Myeloid Wnt ligands are required for normal development of dermal lymphatic vasculature

Resident tissue myeloid cells play a role in many aspects of physiology including development of the vascular systems. In the blood vasculature, myeloid cells use VEGFC to promote angiogenesis and can use Wnt ligands to control vascular branching and to promote vascular regression. Here we show that myeloid cells also regulate development of the dermal lymphatic vasculature using Wnt ligands. Using myeloid-specific deletion of the WNT transporter Wntless we show that myeloid Wnt ligands are active at two distinct stages of development of the dermal lymphatics. As lymphatic progenitors are emigrating from the cardinal vein and intersomitic vessels, myeloid Wnt ligands regulate both their numbers and migration distance. Later in lymphatic development, myeloid Wnt ligands regulate proliferation of lymphatic endothelial cells (LEC) and thus control lymphatic vessel caliber. Myeloid-specific deletion of WNT co-receptor Lrp5 or Wnt5a gain-of-function also produce elevated caliber in dermal lymphatic capillaries. These data thus suggest that myeloid cells produce Wnt ligands to regulate lymphatic development and use Wnt pathway co-receptors to regulate the balance of Wnt ligand activity during the macrophage-LEC interaction.

Genetic incorporation of human metallothionein into the adenovirus protein IX for non-invasive SPECT imaging

As the limits of existing treatments for cancer are recognized, clearly novel therapies must be considered for successful treatment; cancer therapy using adenovirus vectors is a promising strategy. However tracking the biodistribution of adenovirus vectors in vivo is limited to invasive procedures such as biopsies, which are error prone, non-quantitative, and do not give a full representation of the pharmacokinetics involved. Current non-invasive imaging strategies using reporter gene expression have been applied to analyze adenoviral vectors. The major drawback to approaches that tag viruses with reporter genes is that these systems require initial viral infection and subsequent cellular expression of a reporter gene to allow non-invasive imaging. As an alternative to conventional vector detection techniques, we developed a specific genetic labeling system whereby an adenoviral vector incorporates a fusion between capsid protein IX and human metallothionein. Our study herein clearly demonstrates our ability to rescue viable adenoviral particles that display functional metallothionein (MT) as a component of their capsid surface. We demonstrate the feasibility of ^99mTc binding in vitro to the pIX-MT fusion on the capsid of adenovirus virions using a simple transchelation reaction. SPECT imaging of a mouse after administration of a ^99mTc-radiolabeled virus showed clear localization of radioactivity to the liver. This result strongly supports imaging using pIX-MT, visualizing the normal biodistribution of Ad primarily to the liver upon injection into mice. The ability we have developed to view real-time biodistribution in their physiological milieu represents a significant tool to study adenovirus biology in vivo.

Effect of B7.1 costimulation on T-cell based immunity against TAP-negative cancer can be facilitated by TAP1 expression (40.11)

Tumors deficient in TAP expression cannot efficiently induce T cell immunity, and are resistant to T cell lysis. Here we show that introduction of B7.1 molecule into TAP-negative (TAP-) and TAP1-transfected (TAP1+) CMT.64 tumor cells dramatically augments T cell immunity against TAP- tumors. Differences in the immune responses were observed between TAP- and TAP1+ CMT.64 cells depending on the dose of inoculation. While mice immunized with B7.1 expressing TAP1+ cells rejected TAP- tumors with high and low dose inoculations, only high dose inoculations with B7.1 expressing TAP- cells resulted in tumor rejection. The induced protective immunities were T cell dependent as indicated by depletion of CD8 or CD4 cells in immune competent mice. We also found that B7.1 and TAP1 coexpression decreased tumorigenicity. In addition, when CMT.64 cells infected with vaccinia viruses carrying B7.1 and/or TAP1 were used for immunization, we found that B7.1 and TAP1 coexpression, but not B7.1 expression alone, played a critical role in induction of protective immunity after a high dose inoculation, suggesting that viral antigens significantly affected TAP negative and B7.1 expressing cells for tumor antigen presentation and T cell priming. Our results indicate that B7.1-provoked antitumor immunity against TAP- cancer is facilitated by TAP1 expression and thus, both genes should be considered for cancer therapy in the future.

