Clinical significance of various growth factors in patients with different gastric neoplasms

Growth factors represent a family of important biological molecules that can also be critical in the pathogenesis of various gastrointestinal cancers. In this study, we conducted a comprehensive analysis of the systemic levels of selected growth factors - hepatocyte, vascular-endothelial, fibroblast, and insulin-like 1 growth factors (HGF, VEGF, FGF, and IGF-1, respectively), as well as granulocyte-colony stimulating factor (G-CSF) in 75 patients with different gastric neoplasms (carcinomas, gastrointestinal stromal tumors - GISTs, neuroendocrine neoplasms - NENs, and lymphomas) and 40 healthy volunteers. Patients with gastric carcinoma or other types of gastric neoplasms had higher HGF and IGF-1 levels than healthy individuals (P < 0.05 in all cases). In comparison to healthy control subjects, systemic VEGF concentrations were elevated in patients with gastric carcinoma (P < 0.05), but not in individuals with other types of gastric malignancies. No statistically significant differences were observed between the analyzed groups in terms of FGF and G-CSF levels. When patients with gastric carcinoma were subdivided according to the Japanese classification system, significantly elevated levels of HGF, VEGF, and IGF-1 concentrations were observed in patients with advanced gastric carcinoma (extending beyond the submucosal layer of the stomach). Only the systemic levels of HGF were associated with tumor node metastasis - TNM staging, the absolute numbers of bone marrow-derived mesenchymal cells, and very small embryonic/epiblast-like stem cells circulating in patients with gastric carcinoma. ROC curves analyses demonstrated that AUC values of systemic levels of examined growth factors ranged from 0.40-0.65 (P > 0.06 in all cases). In conclusion, patients with gastric malignancies showed a systemic biochemical imbalance in multiple growth factors, which appears to be associated with clinical presentation of these neoplasms in humans. However, none of the growth factors examined here seem to be suitable diagnostic biomarkers for detecting or differentiating different types of gastric malignancies in humans.

Cerebral venous sinus thrombosis in a young patient with ulcerative colitis: A case report

RATIONALE

Cerebral venous sinus thrombosis (CVST) represents one of the most alarming forms of hemostatic abnormalities that may occur in patients with inflammatory bowel diseases (IBDs).

PATIENT CONCERNS

Here we report a case of a 25-year-old male with ulcerative colitis, who developed such thromboembolic complication during flare of the disease. CVST in our patient was clinically manifested by headache and nausea.

DIAGNOSIS

Angio-magnetic resonance imaging scan of the head revealed segments of contrast filling defects/absence indicating right dural venous sinus thrombosis of the transverse sinus.

INTERVENTION

Immediate treatment with low-molecular-weight heparin has been introduced and led to full remission of symptoms and total recanalization of the thrombotic cerebral regions.

OUTCOMES

Currently (over 2 years after diagnosis) the patient is in remission of the disease, and no further thromboembolic complications have been observed.

LESSONS

Our case study highlights the clinical difficulties and challenges associated with diagnosis and treatment of CVST, as well as presents the current state of knowledge about this complication among patients with IBDs. Physicians taking care of IBD patients should be aware of this alarming hemostatic abnormality.

Concise Review: Pancreatic Cancer and Bone Marrow-Derived Stem Cells

Pancreatic adenocarcinoma remains one of the most challenging diseases of modern gastroenterology, and, even though considerable effort has been put into understanding its pathogenesis, the exact molecular mechanisms underlying the development and/or systemic progression of this malignancy still remain unclear. Recently, much attention has been paid to the potential role of bone marrow-derived stem cells (BMSCs) in this malignancy. Hence, herein, we comprehensively review the most recent discoveries and current achievements and concepts in this field. Specifically, we discuss the significance of identifying pancreatic cancer stem cells and novel therapeutic approaches involving molecular interference of their metabolism. We also describe advances in the current understanding of the biochemical and molecular mechanisms responsible for BMSC mobilization during pancreatic cancer development and systemic spread. Finally, we summarize experimental, translational, and/or clinical evidence regarding the contribution of bone marrow-derived mesenchymal stem cells, endothelial progenitor cells, hematopoietic stem/progenitor cells, and pancreatic stellate cells in pancreatic cancer development/progression. We also present their potential therapeutic value for the treatment of this deadly malignancy in humans.

