Breast cancer prognostic significance of a single nucleotide polymorphism in the proximal androgen response element of the prostate specific antigen gene promoter

Prostate Specific Antigen (PSA) expression by breast epithelial cells is associated with favorable breast cancer prognosis. In preliminary studies, we found that a nucleotide variation (G-->A) at position -158 in the androgen response element (ARE-1) of the PSA promoter was present in four out of 9 breast tumors examined and in a breast carcinoma cell line. We have now determined the nucleotide composition at position -158 of DNA extracted from 148 well-characterized breast tumors and compared tumor genotype with that of controls without cancer, with tumor PSA concentration and with clinicopathological variables, overall survival and disease free survival. The G-->A base change at position -158 is a polymorphism. Allelotypes were similarly distributed in breast cancer patients and controls. The Mann-Whitney U Test showed a significantly higher tumor PSA concentration in tumors that presented a homozygous G as opposed to homozygous A genotype. Genotype at position -158 was not associated with clinicopathological variables in contingency table analysis. Univariate Cox regression models showed a 28% reduction in risk for death in patients with homozygous G genotype compared to those with homozygous A genotype (P = 0.03). However, ARE-1 genotype did not significantly add to the prognostic power in the multivariate model of overall survival. In summary, the base change at position -158 is a polymorphism that may affect breast cancer prognosis, but further studies are required to confirm this possibility and to investigate the relevance of this polymorphism in terms of breast cancer susceptibility.

Expression of a prostate-associated protein, human glandular kallikrein (hK2), in breast tumours and in normal breast secretions

The recent demonstration of human glandular kallikrein (hK2) expression in a breast carcinoma cell line has suggested that this putatively prostate-restricted, steroid hormone-regulated protease may also be expressed in breast epithelium in vivo and secreted into the mammary duct system. Given that the only substrate yet identified for hK2 activity is the precursor of prostate-specific antigen (PSA), the expression of which in breast carcinomas may be associated with favourable prognosis, our purpose was to examine the expression pattern of both hK2 and PSA in breast tumour tissues. Cytosolic extracts of 336 primary breast carcinomas prepared for routine oestrogen receptor (ER) and progesterone receptor (PR) analysis, as well as 31 nipple aspirates from six women with non-diseased mammary glands, were assayed for hK2 and PSA using immunofluorometric assays developed by the authors. In the tumour extracts, measurable hK2 and PSA concentrations were detected in 53% and 73% of cases respectively, and were positively correlated to each other (r = 0.59, P = 0.0001). Higher concentrations of PSA and hK2 were found in tumours expressing steroid hormone receptors (P = 0.0001 for PSA and P = 0.0001 for hK2, by Wilcoxon tests for both ER and PR), and both PSA (r = 0.25, P = 0.0001) and hK2 (r = 0.22, P = 0.0001) correlated directly with PR levels. A negative correlation between patient age and PSA (r = -0.12, P = 0.03) was also found. Both proteins were present in nipple aspirate fluid at relatively high concentrations which were positively correlated (r = 0.53, P = 0.002). The molecular weights of the immunoreactive species quantified by the hK2 and PSA assays were established by high-performance liquid chromatography (HPLC) and were consistent with the known molecular weights of hK2 and PSA. Together these data provide the first evidence, to our knowledge, that both malignant breast tissue and normal breast secretion contain measurable quantities of hK2, and that the degree of hK2 expression or secretion is directly proportional to the expression of PSA and steroid hormone receptors. hK2 expression may therefore be a marker of steroid hormone action in breast tissue.

TGF-beta family signal transduction in Drosophila development: from Mad to Smads

The transforming growth factor-beta (TGF-beta) superfamily encompasses a large group of soluble extracellular proteins that are potent regulators of development in both vertebrates and invertebrates. Drosophila TGF-beta family members include three proteins with homology to vertebrate bone morphogenetic proteins (BMPs): Decapentaplegic (Dpp), Screw, and Glass bottom boat-60A. Genetic studies of Dpp signaling led to the identification of Smad proteins as central mediators of signal transduction by TGF-beta family members. Work in mammalian tissue culture has elucidated a biochemical model for signal transduction, in which activation of receptor serine-threonine kinase activity leads to phosphorylation of specific Smad proteins and translocation of heteromeric Smad protein complexes to the nucleus. Once in the nucleus Smad proteins interact with other DNA binding proteins to regulate transcription of specific target genes. Dissection of Dpp-response elements from genes expressed during embryonic mesoderm patterning and midgut morphogenesis provides important insights into the contributions of Smad proteins and tissue-specific transcription factors to spatial regulation of gene expression. Genetic studies in Drosophila are now expanding to include multiple BMP ligands and receptors and have uncovered activities not explained by the current signal transduction model. Identification of more ligand sequences and demonstration of a functional Drosophila activin-like signal transduction pathway suggest that all TGF-beta signal transduction pathways are present in flies.

