1
|
Ray-Coquard I, Leary A, Pignata S, Cropet C, González-Martin A, Marth C, Nagao S, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Alia EMG, Bogner G, Yoshida H, Lefeuvre-Plesse C, Buderath P, Mosconi AM, Lortholary A, Burges A, Medioni J, El-Balat A, Rodrigues M, Park-Simon TW, Dubot C, Denschlag D, You B, Pujade-Lauraine E, Harter P. Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial. Ann Oncol 2023:S0923-7534(23)00686-5. [PMID: 37211045 DOI: 10.1016/j.annonc.2023.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND In the PAOLA-1/ENGOT-ov25 primary analysis, maintenance olaparib plus bevacizumab demonstrated a significant progression-free survival (PFS) benefit in newly diagnosed advanced ovarian cancer patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab, irrespective of surgical status. Prespecified, exploratory analyses by molecular biomarker status showed substantial benefit in patients with a BRCA1/BRCA2 mutation (BRCAm) or homologous recombination deficiency (HRD; BRCAm and/or genomic instability). We report the prespecified final overall survival (OS) analysis, including analyses by HRD status. PATIENTS AND METHODS Patients were randomized 2:1 to olaparib (300 mg bid; up to 24 months) plus bevacizumab (15 mg/kg q3w; 15 months total) or placebo plus bevacizumab. Analysis of OS, a key secondary endpoint in hierarchical testing, was planned for ∼60% maturity or 3 years after the primary analysis. RESULTS After median follow-up of 61.7 and 61.9 months in the olaparib and placebo arms, respectively, median OS was 56.5 versus 51.6 months in the ITT (hazard ratio [HR]=0.92, 95% CI 0.76-1.12; P=0.4118). Subsequent poly(ADP-ribose) polymerase (PARP) inhibitor therapy was received by 105 (19.6%) olaparib patients versus 123 (45.7%) placebo patients. In the HRD-positive population, OS was longer with olaparib plus bevacizumab (HR=0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% versus 48.4%); at 5 years, updated PFS also showed a higher proportion of olaparib plus bevacizumab patients without relapse (HR=0.41, 95% CI 0.32-0.54; 5-year PFS rate, 46.1% versus 19.2%). Myelodysplastic syndrome, acute myeloid leukemia, aplastic anemia, and new primary malignancy incidence remained low and balanced between arms. CONCLUSIONS Olaparib plus bevacizumab provided clinically meaningful OS improvement for first-line patients with HRD-positive ovarian cancer. These prespecified exploratory analyses demonstrated improvement despite a high proportion of patients in the placebo arm receiving PARP inhibitors post-progression, confirming the combination as one of the standards of care in this setting with the potential to enhance cure.
Collapse
Affiliation(s)
- I Ray-Coquard
- Department of Medical Oncology, Centre Léon BERARD, Lyon, and GINECO, France;.
| | - A Leary
- Gynecological Cancer Unit, Department of Medicine, Institut Gustave Roussy, Villejuif, and GINECO, France
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, and MITO, Italy
| | - C Cropet
- Department of Biostatistics Centre Léon BERARD, Lyon, and GINECO, France
| | - A González-Martin
- Department of Medical Oncology, Clínica Universidad de Navarra, Program in Solid Tumors (CIMA), Pamplona, and GEICO, Spain
| | - C Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, and AGO Austria, Austria
| | - S Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, and GOTIC, Japan
| | - I Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, and BGOG, Belgium, European Union
| | - N Colombo
- University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS Milan, and MANGO, Italy
| | - J Mäenpää
- Department of Obstetrics and Gynecology and Cancer Center, Tampere University and University Hospital, Tampere, and NSGO, Finland
| | - F Selle
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, and GINECO, France
| | - J Sehouli
- Charité - Department of Gynecology with Center of Oncological Surgery, Universitätsmedizin Berlin, Berlin, and AGO, Germany
| | - D Lorusso
- (3)Gynecologic Oncology Unit, Catholic University of Sacred Heart and Fondazione Policlinico Gemelli IRCCS, Rome, and MITO, Italy
| | - E M Guerra Alia
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, and GEICO, Spain
| | - G Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, and AGO Austria, Austria
| | - H Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, and GOTIC, Japan
| | - C Lefeuvre-Plesse
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, and GINECO, France
| | - P Buderath
- Universitätsklinikum Essen, University Hospital Essen, West German Cancer Center, Department of Gynecology and Obstetrics, Essen and AGO, Germany
| | - A M Mosconi
- S.C. di Oncologia Medica Osp. S. Maria della Misericordia - AO di Perugia, and MITO, Italy
| | - A Lortholary
- Centre Catherine de Sienne Hopital privé du Confluent, Nantes, and GINECO, France
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, and AGO, Germany
| | - J Medioni
- Hôpital Européen Georges Pompidou, Universite de Paris Cite, Paris, and GINECO, France
| | - A El-Balat
- Spital Uster, Frauenklinik, Uster, Switzerland, and Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - M Rodrigues
- Department of Medical Oncology, Institut Curie, Hopital Claudius Régaud, PSL Research University, Paris, France, and GINECO, France
| | - T-W Park-Simon
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, and AGO, Germany
| | - C Dubot
- Oncologie Médicale, Institut Curie, Hôpital René Huguenin, Saint Cloud, Paris, and GINECO, France
| | - D Denschlag
- Hochtaunuskliniken, Bad Homburg, and AGO, Germany
| | - B You
- HCL - Hospices Civils de Lyon IC-HCL, CITOHL, Université Claude Bernard Lyon 1, CICLY,Lyon, and GINECO, France
| | | | - P Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, and AGO, Germany
| |
Collapse
|
2
|
Boidot R, Blum M, Wissler MP, Gottin C, Ruzicka J, Duforet-Frebourg N, Jeanniard A, Just PA, Harter P, Pignata S, Gonzalez Martin A, Marth C, Mäenpää J, Colombo N, Vergote I, Fujiwara K, Bertrand D, Philippe N, Ray-Coquard I, Pujade-Lauraine E. 39MO Clinical evaluation of a low-coverage whole-genome test for homologous recombination deficiency detection in ovarian cancer. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
|
3
|
Fujiwara K, Harter P, Leary A, Perol D, Pignata S, González-Martín A, Petru E, van Nieuwenhuysen E, Colombo N, Mäenpää J, Selle F, de Gregorio N, Lorusso D, Guerra Alia E, Lefeuvre-Plesse C, Buderath P, Lortholary A, Burges A, Pujade-Lauraine E, Ray-Coquard I. Phase III PAOLA-1/ENGOT-ov25 trial: Olaparib plus bevacizumab (bev) as maintenance therapy in patients (pts) with newly diagnosed, advanced ovarian cancer (OC) treated with platinum-based chemotherapy (PCh) plus bev. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
4
|
Ray-Coquard I, Pautier P, Pignata S, Pérol D, González-Martín A, Sevelda P, Fujiwara K, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Alia EMG, Lefeuvre-Plesse C, Canzler U, Lortholary A, Marmé F, Pujade-Lauraine E, Harter P. Phase III PAOLA-1/ENGOT-ov25 trial: Olaparib plus bevacizumab (bev) as maintenance therapy in patients (pts) with newly diagnosed, advanced ovarian cancer (OC) treated with platinum-based chemotherapy (PCh) plus bev. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
5
|
Veskimäe K, Scaravilli M, Niininen W, Karvonen H, Jaatinen S, Nykter M, Visakorpi T, Mäenpää J, Ungureanu D, Staff S. Expression Analysis of Platinum Sensitive and Resistant Epithelial Ovarian Cancer Patient Samples Reveals New Candidates for Targeted Therapies. Transl Oncol 2018; 11:1160-1170. [PMID: 30056367 PMCID: PMC6079561 DOI: 10.1016/j.tranon.2018.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
Ovarian cancer has the highest mortality rate of all gynecologic malignancies. Identification of new biomarkers is highly needed due to its late diagnosis and high recurrence rate. The objective of this study was to identify mechanisms of therapy resistance and potential biomarkers by analyzing mRNA and protein expression from samples derived from patients with platinum-sensitive and -resistant ovarian cancer (total cohort n = 53). The data revealed new candidates for targeted therapies, such as GREB1 and ROR2. We showed that the development of platinum resistance correlated with upregulation of ROR2, whereas GREB1 was downregulated. Moreover, we demonstrated that high levels of ROR2 in platinum-resistant samples were associated with upregulation of Wnt5a, STAT3 and NF-kB levels, suggesting that a crosstalk between the non-canonical Wnt5a-ROR2 and STAT3/NF-kB signaling pathways. Upregulation of ROR2, Wnt5a, STAT3 and NF-kB was further detected in a platinum-resistant cell-line model. The results of the present study provided insight into molecular mechanisms associated with platinum resistance that could be further investigated to improve treatment strategies in this clinically challenging gynecological cancer.