SIGNIFICANCE

Different bone marrow-derived stem cell populations contribute to the development and/or progression of pancreatic cancer, and they might also be a promising "weapon" that can be used for anticancer treatments in humans. Even though the exact role of these stem cells in pancreatic cancer development and/or progression in humans still remains unclear, this concept continues to drive a completely novel scientific avenue in pancreatic cancer research and gives rise to innovative ideas regarding novel therapeutic modalities that can be safely offered to patients.

Peripheral trafficking of bone-marrow-derived stem cells in patients with different types of gastric neoplasms

Recently, there has been a growing interest in the importance of stem cells (SCs) in the development/progression of gastric neoplasms. In this study, we performed a comprehensive analysis of different populations of bone-marrow-derived stem cells (BMSCs) in patients with various types of gastric malignancies, including gastric cancer, gastrointestinal stromal tumors (GISTs), neuroendocrine neoplasms (NENs), and lymphomas. We found significantly lower numbers of circulating Lin-/CD45 +/ CD133 + hematopoietic stem/progenitor cells (HSPCs), and intensified peripheral trafficking of both Lin-/CD45-/CXCR4+/CD34+/CD133+ very small embryonic/epiblast-like stem cells (VSELs) and CD105 + /STRO-1 +/ CD45- mesenchymal SCs (MSCs) in patients with gastric cancer, but not in those with other types of gastric neoplasms. No significant differences in the absolute numbers of circulating CD34 +/ KDR +/ CD31 +/ CD45- endothelial progenitor cells (EPCs) were observed between the groups. This abnormal balance in the peripheral trafficking of BMSCs in patients with gastric cancer was neither associated with clinical stage of the disease nor with systemic levels of stromal-derived factor-1 (SDF-1), as these were comparable to the values observed in control individuals. Interestingly, the absolute numbers of circulating BMSCs correlated with the concentrations of complement cascade-derived anaphylatoxins/molecules (mainly C5b-9/membrane attack complex-MAC) and sphingosine-1-phosphate (S1P). In summary, our translational study revealed that abnormal peripheral trafficking of BMSCs occurs in patients with gastric cancer, but not in those with other types of gastric neoplasms. Further, our findings indicate that highlighted complement cascade-derived molecules and S1P, but not SDF-1, are significant players associated with this phenomenon.

Selected hemostatic parameters in patients with pancreatic tumors

INTRODUCTION

Recent experimental studies have suggested that various coagulation-related molecules may be important players in the development and progression of pancreatic cancer. However, these findings have not yet been verified in a clinical setting.

METHODS

In this study, we comprehensively examined the levels of multiple hemostatic substances, including prothrombin, antithrombin, plasminogen, thrombin-anti-thrombin (TAT) and plasmin-anti-plasmin (PAP) complexes, as well as, soluble CD40 (sCD40) in patients diagnosed with pancreatic cancer (n = 37) or other tumors (neuroendocrine neoplasms - NEN [n = 7] or solid pseudopapillary tumors-SPT [n = 3]), and healthy individuals (n = 31).

RESULTS

We found significantly higher anti-thrombin, PAP and sCD40 levels in patients with pancreatic cancer compared to healthy controls and patients diagnosed with other types of pancreatic tumors (for all, at least p < 0.05). Cancer patients had lower plasminogen concentrations than individuals from the other analyzed groups (for both, p < 0.05). None of the examined coagulation-related parameters was significantly associated with neither systemic sCD40 concentrations nor clinical staging of malignancy. Levels of analyzed molecules were comparable between pancreatic cancer patients presenting with early and advanced disease. Moreover, our study identified a potential diagnostic value of prothrombin/TAT and anti-thrombin/TAT coefficients in detection of pancreatic cancer in humans. However, both of these were inferior to currently used marker-CA19.9.

CONCLUSIONS

Subclinical hemostatic alterations (mainly in plasmin-related molecules) i) appear as soon as during the earliest stages of the pancreatic adenocarcinoma development in humans, ii) do not seem to alter within progression of the disease nor are associated with clinical staging, iii) are not observed in patients with other types of pancreatic tumors, as well as, iv) do not seem to be associated with elevated sCD40 concentrations in pancreatic cancer patients. Moreover, examined thrombin- and plasmin-related substances do not appear to possess a sufficient diagnostic value to serve as makers of pancreatic adenocarcinoma in humans.