Medea is a Drosophila Smad4 homolog that is differentially required to potentiate DPP responses

Mothers against dpp (Mad) mediates Decapentaplegic (DPP) signaling throughout Drosophila development. Here we demonstrate that Medea encodes a MAD-related protein that functions in DPP signaling. MEDEA is most similar to mammalian Smad4 and forms heteromeric complexes with MAD. Like dpp, Medea is essential for embryonic dorsal/ventral patterning. However, Mad is essential in the germline for oogenesis whereas Medea is dispensable. In the wing primordium, loss of Medea most severely affects regions receiving low DPP signal. MEDEA is localized in the cytoplasm, is not regulated by phosphorylation, and requires physical association with MAD for nuclear translocation. Furthermore, inactivating MEDEA mutations prevent nuclear translocation either by preventing interaction with MAD or by trapping MAD/MEDEA complexes in the cytosol. Thus MAD-mediated nuclear translocation is essential for MEDEA function. Together these data show that, while MAD is essential for mediating all DPP signals, heteromeric MAD/MEDEA complexes function to modify or enhance DPP responses. We propose that this provides a general model for Smad4/MEDEA function in signaling by the TGF-beta family.

Involvement of NF-kappaB associated proteins in FGF-mediated mesoderm induction

In this report, we have used mRNA injection to study the action of mutants of XrelA, a Xenopus homolog of the RelA (p65) component of NF-kappaB, on the induction of mesoderm in Xenopus embryos. A region of the rel homology domain of XrelA was deleted to create XrelA deltaSP, which retains the dimerization and activation domains, but no longer binds to DNA. We also made an analogous derivative of mammalian NF-kappaB1 (p50). We show that both constructs have dominant inhibitory activity. When message encoding either is injected into eggs or oocytes, DNA binding of rel family members is suppressed, as is transactivation of a kappaB-dependent promoter in embryos. Expression of XrelA deltaSP in animal caps blocks the induction of mesoderm by bFGF. In addition, this mutant prevents elongation movements generated by activin, but has little effect on posterior dorsal cytodifferentiation, which in marked contrast is blocked by inhibition of the FGF signal transduction pathway between the receptor and MAP kinase. The specificity of the XrelA deltaSP effect on FGF signaling is shown by rescue of mesodermal marker expression when XrelA deltaSP is co-expressed with a specific rel inhibitor. The target of these dominant negative constructs seems to be neither XrelA itself, nor p50, but rather some other molecule with which XrelA, rather than NF-kappaB1, heterodimerizes. We show that XrelA deltaSP blocks FGF induction of mesoderm downstream of MAP kinase and Xbra expression. Thus it prevents the maintenance of Xbra expression by inhibiting its autoregulation by embryonic FGF (eFGF). We suggest that XrelA deltaSP differs from other reported inhibitors of FGF signaling because it inhibits only gastrula stage FGF signaling and not the maternally programmed signaling at the blastula stage. Our results therefore suggest that zygotic FGF action is required for cell movements rather than dorsal differentiation.

A randomized crossover trial of tamoxifen versus ovarian ablation for metastatic breast cancer in premenopausal women: a report of the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) trial MA.1

We concluded a randomized crossover trial comparing tamoxifen 40 mg daily with ovarian ablation for treatment of metastatic breast cancer in premenopausal women. Objective responses (complete response (CR) plus partial response (PR)) were observed in 5/20 patients treated initially with tamoxifen and in 3/19 patients initially treated with ovarian ablation (p = 0.69). Seven additional patients were stable (SD) on tamoxifen while five additional patients were stable after ovarian ablation, for CR + PR + SD rates of 12/20 (60%) for tamoxifen and 8/19 (42%) for ovarian ablation (p = 0.34). Median time to disease progression was 184 days for tamoxifen and 126 days for ovarian ablation (p = 0.40, logrank test, odds ratio for progression 0.71). Overall survival times were also similar: a median of 2.35 years for tamoxifen and 2.46 years for ovarian ablation (p = 0.98, logrank test, odds ratio for death 1.07). Side effects from tamoxifen included hot flashes and menstrual abnormalities. With one exception, these toxicities were not sufficient to require dose reduction. In this small study, tamoxifen was associated with similar response rates, response durations, and survival times to those observed with ovarian ablation.

Quantification of creatine kinase BB isoenzyme in tumor cytosols and serum with an ultrasensitive time-resolved immunofluorometric technique

OBJECTIVES

To develop a highly sensitive immunofluorometric procedure for creatine kinase BB isoenzyme and use it to measure CK-BB in tumor cytosolic extracts and serum of cancer patients and healthy volunteers.

DESIGN AND METHODS

For assay development, we used two monoclonal antibodies in combination with time-resolved fluorometry and the biotin-avidin system. We measured CK-BB in breast tumor cytosols and studied its association with steroid hormone receptors. We also measured CK-BB in the serum of healthy subjects and patients with prostate cancer. We have examined the molecular weight of CK-BB in serum using high performance liquid chromatography.

RESULTS

The evaluation of the method revealed good precision and accuracy. Study of 336 breast tumor cytosols and 9 normal breast cytosols has shown that CK-BB is overexpressed by 95% of breast tumors and that CK-BB is present in its 80 kDa form. A close association between CK-BB and estrogen but not progesterone receptors was found, suggesting that CK-BB overexpression is another marker of estrogen sensitivity of these tumors. Previous studies, using CK-BB radioimmunoassay could not detect CK-BB in the serum of about 50% of healthy subjects. We have assessed CK-BB levels in 80 male volunteers, detected CK-BB in all sera and provided a detailed distribution of values. We further demonstrated that 30% of prostate cancer patients in remission (PSA < 0.4 microgram/L) post radical prostatectomy and 50% of patients with active prostate cancer (PSA > 20 microgram/L) have elevated serum CK-BB levels. The patients with highly elevated CK-BB also had highly elevated serum PSA. We have demonstrated that some patients who have elevated serum CK-BB also have macromolecular CK complexes in their serum with molecular weights of 700 and 350 kDa as well as the 80 kDa CK-BB isoenzyme. Only the latter was recognized by the assay developed.