Collapse
Affiliation(s)
- K Veskimäe
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
| | - M Scaravilli
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - W Niininen
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - H Karvonen
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - S Jaatinen
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - M Nykter
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - T Visakorpi
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - J Mäenpää
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - D Ungureanu
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - S Staff
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; BioMediTech Institute, University of Tampere, Tampere, Finland
| |
Collapse
|
6
|
Mirza M, Wang J, Mau-Sørensen M, Birrer M, Wang X, Jørgensen M, Zhang ZY, Roed H, Malander S, Nielsen F, Bjørge L, Lassen U, Boufercha L, Brøsen K, Kansra V, Mäenpää J. A phase 1 study to evaluate the safety and tolerability of bevacizumab-niraparib combination therapy and determine the recommended phase 2 dose (RP2D) in women with platinum-sensitive epithelial ovarian cancer (ENGOT-OV24/AVANOVA1). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
7
|
Niemi P, Katevuo K, Kormano M, Baksaas I, Bach-Gansmo T, Mäenpää J. Superparamagnetic Particles as Gastrointestinal Contrast Agent in Magnetic Resonance Imaging of Lower Abdomen. Acta Radiol 2016. [DOI: 10.1177/028418519003100416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Negative gastrointestinal contrast enhancement can be achieved by oral administration of superparamagnetic particles. Their feasibility for the MR imaging of the female pelvis and lower abdomen was evaluated in studies on 32 follow-up patients with treated gynaecologic cancer. All the applied doses (0.2–1.0 mg particles/ml given in a volume of 600–800 ml) of contrast medium decreased the intraluminal signal. However, there was unpredictable individual variation in segmental distribution, and in some cases only a limited contrast effect was obtained. Image distortion was detected when the applied particle concentration exceeded 0.5 mg/ml, especially of the sagittal sections.
Collapse
Affiliation(s)
- P. Niemi
- Departments of Diagnostic Radiology, and Gynaecology and Obstetrics, University Central Hospital, Turku, Finland, and Nycomed A/S, Oslo, Norway
| | - K. Katevuo
- Departments of Diagnostic Radiology, and Gynaecology and Obstetrics, University Central Hospital, Turku, Finland, and Nycomed A/S, Oslo, Norway
| | - M. Kormano
- Departments of Diagnostic Radiology, and Gynaecology and Obstetrics, University Central Hospital, Turku, Finland, and Nycomed A/S, Oslo, Norway
| | - I. Baksaas
- Departments of Diagnostic Radiology, and Gynaecology and Obstetrics, University Central Hospital, Turku, Finland, and Nycomed A/S, Oslo, Norway
| | - T. Bach-Gansmo
- Departments of Diagnostic Radiology, and Gynaecology and Obstetrics, University Central Hospital, Turku, Finland, and Nycomed A/S, Oslo, Norway
| | - J. Mäenpää
- Departments of Diagnostic Radiology, and Gynaecology and Obstetrics, University Central Hospital, Turku, Finland, and Nycomed A/S, Oslo, Norway
| |
Collapse
|
8
|
Veskimäe K, Staff S, Grönholm A, Pesu M, Laaksonen M, Nykter M, Isola J, Mäenpää J. Assessment of PARP protein expression in epithelial ovarian cancer by ELISA pharmacodynamic assay and immunohistochemistry. Tumour Biol 2016; 37:11991-11999. [PMID: 27155850 DOI: 10.1007/s13277-016-5062-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/01/2016] [Indexed: 01/02/2023] Open
Abstract
Targeting Poly (ADP-ribose) polymerase 1 (PARP-1) involved in base excision repair (BER) has been shown to be a clinically effective treatment strategy in epithelial ovarian cancer (EOC) defective in homologous recombination (HR). The aim of this study was to evaluate fresh EOC tumor tissue in regard to PAR (Poly (ADP-ribose)) concentration as a surrogate marker for PARP activity and PARP protein expression in archival samples by immunohistochemistry (IHC). The prospective study cohort consisted of 57 fresh tumor samples derived from patients undergoing primary (n = 38) or interval debulking surgery (n = 19) for EOC and parallel archival paraffin-embedded tumor samples. PARP activity in fresh frozen tumor tissue was assessed by an enzymatic chemiluminescence assay and PARP protein expression in paraffin-embedded tumor tissue by IHC. No correlation was detected between PARP enzyme activity and PARP staining by IHC (p = 0.82). High PARP activity was associated with platinum sensitivity both in the entire study cohort (p = 0.022) and in the high-grade subgroup (p = 0.017). High PARP activity was also associated with improved progression-free survival (PFS) (32 vs 14 months, log-rank p = 0.009). However, PARP immunostaining pattern was not predictive of patient survival. In conclusion, we present a novel finding of high PARP activity associated with platinum sensitivity and improved PFS in EOC. There was no association between PARP IHC and pharmacodynamic assay, and the correlation of PARP IHC with clinico-pathological characteristics and patient survival was poor. Pharmacodynamic assay rather than IHC seems to reflect better biologically significant PARP.
Collapse
Affiliation(s)
- K Veskimäe
- Department of Gynecology and Obstetrics, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland.
| | - S Staff
- Department of Gynecology and Obstetrics, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland.,Laboratory of Cancer Biology, Institute of Biomedical Technology, BioMediTech, University of Tampere, Tampere, Finland
| | - A Grönholm
- Immunoregulation, Institute of Biosciences and Medical Technology, BioMediTech, University of Tampere, Tampere, Finland
| | - M Pesu
- Immunoregulation, Institute of Biosciences and Medical Technology, BioMediTech, University of Tampere, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - M Laaksonen
- Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland
| | - M Nykter
- Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland
| | - J Isola
- Laboratory of Cancer Biology, Institute of Biomedical Technology, BioMediTech, University of Tampere, Tampere, Finland
| | - J Mäenpää
- Department of Gynecology and Obstetrics, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| |
Collapse
|
9
|
Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C, Altundag O, Amant F, van Leeuwenhoek A, Banerjee S, Bosse T, Casado A, de Agustín L, Cibula D, Colombo N, Creutzberg C, del Campo JM, Emons G, Goffin F, González-Martín A, Greggi S, Haie-Meder C, Katsaros D, Kesic V, Kurzeder C, Lax S, Lécuru F, Ledermann J, Levy T, Lorusso D, Mäenpää J, Marth C, Matias-Guiu X, Morice P, Nijman H, Nout R, Powell M, Querleu D, Mirza M, Reed N, Rodolakis A, Salvesen H, Sehouli J, Sessa C, Taylor A, Westermann A, Zeimet A. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015; 27:16-41. [PMID: 26634381 DOI: 10.1093/annonc/mdv484] [Citation(s) in RCA: 685] [Impact Index Per Article: 76.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
Collapse
Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy
| | - C Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Amant
- Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A González-Martín
- Department of Medical Oncology, GEICO Cancer Center, Madrid Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - C Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - R Nout
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France Department of Gynecology and Obstetrics, McGill University Health Centre, Montreal, Canada
| | - M R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Oksa S, Parkkola R, Luukkaala T, Mäenpää J. Breast magnetic resonance imaging findings in women treated with toremifene for premenstrual mastalgia. Acta Radiol 2009; 50:984-9. [PMID: 19863407 DOI: 10.3109/02841850903168083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Toremifene, a selective estrogen receptor modulator, has been shown to be effective in alleviating premenstrual breast pain. However, the exact mechanism by which toremifene and related compounds work in premenstrual mastalgia is poorly understood. PURPOSE To find out if the effect of toremifene on breast would be detectable with dynamic magnetic resonance imaging (MRI). MATERIAL AND METHODS This randomized, double-blind crossover study was performed on women suffering from marked premenstrual mastalgia. Ten women were randomized to receive either toremifene (20 mg) or placebo from cycle day 15 until next menstruation for three menstrual cycles. After a washout period, the treatment was crossed over for three additional cycles. The MRI evaluations were performed premenstrually at the end of each treatment phase. Breast pain and quality-of-life scores were collected from one baseline cycle and from all the treatment cycles. RESULTS Nine patients were evaluable for this analysis. Both the enhancement ratio and the maximum slope of enhancement tended to be smaller during the toremifene cycles as compared to placebo. On the left side, the difference in the maximum slope of enhancement between toremifene and placebo was statistically significant (median 5.150 [range 3.7-6.7] and 6.500 [range 4.9-9.5], respectively; P=0.047). T2 relaxation times as well as breast pain and quality-of-life scores were inconsistent. CONCLUSION Use of toremifene is associated with measurable changes in dynamic breast MRI findings in women with cyclic breast pain.
Collapse
Affiliation(s)
- S. Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - R. Parkkola
- Department of Radiology, University Hospital of Turku, Turku, Finland
| | - T. Luukkaala
- Science Center, Pirkanmaa Hospital District, and Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - J. Mäenpää
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospital of Tampere, and Medical School, University of Tampere, Tampere, Finland
| |
Collapse
|
11
|
Nieminen T, Lehtimäki T, Mäenpää J, Ropo A, Uusitalo H, Kähönen M. Ophthalmic timolol: plasma concentration and systemic cardiopulmonary effects. Scand J Clin Lab Invest 2007; 67:237-45. [PMID: 17366003 DOI: 10.1080/00365510601034736] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Timolol maleate is a non-selective beta-adrenoceptor antagonist currently used mainly as an ocular preparation for the treatment of glaucoma and ocular hypertension. Despite the topical administration, ophthalmic timolol causes systemic adrenergic beta-blocking because of absorption from the eye into the systemic circulation. Gel formulations of ophthalmic timolol have been developed to reduce systemic absorption and adverse effects in comparison with conventional aqueous solution formulations. Timolol is metabolized by the polymorphic cytochrome P450 2D6 enzyme (CYP2D6). The changes in heart rate (HR) are the most striking effects of the systematically absorbed fraction of ophthalmic timolol, with 0.5 % aqueous formulations presenting larger effects than 0.1 % hydrogel formulations, especially during exercise. Plasma levels of ophthalmic timolol correlate with the changes in HR. Neither 0.5 % aqueous nor 0.1 % hydrogel formulations of timolol have exerted noteworthy effects on systolic (SAP) or diastolic (DAP) arterial pressures, probably because of a compensatory increase in systemic vascular resistance due to the attenuation of HR. Ophthalmic timolol does not exert remarkable effects on pulmonary parameter peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) in non-asthmatic patients. CYP2D6 activity is clearly associated with the pharmacokinetic parameters, particularly when 0.5 % aqueous solution of timolol is used: peak plasma concentration, elimination half-life and area-under-the-curve are highest in CYP2D6 poor metabolizers. Finally, since there is a correlation between the plasma level of timolol and several haemodynamic effects - especially HR in the state of elevated beta-adrenergic tonus - the CYP2D6 poor metabolizers may be more prone to bradycardia during treatment with (aqueous) ophthalmic timolol.