Selected cytokines in patients with pancreatic cancer: a preliminary report

BACKGROUND/AIMS

Recent experimental studies have suggested that various cytokines may be important players in the development and progression of pancreatic cancer. However, these findings have not yet been verified in a clinical setting.

METHODS

In this study, we examined the levels of a broad panel of cytokines, including interleukin (IL)-1, IL-6, IL-8, IL-10, IL-12, IL-17, and IL-23, as well as tumor necrosis factor alpha (TNFα) and granulocyte-colony stimulating factor (G-CSF) in patients with pancreatic adenocarcinoma (n=43), other pancreatic malignancies (neuroendocrine [n=10] and solid pseudopapillary tumors [n=3]), and healthy individuals (n=41).

RESULTS

We found that there were higher levels of IL-6, IL-8, IL-10 and TNFα in patients with pancreatic cancer compared to healthy controls (for all, at least p<0.03). Cancer patients had lower IL-23 concentrations than healthy individuals and patients diagnosed with other types of malignancies (for both, p=0.002). Levels of IL-6, IL-8, IL-10, and IL-23 were significantly associated with the direct number of circulating bone marrow (BM)-derived mesenchymal or very small embryonic/epiblast-like stem cells (SCs) in patients with pancreatic cancer. Moreover, our study identified a potential ability of IL-6, IL-8, IL-10, IL-23, and TNFα levels to enable discrimination of pancreatic cancer from other pancreatic tumors and diseases, including acute and chronic pancreatitis and post-pancreatitis cysts (with sensitivity and specificity ranging between 70%-82%).

CONCLUSIONS

Our study i) supports the significance of selected cytokines in the clinical presentation of pancreatic cancer, ii) highlights numerous associations between selected interleukins and intensified BMSCs trafficking in patients with pancreatic cancer, and iii) preliminarily characterizes the diagnostic potential of several cytokines as potential novel clinical markers of pancreatic cancer in humans.

An intensified systemic trafficking of bone marrow-derived stem/progenitor cells in patients with pancreatic cancer

Various experimental studies indicate potential involvement of bone marrow (BM)-derived stem cells (SCs) in malignancy development and progression. In this study, we comprehensively analysed systemic trafficking of various populations of BM-derived SCs (BMSCs), i.e., mesenchymal, haematopoietic, endothelial stem/progenitor cells (MSCs, HSCs, EPCs respectively), and of recently discovered population of very small embryonic/epiblast-like SCs (VSELs) in pancreatic cancer patients. Circulating CD133⁺/Lin⁻/CD45⁻/CD34⁺ cells enriched for HSCs, CD105⁺/STRO-1⁺/CD45⁻ cells enriched for MSCs, CD34⁺/KDR⁺/CD31⁺/CD45⁻ cells enriched for EPCs and small CXCR4⁺CD34⁺CD133⁺ subsets of Lin⁻CD45⁻ cells that correspond to VSELs were enumerated and sorted from blood samples derived from 29 patients with pancreatic cancer, and 19 healthy controls. In addition, plasma levels of stromal-derived factor-1 (SDF-1), growth/inhibitory factors and sphingosine-1-phosphate (S1P; chemoattractants for SCs), as well as, of complement cascade (CC) molecules (C3a, C5a and C5b-9/membrane attack complex – MAC) were measured. Higher numbers of circulating VSELs and MSCs were detected in pancreatic cancer patients (P < 0.05 and 0.01 respectively). This trafficking of BMSCs was associated with significantly elevated C5a (P < 0.05) and C5b-9/MAC (P < 0.005) levels together with S1P concentrations detected in plasma of cancer patients, and seemed to be executed in a SDF-1 independent manner. In conclusion, we demonstrated that in patients with pancreatic cancer, intensified peripheral trafficking of selected populations of BMSCs occurs. This phenomenon seems to correlate with systemic activation of the CC, hepatocyte growth factor and S1P levels. In contrast to previous studies, we demonstrate herein that systemic SDF-1 levels do not seem to be linked with increased mobilization of stem cells in patients with pancreatic cancer.