CONCLUSIONS

CK-BB is a marker of estrogen sensitivity in breast cancer; Patients with prostate cancer have elevated CK-BB in their serum; The new highly specific and sensitive assay may be further used to study the role of CK-BB in various malignancies.

Prostate-specific antigen is a new favorable prognostic indicator for women with breast cancer

Prostate-specific antigen (PSA) is thought to be produced exclusively by prostatic epithelial cells and is currently used as a tumor marker of prostatic adenocarcinoma. We recently found that 30% of breast cancers contain PSA immunoreactivity (IR-PSA). To examine the prognostic value of PSA in female breast cancer, we measured IR-PSA in tumor cytosols of 174 breast cancer patients and classified the breast cancers as either PSA positive or PSA negative based on an IR-PSA cutoff level of 0.03 ng/mg. IR-PSA was present in 27% of the patients. IR-PSA presence was associated with early disease stage, small tumors, and estrogen receptor-positive tumors. We used the Cox proportional hazards regression model to analyze survival of patients in association with PSA status and found that patients with IR-PSA-positive tumors had a reduced risk for relapse and death in univariate analysis (P = 0.02 and 0.06, respectively) and a reduced risk for relapse in multivariate analysis (P = 0.03). Further analysis indicated that the effect of IR-PSA on relapse-free survival was evident in node-positive or estrogen receptor-negative patients. Our study suggests that IR-PSA is an independent favorable prognostic marker for breast cancer and may be used to identify a subgroup of estrogen receptor-negative and/or node-positive patients who have good prognoses.

Prevalence of serum antibodies against the p53 tumor suppressor gene protein in various cancers

We have developed 2 new quantitative methods for measuring anti-p53 antibodies in human serum. Using these methods we analyzed 1,392 sera from patients with various malignancies and 230 sera from individuals without malignancy. Highest prevalence of anti-p53 antibodies was associated with ovarian and colon cancers (15%), followed by lung (8%) and breast (5%) cancers. Prevalence in other malignancies was lower (< 4%). In hospitalized patients and apparently healthy individuals, prevalence was very low (< 2 and 1% respectively). Extremely high antibody concentrations (> 10(5) U/L) were found in 5 ovarian, 2 breast, 1 lung and 1 colon cancers. Sequential analysis of 6 positive samples has shown that the p53 antibody test may have potential for patient monitoring. The p53 antibody-positive sera from breast cancer patients were associated with tumors that were steroid hormone receptor-negative (p < 0.002). We propose that the measurement of p53 antibodies is a relatively specific serological test for cancer, which can be performed with easily automatable and quantitative methodologies and may be further exploited for patient monitoring, prognosis, diagnosis and probably screening for selected cancers.

Immunoreactive prostate-specific antigen levels in female and male breast tumors and its association with steroid hormone receptors and patient age

Prostate-specific antigen (PSA) is believed to be a highly specific marker for normal or cancerous prostatic tissue. We recently found that immunoreactive PSA (IR-PSA) is present in 30% of breast tumor cytosols (from 525 breast cancer patients). In this paper we analyzed a new series of 750 breast tumor cytosols, obtained from 744 women and six men, for IR-PSA. The positivity rates in the old and new series were very similar (approximately 30%). Combining the two series of breast cancer patients, we examined the associations between IR-PSA and estrogen (ER) or progesterone (PR) receptors, or patient age. We found that IR-PSA positivity rate declines with age. PSA-positive tumors were highly associated with either ER-positive or PR-positive tumors alone. However, analysis in a subset of tumors that combine the two receptors, ER(-)/PR(-), ER(+)/PR(-), ER(-)/PR(+), and ER(+)/PR(+), revealed that IR-PSA was only associated with PR, and no relationship was found between IR-PSA and ER. We speculate that the presence of IR-PSA in breast cancer may be associated with the PR action and that the association between PSA and ER is indirect due to the known association between ER and PR. As five of the six male breast tumors were found negative for IR-PSA, it is suggested that androgen may not be involved in the presence of IR-PSA in breast tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of prostate-specific antigen immunoreactivity in breast tumors

Prostate-specific antigen (PSA) is a glycoprotein produced by the epithelial cells of the prostate. PSA is currently used in clinical practice to facilitate diagnosis and monitoring of prostate carcinoma. The prostate is an organ that possesses androgen, estrogen, and progesterone receptors, and in this respect is similar to the breast. We postulated that breast tumors might also have the ability to produce PSA. We performed these studies on a collection of 525 tumor specimens collected for routine biochemical determination of estrogen and progesterone receptors. Using a highly sensitive immunofluorometric procedure, we measured the p53 tumor suppressor gene product and PSA. Twenty nine percent of the breast tumor extracts contained detectable levels of PSA immunoreactivity (> 0.05 microgram/L). The immunoreactive PSA content was associated with estrogen and/or progesterone receptor-positive tumors (P < 0.002). No association was found between PSA immunoreactivity and levels of the p53 tumor suppressor gene product (P = 0.37). High performance liquid chromatography and Western blot analysis revealed that the PSA immunoreactivity in the tumor had a molecular weight of 30 kDa, similar to that of seminal PSA. Immunoreactive PSA-positive tumors were associated with younger women (P = 0.012) and earlier disease stage (P = 0.064). We postulate that PSA immunoreactivity may be an additional marker of steroid hormone receptor-ligand action.