Ligand-mediated selective targeting of adenovirus in metastatic breast cancer

Abstract #2126

The success of gene therapy relies on efficient and targeted delivery systems. Adenovirus vectors have a number of advantages for gene therapy. However, because of their lack of tumor tropism and their tendency to induce liver infection following systemic administration, they cannot be used for systemic attack on metastatic disease. Many solid tumors (e.g., colon, lung, and breast) and hematopoietic tumors over express the chemokine receptor CXCR4. CXCR4 belongs to the large superfamily of G protein-coupled receptors, and is known to participate in a number of biological processes including organogenesis, hematopoiesis, and immune response. Recent evidence has highlighted the role of CXCR4 in cancer, particularly in cancer metastasis due to dysregulation of the receptor leading to enhanced signaling. The present study addresses this issue by retargeting adenovirus to the breast cancer cells overexpressing CXCR4 receptor. We used sCAR-T4-CXCL12, a bispecific adaptor molecule with the ectodomain of CAR linked by the T4 fibritin trimerization motif to the human CXCR4 ligand CXCL12 (also known as SDF-1). The sCAR-T4-CXCL12 should therefore be useful in retargeting adenovirus vectors to CXCR4-positive metastases. Infectivity assays in the absence as well as presence of ligand were performed in human breast cancer MDA-MB-435 cells. Cells were infected with different titres of Ad-CMV-GFP-Luc with and without ligand. Forty-eight hours post-infection, cells were harvested and analysed for the GFP expression by fluorescent microscopy and flow cytometry. It was further interesting to observe the time-dependence of infectivity curve. For this purpose, MDA-MB-435 cells were incubated with optimum titre of Ad-CMV-GFP-Luc vector in the presence of CXCR4 targeting ligand at different time intervals. This was followed by expression analysis of GFP protein by fluorescent microscopy and flow cytometry. Quantification by flow cytometry demonstrated a dramatic 20- to 40-fold increase in the infectivity of MDA-MB-435 cells both in a dose-dependent and time-dependent manner using the sCAR-T4-CXCL12 targeted adenovirus compared to the untargeted vector. In this report, we show that sCAR-T4-CXCL12 can significantly redirect an adenoviral gene therapy vector to CXCR4-positive breast cancer cells in culture. This bispecific ligand should, therefore, be a powerful agent to retarget adenovirus vectors to tumor metastases. The future goal is to investigate the capacity of this agent to re-direct adenoviral vectors in vivo using breast cancer metastasis models.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2126.

Nuclear import and subnuclear localization of the proto-oncoprotein ETO (MTG8)

ETO (MTG8) was first described due to its involvement in the (8;21) translocation frequently observed in acute myeloid leukemias. In the t(8;21) the AML1 gene on chromosome 21 is fused to ETO on chromosome 8. The resultant hybrid protein is comprised of the DNA binding domain of AML-1 and the majority of ETO. This study examines the subnuclear distributions of ETO, AML-1B and AML-1/ETO proteins fused to green fluorescence protein in living cells using fluorescence microscopy. Further, we identified a 40 amino acid portion of ETO (amino acids 241-280) that was sufficient to cause nuclear import of green fluorescent protein. Mutational analysis demonstrated that lysine 265 and/or arginine 266 were required for nuclear import of ETO, but that the surrounding basic residues were not critical. ETO interacted with the nuclear import proteins importin-alpha and beta in vitro, and mutations in ETO that abolish nuclear localization also abolished the in vitro interaction with importin-alpha and beta. These data suggest that ETO enters the nucleus via an importin-mediated pathway. Additionally, ETO and AML-1/ETO co-localized to punctate nuclear bodies distinct from those containing promyelocytic leukemia protein. Nuclear body formation was dependent upon a region of ETO N-terminal to the nuclear localization signal. Thus, ETO and AML-1/ETO reside in potentially novel subnuclear compartments.

