six batches of β-TCP powder were produced with a Ca/P molar ratio varying between 1.440 and 1.550. Fifteen were further processed to obtain dense and polished β-TCP cylinders. Finally, six of them, with a Ca/P molar ratio varying between 1.496 (1 wt% β-CPP) and 1.502 (1 wt% HA), were incubated in the presence of osteoclasts. Resorption was quantified by white-light interferometry. Osteoclastic resorption was significantly inhibited by β-CPP fraction in a linear manner. The presence of 1% β-CPP reduced β-TCP resorption by 40%, which underlines the importance of controlling β-CPP content when assessing β-TCP biological performance.

Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process

Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combined with live interim group discussions was conducted by 33 experts within the field, from Europe, North America, and Asia. DGCE was divided into early DGCE if present within 14 days of surgery and late if present later than 14 days after surgery. The final criteria for early DGCE, accepted by 25 of 27 (93%) experts, were as follows: >500 mL diurnal nasogastric tube output measured on the morning of postoperative day 5 or later or >100% increased gastric tube width on frontal chest x-ray projection together with the presence of an air-fluid level. The final criteria for late DGCE accepted by 89% of the experts were as follows: the patient should have 'quite a bit' or 'very much' of at least two of the following symptoms; early satiety/fullness, vomiting, nausea, regurgitation or inability to meet caloric need by oral intake and delayed contrast passage on upper gastrointestinal water-soluble contrast radiogram or on timed barium swallow. A symptom grading tool for late DGCE was constructed grading each symptom as: 'not at all', 'a little', 'quite a bit', or 'very much', generating 0, 1, 2, or 3 points, respectively. For the five symptoms retained in the diagnostic criteria for late DGCE, the minimum score would be 0, and the maximum score would be 15. The final symptom grading tool for late DGCE was accepted by 27 of 31 (87%) experts. For the first time, diagnostic criteria for early and late DGCE and a symptom grading tool for late DGCE are available, based on an international expert consensus process.

Evaluation of a novel cryoballoon swipe ablation system in bench, porcine, and human esophagus models

Current ablation devices for dysplastic Barrett's esophagus are effective but have significant limitations. This pilot study aims to evaluate the safety, feasibility, and dose response of a novel cryoballoon swipe ablation system (CbSAS) in three experimental in vitro and in vivo models. CbSAS is a through-the-scope compliant balloon that is simultaneously inflated and cooled by liquid nitrous oxide delivered from a disposable handheld unit. When the cryogen is applied through a special diffuser it covers a 90° section of the circumference of the esophagus for 3 cm length. Doses range from 0.9 to 0.5 mm/second. (1) Bench model: The fixture consisted of an 'esophagus-like' tube lined with agar at 37°C to create an inner diameter of 20 or 30 mm, within which thermocouples were embedded. (2) In vivo porcine esophagus: CbSAS ablations were performed in animals that were euthanized and histological assessments of depth and percentage of esophageal mucosa successfully ablated were done. (3) In vivo, pre-esophagectomy human esophagus. After CbSAS ablations, histological assessments were performed (at 0, 4, and 28 days) to assess the depth and percentage of ablated mucosa. As outcomes, we assessed the safety and tolerability (pain and serious, device-related adverse events); efficacy (depth and uniformity) of ablation; and device performance (ease of deployment and device malfunction). In the bench model, during CbSAS, thermocouples measured minimal temperatures of -40 to -48 °C at all doses. In the porcine model, maximal effect on the mucosa was reached with a dose of 0.8 mm/second that extended to superficial submucosa, while 0.5 mm/second extended through the submucosa. All animals tolerated the treatments and, regardless of ablation dose, continued oral intake and gained weight. In the human model, six patients (5 male, 1 female, mean age 68) tolerated the procedure without adverse events. CbSAS was simple to operate, and balloon contact with tissue was easily and uniformly maintained. The maximal effect on the mucosa is achieved with a 0.8 mm/second dose. We concluded that the CbSAS device enables uniform 3 cm long, quarter-circumferential mucosal ablation in a one-step process by using a novel, through-the-scope balloon. The CbSAS delivers predictable ablation with mucosal and limited submucosal necrosis in bench, animal, and human esophagus. Because of its ease of use, this new device merits further clinical study in the treatment of patients with dysplastic Barrett's esophagus.

Management of esophageal gastrointestinal stromal tumor: review of one hundred seven patients

Gastrointestinal stromal tumors (GIST) are the most common type of gastrointestinal mesenchymal tumor, but are rarely found in the thoracic esophagus. There is no clear consensus about the optimal treatment of this rare disease. A systematic search of the literature was performed for localized esophageal GIST that was resected between 2000 and 2015, and individual patients were included from two major academic institutions. We obtained information on demographics, tumor size and location, mitotic rate, treatment method, and time to recurrence or death. We performed univariate and multivariate Cox regression analyses to evaluate the factors associated with recurrence or death. A total of 28 studies met our inclusion and exclusion criteria, and with two patients from two academic institutions, we had a total of 107 patients in the study. Due to lack of uniformity among studies, there were several missing data for different variables. The average patient age was 56 (n = 98) with mostly males (60%, n = 91). The average tumor size on the CT scan was 7.9 ± 5.4 cm (n = 91), located mostly in the distal esophagus (81%, n = 74). A similar number of patients underwent enucleation (n = 47) compared to esophagectomy (n = 42). Approximately half of the patients had a mitotic rate of 0-4 mitosis per 50 high-powered field (48%, n = 80). The median survival time was 73 months with a 5-year disease free survival of 57% (n = 97). Univariate Cox regression analyses showed that a large tumor, undergoing esophagectomy, and a high mitotic rate were associated with poor survival or recurrence control. We found that patients with a lesion smaller than or equal to 5 cm on the CT scan had a better disease-free survival rate than those with a size greater than 5 cm (HR = 12.41, p = 0.014) and had a 5-year survival rate of 92% with 90% of those patients undergoing enucleation (n = 29). Esophageal GIST is a very rare malignancy. The tumor size and mitotic rate of the tumor are associated with poor survival. However, patients with esophageal GIST measuring 5 cm or smaller may be safely treated with esophageal enucleation.