Quantitative analysis of mutant p53 protein in breast tumor cytosols and study of its association with other biochemical prognostic indicators in breast cancer

Breast tumors are thought to originate, grow, and metastasize in an environment which includes steroid hormone receptors, their cognate steroid ligands, and many gene products which are regulated by steroid hormone receptor-ligand complexes. In this paper we describe highly sensitive and quantitative immunofluorometric procedures for measuring three proteins that are candidate prognostic indicators in breast cancer, namely, the p53 tumor suppressor gene product, carcinoembryonic antigen (CEA), and prostate specific antigen (PSA). These proteins were quantified in over 950 cytosolic tumor extracts along with estrogen and progesterone receptors (ER, PR). Association analysis between all five biochemical parameters revealed strong negative associations between p53 and receptors and strong positive associations between CEA and receptors. Negative associations between p53 and CEA and between CEA and PSA were also found. These associations, not quantitatively studied in previous reports, are related to each other using a hypothetical model. The observed associations may further contribute to the understanding of the biology of breast tumors.

Quantification of p53 protein in tumor cell lines, breast tissue extracts and serum with time-resolved immunofluorometry

We have developed a highly sensitive time-resolved immunofluorometric procedure for quantifying mutant or wild-type, human or murine, p53 protein. The method uses monoclonal PAb240 or PAb421 antibodies for capture and a polyclonal rabbit antibody for detection. The final immunocomplex is quantified with an alkaline phosphatase substrate which, when hydrolyzed by the enzyme, forms highly fluorescent long-lived complexes with Tb(3+)-EDTA. The detection limit is approximately 1 pg of protein per assay. The assay was applied for the quantification of p53 protein in lysates from 23 cell lines and overproducers of mutant protein were identified. Eight hundred cancer patients sera tested negative for the presence of p53. We have also applied the quantitative immunofluorometric procedure for measuring mutant p53 protein in breast tumor extracts specifically prepared for steroid hormone receptor analysis. Sixty-four out of the 264 extracts (24%) were positive for p53. Significant negative correlations between levels of p53 and steroid hormone receptors were found. The proposed analytical methodology simplifies the assessment of p53 status in tumor extracts, has many advantages over immunohistochemical techniques and is proposed as a method of choice for routine clinical use and other investigations involving p53.

The standardization of estrogen receptors

Tumour estrogen receptor (ER) status may determine the medical treatment of a patient with breast cancer; yet inter-laboratory results can vary markedly, particularly when absolute cut-offs in fmol/mg cytosol protein are used. The use of standardized log units is proposed to permit greater inter-laboratory comparability. We have assessed the biochemical ER values using the dextran-coated charcoal method with three data sets, two quality control (QC) sets for Ontario laboratories and a data set with values for 184 primary breast cancer patients seen at Women's College Hospital (WCH) between 1985 and 1986. The distributions for all the raw data were skewed toward the lower end of the range; a log transformation improved the symmetry of the distributions. There was marked inter-laboratory variation in the QC data, and standardized log units greatly reduced this variability. The WCH data had similar differentiation by tumour size and nodal status with both the raw data and standardized log units. However, standardized log units provided more consistent evidence of an association between ER and immunohistochemical ERICA. The standardized log units provide quantitative receptor values suitable for multi-centre research, for future work with clinical outcomes, and for the daily management of patients.

Evidence for bimodal distribution of breast carcinoma ER and PgR values quantitated by enzyme immunoassay

Breast carcinoma oestrogen receptor (ER) and progesterone receptor (PgR) values obtained by radioligand binding assays have commonly been observed to have approximate log-normal distributions. We examined the distribution of log-transformed receptor values obtained by enzyme immunoassay for 5468 primary breast carcinomas in five Ontario laboratories. In each laboratory, it was found that the frequency histograms for the log transformed receptor values were not unimodal, and generally were suggestive of bimodality. This was not affected by stratification by age or inferred menopausal status (< or = 49, > or = 50 years), and could not be explained by kit characteristics. However, the low point in the distribution varied from 5 to 63 fmol/mg cytosol protein, depending on the receptor, patient age and laboratory. The tendency towards biomodality was more distinct for ER than for PgR. It remains to be determined whether the low points on the frequency histograms have clinical relevance for discriminating between hormone-sensitive and hormone-insensitive tumours.