Collapse
Affiliation(s)
- T Nieminen
- Department of Pharmacological Sciences, Medical School, University of Tampere, Finland.
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE To investigate the efficacy of toremifene in the treatment of premenstrual mastalgia. DESIGN Double-blind, placebo-controlled crossover study. SETTING Three Finnish general practices from the districts of Satakunta Central Hospital and Tampere University Hospital. POPULATION A total of 62 women aged 25-45 years with premenstrual mastalgia during at least three previous menstrual cycles. METHODS Women were randomised to receive toremifene 20 mg daily or placebo from day 15 of the menstrual cycle until menstruation for three consecutive cycles. After a wash-out cycle, the women were crossed over to receive placebo or toremifene for three additional cycles. MAIN OUTCOME MEASURES Cyclic breast pain relief assessed by visual analogue scale (VAS) score. Quality-of-life scores assessed by a modified 36-item Finnish Depression Scale, with a score ranging from 0 to 108. Acceptability of treatment. RESULTS About 32 women were randomised to receive toremifene first and 30 to receive placebo first. Twenty-nine and 27 participants in the groups treated with toremifene first or placebo first completed the treatment, respectively. There were significant reductions in VAS scores in both groups after three treatment cycles. This was significantly greater in the toremifene-treated group (VAS: 1.8 in the toremifene group and 3.7 in the placebo group, P= 0.004). Treatment effect between treatment cycles was significant (P= 0.001). Quality of life was similar during the toremifene and placebo cycles. CONCLUSION This study demonstrates that the antiestrogenic compound, toremifene, is able to relieve premenstrual breast pain without major adverse effects. There was a 64% reduction in median pain scores in the toremifene-treated cycles compared with a 26% reduction in placebo-treated cycles.
Collapse
Affiliation(s)
- S Oksa
- Department of Obstetrics and Gynaecology, Satakunta Central Hospital, Pori, Finland.
| | | | | |
Collapse
|
13
|
Clamp AR, Mäenpää J, Cruickshank D, Ledermann J, Wilkinson PM, Welch R, Chan S, Vasey P, Sorbe B, Hindley A, Jayson GC. SCOTROC 2B: feasibility of carboplatin followed by docetaxel or docetaxel-irinotecan as first-line therapy for ovarian cancer. Br J Cancer 2006; 94:55-61. [PMID: 16404360 PMCID: PMC2361090 DOI: 10.1038/sj.bjc.6602910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The feasibility of combination irinotecan, carboplatin and docetaxel chemotherapy as first-line treatment for advanced epithelial ovarian carcinoma was assessed. One hundred patients were randomised to receive four 3-weekly cycles of carboplatin (area under the curve (AUC) 7) followed by four 3-weekly cycles of docetaxel 100 mg m(-2) (arm A, n=51) or docetaxel 60 mg m(-2) with irinotecan 200 mg m(-2) (arm B, n=49). Neither arm met the formal feasibility criterion of an eight-cycle treatment completion rate that was statistically greater than 60% (arm A 71% (90% confidence interval (CI) 58-81%; P=0.079; arm B 67% (90% CI 55-78%; P=0.184)). Median-dose intensities were >85% of planned dose for all agents. In arms A and B, 15.6 and 12.2% of patients, respectively, withdrew owing to treatment-related toxicity. Grade 3-4 sensory neurotoxicity was more common in arm A (1.9 vs 0%) and grade 3-4 diarrhoea was more common in arm B (0.6 vs 3.5%). Of patients with radiologically evaluable disease at baseline, 50 and 48% responded to therapy in arms A and B, respectively; at median 17.1 months' follow-up, median progression-free survival was 17.1 and 15.9 months, respectively. Although both arms just failed to meet the formal statistical feasibility criteria, the observed completion rates of around 70% were reasonable. The addition of irinotecan to first-line carboplatin and docetaxel chemotherapy was generally well tolerated although associated with increased gastrointestinal toxicity. Further exploratory studies of topoisomerase-I inhibitors in this setting may be warranted.
Collapse
Affiliation(s)
- A R Clamp
- Cancer Research UK Department of Medical Oncology, Christie Hospital, Manchester M20 4BX, UK
| | - J Mäenpää
- Department of Obstetrics and Gynaecology, Tampere University Hospital, FIN-33521 Tampere, Finland
| | - D Cruickshank
- Women and Children's Directorate, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - J Ledermann
- Department of Oncology, University College London, London W1P 8BT, UK
| | - P M Wilkinson
- Department of Clinical Oncology, Christie Hospital, Manchester M20 4BX, UK
| | - R Welch
- Department of Clinical Oncology, Christie Hospital, Manchester M20 4BX, UK
| | - S Chan
- Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - P Vasey
- Division of Oncology, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia
| | - B Sorbe
- Department of Gynecological Oncology, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - A Hindley
- Rosemere Cancer Centre, Royal Preston Hospital, Fullwood, Preston PR2 9HT, UK
| | - G C Jayson
- Cancer Research UK Department of Medical Oncology, Christie Hospital, Manchester M20 4BX, UK
- Cancer Research UK Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK. E-mail:
| |
Collapse
|
14
|
Mattsson LA, Skouby SO, Heikkinen J, Vaheri R, Mäenpää J, Timonen U. A low-dose start in hormone replacement therapy provides a beneficial bleeding profile and few side-effects: randomized comparison with a conventional-dose regimen. Climacteric 2004; 7:59-69. [PMID: 15259284 DOI: 10.1080/13697130310001651481] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare bleeding control, efficacy and safety of two dose-ranging continuous combined hormone replacement therapy (HRT) regimens with those of a conventional continuous combined HRT. METHODS An open, 2-year, multicenter study was conducted in 393 postmenopausal women recruited from 16 study sites. The women were randomized to three continuous combined HRT regimens. One group (n = 131) started with 1 mg of estradiol valerate (E2V) plus 2.5 mg of medroxyprogesterone acetate (MPA), the second group (n = 130) received 1 mg E2V + 5 mg MPA and the third (n = 132) 2 mg estradiol (E2) and 1 mg norethisterone acetate (NETA). In the two E2V/MPA groups the initial E2V dose of 1 mg was increased to 2 mg after six cycles (one cycle = 28 days) to evaluate the effect of dose increase on bleeding control. RESULTS The E2V/MPA regimens with a lower estrogen dose induced less bleeding and other adverse effects during the first six cycles than did the E2/NETA regimen. Bleeding disturbances and breast tenderness resulted in significantly more discontinuations in the E2/NETA group. After the estrogen dose increase in the E2V/MPA regimens, all groups showed comparable bleeding patterns and adverse effect profiles. The lower E2V dose was as effective as standard-dose E2 in relieving climacteric symptoms. All regimens provided excellent endometrial safety. No hyperplasias were reported. CONCLUSIONS Continuous combined HRT should be started, and continued, with the lowest effective doses. An increase of the estrogen dose is recommended only if the initial dose is not sufficient for symptom control.
Collapse
Affiliation(s)
- L A Mattsson
- Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden
| | | | | | | | | | | |
Collapse
|
15
|
Rees MCP, Kuhl H, Engelstein M, Mattila L, Mäenpää J, Mustonen M. Endometrial safety and tolerability of triphasic sequential hormone replacement estradiol valerate/medroxyprogesterone acetate therapy regimen. Climacteric 2004; 7:23-32. [PMID: 15259280 DOI: 10.1080/13697130310001651445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Two randomized comparative multicenter studies were conducted to establish the endometrial safety and tolerability of a triphasic sequential hormone replacement estradiol valerate/medroxyprogesterone acetate (E2V/MPA) therapy regimen. METHODS Study 1 was a randomized, double-blind, clinical phase III study in 399 postmenopausal women, following parallel-group design with two groups. The duration of study treatment was 12 or 13 cycles of 28 days. A double-dummy technique was used to ensure blinding in the study. The investigational drugs were E2V/MPA triphasic and E2V/MPA biphasic (Diviseq and Divina, respectively; Orion Pharma). In study 2, a total of 341 subjects were randomly allocated by computer into two parallel groups receiving either E2V/MPA or estradiol/norethisterone acetate triphasic (E2/NETA, Trisequens; Novo Nordisk A/S) for 12-13 cycles. The study was an open, clinical phase III trial with a randomized, parallel-group design. Endometrial biopsies combined with transvaginal ultrasound were undertaken before and at the end of treatment during the progestogen phase. Bleeding patterns and symptom control were assessed throughout both studies. RESULTS E2V/MPA triphasic was found to have similar endometrial effects and bleeding patterns to those with E2V/MPA biphasic and E2/NETA triphasic. Climacteric symptoms were relieved as quickly and effectively as with the two comparator treatments. No adverse drug reactions specific to E2V/MPA triphasic were observed. At the end of the study, the proportions of secretory samples were 67.1% for the combined E2V/MPA triphasic groups, 65.6% for the E2V/MPA biphasic group and 71.6% for the E2/NETA triphasic group. One case of hyperplasia occurred in the E2V/MPA triphasic group. Thus the incidence of hyperplasia for the combined groups was 0.33%. CONCLUSIONS The triphasic E2V/MPA regimen was well tolerated and produced endometrial effects similar to those of the two comparators. Extending estrogen during the so-called treatment-free week with a lower dose of estradiol was effective in controlling vasomotor symptoms.