Emulating solid-state physics with a hybrid system of ultracold ions and atoms

We propose and theoretically investigate a hybrid system composed of a crystal of trapped ions coupled to a cloud of ultracold fermions. The ions form a periodic lattice and induce a band structure in the atoms. This system combines the advantages of high fidelity operations and detection offered by trapped ion systems with ultracold atomic systems. It also features close analogies to natural solid-state systems, as the atomic degrees of freedom couple to phonons of the ion lattice, thereby emulating a solid-state system. Starting from the microscopic many-body Hamiltonian, we derive the low energy Hamiltonian, including the atomic band structure, and give an expression for the atom-phonon coupling. We discuss possible experimental implementations such as a Peierls-like transition into a period-doubled dimerized state.

Prevalence of cam and pincer-type deformities on hip MRI in an asymptomatic young Swiss female population: a cross-sectional study

OBJECTIVES

Femoroacetabular impingement is proposed to cause early osteoarthritis (OA) in the non-dysplastic hip. We previously reported on the prevalence of femoral deformities in a young asymptomatic male population. The aim of this study was to determine the prevalence of both femoral and acetabular types of impingement in young females.

METHODS

We conducted a population-based cross-sectional study of asymptomatic young females. All participants completed a set of questionnaires and underwent clinical examination of the hip. A random sample was subsequently invited to obtain magnetic resonance images (MRI) of the hip. All MRIs were read for cam-type deformities, increased acetabular depths, labral lesions, and impingement pits. Prevalence estimates of cam-type deformities and increased acetabular depths were estimated, and relationships between deformities and signs of joint damage were examined using logistic regression models.

RESULTS

The study included 283 subjects, and 80 asymptomatic females with a mean age of 19.3 years attended MRI. Fifteen showed some evidence of cam-type deformities, but none were scored to be definite. The overall prevalence was therefore 0% [95% confidence interval (95% CI) 0-5%]. The prevalence of increased acetabular depth was 10% (95% CI 5-19). No association was found between increased acetabular depth and decreased internal rotation of the hip. Increased acetabular depth was not associated with signs of labral damage.

CONCLUSIONS

Definite cam-type deformities in women are rare compared to men, whereas the prevalence of increased acetabular depth is higher, suggesting that femoroacetabular impingement has different gender-related biomechanical mechanisms.

Minimally invasive esophagectomy versus open esophagectomy, a symptom assessment study

Minimally invasive esophagectomy (MIE) is used with hope to decrease the morbidity associated with an open esophagectomy. Reflux and dumping syndromes are the most important functional complaints in patients after esophagectomy. This study compares the functional benefits of MIE with open esophagectomy. The study enrolled patients who underwent either minimally invasive or open esophagectomy for cancer between 2004 and 2009. No patients in the MIE group had a pyloroplasty or myotomy. Each patient in the MIE group was paired to a patient in the open esophagectomy group via propensity matching. Matching variables included age, race, gender, preoperative treatment, history of prior cancer, American Society of Anesthesiologists Risk Scale, performance status, clinical stage, body mass index, histology, level of anastomosis, and time elapsed since surgery. The patients were asked to answer 26 questions about their reflux and dumping using validated questionnaires. A total of 181 patients were included in the study. From this group, 44 pairs of patients were created and used for the analysis. The median follow-up was 12.1 months for the MIE group and 18.3 months for the open group. The reflux score was slightly worse in the MIE group (5.5 versus 3.5, P= 0.021). There was no difference in the dumping symptoms between the two groups. The most common complaints seen in the dumping questionnaire in almost one-third of all patients were early satiety, abdominal discomfort, nausea, and diarrhea. Of the patients, 77% were satisfied or very satisfied with their condition in the MIE group compared with 93% in the open group (P= 0.287). Reflux, dumping, and overall satisfaction after MIE without pyloroplasty are comparable with those obtained after open esophagectomy with a pyloric drainage procedure.

Néel transition of lattice fermions in a harmonic trap: a real-space dynamic mean-field study

We study the magnetic ordering transition for a system of harmonically trapped ultracold fermions with repulsive interactions in a cubic optical lattice, within a real-space extension of dynamical mean-field theory. Using a quantum Monte Carlo impurity solver, we establish that antiferromagnetic correlations are signaled, at strong coupling, by an enhanced double occupancy. This signature is directly accessible experimentally and should be observable well above the critical temperature for long-range order. Dimensional aspects appear less relevant than naively expected.