Prevention of halothane-induced hepatotoxicity by hemin pretreatment: protective role of heme oxygenase-1 induction

Reductive metabolism of halothane in phenobarbital-pretreated rats is known to increase free radical formation that results in hepatotoxicity. It also is associated with a marked induction of microsomal heme oxygenase-1 (HO-1), suggesting that there is an alteration in heme metabolism. In this study, we examined heme metabolism in rats pretreated with phenobarbital, followed by exposure to halothane-hypoxia. In this model, there was a significant decrease in microsomal cytochrome P450 content in the liver, followed by a rapid increase in free heme concentration and a decrease in the level of mRNA for the nonspecific delta-aminolevulinate synthase. A transient but dramatic induction of HO-1 mRNA and a prolonged induction of heat shock protein 70 mRNA also occurred. The HO-1 protein was detected principally in the hepatocytes around the central vein. Serum alanine transaminase (ALT) activity, an indicator of hepatic dysfunction, increased continuously throughout the experiment. Hemin pretreatment induced hepatic HO-1 with abrogation of the halothane-induced hepatotoxicity in this model, as judged by ALT activity and normal histology. Our findings in this study thus indicate that halothane-induced hepatotoxicity is due not only to its reductive metabolite formation, but also to an increase in hepatic free heme concentration, which is a potent prooxidant; HO-1 induction is an important protective response against such changes. This is also the first study to demonstrate that hemin pretreatment, which induces HO-1 prior to exposure to halothane, effectively prevents halothane-induced hepatotoxicity.

Protective effect of heme oxygenase induction in ischemic acute renal failure

OBJECTIVE

To examine the role of heme oxygenase-1 (HO-1) induction in the recovery of renal function in rats with ischemic acute renal failure.

DESIGN

Randomized, masked, controlled animal study.

SETTING

University-based animal research facility.

SUBJECTS

Sprague-Dawley male rats, weighing 200-250 g.

INTERVENTIONS

Anesthetized rats were subjected to bilateral flank incisions, and the right kidney was removed. Renal ischemia was performed by left renal microvascular clamping, followed by reflow of the blood.

MEASUREMENTS AND MAIN RESULTS

Ischemia of the kidney in the uninephrectomized rat significantly induced HO-1 messenger RNA, protein, and enzyme activity, reaching a maximum at 6 hrs, which was mediated in part through an increase in microsomal heme concentration. Heat shock protein 70 was induced extremely rapidly, reaching a maximum at 1 hr, suggesting that HO-1 and heat shock protein 70 gene expression are regulated separately. Inhibition of HO activity by tin mesoporphyrin, which resulted in an increase in microsomal heme concentration, significantly exacerbated renal function, as judged by the sustained increase in serum creatinine concentration and extensive tubular epithelial cell injuries. In contrast, animals that did not receive tin mesoporphyrin showed normal creatinine concentration and microsomal heme concentration 24 hrs after reperfusion, as well as restoration of abnormal renal histology.

CONCLUSION

These findings indicate that the expression of HO-1 in the ischemic kidney may be critical in the recovery of renal cell function in this animal model. These findings also suggest that H0-1 induction may play an important role in conferring protection on renal cells from oxidative damage caused by heme.

[Induction of anesthesia with midazolam and thiamylal]

Midazolam has a slow onset of action, while thiamylal causes pain on injection and circulatory changes. To compensate for these drawbacks, the usefulness of a combination of midazolam and thiamylal in anesthesia induction was studied. The combination method was compared to the induction with single use of thiamylal in 40 patients (20 patients in each group). The combination of 0.2 mg.kg-1 of midazolam and 1.9 mg.kg-1 of thiamylal showed a shorter onset of action than the 4-5 mg.kg-1 of thiamylal. Pain on injection was observed in 5 cases of thiamylal group but in no cases of combination group. The changes in blood pressure, heart rate and rate pressure product were obviously smaller in combination group than in thiamylal group. Although the recovery time from anesthesia of combination group (13.2 minutes) was longer than that of thiamylal group (10.5 minutes), this was not clinically important. It is concluded that anesthesia induction with the combination of midazolam 0.2 mg.kg-1 and thiamylal 1.9 mg.kg-1 is more useful than that of thiamylal alone.

[Concentrations of haptoglobin and free hemoglobin in preserved whole blood]

In bank blood, red blood cells are destroyed and free hemoglobin increases during preservation. Concentrations of haptoglobin and free hemoglobin were measured in 73 packages of preserved whole blood which had been kept for various periods, 1 to 21 days. Those blood samples were divided into 7 groups depending on preserved period, 1 to 3, 4 to 6, 7 to 9 days, and so on. Total haptoglobin decreased to less than 100 mg.dl-1 in the blood preserved over 7 days. Total hemoglobin increased with the passage of preserved period. Free hemoglobin appeared in 40% or more of the blood preserved over 7 days and its concentration increased depending on preserved time. Free hemoglobin of 10 mg.dl-1 or more was detected in the blood preserved over 7 days. It is recommended that for massive blood transfusion the whole bank blood under 7 days of preservation should be used.