Collapse
Affiliation(s)
- M C P Rees
- Nuffield Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | | | | | | | | | | |
Collapse
|
16
|
Erlund I, Alfthan G, Mäenpää J, Aro A. Tea and coronary heart disease: the flavonoid quercetin is more bioavailable from rutin in women than in men. Arch Intern Med 2001; 161:1919-20. [PMID: 11493148 DOI: 10.1001/archinte.161.15.1919] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
17
|
Sumiala S, Tuominen J, Irjala K, Mäenpää J. Serum total renin after tubal sterilization. Clin Chem Lab Med 2001; 39:615-7. [PMID: 11522107 DOI: 10.1515/cclm.2001.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effect of laparoscopic tubal sterilization by Hulka or Filshie clips on serum total renin levels was evaluated in 33 healthy, regularly menstruating women. Serum total renin levels were measured in the follicular (days 3 to 7) and in the luteal (days 20 to 24) phase during the cycle immediately preceeding the sterilization and 12 months after the procedure. The total renin secreted did not change after the sterilization. The follicular phase levels were lower (160 +/- 113 and 170 +/- 93 ng/l, respectively) than luteal phase levels (230 +/- 124 and 228 +/- 83 ng/l, respectively) in both cycles studied (p=0.0001 for both). The length of the menstrual cycle was not affected, either. Laparoscopic tubal sterilization caused no measurable changes in total renin secretion during one year follow-up.
Collapse
Affiliation(s)
- S Sumiala
- Department of Obstetrics and Gynecology, Turku University Central Hospital, Finland.
| | | | | | | |
Collapse
|
18
|
Ala-Fossi SL, Mäenpää J. [Diphyllobothriasis in a female patient]. Duodecim 2001; 112:1660. [PMID: 10596159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
19
|
Erlund I, Kosonen T, Alfthan G, Mäenpää J, Perttunen K, Kenraali J, Parantainen J, Aro A. Pharmacokinetics of quercetin from quercetin aglycone and rutin in healthy volunteers. Eur J Clin Pharmacol 2000; 56:545-53. [PMID: 11151743 DOI: 10.1007/s002280000197] [Citation(s) in RCA: 324] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Quercetin is a flavonoid with a wide range of biological activities. It mainly occurs in plants as glycosides, such as rutin (quercetin rutinoside) in tea. Quercetin and rutin are used in many countries as vasoprotectants and are ingredients of numerous multivitamin preparations and herbal remedies. OBJECTIVES The primary objective was to characterise and compare the absorption and the pharmacokinetics of quercetin from quercetin aglycone and rutin. A secondary objective was to investigate which forms of quercetin are present in plasma. METHODS In this double blind, diet-controlled, two-period cross-over study, 16 healthy volunteers received three different doses of quercetin and rutin orally. The doses corresponded to 8 mg, 20 mg and 50 mg quercetin aglycone. Blood samples were obtained between 0 h and 32 h post-dose. RESULTS The overall kinetic behaviour of quercetin differed remarkably after ingestion of quercetin aglycone or rutin. The mean area under the plasma concentration-time curve from 0 h to 32 h [AUC(0-32)] and maximum plasma concentration (Cmax) values of the two treatments were similar. However, time to reach Cmax (tmax) was significantly shorter after the quercetin aglycone treatment than after the rutin treatment (1.9, 2.7 and 4.8 versus 6.5, 7.4 and 7.5 h, for doses 1, 2 and 3, respectively). Also, the absorption of quercetin from quercetin aglycone was predictable and inter-individual variation was small. In contrast, after ingestion of rutin, inter-individual variations in AUC(0-32) and Cmax values were considerable and seemed to be associated with gender and use of oral contraceptives. Quercetin and rutin were found in plasma as glucuronides and/or sulfates of quercetin and as unconjugated quercetin aglycone, but no rutin was detected. CONCLUSIONS In clinical trials, studying the effects of quercetin from rutin, bioavailability must be taken into consideration and plasma quercetin concentrations monitored. Whether our results apply to other glycosidic drugs as well, especially other rutosides, should be investigated.
Collapse
Affiliation(s)
- I Erlund
- Department of Nutrition, National Public Health Institute (KTL), Mannerheimintie 166, FIN-00300 Helsinki, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Dastidar P, Mäenpää J, Heinonen T, Kuoppala T, Van Meer M, Punnonen R, Laasonen E. Magnetic resonance imaging based volume estimation of ovarian tumours: use of a segmentation and 3D reformation software. Comput Biol Med 2000; 30:329-40. [PMID: 10988325 DOI: 10.1016/s0010-4825(00)00015-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The application of a new segmentation software, Anatomatic in the evaluation of volumetric measurements of ovarian tumours and the new Medimag three-dimensional (3D) software in the evaluation of 3D image representation of ovarian tumours with 1.5 T magnetic resonance imaging (MRI) is described. Our goal was to compare MRI based volumetry with operative findings at laparotomy for six consecutive patients with suspected ovarian tumours. Volumetric analysis and three dimensional image reconstructions of the tumours were obtained. At laparotomy, the tumour sizes were measured in situ, and the volumes were calculated. Using Anatomatic, reproducible tumour volumes were achieved with ease and within a reasonably fast time in patients with ovarian tumours without ascites. Medimag helped achieve realistic 3D representations of the tumours. For the four solitary tumours segmentation based volumetry and laparotomy findings agreed in three cases. In one patient with an oval shaped tumour, the segmented volume was double as compared to that estimated at laparotomy. Of the two patients with multiple tumours, both patients had significant ascites, and volumetry misinterpreted the fluid as tumour cyst fluid and markedly overestimated the tumour size. In conclusion, the MRI based segmentation volumetry and 3D image reconstructions are rapid, and reproducible methods of measuring ovarian tumours in patients without significant ascites.
Collapse
Affiliation(s)
- P Dastidar
- Department of Diagnostic Radiology, Tampere University Hospital, Tampere, Finland.
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
We evaluated the influence of laparoscopic sterilization by Hulka or Fishie clips on corpus luteum function. Changes in corpus luteum function were evaluated in 46 women, before and after sterilization by Hulka (n = 22) or Filshie clips (n = 24). The mean age of the participants was 37 years (range 31-43 years). All women were healthy with regular menstrual cycles. Serum progesterone (P) was measured in one cycle before, and 3 and 12 months after the sterilization on cycle day 20-24. Endometrial biopsies were performed in the luteal phase before and one year after the procedure. The women measured the basal body temperature daily and kept a menstrual diary. The luteal phase P concentrations declined after the sterilization and the values were at the lowest level 3 months after the procedure (27.9 +/- 14.3 nmol/L vs. 18.7 +/- 13.4 nmol/L, = 0.0016). The values seemed to have recovered by 12 months (23.0 +/- 14.0 nmol/L, = 0.114 vs. baseline). Endometrium tended to be out-of-phase more frequently 1 year after the sterilization than before the surgery (= 0.065). Laparoscopic tubal sterilization is associated with an increased risk of luteal phase deficiency. However, the change may be only temporary in nature.
Collapse
Affiliation(s)
- S Sumiala
- Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland.
| | | | | | | | | |
Collapse
|
22
|
Ala-Fossi SL, Aine R, Punnonen R, Mäenpää J. Is potential to produce inhibins related to prognosis in ovarian granulosa cell tumors? EUR J GYNAECOL ONCOL 2000; 21:187-9. [PMID: 10843483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The prognosis of ovarian granulosa cell tumors is difficult to predict by conventional histological methods. STUDY DESIGN The tumors of 30 patients operated on for a granulosa cell tumor were retrospectively studied for the expression of the inhibin alpha-subunit. The immunohistochemical staining results were correlated to the FIGO stage of the tumor and the prognosis of the patients. RESULTS Twenty-six (87%) of the ovarian granulosa cell tumors stained positively for the inhibin alpha-subunit. All FIGO stage I and II tumors expressed inhibin alpha-subunit. All FIGO stage I and II tumors expressed inhibin, whereas the majority of stages III and IV did not (p=0.001, chi2-test). The survival of the patients with inhibin immunopositive tumors was significantly longer (median 183 months, SE 41, p=0.000, log rank test) than that of patients without inhibin expression (median 2.5 months, SE 5.25). CONCLUSIONS Patients with ovarian granulosa cell tumors with a potential to produce the inhibin alpha-subunit may have a more favorable prognosis than those with inhibin immunonegative tumors.
Collapse
Affiliation(s)
- S L Ala-Fossi
- Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | | | | | | |
Collapse
|
23
|
Abstract
Toremifene is a chlorinated triphenylethylene that is indicated for postmenopausal breast cancer. For advanced disease, toremifene has been found to be as effective and at least as well tolerated as tamoxifen. The same appears to apply for adjuvant setting. After a total cumulative clinical exposure to toremifene of approximately 140000 patient-years, only 9 cases of endometrial carcinoma have been reported. The annual hazard rate (per 1000 patient-years) of developing endometrial carcinoma in breast cancer patients on adjuvant toremifene is 1.14 (versus tamoxifen 2.0 and placebo 0.4). Although toremifene (being a partial agonist) may unmask pre-existing endometrial tumours, there is no clinical data implying that it would per se cause endometrial carcinoma.