VEGF incorporated into calcium phosphate ceramics promotes vascularisation and bone formation in vivo

Bone formation and osseointegration of biomaterials are dependent on angiogenesis and vascularization. Angiogenic growth factors such as vascular endothelial growth factor (VEGF) were shown to promote biomaterial vascularization and enhance bone formation. However, high local concentrations of VEGF induce the formation of malformed, nonfunctional vessels. We hypothesized that a continuous delivery of low concentrations of VEGF from calcium phosphate ceramics may increase the efficacy of VEGF administration.VEGF was co-precipitated onto biphasic calcium phosphate (BCP) ceramics to achieve a sustained release of the growth factor. The co-precipitation efficacy and the release kinetics of the protein were investigated in vitro. For in vivo investigations BCP ceramics were implanted into critical size cranial defects in Balb/c mice. Angiogenesis and microvascularization were investigated over 28 days by means of intravital microscopy. The formation of new bone was determined histomorphometrically. Co-precipitation reduced the burst release of VEGF. Furthermore, a sustained, cell-mediated release of low concentrations of VEGF from BCP ceramics was mediated by resorbing osteoclasts. In vivo, sustained delivery of VEGF achieved by protein co-precipitation promoted biomaterial vascularization, osseointegration, and bone formation. Short-term release of VEGF following superficial adsorption resulted in a temporally restricted promotion of angiogenesis and did not enhance bone formation. The release kinetics of VEGF appears to be an important factor in the promotion of biomaterial vascularization and bone formation. Sustained release of VEGF increased the efficacy of VEGF delivery demonstrating that a prolonged bioavailability of low concentrations of VEGF is beneficial for bone regeneration.

Atomic color superfluid via three-body loss

Large three-body loss rates in a three-component Fermi gas confined in an optical lattice can dynamically prevent atoms from tunneling so as to occupy a lattice site with three atoms. This effective constraint not only suppresses the occurrence of actual loss events, but stabilizes BCS-pairing phases by suppressing the formation of trions. We study the effect of the constraint on the many-body physics using bosonization and density matrix renormalization group techniques, and also investigate the full dissipative dynamics including loss for the example of 6Li.

Differential response of porcine osteoblasts and chondrocytes in cell or tissue culture after 5-aminolevulinic acid-based photodynamic therapy

OBJECTIVE

Outcome in osteochondral allografting is limited by the immunological incompatibility of the grafted tissue. Based on a resistance of chondrocytes to photodynamic therapy in cell culture it is proposed that 5-aminolevulinic acid-based photodynamic therapy (5-ALA-PDT) might be used to inactivate bone while maintaining viability of chondrocytes and thus immunomodulate bone selectively.

METHODS

Chondrocytes and osteoblasts from porcine humeral heads were either isolated (cell culture) or treated in situ (tissue culture). To quantify cytotoxic effects of 5-ALA-PDT (0-20 J/cm(2), 100 mW/cm(2)) an (3-(4,5-dimethylthiazol-2-yl)-2,5-di-phenyltetrazolium bromide) (MTT)-assay was used in cell culture and in situ hybridization in tissue culture to assess metabolic active cells (functional osteoblasts: col alpha(1)(I) mRNA, functional chondrocytes: col alpha(1)(II) mRNA).

RESULTS

In cell culture, survival after 5-ALA-PDT was significantly higher for chondrocytes (5 J/cm(2): 87+/-12% compared to untreated cells) than for osteoblasts (5J/cm(2): 12+/-11%). In tissue culture, the percentage of functional chondrocytes in cartilage showed a decrease after 5-ALA-PDT (direct fixation: 92+/-2%, 20 J/cm(2): 35+/-15%; P<0.0001). A significant decrease in the percentage of bone surfaces covered by functional osteoblasts was observed in freshly harvested (31+/-3%) compared to untreated tissues maintained in culture (11+/-4%, P<0.0001), with no further decrease after 5-ALA-PDT.

CONCLUSION

Chondrocytes were more resistant to 5-ALA-PDT than osteoblasts in cell culture, while in tissue culture a loss of functional chondrocytes was observed after 5-ALA-PDT. Since osteoblasts - but not chondrocytes - were sensitive to the tissue culture conditions, devitalized bone with functional cartilage might already be achieved by applying specific tissue culture conditions even without 5-ALA-PDT.

Therapy-induced expression of NF-kappaB portends poor prognosis in patients with localized esophageal cancer undergoing preoperative chemoradiation