DNA content and estrogen receptors in primary carcinoma of the breast

DNA content and estrogen-receptor status were studied in 54 consecutive patients with primary breast carcinoma. Estrogen-receptor determinations were performed by immunohistochemical assay on frozen sections with a monoclonal antibody against the estrogen-receptor molecule and by biochemical analysis with a dextran-coated charcoal method. Nuclear DNA content was measured by flow cytometry performed on formalin-fixed, paraffin-embedded sections. Seventy-two percent of tumours were positive for estrogen receptors by immunohistochemical assay and 67% by biochemical assay. Comparison of the qualitative results of immunohistochemical and biochemical estrogen-receptor determinations revealed a strong correlation between the two assays, with agreement in 90% of the cases (p less than 0.001). Regression analysis showed only a weak relationship between the quantitative results of the two assays. DNA analysis was performed in 51 cases, and 54% demonstrated aneuploid stemlines by flow cytometry. An association was demonstrated between aneuploidy and low levels of estrogen receptor. The association was highly significant with the immunohistochemical assay but not with the biochemical assay. The authors' results suggest that immunohistologic determinations of estrogen receptor status may better reflect the biologic features of the tumour cells. However, improved standardization in reporting the results is necessary if the test is to have widespread use.

Plasminogen activator in human breast cancer cytosols: revisited after five years

The outcome after five years in 63 women with breast cancer was correlated with biochemical parameters (estrogen and progesterone receptors, plasminogen activator activity) determined in the cytosol of tumour specimens obtained at surgery. The information from tumour cell products and their regulatory proteins may provide additional prognostic indicators, independent of subsequent treatment.

The use of endocrine therapy

Endocrine therapy is still a mainstay in the treatment of metastatic breast cancer. It has been observed that about one third of women with metastatic breast cancer will respond to endocrine therapy. This response rate is surprisingly consistent for a wide variety of endocrine approaches, with a few exceptions, such as the use of corticosteroids, androgens, or danazol for which the response rate appears lower. Endocrine therapy is, in general, considerably less toxic than single or combination chemotherapy, but toxicities within the endocrine therapies may vary considerably. Thus, the choice and optimal sequencing of endocrine maneuvers relate largely to minimizing toxicity and optimizing total duration of benefit. A number of newer endocrine approaches including the antiestrogens and aminoglutethimide have recently provided a variety of less toxic choices. Even more recently, compounds such as the LHRH agonists and antiandrogens are being tested, although their use remains experimental. Combinations of two or more endocrine therapies or of chemotherapy and endocrine therapy are currently, also a subject of considerable interest. No studies to date, however, have shown a clear advantage to concurrent chemotherapy endocrine combinations or to the use of two or more concurrent hormonal maneuvers, with the possible exception of the combination of prednisolone with tamoxifen or with oophorectomy, which has improved overall survival in two trials.

Tamoxifen tolerance and steroid receptors in a tumor model

In a rat mammary adenocarcinoma model, prolonged exposure to the antiestrogen Tamoxifen results in a Tamoxifen-tolerant tumor cell line which is readily transplantable and grows under continuous oral intake of the drug. The solid tumor contains steroid receptors; however, the level of Tamoxifen needed for effective displacement of diethylstilbestrol cannot be achieved with therapeutical doses; resistance to Tamoxifen is not the result of diminished or absent estrogen receptors.

Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery

A clinical study was undertaken to assess gynecologic-obstetric changes in morbidly obese women who lost greater than or equal to 50% of their excess weight with bariatric surgery. The 138 females (109 of reproductive age), age 35 +/- 9 SD yr, weighed 124 +/- 23 kg before surgery and 79 +/- 13 kg after weight loss had stabilized. Menstrual irregularities were present in 40.4% of premenopausal patients preoperatively; after massive weight loss, cycles were abnormal in 4.6% (p less than 0.001). Infertility problems were present preoperatively in 29.3% Of these, nine tried to conceive after weight loss and were successful. During past pregnancies, medical complications were frequent (hypertension 26.7%, pre-eclampsia 12.8%, diabetes 7.0%, and deep vein thrombosis 7.0%). After weight-loss stabilization, these obstetric complications did not occur. Incidence of urinary stress incontinence decreased from 61.2% to 11.6% (p less than 0.001). Gynecologic-obstetric changes tended to normalize after loss of massive body weight.

Sex hormonal changes accompanying loss of massive excess weight

With adequate weight loss following bariatric surgery, we previously found correction of the clinical gynecologic abnormalities associated with obesity. In this study, sex hormonal changes offered an explanation for the clinical findings.

Role and mechanism of action of tamoxifen in premenopausal women with metastatic breast carcinoma

Tamoxifen was evaluated as initial hormone therapy for metastatic breast cancer in 85 premenopausal patients. Tamoxifen responders continued on tamoxifen, while tamoxifen failures and initial responders who later progressed were to receive ovarian ablation next. Of 74 evaluable patients, 5 had complete responses (CR) and 15 had partial responses (PR) while 12 remained stable (ST), giving response rates of 27% (CR + PR) or 43% (CR + PR + ST). Of the 23 patients who initially responded (CR + PR + ST) to tamoxifen but then progressed and received ovarian ablation alone, 15 are assessable. Nine (60%) responded (CR + PR + ST) to ovarian ablation. Sixteen patients who failed tamoxifen had ovarian ablation alone, and of 14 assessable patients 2 had ST while 12 progressed. Thus response to tamoxifen strongly predicted response to ovarian ablation (P = 0.021). Serial follicle stimulating hormone, prolactin, and estradiol levels suggested that tamoxifen does not act by induction of a "medical ovariectomy" or by alteration of prolactin levels in premenopausal patients.