Collapse
Affiliation(s)
- J Mäenpää
- Departments of Obstetrics and Gynecology, and Oncology and Radiotherapy, University Hospital, PO Box 2000, FIN-33521, Tampere, Finland.
| | | | | |
Collapse
|
24
|
Backman JT, Mäenpää J, Belle DJ, Wrighton SA, Kivistö KT, Neuvonen PJ. Lack of correlation between in vitro and in vivo studies on the effects of tangeretin and tangerine juice on midazolam hydroxylation. Clin Pharmacol Ther 2000; 67:382-90. [PMID: 10801247 DOI: 10.1067/mcp.2000.105756] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tangeretin is a flavonoid that stimulates the catalytic activity of cytochrome P450 3A4 (CYP3A4) and is found in high levels in tangerine juice. METHODS The effect of tangeretin on hydroxylation of midazolam, a CYP3A4 probe, was examined in vitro with human liver microsomes and recombinant CYP3A4. In addition, the effect of tangerine juice on the pharmacokinetics and pharmacodynamics of orally administered midazolam (15 mg) and its active 1'-hydroxymetabolite was studied in a randomized crossover study in eight healthy volunteers. RESULTS In microsomes from three human livers, tangeretin (1 to 100 micromol/L) increased 1'-hydroxymidazolam formation (12.5 micromol/L midazolam) by up to 212%. In complementary deoxyribonucleic acid-expressed CYP3A4, a 52% stimulation of midazolam 1'-hydroxylation was reached at 50 micromol/L tangeretin with no effect on midazolam 4-hydroxylation. In the pharmacokinetic-pharmacodynamic study, 200 mL tangerine juice reduced the area under the concentration versus time curve to 1.5 hours [AUC(O-1.5h)] of midazolam and 1'-hydroxymidazolam by 39% and 46%, respectively, and prolonged the time to reach peak concentration (P < .05) without affecting the total AUC values, elimination half-life values, or AUC ratios (1'-hydroxymidazolam/midazolam). These findings are consistent with a small delay in the absorption of midazolam and lack of effect on midazolam 1'-hydroxylation. Accordingly, tangerine juice slightly postponed the maximum pharmacodynamic effects of midazolam (P < .05). CONCLUSION Tangeretin is a potent regioselective stimulator of midazolam 1'-hydroxylation by human liver microsomes and complementary deoxyribonucleic acid-expressed CYP3A4. However, tangerine juice is unlikely to have any appreciable effect on CYP3A4 in humans. Further studies are required to assess whether in vitro stimulators of CYP3A4 can influence drug metabolism in vivo.
Collapse
Affiliation(s)
- J T Backman
- Department of Clinical Pharmacology, University of Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
25
|
Ala-Fossi SL, Mäenpää J, Bläuer M, Tuohimaa P, Punnonen R. Inhibin A, B and pro-alphaC in serum and peritoneal fluid in postmenopausal patients with ovarian tumors. Eur J Endocrinol 2000; 142:334-9. [PMID: 10754473 DOI: 10.1530/eje.0.1420334] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare serum and peritoneal fluid concentrations of inhibin A, B, and pro-alphaC in women with ovarian tumors. METHODS Serum and peritoneal fluid samples were taken from 41 postmenopausal women operated on for an ovarian tumor. Twenty-one patients with endometrial cancer formed a control group. Serum and peritoneal fluid inhibin A, B, and pro-alphaC concentrations, and serum FSH and tumor marker CA 125 (study group only) concentrations were analyzed. RESULTS Inhibin A was found in low concentrations (median 4.1pg/ml, range <2-29pg/ml) in serum in most postmenopausal patients with epithelial ovarian carcinoma, whereas inhibin B was not measurable. Inhibin pro-alphaC circulated in high concentrations (median 125pg/ml, range 37->1000pg/ml). All inhibins were found in clearly greater concentrations in the peritoneal fluid than in serum. International Federation of Gynecology and Obstetrics (FIGO) stage III-IV and poor differentiation grade were associated with significantly lower concentrations of inhibin A and pro-alphaC in the peritoneal fluid compared with stages I-II or low grade. This correlation was not found in the serum concentrations of inhibin A or pro-alphaC. In the control group, no dimeric inhibins were found in serum, and pro-alphaC circulated in median concentrations of 47pg/ml (range 12-174pg/ml). CONCLUSIONS Postmenopausal patients with epithelial ovarian tumors had low concentrations of inhibin A and relatively high concentrations of inhibin pro-alphaC in serum. The peritoneal fluid concentrations of all inhibins far exceeded those in the serum. Relatively low concentrations of inhibin A and pro-alphaC in the peritoneal fluid of patients with ovarian cancer seem to be associated with high stage and grade and, to a lesser degree, with positive peritoneal cytology.
Collapse
Affiliation(s)
- S L Ala-Fossi
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
| | | | | | | | | |
Collapse
|
26
|
Virtanen SM, Ylönen K, Räsänen L, Ala-Venna E, Mäenpää J, Akerblom HK. Two year prospective dietary survey of newly diagnosed children with diabetes aged less than 6 years. Arch Dis Child 2000; 82:21-6. [PMID: 10630905 PMCID: PMC1718181 DOI: 10.1136/adc.82.1.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The food consumption of 38 children newly diagnosed with diabetes aged < 6 years at diagnosis was assessed by 5 day food records. During the 2 year follow up, the proportion of the total energy intake made up of protein decreased from 20% to 18%, that of carbohydrates from 54% to 52%, and that of fat increased from 26% to 30%. The energy intake from sucrose (3%) did not change. In addition, There was a small decrease in the intake of fibre and several vitamins and minerals. One year after diagnosis, the diet of diabetic children was compared with that of 66 age, sex, and social status matched control children. More energy was derived from protein (19% v 15%) and carbohydrates (53% v 50%), and less from fat (28% v 35%), especially from saturated fatty acids (11% v 15%), and sucrose (3% v 16%) in the diet of children with diabetes compared with that of control children. The higher intakes of several vitamins and minerals reflected the higher nutrient density of the diet of children with diabetes. Therefore, the diet of young children with diabetes met the dietary recommendations for subjects with diabetes. Only the protein content of the diet was higher than necessary.
Collapse
Affiliation(s)
- S M Virtanen
- School of Public Health and Medicine, University of Tampere, PO Box 607, FIN-33101 Tampere, Finland.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
STUDY OBJECTIVE Abdominal pain is a common symptom in female children and adolescents that may be caused by appendicitis, other gastrointestinal or urological conditions, or gynecological problems. This study evaluates retrospectively the preoperative work-up and the operative treatment of ovarian masses in young girls at our institution. SETTINGS The medical records of all female patients aged 17 years or less operated on for an ovarian mass in 1971-1995 at the Tampere University Hospital were reviewed. RESULTS Seventy-nine patients were identified. In the 1970's preoperative sonography was done on only 15% of the patients. In the 1990's the figure was 65%. Thirty-seven (47%) of all operations were emergency procedures; of these, 41% were performed by a gynecologist. Seven of the tumors were malignant. Thirty-four patients had a benign neoplasm and 26 had functional ovarian cysts. Eight patients were operated on for an adnexal torsion and four patients had other adnexal conditions. Unilateral salpingo-oophorectomy was performed on 20 patients, unilateral oophorectomy on 12 patients, and ovarian resection on 27 patients. An occasional appendectomy was performed on 37 patients. CONCLUSIONS Surgery for benign neoplasms and functional lesions seems to be too extensive. This is likely to be due to inadequate preoperative work-up and to the fact that many of the operations were performed on an emergency basis and by non-gynecologists. A gynecological examination with sonography should be included in the diagnostic work-up of a young girl's abdominal complaints. With a proper preoperative work-up adequate treatment, which often consists of expectation, can be chosen for the patient and subsequent problems related to fertility and abdominal complaints can be avoided.
Collapse
Affiliation(s)
- S Piippo
- Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | | | | | | | | |
Collapse
|
28
|
Ala-Fossi SL, Grenman S, Zhang FP, Bläuer M, Punnonen R, Mäenpää J. Ovarian cancer and gonadotropins in vitro: new evidence in favor of independence. Anticancer Res 1999; 19:4289-95. [PMID: 10628389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The aim of this study was to investigate whether newly established epithelial ovarian carcinoma cell lines secrete inhibins, and whether their proliferative and secretory activity can be regulated by gonadotropins. MATERIALS AND METHODS Three recently characterized human epithelial ovarian carcinoma cell lines were exposed to human choriongonadotropin hCG and follicle stimulating hormone FSH. Cell proliferation was determined by counting. Secretory activity of the cell lines was studied by analyzing inhibin A, inhibin B, inhibin pro-aC, estradiol, progesterone, testosterone, and CA 125 concentrations from the medium. The expression of gonadotropin receptors was studied by RT-PCR. RESULTS None of the cell lines were found to secrete any of the inhibins, progesterone or testosterone. Only UT-OC-4 cells secreted low levels of estradiol. Gonadotropin receptors were not expressed by any of the cell lines, and accordingly neither FSH nor hCG stimulated the growth of these cells. However, hCG had some dose dependent growth inhibitory effect on UT-OC-3. Passage 42 cells of UT-OC-3 secreted significantly more CA 125 than passages 8 cells (P = 0.000). CONCLUSIONS The present results suggest that the carcinomatous epithelial cells of the ovary do not secrete inhibins. The serum inhibin levels previously detected in patients with epithelial ovarian carcinoma may therefore reflect an ovarian stromal response to carcinoma. The findings are also in favor of an independence of ovarian cancer of gonadotropins.