Activated nuclear factor-kappa B (NF-kappaB) in the pretreatment cancer tissue of patients with localized esophageal adenocarcinoma (LEA) undergoing preoperative chemoradiation is associated with poor prognosis. It is known that constitutively activated NF-kappaB prior to any therapy portends poor prognosis, and it is also known that activated NF-kappaB in the treated specimen is associated with poor prognosis. However, the prognosis of patients who have treatment-induced activation of NF-kappaB (meaning their cancers activate NF-kappaB during or after therapy) is not been reported. We hypothesized that the treatment-induced activation of NF-kappaB would impart poor prognosis similar to that imparted by constitutively activated NF-kappaB cancer. Patients with LEA who had undergone preoperative chemoradiation plus surgery and had pre- and post-therapy cancer tissue available were selected. Pre- and post-therapy cancer tissues were stained by immunohistochemistry for nuclear staining of NF-kappaB. The overall survival (OS) and disease-free survival were assessed and compared for patients who had intrinsic constitutively activated NF-kappaB cancer with those who had induced activation of NF-kappaB only post-therapy. A total of 41 patients with LEA were investigated. Twenty-five patients had NF-kappaB positive cancer at baseline, and 16 had NF-kappaB negative cancer at baseline but became positive post-therapy. There was no difference in the location, histology grade, clinical stage, or the curative resection (RO) resection rate in the two populations. OS (P = 0.71), disease-free survival (P = 0.86), and median survivals (Converters: 24 months [95% confidence intervals: 7.78 to 40.22]vs. Nonconverters: 34.13 months [95% confidence intervals: 3.54 to 64.27]) were not different between the two groups. Our data suggest that activation of NF-kappaB in response to stress/injury of therapy leads to poor OS. These results need to be confirmed in a larger number of patients. It may be that only pre-therapy evaluation of NF-kappaB is insufficient to assess prognosis of patients with LEA. Additional implications include that when effective anti-NF-kappaB therapies become available, they may have to be considered in patients whose cancers do not have constitutively activated NF-kappaB or cancer may have to be monitored during therapy with biomarker assessments.

Supersolid bose-fermi mixtures in optical lattices

We study a mixture of strongly interacting bosons and spinless fermions with on-site repulsion in a three-dimensional optical lattice. For this purpose we develop and apply a generalized dynamical mean-field theory, which is exact in infinite dimensions and reliably describes the full range from weak to strong coupling. We restrict ourselves to half filling. For weak Bose-Fermi repulsion a supersolid forms, in which bosonic superfluidity coexists with charge-density wave order. For stronger interspecies repulsion the bosons become localized while the charge-density wave order persists. The system is unstable against phase separation for weak repulsion among the bosons.

Infliximab inhibits bone resorption by circulating osteoclast precursor cells in patients with rheumatoid arthritis and ankylosing spondylitis

OBJECTIVE

To examine the effects of infliximab on bone resorption by osteoclast precursor cells (OCPs) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to compare the results with changes in disease activity.

METHODS

Before and during 24 weeks of infliximab treatment, peripheral blood mononuclear cells of 9 RA and 10 AS patients were seeded onto ivory wafers and adherent cells, including OCPs, were grown in medium promoting osteoclast differentiation. Bone resorption was evaluated morphometrically and correlated to disease activity. A total of 19 healthy individuals were studied in parallel. In addition, biochemical bone markers were assessed in all patients at baseline and after 24 weeks.

RESULTS

OCPs from RA patients showed a higher bone resorption at baseline when compared to AS patients. Blocking of tumour necrosis factor (TNF)alpha with infliximab resulted in a strong reduction of bone resorption by OCPs in both cohorts and occurred faster in RA compared to AS patients. This inhibition coincided with a reduction of clinical disease activity in both patient cohorts and with an increase of serum osteocalcin levels and a relative decrease of collagen crosslinks in RA compared to AS patients.

CONCLUSION

These results provide an explanation on the cellular level for the anticatabolic effect of TNF neutralisation on bone. The variation in the kinetics of bone resorption by the OCPs in patients with RA and AS suggests disease-specific differences in the type or in the preactivation of OCPs.

Kondo-transport spectroscopy of single molecule magnets

We demonstrate that in a single molecule magnet strongly coupled to electrodes the Kondo effect involves all magnetic excitations. This Kondo effect is induced by the quantum tunneling of the magnetic moment. Importantly, the Kondo temperature TK can be much larger than the magnetic splittings. We find a strong modulation of the Kondo effect as a function of the transverse anisotropy parameter or a longitudinal magnetic field. Both for integer and half-integer spin this can be used for an accurate transport spectroscopy of the magnetic states in low magnetic fields on the order of the easy-axis anisotropy parameter. We set up a relationship between the Kondo effects for successive integer and half-integer spins.

Spectroscopy of ultracold atoms by periodic lattice modulations

We present a nonperturbative analysis of a new experimental technique for probing ultracold bosons in an optical lattice by periodic lattice depth modulations. This is done using the time-dependent density-matrix renormalization group method. We find that sharp energy absorption peaks are not unique to the Mott insulating phase at commensurate filling but also exist for superfluids at incommensurate filling. For strong interactions, the peak structure provides an experimental measure of the interaction strength. Moreover, the peak height of the peaks at Planck's omega > or approximately 2U can be employed as a measure of the incommensurability of the system.

Malignant melanoma and bone resorption

The cellular and humoral mechanisms accounting for osteolysis in skeletal metastases of malignant melanoma are uncertain. Osteoclasts, the specialised multinucleated cells that carry out bone resorption, are derived from monocyte/macrophage precursors. We isolated tumour-associated macrophages (TAMs) from metastatic (lymph node/skin) melanomas and cultured them in the presence and absence of osteoclastogenic cytokines and growth factors. The effect of tumour-derived fibroblasts and melanoma cells on osteoclast formation and resorption was also analysed. Melanoma TAMs (CD14+/CD51-) differentiated into osteoclasts (CD14-/CD51+) in the presence of receptor activator for nuclear factor kappaB ligand (RANKL) and macrophage-colony stimulating factor. Tumour-associated macrophage-osteoclast differentiation also occurred via a RANKL-independent pathway when TAMs were cultured with tumour necrosis factor-alpha and interleukin (IL)-1alpha. RT-PCR showed that fibroblasts isolated from metastatic melanomas expressed RANKL messenger RNA and the conditioned medium of cultured melanoma fibroblasts was found to be capable of inducing osteoclast formation in the absence of RANKL; this effect was inhibited by the addition of osteoprotegerin (OPG). We also found that cultured human SK-Mel-29 melanoma cells produce a soluble factor that induces osteoclast differentiation; this effect was not inhibited by OPG. Our findings indicate that TAMs in metastatic melanomas can differentiate into osteoclasts and that melanoma fibroblasts and melanoma tumour cells can induce osteoclast formation by RANKL-dependent and RANKL-independent mechanisms, respectively.