Perioperative release of pro-regenerative biochemical signals from human renal allografts subjected to ischemia-reperfusion injury

Complement-derived molecules modulate the intensity of renal ischemia-reperfusion injury and may lead to the generation of biochemical signals [such as stromal-derived factor-1 (SDF-1) or sphingosine-1-phosphate (S1P)], which stimulate tissue/organ regeneration after injury. We tested the association between perioperative C5b-9/membrane attack complex (MAC) levels and intensified erythrocyte lysis, and asked whether significant changes in the levels of pro-regenerative substances occur during the early phase of renal allograft reperfusion. Seventy-five recipients were enrolled and divided into the early, slow, and delayed graft function (DGF) groups. Perioperative blood samples were collected from the renal vein during consecutive minutes of reperfusion. Extracellular hemoglobin (eHb), albumin (plasma S1P transporter), 8-iPF2α-III isoprostane, SDF-1 and S1P concentrations were measured. Throughout the reperfusion period, erythrocyte lysis intensified and was most pronounced in the DGF group. However, perioperative eHb levels did not correlate significantly with C5b-9/MAC values, but rather with the intensity of oxidative stress. No significant changes were observed in S1P, its plasma transporter (albumin) or SDF-1 levels, which were relatively low in all groups throughout the reperfusion period. Our study therefore demonstrates that no known biochemical signal for bone marrow-derived stem cell mobilization is released from human renal allografts to the periphery during the early phase of reperfusion.

Clinical analysis of selected complement-derived molecules in human adipose tissue

Background

It has been suggested that action of complement cascade [CC]-derived anaphylatoxins/molecules may represent a missing link between obesity and metabolic disorders. However, to date, the direct biochemical/immunomodulatory composition of the human AT environment remains poorly understood. In this study, we examined plasma and AT (subcutaneous and visceral/omental) levels of selected CC-derived anaphylatoxins/molecules, and adipsin as well as verified their associations with immune and stem cells chemoattractant - stromal-derived factor-1 (SDF-1).

Methods

A total of 70 (35 subcutaneous and 35 omental) AT samples were obtained from patients undergoing elective surgery. Plasma and AT-derived interstitial fluid levels of C3a, C5a, C5b-9/membrane attack complex (MAC), complement factor D (adipsin) were measured using ELISA.

Results

AT levels of all examined substances were significantly lower than the corresponding levels in the plasma (in all cases P < 0.0000001). Moreover, in subcutaneous AT, robust C3a and adipsin concentrations were observed, whereas high levels of C5b-9/MAC were detected in the visceral depots. In addition, we established the correlations between analyzed molecular substances and body composition, BMI and/or the adiposity index of the examined patients.

Conclusions

Our study demonstrated for the first time that significantly reduced levels of complement-derived molecules were present in human AT than in the peripheral blood, and that these factors are associated with the metabolic status of examined individuals. Moreover, in human AT, various associations between complement-derived molecules and SDF-1 levels exist.

Plasma and Adipose Tissue Levels of Selected Growth/Inhibitory Factors, Proteolytic Enzymes and Sphingosine-1-Phosphate in Humans

Recent studies have shown that adipose tissue (AT), while implicated in orchestrating the sophisticated process termed “immunometabolism,” may also serve as a potential niche for various bone marrow-derived (stem) cells. However, at present, the direct biochemical and immunomodulatory composition of the human AT environment has not been studied. Several substances that might play a crucial role in regulating stem cell migration and/or homing to AT, have been implicated, namely, hepatocyte/vascular endothelial growth factor (VEGF/HGF), leukemia inhibitory factor (LIF), and sphingosine-1-phosphate (SIP). Therefore, we examined and compared the AT concentrations of these substances between plasma, subcutaneous, and omental AT samples derived from 35 generally healthy subjects. VEGF, HGF, LIF, and metalloproteinases (MMP)-2 and MMP9 levels were measured using ELISA, and S1P concentrations were analyzed using reverse-phase high performance liquid chromatography. We found that AT levels of analyzed growth/inhibitory factors were generally comparable (VEGF and LIF) or even higher (HGF) than the corresponding levels in the peripheral blood, particularly in overweight/obese subjects. In subcutaneous AT, significantly lower VEGF and LIF concentrations were observed, and these were accompanied by higher MMP levels. No depot-specific differences in S1P concentrations were found in all examined groups. Moreover, we established several associations between analyzed molecular substances and body composition, BMI, or adiposity index of the examined patients. In conclusion, our study revealed that human AT possesses relatively high levels of selected growth/inhibitory factors and of chemoattractants involved in the regulation of stem cell trafficking, and these factors are associated with the metabolic status of an individual. Further studies are needed to clearly establish the role of these factors in the regulation of bone marrow-derived (stem) cell homeostasis and homing in human AT.