[Interaction of nicardipine and inhalational anesthetics--comparison between enflurane and isoflurane]

The effects of nicardipine 1 mg bolus injection under enflurane anesthesia were compared with those under isoflurane anesthesia. Twelve neurosurgical patients were divided into 2 groups, enflurane group (n = 6) and isoflurane group (n = 6). In all patients anesthesia was induced with midazolam, thiamylal, fentanyl and vecuronium. Anesthesia was maintained with fentanyl, nitrous oxide, pancuronium plus enflurane (enflurane group) or plus isoflurane (isoflurane group). After incision of dura mater, nicardipine 1 mg was given through forearm venous line. For about 30 minutes before and after nicardipine injection, concentration of inhalational anesthetics was kept constant and no drugs were given. Blood pressure (BP), heart rate (HR), rate pressure product (RPP), and serum concentrations of catecholamine and nicardipine were monitored for 30 minutes after nicardipine injection. In isoflurane group, BP decreased more and longer, and increases of HR and serum concentration of catecholamine continued longer compared with enflurane group. Elimination half life of nicardipine was shorter, area under the curve (AUC) was smaller and clearance of nicardipine was larger in isoflurane group than in enflurane group. It was concluded that isoflurane increased the effects of nicardipine, which were BP depression and reflex sympathetic stimulation, than enflurane and that metabolism and elimination of nicardipine were accelerated more by isoflurane than by enflurane.

[Epidural midazolam with bupivacaine--optimal dose for postoperative pain relief]

Optimal dose of epidural midazolam with bupivacaine for postoperative pain relief was investigated. Forty seven patients for upper abdominal surgery were divided into 5 groups. Each group had either 0.25% bupivacaine 6 ml (control group), 0.25% bupivacaine 6 ml + midazolam 0.025 mg.kg-1 (0.025 group), 0.05 mg.kg-1 (0.05 group), 0.075 mg.kg-1 (0.075 group), or 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of first postoperative pain. Blood pressure (BP), heart rate (HR), respiratory rate (RR) and sedation score (SS) were monitored for 120 minutes, and the time interval for next analgesics (TNA) was checked. In each group, BP fell down 10 minutes after injection, HR was unchanged, and RR (except for 0.1 group) decreased, compared with the preinjection level. There was no difference between control group and others in BP, HR and RR. But 3 cases in 0.075 group and 4 cases in 0.1 group needed chin lift with a pillow under the shoulder for slight airway obstruction. The most optimal SS was obtained in 0.05 group. TNA was significantly longer in 0.025 and 0.05 groups than in the control group. It was concluded that the optimal dose of epidural midazolam with 0.25% bupivacaine 6 ml was 0.05 mg.kg-1 for postoperative pain relief after an upper abdominal surgery.

[Surgical stress stimulates release of polymorphonuclear leukocyte elastase from a segmented neutrophil]

The studies were performed to find out whether increased serum levels of polymorphonuclear leukocyte elastase (PMNE) depend on increase of segmented neutrophils or increase of PMNE release from a segmented neutrophil on 17 patients for various elective surgeries. Serum levels of PMNE, leukocyte count and leukogram were determined before incision (preoperation), as well as on the 1st, 3rd and 5th day after operation. Serum levels of PMNE, segmented cell count, stab cell count, stab cell-segmented cell ratio increased most on the 1st postoperative day and decreased thereafter. Leukocyte count showed no significant changes. Serum levels of PMNE correlated well with PMNE released from a segmented neutrophil, but not with leukocyte count or segmented cell count. It was concluded that increased serum levels of PMNE by surgical stress depend on the increased PMNE release from a segmented neutrophil but not on the increased segmented cell count.