Quantum-tunneling-induced Kondo effect in single molecular magnets

We consider transport through a single-molecule magnet strongly coupled to metallic electrodes. We demonstrate that, for a half-integer spin of the molecule, electron and spin tunneling cooperate to produce both quantum tunneling of the magnetic moment and a Kondo effect in the linear conductance. The Kondo temperature depends sensitively on the ratio of the transverse and easy-axis anisotropies in a nonmonotonic way. The magnetic symmetry of the transverse anisotropy imposes a selection rule on the total spin for the occurrence of the Kondo effect which deviates from the usual even-odd alternation.

Frequency-dependent transport through a quantum dot in the Kondo regime

We study the ac conductance and equilibrium current fluctuations of a Coulomb-blockaded quantum dot in the Kondo regime. To this end we have developed an extension of the numerical renormalization group suitable for the nonperturbative calculation of finite-frequency transport properties. We demonstrate that ac transport gives access to the many-body resonance in the equilibrium spectral density. It provides a new route for measuring this key signature of Kondo physics, which so far has defied direct experimental observation.

Luttinger liquid of polarons in one-dimensional boson-fermion mixtures

We use the bosonization approach to investigate quantum phases of boson-fermion mixtures (BFM) of atoms confined to one dimension by an anisotropic optical lattice. For a BFM with a single species of fermions we find a charge-density wave phase, a fermion pairing phase, and a phase separation regime. We also obtain the rich phase diagram of a BFM with two species of fermions. We demonstrate that these phase diagrams can be understood in terms of polarons, i.e., atoms "dressed" by screening clouds of the other atom species. Techniques to detect the resulting quantum phases are discussed.

Cryopreservation with dimethyl sulfoxide sustains partially the biological function of osteochondral tissue

The clinical routine use of bone allograft transplants dates back to the discovery that grafts devitalized by freezing bear a reduced antigenicity. Graft failures, caused by a host versus graft reaction, however, remain a clinical problem. Previous investigations on pancreatic islet allografts revealed improved survival and biological function when fast cryopreservation (-70 degrees C/min) was performed in the presence of dimethyl sulfoxide (DMSO). The aim of this study was to determine the effect of fast freezing using DMSO on the biological function of osteochondral tissues. Organ culture was performed with neonatal femora of mice, untreated, rapidly frozen (-70 degrees C/min) with DMSO, or frozen without DMSO. After the culture, tissue morphology, cellular proliferation, osteoblast function, osteoclasts, and the presence of antigen-presenting cells were investigated. In untreated control femora histology appeared normal and proliferating and collagen-synthesizing osteoblasts, osteoclasts, and B-cells and macrophages were present. In frozen femora (with and without DMSO) a disintegration of the periosteum and the epiphyseal growth plate were observed and no active osteoblasts could be detected. Osteoclasts were partially detached from the bone surface. Cell proliferation was fully blocked in femora frozen in the absence of DMSO, while freezing in the presence of DMSO preserved cell proliferation in the medullary canal. The proliferating cells do not express epitopes present on the cells of the B-cell or macrophage lineages. Although the biological function of osteoblasts and osteoclasts was lost upon freezing of osteochondral tissue, DMSO included in freezing protocols preserves some residual cell viability which may be of importance for early graft revascularization as has been previously demonstrated by our group.

Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement

OBJECTIVE

To use the surgical samples of patients with femoro-acetabular impingement due to a nonspherical head to analyze tissue morphology and early cartilage changes in a mechanical model of hip osteoarthritis (OA).

DESIGN

An aberrant nonspherical shape of the femoral head has been assumed to cause an abutment conflict (impingement mechanism) of the hip with subsequent cartilage lesions of the acetabular rim and surface alterations of the nonspherical portion of the head. In this study, 22 samples of the nonspherical portions of the head have been obtained during hip surgery from young adults (mean 30.4 years, range 19-45 years) with an impingement conflict. The samples were first compared with tissue from the same area obtained from six age-matched deceased persons (control group) with normal hip morphology and second with cartilage from 14 older patients with advanced OA. All samples were characterized histologically and hyaline cartilage was graded according to the Mankin criteria. They were further subjected to examination on a molecular basis by immunohistology for cartilage oligomeric matrix protein (COMP), tenascin-C and a collagenase cleavage product (COL2-3/4C(long)) and by in situ hybridization for collagen type I and collagen type II.