Clinical analysis of perioperative complement activity during ischemia/reperfusion injury following renal transplantation

BACKGROUND AND OBJECTIVES

The complement cascade seems to be an important mediator modulating renal ischemia/reperfusion injury. This study analyzed whether significant changes occur in the levels of a terminal panel of complement molecules (C3a, C5a, and C5b-9/membrane attack complex) during the early phase of human kidney allograft reperfusion and evaluated the potential association of these changes with clinical post-transplant graft function in kidney transplant recipients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Seventy-five renal transplant recipients undergoing transplantation between 2004 and 2006 were enrolled in the study and divided into early, slow, and delayed graft function groups. Blood samples were collected perioperatively during consecutive minutes of allograft reperfusion from the renal vein. Levels of complement molecules were measured using ELISA.

RESULTS

Analysis revealed no significant changes in C3a and C5a levels throughout reperfusion. The main complement molecule that was significantly associated with post-transplant graft function was C5b-9/membrane attack complex; throughout the reperfusion period, perioperative levels of C5b-9/membrane attack complex were around two to three times higher in delayed graft function patients than early and slow graft function individuals (P<0.005). In addition, C5b-9/membrane attack complex levels had a relatively high clinical sensitivity and specificity (70%-87.5%) for the prediction of early and long-term (1 year) post-transplant allograft function.

CONCLUSIONS

This clinical study supports a role for the complement cascade in delayed graft function development. However, additional studies are needed to elucidate the exact mechanisms responsible for this phenomenon. In addition, perioperative measurements of C5b-9/membrane attack complex are highlighted as promising potential clinical markers of post-transplant renal allograft function.

Adipose tissue as a potential source of hematopoietic stem/progenitor cells

It has been more than 30 years since adipose tissue (AT) has been recognized as a central modulator orchestrating sophisticated process termed "immunometabolism". Nonetheless, despite its unique involvement in the regulation of immune and endocrine homeostasis, recent studies demonstrated that AT also contains significant number of hematopoietic stem/progenitor cells (HSPCs) that may be there "settling down" throughout life. In this article we will focus on presenting the current concepts regarding endocrine, immunological, and molecular mechanisms that may contribute to and regulate bone marrow (BM)-derived HSPCs homing into AT environment, as well as, highlight various structural and morphological similarities between BM and AT that might be involved in creating appropriate tissue niches for BM-derived HSPCs in AT. Finally, we will discuss how development of obesity or type 2 diabetes may influence balance of homing signals for HSPCs in AT environment.

Association between the perioperative antioxidative ability of platelets and early post-transplant function of kidney allografts: a pilot study

BACKGROUND

Recent studies have demonstrated that the actions of platelets may unfavorably influence post-transplant function of organ allografts. In this study, the association between post-transplant graft function and the perioperative activity of platelet antioxidants was examined among kidney recipients divided into early (EGF), slow (SGF), and delayed graft function (DGF) groups.

METHODOLOGY/PRINCIPAL FINDINGS

Activities of superoxide dismutase, catalase, glutathione transferase (GST), glutathione peroxidase, and glucose-6-phosphate dehydrogenase (G6P) were determined and levels of glutathione, oxidized glutathione, and isoprostane were measured in blood samples collected immediately before and during the first and fifth minutes of renal allograft reperfusion. Our results demonstrated a significant increase in isoprostane levels in all groups. Interestingly, in DGF patients, significantly lower levels of perioperative activity of catalase (p<0.02) and GST (p<0.02) were observed. Moreover, in our study, the activity of platelet antioxidants was associated with intensity of perioperative oxidative stress. For discriminating SGF/DGF from EGF, sensitivity, specificity, and positive and negative predictive values of platelet antioxidants were 81-91%, 50-58%, 32-37%, and 90-90.5%, respectively.

CONCLUSIONS

During renal transplantation, significant changes occur in the activity of platelet antioxidants. These changes seem to be associated with post-transplant graft function and can be potentially used to differentiate between EGF and SGF/DGF. To the best of our knowledge, this is the first study to reveal the potential protective role of platelets in the human transplantation setting.

