Enhanced urinary gelatinase activities (matrix metalloproteinases 2 and 9) are associated with early-stage bladder carcinoma: a comparison with clinically used tumor markers

Matrix metalloproteinases (MMPs) are involved in tumor growth and metastasis, promoting the migration and invasion of cells. In this study, the amount of MMP-2 and MMP-9 activity was measured in urine from superficial bladder carcinoma patients (pTa, pT1) to evaluate their possible diagnostic value. The active and total amount of MMP-2 and MMP-9, respectively, in urine from tumor patients were compared with the levels in urine from age- and gender-matched healthy volunteers. Both MMP-2 and MMP-9 activity levels were significantly enhanced in urine from patients with high invasive cancers (pT2, PT3), whereas in urine from healthy controls no or very low MMP activities were found. More importantly, a substantial number of urine samples from patients with superficial tumors contained elevated MMP-2 and MMP-9 activities, suggesting that enhanced urinary MMP activity levels, indeed, might be indicative for early-stage bladder cancer. Overall, urinary MMP-2 and MMP-9 activity levels were significantly correlated to each other, with some individual exceptions. A comparison between urinary MMP-9 activity and a recently proposed urinary marker for bladder cancer, NMP-22, showed slightly lower numbers of patients with elevated levels for MMP-9. But because MMP-9 and NMP-22 levels were not correlated, enhanced urinary MMP activity might be useful as a marker for superficial bladder carcinoma like, or especially in combination with, other markers.

Presence of urokinase-type plasminogen activator receptor in urine of cancer patients and its possible clinical relevance

High levels of urokinase-type plasminogen activator receptor (uPAR) are expressed in various types of cancer. Recent studies showed that cancer patients may have increased levels of soluble (s)uPAR in their serum. In the present study, we show that urine samples from healthy volunteers contain measurable amounts of suPAR. suPAR/creatinine levels from healthy controls showed only little variation over the day and were even stable during a month of continued monitoring. Importantly, urinary suPAR/creatinine levels were highly correlated with serum suPAR concentrations. Urinary suPAR levels were elevated in patients with different types of cancer. Interestingly, part of the urinary suPAR seemed to be present in a cleaved form, as has been found in tumor tissue extracts. Together with the recently established, cell migration-promoting effect of certain cleaved fragments of suPAR, the present data suggest that the measurement of urinary suPAR and/or its cleaved forms might have clinical implications.

Relation between left ventricular function and oxidative stress in patients undergoing bypass surgery

OBJECTIVE

To determine whether preoperative left ventricular ejection fraction (LVEF) is related to the degree of myocardial oxidative stress during bypass surgery in man.

DESIGN

Observational study.

SETTING

Tertiary care centre.

PATIENTS AND INTERVENTIONS

31 patients (LVEF range was 20% to 68%) undergoing elective coronary bypass surgery with blood cardioplegic reperfusion were studied. Arterial and coronary sinus blood was collected before aortic cross clamping (T0) and at 0 (T1), 15 (T2), and 30 (T3) minutes after unclamping. Transmural left ventricular biopsies were also obtained from 15 patients at T0 and at T1.

MAIN OUTCOME MEASURES

Glutathione and adenine nucleotides were measured in myocardial biopsies, while coronary sinus-artery differences for glutathione, nucleotides, and products of lipid peroxidation were calculated from blood specimens. Creatine kinase (myocardial band; CK-MB) was measured in plasma at four and 12 hours after operation.

RESULTS

Myocardial glutathione and adenine nucleotides were correlated (p < 0.02) with preoperative LVEF both at T0 (r = 0.909 and 0.672) and T1 (r = 0.603 and 0.605). Oxidised glutathione released from the heart during reperfusion was inversely correlated with LVEF (r = -0.448, -0.466, and -0461 at T1, T2, and T3, p < 0.01), while reduced glutathione (r = 0.519 and 0.640 at T1 and T2) and glutathione redox ratio (r = 0.647, 0.714, 0.645, and 0.702 at T0, T1, T2, and T3) showed a direct correlation (p < 0.01). Lipid peroxidation at T1 was negatively related to LVEF (r = -0.492). CK-MB was also negatively related to LVEF (r = -0.440 at 4 h and -0.462 at 12 h).

CONCLUSIONS

The capacity to counterbalance oxidative burst following ischaemia and reperfusion appears to be related to the functional ability of the heart.

Role of leucocytes in free radical production during myocardial revascularisation

OBJECTIVE

To evaluate the role of leucocytes in free radical production in patients with depressed or normal ejection fraction undergoing coronary bypass.

DESIGN

Two randomised control trials.

SETTING

Tertiary care centre.