RESULTS

All samples from the patient group revealed hyaline cartilage with degenerative signs. According to the Mankin criteria, the cartilage alterations were significantly different when compared with the control group (p=0.007) but were less distinct when compared with cartilage from patients with advanced OA (p=0.014). Positive staining and distribution pattern for COMP, tenascin-C and COL2-3/4C(long) showed similarities between the samples from the impingement group and osteoarthritic cartilage but they were distinctly different when compared with healthy cartilage. Levels of collagen I and II transcripts were upregulated in 6 and 10, respectively, of the 14 samples with OA and in 9 and 12, respectively, of the 22 samples from the impingement group. None of the samples from the control group showed upregulation of Collagen I and II mRNA.

CONCLUSIONS

The aberrant nonspherical portion of the femoral head in young patients with an impingement conflict consists of hyaline cartilage which shows clear degenerative signs similar to the findings in osteoarthritic cartilage. The tissue alterations are distinctly different when compared with a control group, which substantiates an impingement conflict as an early mechanism for degeneration at the hip joint periphery.

High-temperature superfluidity of fermionic atoms in optical lattices

Fermionic atoms confined in a potential created by standing wave light can undergo a phase transition to a superfluid state at a dramatically increased transition temperature. Depending upon carefully controlled parameters, a transition to a superfluid state of Cooper pairs, antiferromagnetic states or d-wave pairing states can be induced and probed under realistic experimental conditions. We describe an atomic physics experiment that can provide critical insight into the origin of high-temperature superconductivity in cuprates.

Kondo correlations and the Fano effect in closed Aharonov-Bohm interferometers

We study the Fano-Kondo effect in a closed Aharonov-Bohm (AB) interferometer which contains a single-level quantum dot and predict a frequency doubling of the AB oscillations as a signature of Kondo-correlated states. Using the Keldysh formalism, the Friedel sum rule, and the numerical renormalization group, we calculate the exact zero-temperature linear conductance G as a function of the AB phase phi and level position epsilon. In the unitary limit, G(phi) reaches its maximum 2e(2)/h at phi = pi/2. We find a Fano-suppressed Kondo plateau for G(epsilon) similar to recent experiments.

Development of transplanted fetal bones: differences between isografts and allografts in mice

Allogeneic bone from bone banks frequently is used when large skeletal defects have to be bridged in orthopaedic surgery. Beside immunologic rejection of the graft, the loss in osteogenic potential caused by bone banking procedures may be a major reason for limited clinical success. Similar problems as described for bone have occurred with cartilage and osteochondral transplants. Improving the properties of allogenic bone so that its biologic activity becomes comparable to autologous bone could be substantially beneficial for the outcome of allograft transplantation. To dissect the steps involved in the integration of a fetal osteochondral graft as it matures to bone, the current study compared the development and biologic function of metatarsals from 18-day-old fetal mice freshly transplanted in three different immunologic settings. Morphologic assessment of (1) isografts and (2) allografts in nonsensitized hosts 12 days after transplantation revealed that the grafts bear an intrinsic potential to develop after transplantation. In allografts in nonsensitized hosts, however, a slight alteration in biologic activity as compared with isografts could be detected already in this early phase after transplantation by in situ hybridization for messenger ribonucleic acids encoding extracellular matrix proteins. (3) In contrast to isografts and allografts in nonsensitized hosts, morphologic features and biologic function of allografts transplanted to presensitized hosts were altered severely.

Generalized numerical renormalization group for dynamical quantities

In this paper we introduce a new approach for calculating dynamical properties within the numerical renormalization group. It is demonstrated that the method previously used fails for the Anderson impurity in a magnetic field due to the absence of energy scale separation. The problem is solved by evaluating the Green function with respect to the reduced density matrix of the full system, leading to accurate spectra in agreement with the static magnetization. The new procedure provides a unifying framework for calculating dynamics at any temperature and represents the correct extension of Wilson's original thermodynamic calculation.

Anderson impurity in a correlated conduction band

We investigate the physics of a magnetic impurity with spin 1/2 in a correlated metallic host. Describing the band by a Hubbard Hamiltonian, the problem is analyzed using dynamical mean-field theory in combination with Wilson's nonperturbative numerical renormalization group. We present results for the single-particle density of states and the dynamical spin susceptibility at zero temperature. New spectral features (side peaks) are found which should be observable experimentally. In addition, we find a general enhancement of the Kondo scale due to correlations. Nevertheless, in the metallic phase, the Kondo scale always vanishes exponentially in the limit of small hybridization.

Transcriptional regulation of the expression of macrophage colony stimulating factor

The regulatory regions for transcriptional control of the MCSF gene are unknown. We examined regulatory control in a 774-bp murine MCSF promoter transfected into MC3T3-E1 osteoblast-like and COS-7 cells. Deletion of upstream sequence from -635 increased basal activity of the promoter by at least four-fold, an increase that was maintained when PU.1, NFkappaB and Egr1/Sp1 consensus sequences were subsequently removed. Mutagenesis identified a suppressor element between -635 and -642 from the transcriptional start site and an oligonucleotide representing this sequence was retarded by nuclear cell protein. TNFalpha (1 ng/ml), PTH (5x10(-8) M), and IL-1alpha (100 pg/ml), which increased MCSF protein secretion, failed to enhance the transcriptional rate of the full-length promoter. TNFalpha was able to stimulate transcription of a heterologous reporter transfected into COS-7 containing multiple copies of the murine MCSF NFkappaB site inserted before a minimal promoter. In contrast, deletion of the same NFkappaB response element increased basal activity in the native promoter. Thus, the NFkappaB sequence may act as a negative regulator in the context of the endogenous promoter. Our results indicate that constitutive transcriptional activity conferred by the MCSF promoter may be damped by a suppressor protein. Transcriptional regulation, however, does not appear to be a major stimulatory mechanism for MCSF secretion.