Uterine rupture in the second trimester of pregnancy as an iatrogenic complication of laparoscopic myomectomy

Uterine rupture is one of the most dangerous obstetric emergencies carrying a high risk for the mother and the fetus. Reports about uterine rupture in pregnancy following previous laparoscopic surgery have not been frequent; however, an increasing rate of the occurrence of this complication has been observed and reviewed in contemporary literature. We report a case of a spontaneous uterine rupture at 22 weeks of gestation in a 25-year old primigravida, who had had a laparoscopic removal of a small, peduncular, asymptomatic myoma located in the right uterine horn 20 months earlier. Ultrasound examination and subsequent urgent laparotomy confirmed a spontaneous uterine rupture with a nonviable fetus in the peritoneal cavity. Women planning to become pregnant should be qualified for laparoscopic myomectomy with special carefulness. Special attention must be paid to the potential solutions that limit the risk of postoperative uterine rupture, if the absolute necessity for the enucleation of myomas during the reproductive age occurs and a decision about laparoscopic intervention is made.

Presence of glucose in dialyzing fluid and synthesis of selected lipoxygenase-derived eicosanoids during hemodialysis

PURPOSE

Active metabolites of arachidonic acid (AA), eicosanoids, are exerting a significant influence on renal homeostasis. In our recent paper, we demonstrated that high levels of lipoxygenase (LOX)-derived AA metabolites, hydroxyeicosatetraenoic acids (HETEs), unfavorably influence post-transplant function of kidney allografts. Hence, in this study, we wanted (1) to analyze 5-, 12- and 15-HETE levels in non-diabetic chronic kidney disease (CKD) patients, already undergoing regular hemodialysis treatment, and determine factors that may influence these eicosanoids' generation, as well as, (2) to verify whether application of glucose-containing, instead of glucose-free, dialyzing fluids may be beneficial for the limitation of 5-, 12- and 15-HETE synthesis during a single hemodialysis session.

METHODS

Twenty-four healthy individuals and 50 CKD patients undergoing regular hemodialysis treatment were included in the study. CKD patients were divided into two subgroups depending on presence/absence of glucose in dialyzing fluid. LOX-derived HETEs were measured using liquid chromatography.

RESULTS

Results demonstrated higher levels of examined eicosanoids in CKD patients (P<0.05 for all). Older age and higher C-reactive protein levels were associated with HETEs concentrations. Presence of glucose in dialyzing fluid significantly diminished the increase in 5- and 12-HETE synthesis (411.24% vs. 107.29%, P<0.006; 301.70% vs. 98.21%, P<0.0008, respectively), however, it did not influence 15-HETE generation (156.98% vs. 135.24%, P=0.26).

CONCLUSIONS

Non-diabetic CKD patients have higher levels of LOX-derived HETEs, which are associated mainly with age and intensified inflammatory process. The presence of glucose in the dialysate is associated with a reduced synthesis of selected LOX-derived HETEs in these patients; hence, we speculate that the application of such a simple hemodialysis fluid modification may have a favorable influence on post-transplant outcomes.

Clinical evidence of the association between serum perioperative changes in xanthine metabolizing enzymes activity and early post-transplant kidney allograft function

BACKGROUND

Xanthine oxidoreductase (XOR) and its active forms, dehydrogenase (XD) and oxidase (XO), act as double-edged swords during ischemia-reperfusion injury. On the one hand, their action generates antioxidants, such as uric acid (UA); however, they may strongly enhance production of free radicals. In this study, we examined the association between post-transplant graft function and perioperative xanthine metabolizing enzymes (XME) activity in kidney transplant recipients divided into early (EGF), slow (SGF), and delayed graft function (DGF) groups.

STUDY DESIGN

XME activity and UA levels were measured in blood samples collected directly before and during the first and fifth minutes of reperfusion.

RESULTS

Results demonstrated an increase in XO and XOR activity in all groups; however, these parameters were lower in the EGF than in the DGF group (p < 0.005; p < 0.05). XD activity increased in SGF and DGF patients (p = 0.01); nevertheless, the XD/total XOR coefficient decreased only in DGF individuals (p = 0.0007). XME sensitivity, specificity, and positive and negative predictive values in discriminating SGF/DGF from EGF were 73.3% to 78%, 54% to 62.5%, 76% to 78.6%, and 56.5%, respectively. Moreover, mixed model analysis revealed that recipients classified according to results of XOR(5) and XO(5) significantly differ in 1-year post-transplant allograft function (p = 0.04 and p = 0.02, respectively), but not in the frequency of acute rejection episodes (p = 0.66 and p = 0.90, respectively).