PATIENTS AND INTERVENTIONS

In the first study, 22 patients with ejection fractions of < or = 40% received blood cardioplegic reperfusion with (n = 11) or without (n = 11) leucocyte depletion. In the second study, 22 patients with ejection fractions > or = 45% received either leucocyte depleted (n = 11) or blood cardioplegia (n = 11).

MAIN OUTCOME MEASURES

Glutathione, hypoxanthine, and lipid peroxidation products were measured in coronary sinus blood and plasma before aortic cross clamping and at 0, 15, and 30 minutes after unclamping. Haemodynamic variables and creatine kinase MB isoenzymes were monitored on the first postoperative day. Comparison between treatments was performed on difference (delta) between measurements at time 0 and at baseline, and on slopes obtained by fitting measurements after unclamping with a linear regression model.

RESULTS

At unclamping no difference in delta for plasma glutathione redox ratio (oxidised/total glutathione, %) was observed between treated and control groups with low ejection fraction (delta = 16 (SD 8.39) and 24 (7.0) redox ratio %, respectively). Baseline value recovery rate (redox ratio %/min) was significantly faster in treated v control patients (slope -0.912 (0.380) v -0.158 (0.200), P < 0.005, respectively). Cardiac index showed a trend to greater improvement in the treated group (slope 0.04 (0.03) v 0.003 (0.002) 1/min/m2/h, P < 0.02, treated v controls, respectively). In patients with normal ejection fraction, leucocyte depletion did not result in significant improvement v controls.

CONCLUSIONS

Leucocyte depletion seems to provide benefit only in patients with left ventricular dysfunction.

Myocardial protection with and without leukocyte depletion: a comparative study on the oxidative stress

We tested the hypothesis that controlled reperfusion with leukocyte-depleted blood could improve myocardial protection by reducing the oxidative stress in patients undergoing myocardial revascularization. Thirty-four patients receiving antegrade/retrograde blood cardioplegia were divided into: group A: 11 patients with ejection fractions (EF) less than 35%, treated with leukocyte-depleted controlled blood reperfusion, group B: 11 patients with EF less than 35% in whom no leukocyte depletion was performed, group C: 6 patients with EF more than 45% treated as group A and group D: 6 patients with EF more than 45% without leukocyte depletion. To asses the oxidative stress, we evaluated total, total oxidized (GSSX), and reduced glutathione (GSH) in coronary sinus plasma, immediately before cross-clamping the aorta (T0), and at 0 (T1), 15 (T2) and 30 (T3) min after unclamping it. In groups A and B a significant shift towards oxidation of redox status of glutathione (GSH/GSSX) at T1 vs T0 was observed. Glutathione redox ratio remained low in group B while in group A it returned to the basal value at T2 with a significant difference from group B at T2 and T3. No differences were observed between groups C and D. In conclusion, our data show that leukocyte-depleted reperfusion can afford a better myocardial protection in patients with left ventricular dysfunction, while it seems unnecessary in patients with normal EF.

Usefulness of free testosterone/cortisol ratio during a season of elite speed skating athletes

Free testosterone/cortisol ratio (FTCR) was used in eight elite speed skaters (five males, three females), during an eight-month season, to study the effectiveness of the hormonal parameter as a marker of the condition of overstrain and/or incomplete recovery. We did not find values lower than 0.35 x 10(-3). We confirmed the reliability of the criterion of FTCR decrease of 30% or more to indicate temporary incomplete recovery from intensive training and residual weariness and, consequently, of reduced effectiveness for competitive purposes; a formula was used in this case to calculate FTCR. When FTCR was calculated by using directly measured FT, we remarked that such threshold criterion could not be used and the significant decrease was of 18% or more. The major problem of FTCR is the limitation of its use to male athletes, although the trend found in females was similar to that presented in males. FTCR is a useful index in elite speed skaters: broader application of this index and further investigation are required to set testing times, to use direct measurement of free testosterone and, finally, to find an equivalent support for women.

[Evaluation of a colorimetric enzymatic procedure for determining the total bile acids in the blood]

A simple enzymatic colorimetric procedure for the total serum bile acids determination was evaluated. In 518 normal patients values of statistical analysis ranged from 0.60 to 7.75 mumol/l (mean = 3.38 and S.D. = 2.00).

[Semiautomatic procedure for determining urine iron in subjects treated with deferoxamine B]

A semiautomatic method for the determination of urine iron during treatment with deferoxamine B has been evaluated: samples were diluted 1:10 with a TCA 10% and thioglycolic acid 1.1% solution and processed after centrifugation by the aca III discrete clinical analyzer Du Pont. In this way an overestimation of values depending on the turbidity caused by proteins is avoided and the bad smell is limited thanks to the very low concentration of the thioglycolic acid solution. A good correlation with the atomic absorption spectrophotometry, specially for values less than or equal to 20 mg/l, was observed examining urine samples of 150 patients treated with deferoxamine B.