Exercise electrocardiographic mapping in normal subjects

To investigate the spectrum of change in multiple-lead exercise electrocardiograms, 120-lead body surface potential maps (BSPM) in normal adult subjects during upright, graded, submaximal exercise testing were recorded. Results showed that in the normal group, exercise was associated with substantial electrocardiographic changes on the body surface, many of which persisted during early recovery. The QRS waveform was minimally altered during exercise. Despite, however, no change in QRS duration, there was significant reduction in QRS potential range with consequent reduction QRS integral value. The ST waveforms changed markedly with exercise, showing abbreviated duration and increased slope. This was reflected by significantly increased ST potential range from rest to immediate cessation of exercise, which returned towards resting value during recovery. The effect of the altered ST-segment waveform was also reflected in torso potential distributions at two time instants during the ST-segment. When a spatially-fixed position on the ST-T waveform was evaluated (ST-segment offset), exercise resulted in small potential changes, especially over the torso area occupied by the standard V1 to V6 chest leads. However, when a temporally-fixed point (80 ms after QRS offset) was evaluated, there were large increases in potential over the precordium with exercise. Isointegral ST-segment maps, which reflect both spatial and temporal ST properties, showed that exercise was associated with substantial decreases in values over the precordium and inferior torso, and although diminished, they tended to persist through five minutes of recovery. Thus, electrocardiographic repolarization parameters are particularly affected by physiological exercise and, although the underlying causes of these changes remain undefined, they should be taken into account when evaluating the population at risk.

The effect of caffeine on cardiac rate, rhythm, and ventricular repolarization. Analysis of 18 normal subjects and 18 patients with primary ventricular dysrhythmia

To determine clinical electrophysiologic effects of a moderate dose of caffeine, we compared prevailing cardiac rhythm and rate, the prevalence and frequency of ventricular dysrhythmia, and Q-T intervals in two populations over an initial 24-hour caffeine-free period and a subsequent 24-hour period in which caffeine was ingested in a dosage of 1 mg/kg of body weight at intervals of one half-life during waking hours. Group 1 was composed of 18 clinically normal subjects; group 2 was 18 subjects with frequent ventricular ectopic beats (VEBs) and no (n = 16) or minor (n = 2) cardiac disease. Sinus rhythm was the prevailing rhythm in all subjects at all times. For group 1, the mean sinus rate during the caffeine-free period was 77 +/- 10 beats per minute, compared to 73 +/- 9 beats per minute during the period of caffeine ingestion (not significant). Similarly, for group 2, the average sinus rate during the caffeine-free period was 76 +/- 11 beats per minute, not significantly different from the average sinus rate during the test period, 76 +/- 10 beats per minute. During abstention from caffeine, four of 18 subjects in group 1 had infrequent (less than 1/hr) VEBs, compared to nine of 18 during caffeine ingestion (not significant). In group 2, some 16 of the 18 subjects had VEBs during the caffeine-free period, with the frequencies varying from less than one VEB per hour to 1,449 VEBs per hour. During the test period, 14 of the 18 subjects in group 2 increased their VEB frequency, and the group's mean frequency rose from 207 +/- 350 VEBs per hour (control period) to 307 +/- 414 VEBs per hour (test period) (p less than 0.01). The Q-T interval in group 1, measured as the corrected Q-T interval (Q-Tc), averaged 0.430 +/- 0.027 during the caffeine-free period, not significantly different from the test period (0.425 +/- 0.019). The comparable Q-Tc values for group 2 were 0.424 +/- 0.018 during the caffeine-free period and 0.433 +/- 0.025 for the period of caffeine ingestion (not significant).(ABSTRACT TRUNCATED AT 400 WORDS)

Inter-laboratory quality control of estrogen and progesterone receptor assays in breast cancer tissue using lyophilised cytosols

In 1981 a quality control (QC) program for estrogen and progesterone receptor assays was organized among six laboratories in Ontario, Canada. Twenty-three vials of lyophilised cytosol prepared from human breast tumor tissues were analysed by each laboratory over a two-year period. Samples of each batch of QC material were analysed at least twice: either in the same batch or on separate occasions. The present study demonstrates the stability of the QC material, defines the relative accuracy of the receptor assays, and provides estimates of within-batch and between-batch precision of the receptor assays.

Clinical observations on the response of equine hoof defects to dietary supplementation with biotin

Horses with weak hoof horn, which becomes misshapen and crumbles around the lower parts of the hoof walls, pose problems for treatment in practice. The effects of dietary supplementation with a high level of the B-group vitamin biotin (which has proved successful in the treatment of the similar condition in pigs) were investigated in more than 40 cases. Varying degrees of improvement in the hardness, integrity and conformation of the hoof horn were observed in all cases. The signs and progress seen in three typical cases are described. It is concluded that dietary supplementation with 10 to 30 mg biotin/day (depending on bodyweight) for not less than six to nine months is a useful treatment to support other remedial measures in such cases.