CONCLUSIONS

During renal transplantation, significant changes in XME occur that are associated with early post-transplant graft function and have potential value to discern between EGF and SGF/DGF.

Isoprostanes 8-iPF2alpha-III: risk markers of premature rupture of fetal membranes?

AIMS

Isoprostanes may serve as sensitive and specific markers of in vivo oxidative stress intensity. We wanted to determine, whether or not isoprostane concentration may be considered as a risk marker of premature rupture of fetal membranes (PROM).

METHODS

On the basis of the presence of PROM and gestational maturity, a total of 128 patients were divided into: (1) preterm PROM (pPROM) group; (2) PROM at term group; (3) control preterm (C1) group and (4) control at term (C2) group. The concentrations of 8-iPF(2alpha)-III were determined using the enzyme-linked immunosorbent assay method.

RESULTS

The mean free isoprostane concentrations, examined in amniotic fluid and maternal plasma in the PROM at term patients were significantly higher than in C2 individuals (p < 0.01). The mean concentrations of free 8-iPF(2alpha)-III measured in blood plasma from women in the C1 group were significantly lower than in patients from the pPROM, PROM at term and C2 groups (p < 0.001, p < 0.00001 and p < 0.00001, respectively).

CONCLUSION

The measurement of free isoprostane concentration in maternal plasma and amniotic fluid may be considered as a laboratory marker of a PROM-risk pregnancy.

Platelets arachidonic acid metabolism in patients with essential hypertension

Arachidonic acid's (AA) metabolites, eicosanoids, exert a tremendous influence on circulatory and vascular homeostasis, and in humans are generated by many organs and cell types. In this study we wanted to verify whether platelets AA metabolism play a significant role in pathogenesis of essential hypertension (EH). Participants were divided into the study (EH) and the control group. Plasma and urine concentrations of isoprostanes (8-iPF(2alpha)-III) and thromboxane B(2) (TxB(2)) were determined using the ELISA method. The levels of 5- and 12-hydroxyeicosatetraenoic (HETE) acids, generated by platelets, were analysed using RP-HPLC. In a suspension of not stimulated and AA-stimulated platelets TxB(2) level was statistically lower in the study than in the control group (p < 0.0001 and 0.001 respectively). The concentration of 12-HETE was significantly elevated in EH patients compared to the control group; however, only in the non-stimulated conditions (p < 0.05). Plasma and urine F2-isoprostanes levels were significantly higher in hypertensive individuals than in the control group (p < 0.00002 and p < 0.01 respectively). Moreover, EH patients excreted more TxB(2) in urine than normotensive individuals (p < 0.05). Our results highlight the mutual connections between the platelets AA metabolism and indicate its possible role in the pathogenesis of arterial hypertension. Moreover, we hypothesize that platelets AA metabolism may exert a pro-atherosclerotic effect. Finally, we suggest the use of (5-HETE+12-HETE)/TxB(2) parameter in further studies.

Dynamics of thromboxane level changes during early phase of allograft reperfusion

BACKGROUND

Thromboxane (Tx) is a metabolite of arachidonic acid, which exerts a significant influence on kidney homeostasis, and may be involved in the pathogenesis of allograft rejection. The aim of this study was to: examine the dynamics of TxB2 changes during early phase of kidney allograft reperfusion, and analyze whether the observed changes in the concentrations and direction of TxB2 changes, are associated with post-transplant graft function.

METHODS

Sixty-nine transplant recipients were divided into early, slow and delayed graft function group. Blood samples were collected directly before and during first the five minutes of allograft reperfusion. TxB2 concentrations were measured using ELISA. Creatinine and GFR levels were measured on the first, fifth, and 10th post-transplant day.

RESULTS

The results demonstrated that during reperfusion significant differences in TxB2 concentrations occur in all groups. Moreover, significant differences in the concentrations, as well as in the dynamics of TxB2 changes between patients with immediate graft function, and individuals with allograft activation problems, were noticed. These differences were associated with post-transplant graft function.

CONCLUSIONS

Human renal transplantations are accompanied by changes in TxB2 concentrations, and the dynamics of TxB2 changes is associated with early post-transplant graft function. Our results also highlight TxB2 as a potential pre-transplant marker of post-transplant allograft function.