Abdominal insufflation does not cause hematogenous spread of colon cancer

BACKGROUND AND PURPOSE

Previous investigators have suggested that port-site recurrences are possibly a result of abdominal insufflation, forcing viable cancer cells into the circulation to metastasize and thrive in areas of trauma. Using a syngeneic animal cancer model, we tested the hypothesis that pneumoperitoneum increases the incidence of wound metastasis by a blood-borne mechanism.

METHODS

Male BD IX rats (N = 150) were injected intraperitoneally with 2 x 10(5) viable syngeneic 1,2-dimethylhydralazine-induced colon cancer cells (DHD-K12). Animals were divided into three groups: A (abdominal insufflation with 3-cm incision on the back into muscle remote from the peritoneum); B (3-cm back incision alone); and C (control group with 3-cm midline abdominal incision). Three weeks after surgery, the animals were euthanized and autopsied.

RESULTS

In the two groups with back wounds, the incidence of cancer growth at the incision was zero, as demonstrated grossly and by histologic sample (A: 0/47, B: 0/43). In contrast, the autopsied control group had a 42% incidence of metastasis to the wound (25/59). There seemed to be no difference in the distribution of intra-abdominal disease between those rats that underwent insufflation and those that did not.

CONCLUSION

It is unlikely that pneumoperitoneum promotes hematogenous wound implantation of free intraperitoneal cancer cells.

In vivo expression of transcripts encoding the Glvr-1 phosphate transporter/retrovirus receptor during bone development

In vitro observations suggest that inorganic phosphate (Pi) transport plays an important functional role in osteogenic cells and in their matrix vesicles for the initiation of matrix calcification. Recent studies have shown that the type III sodium-dependent Pi transporters, Glvr-1 and Glvr-2, are expressed in human osteoblast-like cells and have suggested a potential role for type III transporters in regulated Pi handling in osteogenic cells. To address the relevance of these findings in the context of bone formation in vivo and, in particular, in relation to matrix calcification, we investigated expression of the Glvr-1 transporter by in situ hybridization in developing embryonic murine metatarsals, using human Glvr-1 cDNA as a probe. In this model of endochondral ossification, expression of transcripts encoding Glvr-1 could be detected from day 17 of embryonic development. A hybridization signal for Glvr-1 was specifically observed in a subset of hypertrophic chondrocytes and could not be detected in osteoblasts. The expression of Glvr-1 mRNA was compared with that of transcripts encoding extracellular matrix proteins. Glvr-1 mRNA expression was confined to a population of early hypertrophic chondrocytes expressing type X collagen and to slightly more mature cells that express transcripts encoding osteopontin but lack type X collagen mRNA. No Glvr-1 transcripts were detected in fully differentiated hypertrophic chondrocytes. This pattern of Glvr-1 mRNA expression was maintained throughout embryonic development until after birth. In conclusion, the Glvr-1 phosphate transporter is selectively expressed in a subset of hypertrophic chondrocytes during endochondral bone formation, in a region where matrix mineralization proceeds. This observation represents the first in vivo evidence consistent with a potential role for this phosphate transporter in matrix calcification.

Expression of colony-stimulating factor-1 in vivo during the formation of osteoclasts

Colony-stimulating factor-1 (CSF-1), originally described as a growth factor for macrophages, is essential for the proliferation and differentiation of the cells of the osteoclast lineage. The cytokine is synthesized either as a secreted or a membrane-bound protein, which are encoded by four transcripts. The aim of the present study was to investigate the expression of CSF-1 in vivo at the mRNA level. Transcripts encoding CSF-1 were determined in total RNA from fetal murine metatarsals of different ages by a quantitative reverse-transcription polymerase chain reaction assay. Within the investigated period of time, the bone rudiments contain cells of the osteoclastic lineage representing well-defined differentiation stages. We found that only low levels of transcripts encoding CSF-1 could be detected in metatarsals from 15-day-old fetuses. Transcript levels increased slowly during the following days to reach a maximum in the rudiments from 18-day-old fetuses. After birth, in newborn animals, transcript levels were lowered again. While in rudiments from 15-day-old fetuses a considerable portion of the transcripts encoded the membrane-bound molecule, a transcript encoding the secreted form of the cytokine was the predominant species during the following days. These results suggest that the maintenance of proliferating and postmitotic osteoclast precursors requires low levels of CSF-1 only. Highest levels of locally synthesized CSF-1 are required, however, during the initial recruitment and activation of osteoclasts. After birth, levels of CSF-1 transcripts decrease again, suggesting that newly synthesized CSF-1 may be replaced by protein released from the mineralized matrix during resorption. In conclusion, the present data further strengthen the notion that CSF-1 produced locally acts in a paracrine fashion during the formation of osteoclasts.