Collapse
Affiliation(s)
- S L Ala-Fossi
- Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | | | | | | | | | | |
Collapse
|
29
|
Mäenpää J, Ellmén J, Pasanen T, Kaukonen M. Re: Effects of the antiestrogens tamoxifen, toremifene, and ICI 182,780 on endometrial cancer growth. J Natl Cancer Inst 1999; 91:972-3. [PMID: 10359551 DOI: 10.1093/jnci/91.11.972] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
30
|
Vainio M, Mäenpää J, Riutta A, Ylitalo P, Ala-Fossi SL, Tuimala R. In the dose range of 0.5-2.0 mg/kg, acetylsalicylic acid does not affect prostacyclin production in hypertensive pregnancies. Acta Obstet Gynecol Scand 1999; 78:82-8. [PMID: 10023867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To determine the dose of acetylsalicylic acid (ASA), that inhibits the production of the vasoconstrictive, aggregatory thromboxane A2 while sparing the production of the vasodilatory antiaggregatory prostacyclin. DESIGN A controlled study comparing the effects of three doses of ASA on the production of thromboxane A2 and prostacyclin. METHODS Seven pregnant hypertensive patients and five non-pregnant healthy women received 0.5, 1.0 and 2.0 mg/kg/day of ASA, each dose for 10-12 days, the treatment periods following each other immediately. Seven normotensive pregnant women served as controls and were given no ASA. Blood and urine samples were taken at baseline and after the treatment periods to determine serum thromboxane B2 and the urinary 2.3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxaneB2, the major stable metabolites of prostacyclin and thromboxane A2, respectively. RESULTS The urinary excretion of 11-dehydrothromboxaneB2 was significantly higher in both hypertensive (34.9+/-18.3 pg/micromol creatinine) and normotensive (39.3+/-14.4 pg/micromol creatinine) pregnant women than in non-pregnant women (14.8+/-6.4 pg/micromol creatinine). The urinary excretion of 2.3-dinor-6-ketoprostaglandinF1alpha was also higher in normotensive pregnant women (93.9+/-50.9 pg/micromol creatinine) than in non-pregnant women (18.2+/-11.3 pg/micromol creatinine). The excretion rate of 2.3-dinor-6-ketoprostaglandinF1alpha in hypertensive patients was lower than in normotensive pregnant women (44.7+/-24.2 pg/micromol creatinine). At baseline the urinary 2.3-dinor-6-ketoprostaglandin F1alpha/11-dehydrothromboxaneB2 ratio was almost the same in the hypertensive patients (1.6) and in the non-pregnant women (1.2). The ratio was 2.6 in normotensive pregnant women. In the hypertensive group, already the lowest dose of ASA inhibited urinary 11-dehydrothromboxaneB2 excretion significantly. Because none of the doses of ASA inhibited 2.3-dinor-6-ketoprostaglandinF1alpha production, the 2.3-dinor-6-ketoprostaglandinF1alpha/11-dehydrothromboxaneB2 ratio was shifted in the favor of prostacyclin at all dose levels. In the non-pregnant women, even the highest dose level of ASA failed to affect the ratio. CONCLUSION In the dose range of 0.5-2.0 mg/kg/day, ASA has a favorable effect on the ratio of prostacyclin to thromboxane A2 in hypertensive pregnancies.
Collapse
Affiliation(s)
- M Vainio
- Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | | | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- O Pelkonen
- Department of Pharmacology and Toxicology, University of Oulu, Finland
| | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE The aim of the study was to investigate the origin of inhibin A and B during the last years of the reproductive age and after menopause by measuring their levels in the ovarian and peripheral venous blood. METHODS The study population consisted of 43 women, aged 42-69 years (mean 50), who underwent hysterectomy with ovarian removal for a benign disease. A total of 24 of them were in follicular phase, 11 in luteal phase, and eight were postmenopausal. Peripheral and ovarian venous blood was collected for measurement of inhibin A and B. In addition, sex steroid hormone and gonadotropin levels were measured. RESULTS Ovarian venous inhibin B correlated significantly with ovarian estradiol secretion (r = 0.5, P = 0.001). The levels of inhibin B were significantly higher in the ovarian vein than in the peripheral vein (P = 0.006). The highest inhibin B concentrations were detected in the mid-proliferative (mid-follicular) phase (median 31.6 pg/ml range 25.9-47.9). In postmenopausal women, inhibin B was not detectable. No correlation between FSH and ovarian inhibin B was found. Inhibin A rose rapidly in late proliferative (late follicular) phase (median 28.5, range < 2-51.8) and dominated in the circulation throughout the luteal phase (median 20.9, range 8.8-60). For inhibin A, no concentration gradient existed between the ovarian and peripheral vein. Unlike inhibin B, inhibin A was detectable in ovarian and peripheral blood in postmenopausal women. A significant negative correlation between ovarian and peripheral inhibin A and FSH was found (r = -0.386, P = 0.015; r = -0.345, P = 0.034, respectively). CONCLUSION Inhibin B correlates with ovarian estradiol secretion and seems to reflect follicular function. Inhibin A dominates in circulation during the luteal phase but is detectable at low concentrations both in follicular phase and even in postmenopause. Our findings suggest that inhibin A may play a role in FSH suppression in the female reproduction. In addition to the ovary, there may be extragondal source(s) of inhibin A.
Collapse
Affiliation(s)
- S L Ala-Fossi
- Department of Obstetrics and Gynecology, Tampere University Hospital, Finland.
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
Episodes of severe hypoglycaemia, resulting in coma and/or convulsions, were documented in an unselected, population-based group of 376 children and adolescents with Type 1 diabetes mellitus (Type 1 DM) treated at the Aurora Hospital, City of Helsinki. A prospective study in 1994-95 yielded 493 patient-years and a retrospective study in 1990-93, 904 patient-years of data. Of these patients, 77-85% received insulin in three or more daily doses. During 1990-95, 43 patients had a total of 48 severe hypoglycaemic episodes. For each episode (n = 48), one control Type 1 DM patient who had never experienced any severe hypoglycaemia, matched by age, diabetes duration and puberty, was sought from the study population. Incidence of severe hypoglycaemia was 3.1/100 patients years prospectively and 3.6/100 retrospectively. At the time of the episode, median age was 13.3 (range 2.2-21) years, and median diabetes duration 6.1 (0.5-14.6) years. Rates were similar in different age groups (< 6, 6-12.9 and > or = 13 years). A potential explanation for the hypoglycaemia was found in 79% of the episodes. Insulin dose was higher (p = 0.04) and HbA1c lower (p = 0.005) in patients with severe hypoglycaemia than in controls. In conclusion, multiple-dose insulin therapy in young patients with Type 1 DM can be associated with a low rate of severe hypoglycaemia. The majority of such episodes seem to be preventable.
Collapse
Affiliation(s)
- S Tupola
- Aurora Hospital, Helsinki, Finland.
| | | | | |
Collapse
|
34
|
Abstract
OBJECTIVE The aim of the study was to investigate ovarian testosterone secretion during the last few years of reproductive life and after menopause. MATERIALS AND METHODS Ovarian and peripheral venous levels of total testosterone were analyzed in 52 women aged 42-69 years (mean 51) undergoing hysterectomy with adnexal removal for benign indications at the Department of Obstetrics and Gynecology at Tampere University Hospital, Finland. The study population was divided into pre- (n = 19), peri- (n = 18) and postmenopausal (n = 15) women in addition to the classical division according to menstrual cycle. Corresponding serum estradiol, progesterone and gonadotropin levels were measured, and the degree of ovarian stromal hyperplasia was analyzed. RESULTS The levels of all steroid hormones were higher in the ovarian vein than in the periphery. A significant positive correlation was found between age and ovarian vein testosterone levels (r = 0.3, P = 0.01). In premenopausal women, it was 1.5 nmol/l (median; range 0.78-6.0), in perimenopausal women 2.2 nmol/l (range 0.9-13.6), and 2.5 nmol/l (range 0.6-26.6) in postmenopause, respectively. Peripheral testosterone level did not increase with age. Ovarian stromal hyperplasia was significantly associated with increased testosterone secretion (P = 0.009). CONCLUSION The ovary seems to increase the secretion of testosterone into circulation during the menopausal transition period, as the highest levels were measured in postmenopausal women. High testosterone levels in the ovarian vein, however, were not reflected in the peripheral venous blood.
Collapse
Affiliation(s)
- S L Ala-Fossi
- Department of Obstetrics, Tampere University Hospital, Finland.
| | | | | | | |
Collapse
|
35
|
Mäenpää J, Hall SD, Ring BJ, Strom SC, Wrighton SA. Human cytochrome P450 3A (CYP3A) mediated midazolam metabolism: the effect of assay conditions and regioselective stimulation by alpha-naphthoflavone, terfenadine and testosterone. Pharmacogenetics 1998; 8:137-55. [PMID: 10022752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The effect of ionic strength, assay constituents, alpha-naphthoflavone (aNF), terfenadine and testosterone on human CYP3A mediated midazolam (MDZ) 1'-hydroxylation (MDZ 1'-OH) and 4-hydroxylation (MDZ 4-OH) in vitro was examined. Increasing concentration of Tris-HCl (Tris) and sodium phosphate (PO4) buffers differentially affected MDZ 1'-OH and MDZ 4-OH formation rates and had a different effect on MDZ metabolism mediated by microsomes containing CYP3A4 versus CYP3A4 and CYP3A5. MDZ metabolism was not affected by PO4 buffer concentration when cumene hydroperoxide (CUOOH) was used as the source of reactive oxygen. Interestingly, the ammonium ion present in the solution of glucose 6-phosphate dehydrogenase was found to inhibit MDZ metabolism. The addition of MgCl2 up to 50 mM and CaCl2 (5-30 mM) had no affect or inhibited MDZ metabolism, respectively. Formation of MDZ 1'-OH by microsomes from adult and fetal liver and expressed CYP3A4 was regioselectively stimulated by aNF (10 microM). In human hepatocytes, aNF stimulated MDZ 1'-OH formation (up to 100%). Terfenadine (20 microM) regioselectively stimulated MDZ 1'-OH formation in Tris (1-200 mM) and PO4 (1-10 mM) buffers by up to 159%. Surprisingly, with expressed CYP3A4, terfenadine (20 microM) inhibited MDZ 1'-OH formation. Terfenadine (20 microM) had little effect on MDZ 1'-OH formation by fetal liver microsomes. Testosterone (10 and 100 microM) regioselectively stimulated (up to 269%) MDZ 4-OH formation by adult liver microsomes and expressed CYP3A4. Testosterone (100 microM) inhibited (> 40%) MDZ 1'-OH and MDZ 4-OH formation by fetal liver microsomes. With adult liver microsomes, aNF and terfenadine had little effect on the Km for MDZ 1'-OH formation. However, the Km for MDZ 4-OH formation was decreased (up to 94%) by 100 microM testosterone. In the presence of CUOOH, no stimulation of MDZ metabolism was observed by aNF, terfenadine or testosterone in adult liver microsomes. These studies indicate that because assay conditions can substantially alter the catalytic activity of CYP3A, caution should be exerted when extrapolating results between in vitro and in vivo, and when results from different laboratories are compared. Further, these results suggest that the stimulation of CYP3A4 may also occur in vivo and, consequently, may have clinical importance.