[Epidural midazolam with saline--optimal dose for postoperative pain]

Optimal dose of epidural midazolam with saline for postoperative pain relief was investigated. Forty three patients for upper abdominal surgery were divided into 5 groups. Each group had either 10 ml saline only (saline group), 10 ml saline + midazolam 0.025 mg.kg-1 (0.025 group), 10 ml saline + midazolam 0.05 mg.kg-1 (0.05 group), 10 ml saline + midazolam 0.075 mg.kg-1 (0.075 group), or 10 ml saline + midazolam 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of postoperative pain. Blood pressure (BP), heart rate (HR), respiratory rate (RR) and sedation score (SS) were monitored for 120 minutes, and the time interval for next analgesics (TNA) was checked. In each group, BP was unchanged compared with preinjection level. HR changes were less in 0.05 and 0.1 group than in others. RR changes were less in 0.025 and 0.05 group than in others. Optimal SSs were obtained in 0.025 and 0.05 groups. In 0.075 and 0.1 groups, many patients fell into complete sleep (not responded to verbal command). TNA was about 2 hours in 0.025 and 0.05 groups, over 6 hours in 0.075 and 0.1 groups. Complete sleep was the cause of long TNA in 0.075 and 0.1 groups. It was concluded that optimal dose of epidural midazolam with saline 10 ml was 0.05 mg.kg-1 for postoperative pain relief after upper abdominal surgery.

[Epidural midazolam for treatment of postoperative pain]

Postoperative pain relief and sedation with epidural midazolam were studied. Twenty-one patients for elective upper abdominal surgery were divided into 3 groups. Epidural catheter was inserted into thoracic epidural space before induction of general anesthesia. In each group, either 10 ml saline only, midazolam 0.05 mg.kg-1 + 10 ml saline, or midazolam 0.1 mg.kg-1 + 10 ml saline was injected into epidural catheter for complaint of pain in recovery room. For 120 minutes after epidural injection, blood pressure, heart rate, respiratory rate, serum concentration of midazolam, and sedation score were monitored. In midazolam injected groups, only slight changes were seen in blood pressure, heart rate, and respiratory rate. Sedation score was graded from 1 to 6:1 means complete sleep, and not responded to verbal command, 6 means agitated and many complaints. Midazolam 0.1 mg.kg-1 + 10 ml saline group had the lowest score, and saline 10 ml group had the highest score. Prolonged sedation and pain relief were obtained in midazolam injected group, especially 0.1 mg.kg-1 + 10 ml saline group. Serum midazolam concentrations were lower than 200 ng.ml-1. These values were considered as the lower limit for sedation by intravenous administration. In conclusion, epidural midazolam was useful for postoperative pain relief. The mechanism is considered to involve spinally mediated CNS action or direct spinal action.

[Does midazolam release histamine?]

Effects of induction with midazolam on serum histamine levels (Study 1) and the volume as well as pH of gastric juice (Study 2) were studied. Anesthesia was induced with midazolam 0.2 mg.kg-1 in midazolam group, thiamylal 4 mg.kg-1 in control group. In Study 1, serum histamine levels were measured with high performance liquid chromatography till 180 minutes after intubation. There were no statistical significance between the two groups in serum histamine levels at all points. But in midazolam group, at 30 minutes after intubation, the histamine level was significantly lower than the preinduction level. In control group, serum concentration of histamine increased but not significantly. In Study 2, gastric juice was sampled through naso-gastric tube inserted on the morning of operation. Gastric juice pH was measured with the use of pH Strip (E. Merck, F.R. Germany). There were no significant differences between the two groups in volume as well as pH of gastric juice at all points. It is concluded that midazolam used for induction of anesthesia might decrease histamine release, but it has no clinical effects on gastric juice secretion.

[Total intravenous anesthesia with continuous infusion of midazolam--study on plasma levels of midazolam and catecholamines]

Total intravenous anesthesia was performed with continuous infusion of midazolam and bolus injection of fentanyl. A bolus injection of midazolam 0.3 mg.kg-1 was followed by an infusion regimen with an initial infusion rate of 0.68 mg.kg-1.hr-1 for 15 min followed by a maintenance infusion of 0.125 mg.kg-1.hr-1 and infusion was stopped at about 30 min before the end of operation. Fentanyl and pancuronium were injected as required. Nicardipine was given for intraoperative hypertension. Plasma concentrations of epinephrine and norepinephrine decreased significantly at 10 min after induction, but increased significantly during operation. Therefore, this anesthetic method was considered not to be so deep. Plasma concentrations of midazolam were higher than 200 ng.ml-1 during operation. After discontinuation of midazolam infusion, its concentration decreased quickly, and the elimination half life of midazolam was 1.675 +/- 0.2807 hr. The value was not so large as we had anticipated. Total intravenous anesthesia with continuous infusion of midazolam and bolus injection of fentanyl is thought to produce light anesthesia. Plasma concentration of midazolam decreased quickly.