Body weight and prognosis in breast cancer

We have examined the relationship between risk factors for breast cancer incidence and the subsequent prognosis of breast cancer among patients in a randomized controlled trial of adjuvant ovarian ablation. Body weight was the only risk factor found to be associated with statistically significant differences in survival. This finding could not be explained by a disproportionate number of anatomically more advanced tumors in the heavier women. In premenopausal women aged 45 years or more, the only group to benefit from adjuvant ovarian ablation, there was an interaction of treatment and weight, suggesting that weight exerts its influence on prognosis by a hormonal mechanism. The prognostic effect of weight was generally most marked in patients with tumors whose prognostic characteristics were favorable, and in these patients weight loss as an adjuvant treatment may reduce the frequency of disease recurrence.

Distribution of heavy metals and radionuclides in sediments, water, and fish in an area of Great Bear Lake contaminated with mine wastes

The concentrations of heavy metals and radionuclides in the sediments and water of Great Bear Lake were determined during 1978 near an operating silver mine and an abandoned uranium mine. Additional information on the level of mercury in fish tissues were also collected. The mines, situated on the same site, deposited tailings and other waste material directly into the lake. The concentrations of mercury, lead, manganese, and nickel in the sediments were highest near the tailings deposit and decreased significantly as the distance from the mine increased. Although there were also significant positive correlations between these metals and the organic content of the sediments, water depth and slope of the bottom had no impact on metal distribution. Since the concentrations of arsenic, cobalt, copper, 226radium, 210lead and 230thorium varied inconsistently throughout the study area, the distribution of these substances could not be related to any of the environmental factors that were measured. There were, however, significant negative correlations between the concentrations of 232thorium and 228thorium and distance from the mine and organic content of the sediments. Heavy metal and radionuclide levels in water were generally below detectable limits, reflecting the strong chemical bonding characteristics of the sediments. The low concentrations of mercury in the tissues of lake trout Salvelinus namaycush were probably related to low uptake rates and the ability of this species to move into uncontaminated areas of the lake.

Chemotherapy for adenocystic carcinoma

Seventeen patients with adenocystic carcinoma have received 34 adequate trials of chemotherapy at Princess Margaret Hospital since 1969. There have been five objective responses to chemotherapy in 4 cases, lasting from five to 24 months, and 3 other patients have had stabilized disease for a period of five to seven months. Responding and stabilized patients all had symptomatic improvement. Most responses were to 5-fluorouracil, the preferred drug for initial treatment of metastatic disease or locoregional disease that cannot be controlled by means of surgery or radiation therapy.

Tamoxifen therapy in premenopausal patients with metastatic breast cancer

Tamoxifen was evaluated in a phase II trial as initial hormonal therapy in premenopausal patients with metastatic breast cancer. The study design was such that responders remained on tamoxifen therapy; those who initially or subsequently progressed went on to ovarian ablation either by surgery or irradiation. Of 42 evaluable patients treated with tamoxifen, three had complete responses (CR), ten had partial responses (PR), and four remained stable (ST), giving total response rates of 32% (CR + PR) or 41% (CR + PR + ST). Among the 18 patients with positive estrogen (ER) or progesterone (PgR) receptors, there were eight responders, but only one responder (ST) in the nine patients with negative ER or PgR. Of the 25 patients who failed to respond to tamoxifen, 13 underwent ovarian ablation; all failed to respond. These 13 included four patients who were ER positive or equivocal and PgR positive or unknown. Nine tamoxifen responders (CR + PR + ST) have subsequently progressed; of these, eight have gone on to ovarian ablation. Six of these eight have responded (five PR and one ST) to ovarian ablation, and one has failed to respond. Thus, steroid receptors generally predicted a patient's response to tamoxifen therapy, but response to tamoxifen also strongly predicted a patient's subsequent response to ovarian ablation.

Plasminogen-activating activity: association with steroid binding by cytosols of human breast cancers

Plasminogen-activating activity (PAA) was determined on cytosols prepared from human breast cancers. Coincident assays of steroid-binding proteins were obtained for 119 patients. Significant positive correlations were found between PAA and binding of: 1) estrogen (P less than 0.01), 2) progestin (P less than 0.001), and 3) triamcinolone (P = 0.01). Stepwise regression analysis indicated that variations in the levels of progestin binding accounted for 17% (P less than 0.01) and variations in the levels of triamcinolone binding for 3% (P = 0.05) of the variation observed in PAA. Use of the median value of each assay to discriminate positive from negative values accentuated the positive correlation between PAA and binding of 1) estrogen (P = 3.9 X 10(-5), 2) progestin (P = 1.9 X 10(-4), and 3) triamcinolone (P = 6.1 X 10(-5). Preliminary results suggested that values of PAA equal to or greater than the median correlated positively with response to treatment by hormone manipulation (P = 0.0549). Possible significance of these observations was discussed.

Carcinoembryonic antigen in breast cancer

Carcinoembryonic antigen (CEA) levels were determined in 742 postoperative patients with breast cancer. Within this group the percentage of elevated (greater than or equal to 4.0 ng/ml) assays increased with UICC clinical stage and was 14.8% (12/81), 23.7% (27/114), 73.1% (190/260) and 20.0% (49/245) for stages I, II, III, IV and X (unstagable due to insufficient data) patients. We have now followed the above 482 stages I, II, III and X patients in whom CEA was performed less than or equal to 3 months after initial surgery at a time when there was no evidence of residual disease, for an average interval of 255 days from date of diagnosis. At present 16.2% (17/105) of patients with elevated CEA values compared to only 4.8% (18/377) of patients with normal values have developed recurrent disease (p less than .0005). There is an association of elevation of CEA postoperatively with different clinical stages of breast cancer. Elevated CEA levels postoperatively are associated with an increased risk of development of recurrent disease in breast cancer patients.