Macrophage colony stimulating factor down-regulates MCSF-receptor expression and entry of progenitors into the osteoclast lineage

Macrophage colony-stimulating factor (MCSF), although necessary for entry of precursors into the early preosteoclast pathway, inhibits osteoclastogenesis at high doses. To clarify the relationship between MCSF and osteoclast formation, we investigated the effect of exogenous MCSF in murine bone marrow culture. Precursor proliferation and the expression of MCSF-receptor were examined after 4 days of culture in the presence or absence of accessory stromal cells. In both mixed marrow and destromalized cell cultures, exogenous MCSF dose-dependently decreased 125I-MCSF binding (by 65 +/- 5.0% at 3500 and 87 +/- 16.7% at-7000 U/ml, respectively) while enhancing mononuclear cell proliferation after 3 days of exposure (by 2.8- and 6.3-fold, respectively). These effects were maintained 24 h after removal of exogenous MCSF and, as such, likely represented an MCSF-induced change in MCSF receptor-bearing cells. Exposure to exogenous MCSF (3500 U/ml) days 2-4 dose-dependently inhibited tartrate resistant acid phosphatase positive multinuclear cell (TRAP+ MNC) formation counted at the end of day 7, by 64.3 +/- 4.1%. This inhibition of TRAP+ MNC formation was preceded by a 92 +/- 9% decrease in the expression of carbonic anhydrase II mRNA measurable at 4 days. These results indicate that MCSF promotes proliferation of a population of cells expressing lower cognate receptor sites. Changes in MCSF-receptor expression appear to modulate the final lineage selection of the pluripotent monoblastic progenitor.

Identification and characterization of the insulin-like growth factor I receptor in mature rabbit osteoclasts

In this study, the insulin-like growth factor I (IGF-I) receptor was identified in rabbit osteoclasts at mRNA and protein levels by in situ hybridization and autoradiography, respectively. Using highly purified mature osteoclasts, the IGF-I receptor was characterized on the molecular level according to its size and its affinity and number per osteoclast by isolation of the receptor-ligand complex and by binding studies, respectively, and on the cellular level according to the response of mature osteoclasts to IGF-I stimulation. In situ hybridization and autoradiography experiments showed that osteoclasts express IGF-I receptor mRNA and IGF-I binding sites. Chemical cross-linking of 125I-IGF-I bound to the purified mature osteoclasts and subsequent sodium dodecyl sulfide-polyacrylamide gel electrophoresis revealed the specific binding of 125I-IGF-I in complexes with molecular masses of 130 and 230-RD consistent with binding to the IGF-I receptor. In competition experiments, 125I-IGF-I binding to mature osteoclasts was dose-dependently reduced by unlabeled IGF-I in the picomolar range, whereas 20 nM insulin did not reduce the binding of 125I-IGF-I binding. The calculated receptor number was 6000 per osteoclast, and the Kd was 0.10 nM. Searching for a role of the IGF-I receptor in mature osteoclasts, we found no significant influence of IGF-I on the levels of the proform of matrix metaloproteinase 9 and tartrate-resistant acid phosphatase. However, the induction of nuclear fragmentation in serum-depleted cultures of purified mature osteoclasts was dose-dependently inhibited by IGF-I in the picomolar range, but not by 1 nM insulin. These data show that functionally active IGF-I receptor is present in mature osteoclasts.

Role of CSF-1 in bone and bone marrow development

There is a close interaction between the processes involved in osteogenesis and hemopoiesis. In developing bone, the osteoclasts, cells of hemopoietic origin, resorb and invade the calcified cartilage rudiment. As a result, the primitive marrow cavity is formed and hemopoiesis initiates. Osteogenic cells-osteoblasts and osteocytes-control the development and activity of the osteoclasts through the local release of factors. One factor responsible for this osteoblast-osteoclast interaction is colony-stimulating factor-1 (CSF-1). Studies performed on the osteopetrotic op/op mouse mutant have established that this factor is essential for proliferation and differentiation of the osteoclasts. Expression of CSF-1 receptors by mature osteoclasts and osteoclast precursors strongly suggests that CSF-1 action is exerted directly on cells of this lineage. In vivo, CSF-1 synthesis by osteoblasts is temporally and spatially related to sites of osteoclast development. Thus CSF-1 may represent one of the factors responsible for coupling hemopoiesis to osteogenesis. In vitro, osteoblasts express at least 4 transcripts encoding either a secreted or a membrane-bound form of CSF-1. At the protein level, osteoblasts in vitro synthesize the membrane-bound form and secrete the majority of CSF-1 as a proteoglycan, a small fraction of which is integrated into the matrix. These different molecular forms may locally restrict the biological action of this cytokine. Indeed, injection of recombinant human CSF-1 in op/ op mutants does not correct the osteoclast deficiency in the metaphyseal spongiosa of long bones, and sclerosis persists at this site. Similarly, the deficiency of some tissue macrophage populations in op/op mice is only partially or not at all corrected by injection of CSF-1. The expression of CSF-1 receptors by mature osteoclasts may imply that CSF-1 also influences their bone resorbing activity. Indeed, CSF-1 has been shown to induce osteoclast fusion, spreading, and survival. These findings suggest that CSF-1 is essential for the proliferation, differentiation, activity, and survival of tissue macrophages and osteoclasts, cells involved in tissue turnover. Furthermore, they corroborate the view that both osteoclasts and tissue macrophages stem from a CSF-1-dependent common precursor along the macrophage lineage.