Is it possible to predict the early post-transplant allograft function using 20-HETE measurements? A preliminary report

20-HydroxyEicosaTetraEnoic (20-HETE) acid is an arachidonic acid metabolite that is generated via cytochrome P450 enzymes, and according to the findings from recent studies, may be involved in the pathogenesis of ischemia-reperfusion injury. The aim of this study was to: examine the dynamics of 20-HETE changes during the first 5 min of allograft reperfusion, and analyze whether the observed changes are associated with post-transplant graft function. Sixty-nine renal transplant recipients were divided, according to their outcome, into early, slow and delayed graft function (EGF, SGF, DGF) group. Blood samples were collected directly before and during the first 5 min of allograft reperfusion. 20-HETE concentrations were measured using ELISA. The results demonstrated significant differences in the concentrations and in the dynamics of 20-HETE changes between patients with immediate graft function, and individuals with allograft activation problems. The sensitivity, specificity, positive and negative predictive value of 20-HETEDelta(5-0) parameter in discriminating EGF and SGF from DGF were 69%, 54%, 74% and 48% respectively. Therefore, our results demonstrated that the dynamics of 20-HETE changes, which occurs during early phase of allograft reperfusion, is associated with early post-transplant graft function and also highlighted 20-HETE as a novel clinical marker of post-transplant allograft function.

Serum YKL-40 levels in patients with ovarian cancer and women with BRCA1 gene mutation--comparison to CA 125 antigen

PURPOSE OF INVESTIGATION

Our work was undertaken to determine the usefulness ofYKL-40 as a tumor marker in patients with ovarian cancer and women with BRCA 1 gene mutations.

METHODS

Our study population consisted of 111 patients. They were divided into five study groups: I--newly diagnosed ovarian caner, II--recurrence of ovarian cancer, III--complete remission, IV--benign epithelial tumors and V--patients with BRCA 1 gene mutations. YKL-40 and CA 125 were determined in patient sera.

RESULTS

YKL-40 in newly diagnosed ovarian cancer patients was significantly higher (181.17 n/ml) than in patients with BRCA 1 gene mutation (97.74 ng/ml, p < 0.01), women with benign epithelial cancer (57.19 ng/ml, p < 0.005) and patients with ovarian cancer at the time of complete remission (58.12 ng/ml, p < 0.005). Taking 124 ng/ml as a cut-off value for YKL-40 (95th percentile for healthly women) we observed higher levels in 50% of patients from group I and in 38% from group II.

CONCLUSIONS

YKL-40 appears to demonstrate no advantage over CA 125 as a biomarker of ovarian cancer, particularly in women with early-stage tumors. More research is needed on carriers of the BRCA 1 gene muation in view of the elevated YKL-40 concentrations in this group.

[The effect in vitro of glucose on erythrocyte resistance to hemolysis]

INTRODUCTION

The resistance of erythrocytes to hemolysis is a measurable indicator of the sensitivity of these cells to the action of hemolytic factors. A normal, chemically unmodified red blood cell demonstrates significant resistance against hypo-osmotic solutions of NaCl or detergents like saponin. It has recently been reported that glucose participates in the function of the erythrocyte wall and modifies sensitivity towards hemolytic factors. This work was undertaken to examine the effect of short-term hyperglycemia on saponin and osmotic resistance of erythrocytes.

MATERIAL AND METHODS

Peripheral blood erythrocytes were obtained from 25 healthy individuals (12 females and 13 males) aged 28 to 54 years. Erythrocytes were incubated for 90 min at 37 degrees C in glucose solutions: < 5 mmol/L (control group), 6.66 and 9.99 mmol/L (study groups). Osmotic resistance (NaCl solutions from 10 to 150 mmol/L) and saponin resistance (saponin from 5 to 35 mg/L) was followed with a spectrophotometer. We calculated F50 representing the concentration of NaCl or saponin producing hemolysis of 50% of the erythrocyte population. Concentrations of extracellular hemoglobin were determined spectrophotometrically with Drabkin's reagent. Statistical analysis was done with Statistica 6.1 (StatSoft, Krakow) software and Student's t-test for paired results was applied. Statistical significance was taken as p < 0.05.

RESULTS

We found that mean concentrations of NaCl or saponin producing lysis of 50% of erythrocytes (F50) and concentrations of extracellular hemoglobin changed significantly with rising concentration of glucose in the incubation medium.

CONCLUSIONS

Glucose affected the osmotic and saponin resistance. Short-term hyperglycemia decreased the resistance of erythrocytes against osmotic factors and increased saponin resistance.