[Total intravenous anesthesia with continuous infusion of midazolam]

Continuous infusion of midazolam and fentanyl were used in total intravenous anesthesia. Anesthesia was induced with midazolam 0.3 mg.kg-1 in 100% O2. Tracheal intubation was facilitated with succinylcholine 1 mg.kg-1 after precurarization with pancuronium 1 mg. The infusion regimen of midazolam was as follows; an initial infusion of 0.68 mg.kg-1.hr-1 for 15 min followed by a maintenance infusion of 0.125 mg.kg-1.hr-1, and about 30 min before the end of operation infusion was stopped. Fentanyl and pancuronium were injected as required. During operation, blood pressure and heart rate were stable with a small dose of nicardipine. Total dose of fentanyl was the same as in NLA. Extubation was done as quickly as in NLA, after aminophylline infusion which was said to reverse midazolam. In the recovery room, patients were asleep and snored. But they opened eyes and responded to verbal command. Respiratory rate and PaCO2 were in normal ranges. Total intravenous anesthesia was possible with midazolam and fentanyl but a further study is necessary.

[Does induction with midazolam decrease stress response during anesthesia?]

The effects of midazolam on stress response during surgery compared with thiamylal were studied. Twelve patients were divided into 2 groups at random; midazolam group and thiamylal group. Anesthesia was induced with midazolam 0.2 mg.kg-1 or thiamylal 4 mg.kg-1 in each group, and maintained with O2 2 l.min-1, N2O 4 l.min-1 and enflurane. The plasma concentration of catecholamine was measured at preinduction, 10, 30, 60, 120 and 180 minutes after intubation. No significant differences were seen between 2 groups in plasma concentration of catecholamine. In midazolam group, plasma concentration of epinephrine decreased significantly 10 minutes after intubation as compared with preinduction level. The plasma concentration of norepinephrine in midazolam group tended to decrease. In thiamylal group, plasma concentration of norepinephrine tended to increase and increased significantly at 120 and 180 minutes after intubation as compared with preinduction level. These results suggest that induction with midazolam suppresses stress response during anesthetic induction and surgery more intensely than induction with thiamylal.

[Midazolam for rapid sequence induction]

We compared midazolam 0.2 mg.kg-1 and fentanyl 50 micrograms with thiamylal 4 mg.kg-1 for rapid sequence induction. We could use midazolam safely in patients with bronchial asthma or drug allergy. There was no difference in time from the beginning of induction to intubation between midazolam treated group and thiamylal treated group. Changes in systolic as well as diastolic blood pressure and heart rate during 2 hours from intubation were smaller in midazolam treated group than in thiamylal treated group. In midazolam treated group, no arrhythmias were observed at the time of intubation. We could reduce the amount of anesthetics in midazolam treated group during 2 hours from intubation. From the results mentioned above, we conclude that midazolam is a useful agent for rapid sequence induction.

[Clinical effectiveness of arterial infusion chemotherapy in advanced and recurrent gastric cancer]

Arterial infusion therapy was applied to 77 patients with 18 unresectable, 29 non-curatively resected and 20 recurrent gastric cancers. 5-fluorouracil (5-FU) was administered by arterial continuous infusion, and adriamycin (ADM) and mitomycin C (MMC) by bolus infusion. The clinical effectiveness of each was evaluated. One-year cumulative survival rate of primary case by Kaplan-Meier method was 19.2%, and that of recurrent gastric cancer was 5.3%. Median survival time of primary case was 6.5 months, showing prolongation compared with recurrent ones. Also, in primary cases, the arterial infusion therapy was more effective in non-curatively resected cases than in unresectable ones. Two of the patients are now alive and another is apparently free of tumor and the remaining one had a recurrence. Continuous arterial 5-FU infusion and ADM low-dose intermittent bolus infusion chemotherapy (AF therapy) were considered an effective supportive treatment without any serious side effects for unresectable, noncuratively resected and recurrent gastric cancer.