Collapse
Affiliation(s)
- J Mäenpää
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Centre, Indianapolis, IN 46285, USA
| | | | | | | | | |
Collapse
|
36
|
Suonio E, Lipponen P, Mäenpää J, Syrjänen K, Kangas L, Tuomisto L. Mitotic index in the subrenal capsule assay as an indicator of the chemosensitivity of ovarian cancer. Cancer Chemother Pharmacol 1998; 41:15-21. [PMID: 9443609 DOI: 10.1007/s002800050702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The subrenal capsule assay (SRCA) is used in clinical oncology to assess the sensitivity of individual malignant tumors to various anticancer agents and their combinations. Mitotic indices reflect cancer cell proliferation and have prognostic value in epithelial neoplasms, including ovarian carcinoma. We combined the two tests (SRCA, mitotic index) by evaluating the numbers of mitotic figures per square millimeter of neoplastic epithelium (M/V) in paraffin-embedded tumor samples after SRCA. The M/V index was compared with the tumor size measurement (dTS), which is used in conventional SRCA to predict the drug response. Histology examination showed insignificant changes in the size of tumor transplants due to host reaction but disclosed a number of potential errors in the use of dTS to evaluate transplant growth and drug effects. In our series of 62 patients with advanced ovarian carcinoma the M/V value was superior to the dTS in explaining the clinical response after 6 months as assessed at second-look laparotomy. Patients showing no response had significantly higher M/V values than did those displaying complete or partial responses (P < 0.033). The use of 6 mitotic figures/mm2 as a limit differentiating responders from nonresponders resulted in an overall predictive accuracy of 79% in the logistic regression analysis. In comparison to the FIGO stage, residual tumor size, and the dTS, the M/V value obtained for the cytostatic combination given to the patient was the single most significant factor predicting the 6-month clinical response. The results indicate that the combined use of the M/V index and SRCA is a promising new approach to prediction of the drug response in ovarian adenocarcinoma.
Collapse
Affiliation(s)
- E Suonio
- Department of Pharmacology and Toxicology, University of Kuopio, Finland
| | | | | | | | | | | |
Collapse
|
37
|
Ala-Fossi SL, Mäenpää J, Aine R, Koivisto P, Koivisto AM, Punnonen R. Prognostic significance of p53 expression in ovarian granulosa cell tumors. Gynecol Oncol 1997; 66:475-9. [PMID: 9299263 DOI: 10.1006/gyno.1997.4803] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of the study was to investigate the significance of p53 expression for the prognosis in patients with ovarian granulosa cell tumors (GCT). METHODS The records of 30 patients operated on for GCT at Tampere University Hospital, Finland, were reviewed. The mean age at the time of the diagnosis was 55 years. Twenty-one of the tumors were of FIGO stage I, three were of stage II, three were of stage III, and three were of stage IV. Paraffin-embedded tumor specimens were analyzed by immunohistochemistry for expression of mutated p53 protein and by flow cytometry. RESULTS Eleven tumors were positive for p53 and 19 were negative. The median crude survival of p53-negative patients was 10 times that of p53-positive ones (210 months vs 21 months, P = 0.037, log-rank test). The association between p53 immunoreactivity and stage was statistically significant (P = 0.026 Pearson chi2 test), while there was no association between p53 expression and DNA ploidy or S-phase fraction. CONCLUSION Although the results should be considered as preliminary, expression of mutated p53 in ovarian granulosa cell tumors seems to be associated with unfavorable prognosis.
Collapse
Affiliation(s)
- S L Ala-Fossi
- Department of Clinical Chemistry, Tampere University Hospital, Tampere, FIN-33521, Finland
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVE To find out if ovarian endocrine function is hampered by laparoscopic tubal sterilization. METHODS Salivary progesterone levels were measured in 55 women undergoing a laparoscopic tubal sterilization with Hulka or Filshie clips. The participants were 31-43 years old (mean 37) and were menstruating regularly. The saliva was collected every morning during three menstrual cycles: on the cycle preceding sterilization, and 3 and 12 months after the procedure. Salivary progesterone levels were determined by a radioimmunoassay. RESULTS Total progesterone secreted in the luteal phase declined slowly after the sterilization, resulting in the lowest values 1 year after the procedure (1780 +/- 807 versus 2431 +/- 1187 pmol/L before surgery, P = .001). The luteal peak progesterone values were lowest 3 months after sterilization (277 +/- 137 pmol/L). Although the peak progesterone secretion seemed to have started to recover at 12 months (318 +/- 171 pmol/L), it was still significantly less than before surgery (378 +/- 150 pmol/L, P = .015). The length of the entire menstrual cycle and the lengths of the follicular and luteal phases were not affected. CONCLUSION Although the menstrual pattern was not affected, laparoscopic tubal sterilization caused measureable changes in the luteal function. However, these changes may be temporary in nature.
Collapse
Affiliation(s)
- S Sumiala
- Department of Obstetrics and Gynecology, University of Turku, Finland
| | | | | | | |
Collapse
|
39
|
Abstract
Sera from children (n = 173) were tested for antiphospholipid antibodies (aPL) using an enzyme immunoassay detecting IgG anti-cardiolipin antibodies (GPL). Sera from adults (n = 100) were also tested. GPL were detected more frequently and at higher levels in children than in adults. Eighty-two per cent of the children and 27% of the adults tested positive (> or = 10 GPL Uml-1) for aPL (p < 0.001). Values of 45 GPLUml-1 or higher were detected in about 5% of the children, and 25 GPLUml-1 or higher in about 5% of the adults. Normal values should be adjusted accordingly.
Collapse
Affiliation(s)
- S Kontiainen
- Department of Paediatrics and Medical Microbiology, Aurora Hospital, Helsinki, Finland
| | | | | | | | | |
Collapse
|
40
|
Hakkola J, Pasanen M, Hukkanen J, Pelkonen O, Mäenpää J, Edwards RJ, Boobis AR, Raunio H. Expression of xenobiotic-metabolizing cytochrome P450 forms in human full-term placenta. Biochem Pharmacol 1996; 51:403-11. [PMID: 8619884 DOI: 10.1016/0006-2952(95)02184-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The expression of individual xenobiotic-metabolizing cytochrome P450 (CYP) genes in human placenta was studied at the mRNA level by reverse transcriptase-polymerase chain reaction (RT-PCR). mRNAs of CYP1A1, CYP2E1, CYP2F1, CYP3A3/4, CYP3A5, and CYP4B1 were detected by RT-PCR, and CYP1A2, CYP2A6/7, CYP2B6/7, CYp2C8-19, CYP2D6, and CYp3A7 were not detected. Several enzyme activity assays and immunoblasts were used to further characterize expression of forms producing detectable mRNA transcripts. The catalytic activities of 7-ethoxycoumarin O-deethylase (ECOD), 7-ethoxyresorufin O-deethylase (EROD) and aryl hydrocarbon hydroxylase (AHH) were substantially increased in response to maternal cigarette smoking, and paralleled the amount of CYP1A1 mRNA and protein. Aromatase activities were slightly lower in placentas exposed to cigarette smoke compared with nonexposed placentas. These data show that several xenobiotic-metabolizing CYP genes are expressed in human placenta at a low level. The significant of such low-level expression is unknown, but it may have local physiological or toxic consequences.
Collapse
Affiliation(s)
- J Hakkola
- Department of Pharmacology and Toxicology, University of Oulu, Finland
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVE To investigate whether girls with insulin dependent diabetes mellitus (IDDM) were more overweight than nondiabetic girls, and how diet, insulin treatment, metabolic control, age, and pubertal status were related to body weight and fat content. DESIGN Case-control study. SUBJECTS AND METHODS 48 IDDM girls aged 10-19 years and controls matched for age and social class participated in the study. Overweight was assessed by body mass index (BMI), relative weight, and body fat from skinfold thicknesses. Food consumption data were collected by a 48 hour recall method. RESULTS The girls with IDDM were more overweight than control girls according to all measures of obesity (for example, mean BMI 20.3 v 18.9 kg/m2). The daily insulin dose/body weight correlated positively with BMI and per cent body fat. CONCLUSIONS Girls with IDDM are more overweight than their peers, which indicates that a more effective prevention of obesity is needed in the treatment of diabetes.