Rapid assays for evaluating the drug sensitivity of tumor cells

Assays that assess the ability of cells to incorporate labeled precursors into acid-precipitable material in the presence of adriamycin, daunorubicin, puromycin, vinblastine, melphalan, or methotrexate were investigated as an approach to the detection of resistant cells in human tumor samples. Each assay was evaluated with suitable drug-resistant Chinese hamster ovary cell lines and normal human fibroblasts to determine whether the assays reflected the drug sensitivity of these lines. Moreover, the ability to detect the presence of drug-resistance cells in a mixed population was evaluated. Validated assays were then used to measure the drug sensitivity of cell samples from pleural and peritoneal effusions of patients, mainly with carcinoma of the breast or ovary. Though the responsiveness of the majority of the samples in these assays was similar to that of a human fetal lung fibroblast line, 37 of 142 samples displayed responses consistent with the presence of a significant proportion of drug-resistant cells. Of these 37 nonresponsive samples, 12 displayed nonresponsiveness to three drugs.

Uptake of the mosquito larvicide Temefos by the salt marsh snail, New Jersey--1973-1974

Uptake of the mosquito larvicide temefos (Abate) by the salt march snail (Melampus bidentatus Say) in New Jersey was measured by gas-chromatographic analysis. Measurable quantities of temefos were found in the snails within 1 day after the first treatment with a 2% granular formulation but 3 weeks elapsed before uptake occurred following treatment with a temefos emulsion. Residues in the snails exposed to the granular formulation were generally more than 10 times higher than those in snails exposed to the emulsion although application rates of the granular formulation were only about three times higher than those of the emulsion. Residues in snails exposed to the emulsion fell below detectable levels less than 3 weeks after cessation of treatments although measurable amounts were found in snails exposed to the granular formulation for more than 5 weeks after the last treatment. The persistence of temefos in M. bidentatus suggests the potential for its movement through food webs exposed to the granular formulation.

Androgen-dependent fibrinolytic activity in a murine mammary carcinoma (Shionogi SC-115 cells) in vitro

Physiological concentrations of dihydrotestosterone (DHT) can specifically induce the release of fibrinolysin from androgen-dependent mammary carcinoma (Shionogi SC-115) cells in vitro. No fibrinolytic activity was observed in cells cultured either in the absence of DHT or presence of pharmacological concentrations of estrogen. Furthermore, an autonomous tumor derived from the Shionogi SC-115 cells produced fibrinolytic activity independent of added DHT or estrogen. These observations suggest a close correlation between fibrinolytic activity of a tumor and its ability to grow in vivo.

Androgen receptors: relationship to growth response and to intracellular androgen transport in nine variant lines of the Shionogi mouse mammary carcinoma

Aspects of the biological significance of androgen receptors have been studied in nine variant lines of the Shionogi carcinoma, two of which are androgen dependent and seven of which are autonomous. The dependent lines, and two of the seven autonomous lines, contain androgen receptors; this finding demonstrates that the presence of receptors is not an accurate marker of hormonal dependence in vivo. Since the ability to transport androgens into the nucleus, as judged from the relative maximal rates of transport, is virtually restricted to dependent and autonomous lines which possess cytoplasmic receptors, it is clear that such receptors may play a role in regulating the intranuclear concentration of androgens. The absence of cytoplasmic receptors and the comparative lack of perceptible transfer of androgens across the nuclear membrane are features peculiar to the autonomous condition.

The influence of testosterone on the endogenous levels of prostaglandin F in the accessory reproductive glands of the adult male rat

Orchidectomy increased the endogenous concentration of prostaglandin F (PGF) in the prostatic and vesicular glands of adult rats. A single intramuscular dose of free testosterone (5.0 mg/100 g) was able to reverse the effects of castration on PGF concentration of the accessory reproductive organs. In the case of seminal vesicles, administration of testosterone to castrate rats markedly reduced the PGF levels within 144 h of hormone treatment.

Persistence of cadmium-induced metabolic changes in liver and kidney

Daily intraperitoneal injection of cadmium chloride (1 milligram per kilogram) for 45 days enhanced gluconeogenesis as evidenced by significant increases in the activities of liver and kidney cortex pyruvate carboxylase, phosphopyruvate carboxylase, hexosediphosphatase, and glucose-6-phosphatase, the quartet of key, rate-limiting enzymes involved in the biotransformation of noncarbohydrate precursors into glucose. Whereas cadmium treatment decreased the level of hepatic glycogen, the concentration of blood glucose and urea was significantly elevated by this heavy metal. Discontinuation of the heavy metal treatment for 28 days, in rats previously injected with cadmium for 45 days, failed to restore the observed biochemical alterations in hepatic and renal carbohydrate metabolism to control values. Evidence indicates that cadmium augments the glucose-synthesizing capacity of liver and kidney cortex and that various metabolic changes persist even after a 4-week period of withdrawal from exposure to the heavy metal.