[Hyperfunctioning follicular carcinoma of the thyroid. A case report]

A 76-year-old female patient with a large neck lump of 15-year duration, was accompanied by palpitation and tremor. The lump was 9 x 5cm in size and the lower half of it was not palpable because the lower pole was located in the mediastinum. Physical examination revealed two enlarged lymph nodes in the right supraclavicular area. Chest X-ray film showed a coin lesion in the right lung that seemed to be a metastasis. The patient was apparently thyrotoxic with elevated serum concentrations of 15.7 micrograms/dl thyroxin and 359 ng/dl triiodothyronine. A neck scintigraphy using 123Iodine showed a thyroid hot nodule in accordance with this lesion. A total thyroidectomy with a modified neck dissection was carried out. This was followed by 131Iodine therapy. Specimen of the primary lesion weighed 147 g. Pathology of this tumor was follicular carcinoma of the thyroid. The patient was doing well 14 months after surgery. In the literature, three cases of similar hyperfunctioning thyroid carcinoma have been reported, all of which had a large primary lesion. The histological features proved to be of follicular or papillofollicular type. The treatment in these cases was administration of an antithyroid drug followed by surgical removal.

A resuscitation puzzle: acute acquired methemoglobinemia

We treated a 32-day-old baby suffering acute acquired methemoglobinemia induced by topical application of aniline cocaine. Although acute acquired methemoglobinemia with severe cyanosis and distress is potentially fatal, this rare syndrome is easily curable if it is correctly diagnosed.

Simultaneous determination of tegafur and 5-fluorouracil in serum by GLC using nitrogen-sensitive detection

A sensitive assay of both tegafur (I) and 5-fluorouracil (5-FU) using GLC with a nitrogen-phosphorus-sensitive detector is described. The drugs were extracted from rabbit serum with ethyl acetate and methylated with diazomethane. Linearity was obtained over the concentration ranges of 3.13-200 micrograms/ml for I and 0.0313-2 micrograms/ml and 10-50 ng/ml for 5-FU. The detection limits of I and 5-FU in serum were 50 and 8 ng/ml, respectively. The serum concentrations of the drugs determined by the present method closely agreed with those obtained by spectrophotometry for I and microbial assay for 5-FU.

Transport of L-cysteine and reduced glutathione through biological membranes

Comparative studies were carried out on in vivo and in situ absorption in rats and in vitro uptake by red cells of L-cysteine (CySH) and reduced glutathione (GSH). After oral administration of CySH, the plasma and liver CySH levels and liver GSH level significantly increased, but the plasma GSH level did not. In contrast to the results with CySH, when GSH given orally at a dose equivalent to that of CySH either on a weight or molar base, no increase in the levels of GSH was observed at either dose level. In a rat small intestine recirculation system in situ, CySH added to the recirculation perfusate disappeared progressively with time from the perfusate, indicating that transportation occurred across the intestinal wall, but with GSH such disappearance was not observed. CySH was taken up well by rabbit erythrocytes in vitro, but GSH was not. It was concluded, therefore, that CySH passes through biological membranes and serves as a good source of SH groups, whereas GSH is ineffective when given orally because of its poor absorption from the digestive tract and/or poor ability to permeate through the membrane.

Studies on the biochemical action of ginseng saponin. I. Purification from ginseng extract of the active component stimulating serum protein biosynthesis

Systematic isolation and purification of the biologically active component of ginseng extract were followed by observing the incorporation of labeled leucine into serum protein at 6 hr after a single intraperitoneal injection in a mouse. Ginseng saponin mixture (fraction 5) exhibited high activity for such incorporation. Seven saponins were isolated from fraction 5 by means of preparative TLC, and assayed. Administration of all these saponins (ginsenoside-Rb2, Rc, Rc2, Rd, Re, and Rg1)except for ginsenoside-Rb1, caused an increase of leucine incorporation over that in control animals. The incorporation rate was directly proportional to the dose in the case of ginsenoside-Rd, which had the highest activity. The increase specific radio-activity of serum protein was not due to a decrease in the pool size of free amino acids in the liver. It was conclusively shown that the active component stimulating serum protein biosynthesis is saponin.