Collapse
Affiliation(s)
- K H Pietiläinen
- Department of Applied Chemistry and Microbiology, University of Helsinki, Finland
| | | | | | | | | |
Collapse
|
42
|
Sumiala S, Pirhonen J, Tuominen J, Mäenpää J. Increased uterine and ovarian vascular resistance following Filshie clip sterilization: preliminary findings obtained with color Doppler ultrasonography. J Clin Ultrasound 1995; 23:511-516. [PMID: 8537472 DOI: 10.1002/jcu.1870230902] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effect of Filshie clip sterilization on uterine and ovarian circulation was studied with color Doppler ultrasonography in 16 women before and twice after the operation. As a whole, the vascular resistance was slightly raised in the largest uterine artery and in the fundal parts of the uterine arteries; likewise in the ovarian arteries 2 days after sterilization. The resistance in the uterine arteries approached the presterilization level at 3 months after the operation, although these changes were not statistically significant. Two women had pelvic pain in the first days after the procedure, and they were compared with the symptom-free patients. Two days after sterilization, the patients with pain had significantly higher vascular resistance in all parts of the uterine arteries as compared to the symptom-free patients. After 3 months the difference had decreased in the largest uterine arteries and in the middle parts of the uterine arteries, but in the fundal parts the resistance was still higher than before sterilization. Vascular resistance in the ovarian arteries was increased in both groups, although the elevation was more pronounced in patients with pain. These preliminary findings imply that sterilization may cause an increase in the local vascular resistance, which is measurable by color Doppler sonography.
Collapse
Affiliation(s)
- S Sumiala
- Department of Obstetrics and Gynecology, University of Turku, Finland
| | | | | | | |
Collapse
|
43
|
Abstract
A consecutive series of 78 children with transient asymptomatic glucosuria was studied and followed up for up to 7.3 years. The age at presentation was 0.9-17.6 (median 4.6) years. One third of the patients had random blood glucose levels of > 10.0 mmol/l (180 mg/dl). Five patients (6.4%) developed insulin-dependent diabetes mellitus within 2.1 years after the first incident of glucosuria. These patients presented with higher levels of glycaemia than others, and three out of five were positive for islet cell antibodies with a first-phase insulin response < 46 mU/l in all four studied. Of the remaining 73 children, 3 were positive for islet cell antibodies and 12/55 had a first-phase insulin response under 46 mU/l. The insulin response deteriorated in 3 but reverted to normal in 7 patients. CONCLUSION. For a child with transient glucosuria and with presence of islet cell antibodies and a subnormal first-phase insulin response, therapeutic attempts to prevent overt insulin-dependent diabetes mellitus should be considered.
Collapse
|
44
|
Simell T, Mäenpää J, Kaprio EA, Hakulinen A, Hakalax J, Sipilä I, Akerblom HK, Simell O. Serum insulin profiles in consecutive children 2 years after the diagnosis of IDDM. Diabetologia 1995; 38:97-105. [PMID: 7744234 DOI: 10.1007/bf02369358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We studied associations of 24-h serum insulin profiles with insulin dose, age, gender, haemoglobin A1c (HbA1c) and C-peptide values, as well as blood glucose profiles in 77 consecutive children-nine aged 2-4, 14 aged 5-8, 26 aged 9-12, and 28 aged 13-17 years--2 years after the onset of insulin-dependent diabetes mellitus (IDDM). Mean weight-based insulin doses in the four age groups were similar (0.7 +/- 0.2 U.kg-1.day-1 in all); body surface-area-based doses differed. Insulin doses correlated significantly with the 24-h mean and area-under-the-curve (AUC) values, and with mean values at 03.00 hours of serum insulin in the children aged 5-8 and 13-17 years. The mean insulin concentrations of the age groups (95% confidence intervals) increased with age [6.1 (3.8, 9.7), 7.6 (5.9, 9.8), 10.4 (8.6, 12.4), and 14.0 (11.6, 16.8) mU/l; p < 0.0002]. The 24-h mean of serum insulin together with HbA1c concentration predicted 32% of the variation of mean blood glucose concentrations. Of children aged less than 9 years, 50% had insulin values less than 5 mU/l (healthy subjects' lower reference limit), and 14% were of less than 2 mU/l (detection limit of the assay) at 03.00 hours. At 07.00 hours, 82% had insulin values of less than 5 mU/l, and 36% were of less than 2 mU/l, respectively. Some young children had night-time hypoglycaemia with simultaneous hypoinsulinaemia. Insulin profiles correlated poorly with the HbA1c and peak C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- T Simell
- I Department of Paediatrics, Children's Hospital, University of Helsinki, Finland
| | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Abstract
The prevalence of bacterial antibodies was determined in 173 children aged 0-15 years. The prevalence of IgG Borrelia burgdorferi antibodies in titres > 500 in children less than 8 years of age was 6% while none of the older children had these antibodies in titres > 400. IgG Helicobacter pylori antibodies were detected only in children older than 6 years of age, with a prevalence of 6.5%, as were IgA H. pylori antibodies, with a prevalence of 3.7%. The prevalence of high-titre IgG Campylobacter jejuni antibodies was 1.2%, that of IgA 1.8% and IgM 1.2%. The prevalence of high-titre (> 500 IU/ml) antistreptolysin O was 3%, that of antistaphylolysin-alpha (> or = 4 IU/ml) 2% and that of anti-teichoic acid antibodies (titre 2) 2%. Low-titre Yersinia antibodies were detected in 2%. High-titre Bordetella pertussis antibodies were detected in 6% of recently vaccinated children and in 8% of children in their first years of school. In the latter, high-titre antibodies were mainly of the IgM and IgA classes. Altogether 35 children tested positive for bacterial antibodies other than Bordetella pertussis antibodies. Clinical evaluation revealed a possible infection, suggested by the antibody, in 5 (3%) of the children. Two (vaccinated) children had evidence of whooping cough. Eight of the 35 children with high-titre bacterial antibodies (23%) also had elevated levels of autoantibodies (but not autoimmune diseases).
Collapse
Affiliation(s)
- S Kontiainen
- Department of Paediatrics and Medical Microbiology, Aurora Hospital, Finland
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Methoxsalen (8-methoxypsoralen) is a very potent inhibitor of human cytochrome P450 2A6 (CYP2A6) and mouse Cyp2a-5-mediated coumarin 7-hydroxylation in vitro. To determine the effect of methoxsalen on coumarin 7-hydroxylation in humans in vivo, five subjects were given 45 mg of methoxsalen and 5 mg of coumarin. Methoxsalen inhibited in vivo coumarin metabolism by 47 +/- 9.2% (mean +/- SEM). Methoxsalen was metabolized in human liver microsomes at the rate of 50-100 pmol/mg protein/min (approx. 30% of the activity in mouse liver microsomes). Metabolism was not inhibited by the anti-Cyp2a-5 antibody in human liver microsomes. NIH 3T3 cells stably expressing catalytically active CYP2A6 enzyme did not metabolize methoxsalen, indicating that CYP2A6 does not accept methoxsalen as a substrate. In pyrazole-induced mouse liver microsomes, methoxsalen metabolism was inhibited by the anti-Cyp2a-5 antibody. Cyp2a-5 protein expressed in the yeast Saccharomyces cerevisiae was capable of metabolizing methoxsalen, indicating that methoxsalen is a substrate of Cyp2a-5. Although kinetic studies indicated that the inhibition of coumarin 7-hydroxylation by methoxsalen is competitive in human liver microsomes, methoxsalen does not appear to be a substrate for CYP2A6. Methoxsalen and coumarin have the potential of strong metabolic interactions in man.
Collapse
Affiliation(s)
- J Mäenpää
- Department of Pharmacology and Toxicology, University of Oulu, Finland
| | | | | | | | | |
Collapse
|
48
|
Hakkola J, Pasanen M, Purkunen R, Saarikoski S, Pelkonen O, Mäenpää J, Rane A, Raunio H. Expression of xenobiotic-metabolizing cytochrome P450 forms in human adult and fetal liver. Biochem Pharmacol 1994; 48:59-64. [PMID: 8043031 DOI: 10.1016/0006-2952(94)90223-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Expression of human cytochrome P450 (CYP) genes in human adult and fetal liver were studied using the reverse transcriptase-polymerase chain reaction (RT-PCR) method. In adult liver mRNA of CYPs 1A1, 1A2, 2A6/2A7, 2B6/2B7, 2C8-19, 2D6, 2E1, 3A3/3A4 and 3A7 were detected while CYPs 2F1 and 4B1 were absent. In fetal liver mRNA of CYPs 2C8, 2D6, 3A3/3A4 and 3A7 were found but all other forms studied were undetectable. The results provide a comprehensive qualitative picture of the expression of CYP genes in families CYP1 through CYP4 in human adult and fetal liver.
Collapse
Affiliation(s)
- J Hakkola
- Department of Pharmacology and Toxicology, University of Oulu, Finland
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Grénman SE, Klemi P, Toikkanen S, Kaihola HL, Laippala P, Mäenpää J, Mäkinen J, Grönroos M. Steroid hormone receptors and flow cytometric DNA ploidy in ovarian carcinoma. Ann Chir Gynaecol Suppl 1994; 208:15-19. [PMID: 8092763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The biochemical and immunohistochemical estrogen (ER) and progesterone receptor (PR) content and flow cytometric DNA ploidy was analyzed in five semimalignant and 35 malignant epithelial ovarian tumours. By biochemical assay, 67% of the tumours were ER-positive (> or = 5 fmol/mg protein) and 56% were PR-positive (> or = 10 fmol/mg protein). The corresponding values by immunohistochemical assay (with a HSCORE of 10 as the cutoff level) were 22% and 27%, respectively. DNA histogram measured from paraffin embedded specimens were diploid in 20% (7/35) and aneuploid in 80% (28/35) of the malignant tumours. All semimalignant tumours were diploid. The mean receptor values in the diploid and aneuploid tumours did not differ significantly and receptor-positive and receptor-negative tumours were evenly distributed in all stages and grades. In contrast, flow cytometric DNA ploidy was clearly associated with tumour stage (G2 = 10.52, Df = 3, P = 0.015) and histological differentiation (G2 = 20.57, Df = 3, P = 0.0001).
Collapse
Affiliation(s)
- S E Grénman
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Finland
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- O Pelkonen
- Department of Pharmacology and Toxicology, University of Oulu, Finland
| | | | | | | | | |
Collapse
|