Bone marrow transplantation for good-risk patients with leukemia in a university affiliated hospital

Of the first 14 patients with acute or chronic leukemia to undergo bone marrow transplantation at our hospital, 9 (64%), all good-risk, are still alive in remission at 18 to 42 months of follow-up (mean, 29 months) with their Karnofsky performance status between 80% and 100%. The conditioning regimen of fractionated-dose irradiation and high-dose chemotherapy eradicated their disease; only two patients relapsed after transplantation. Toxicity was acceptable. Acute graft-versus-host disease developed in six patients (43%) (grade I or II in four, grade IV in two) and progressed to chronic graft-versus-host disease in four. Viral pneumonitis developed in three patients (21%), but none had idiopathic interstitial pneumonitis. The mean hospital charge was $54,355. These preliminary results suggest that good-risk patients with acute or chronic leukemia can be treated with bone marrow transplantation in a university affiliated hospital with appropriate staff and support facilities and achieve results comparable to those in research institutions at a competitive cost.     

Approaching the controversies in antibacterial management of cancer patients

The principles for management of infectious complications in cancer patients are continuing to evolve. The critical element includes the prompt institution of broad-spectrum antibiotic(s) empirically when granulocytopenic patients become febrile and continuation and modification of the regimen in patients with persistent fever and granulocytopenia. The view is presented that antibiotics provide systemic prophylaxis as well as therapy in persistently granulocytopenic patients and that they should be continued until all signs of infection have cleared or the granulocyte count has recovered. Such aggressive therapy, supplemented by continued evaluation and monitoring of the patient, can significantly reduce infection-relation morbidity and mortality.     

Dicinnamoylquinides in roasted coffee inhibit the human adenosine transporter

Preliminary screening of a minor, non-xanthine constituent of roasted coffee, 3,4-diferuloyl-1,5-quinolactone (DIFEQ), showed inhibition of the adenosine transporter at low micromolar concentration. DIFEQ is a neutral derivative of the chlorogenic acids, i.e. isomeric mono- and di-substituted coumaroyl-, caffeoyl-, and feruloyl-esters of quinic acid, formed in the roasting process of coffee. Displacement of the adenosine transporter antagonist [(3)H](S)-(nitrobenzyl)-6-thioinosine binding by DIFEQ in cultured U-937 cell preparations, expressing the human adenosine transporter protein (hENT1), showed a K(i) of 0.96+/-0.13 microM. Extracts of regular and decaffeinated coffee showed binding activities equivalent to 30-40 mg DIFEQ per three cups of coffee. Acute administration of a high dose of DIFEQ (100 mg/kg i.p.) reduced open field locomotion in mice for 20 min in correlation with brain levels of DIFEQ. Both 3,4-dicaffeoyl-1,5-quinide and 3,4-dicoumaroyl-1,5-quinide, two close structural analogs of DIFEQ also present in roasted coffee, showed similar affinities for the adenosine transporter, while the corresponding 3- and 4-mono caffeoyl- and feruloyl-quinides were one to two orders of magnitudes less active. This suggests that 3,4-dicinnamoyl-1,5-quinides in coffee could have the potential to raise extra-cellular adenosine levels, thereby counteracting the stimulant effect of caffeine.     

Synthesis of type III collagen by cultured kidney epithelial cells

Studies have been performed to evaluate both the relative amounts and molecular forms of the collagens synthesized by an established line of cultured rat kidney epithelial (clone NRK52E) cells. The collagens secreted into the culture medium and extracted from the cell layers of cultured NRK52E cells were isolated after limited pepsin digestion and differential salt fractionation. Greater than 95% of the collagenous proteins synthesized by NRK52E cells were found to be associated with the cells and not secreted. Polyacrylamide gel electrophoresis under denaturing conditions of the NRK52E cell collagens indicated the presence of components exhibiting properties corresponding to those of the chains present in types I, III, IV and V collagen. Analysis of each fraction by carboxymethyl-trisacryl chromatography revealed that approximately two-thirds of the total collagen synthesized by NRK52E cells was type III. Of the remaining collagen types I, IV and V molecules represented 20%, 4% and 10% respectively, of the total produced. Essentially all of the type I collagen produced by NRK52E cells was recovered as the type I-trimer, whereas the type V molecules synthesized by NRK52E cells had the molecular compositions of [alpha 1(V)]2 alpha 2(V) and alpha 1(V)alpha 2(V)alpha 3(V). These data establish the relative proportions and molecular forms of the collagens synthesized by cultured NRK52E cells. Furthermore, these findings suggest that NRK52E cells may be a useful in vitro model for investigating the regulation of changes in collagen biosynthesis occurring under situations of renal epithelial cell injury.     

Infectious complications of intraventricular reservoirs in cancer patients

Drug administration via an intraventricular reservoir is useful in the treatment of leukemic and carcinomatous meningitis that occurs in patients who have previously received lumbar intrathecal chemotherapy. The intraventricular route, however, is associated with a higher incidence of infectious complications compared with therapy given by the lumbar route. To characterize the infectious complications associated with such reservoirs, we reviewed the 10-year experience of the Pediatric Branch, National Cancer Institute, National Institutes of Health, and Children's Orthopedic Hospital, Seattle, WA, with 61 patients (49 with leukemia, 8 with lymphoma, 4 with solid tumors) who had intraventricular reservoirs placed for administration of chemotherapy. The reservoirs were in place for a median of 36 weeks and were punctured a median of 29.5 times, Infectious complications occurred in 14 of 61 patients (23%) and Propionibacterium acnes was the most common organism recovered from cultures. Twelve patients (19.7%) had 19 episodes of clinically suspected and microbiologically documented meningitis or of positive intraventricular reservoir cerebrospinal fluid cultures without symptoms which were treated successfully. Local cellulitis occurred at the site of intraventricular reservoir placement in 2 patients (3.3%) and removal of the intraventricular reservoir was necessary for successful management. Nine patients had their intraventricular reservoir removed (5 because of associated infection and 4 because of malfunction unassociated with infection).(ABSTRACT TRUNCATED AT 250 WORDS)     

Transforming growth factor b as a potential tumor progression factor among hyperdiploid glioblastoma cultures: Evidence for the role of platelet-derived growth factor

Among early-passage, near-diploid gliomas in vitro, transforming growth factor type (TGF) has been previously shown to be an autocrine growth inhibitor. In contrast, hyperdiploid ( 57chromosomes/metaphase) glioblastoma multiforme (HD-GM) cultures were autocrinely stimulated by the TGF. The mechanism of this conversion from autocrine inhibitor to mitogen is not understood; previous studies have suggested that platelet-derived growth factor (PDGF) might be modulated by TGF. The similar expression of TGF types 1—3, PDGF-AA, — BB, as well as the PDGF receptor and subunits (a/PDGFR) between biopsies of the HD-GM and near-diploid, TGF-inhibited glioblastomas (GM) by immunohistochemistry did not explain the discrepancy in their regulatory responses. Flowcytometry demonstrated that TGF's mitogenic effect was selective for the aneuploid subpopulations of two of three selected HD-GM cultures,while the diploid cells were inhibited. Among the HD-GM, TGF1 induced the RNA of PDGF-A, c-sis and TGF1. The amount of PDGF-AA secreted following TGF treatment was sufficient to stimulate the proliferation of a HD-GM culture. Antibodies against PDGF-AA, -BB, -AB,PDGFR and/or PDGFR subunits effectively neutralized TGF's induction of DNA synthesis among the HD-GM cell lines, indicating that PDGF served as the principal mediator of TGF's growth stimulatory effect. By comparison, TGF induced only the RNA of PDGF-A and TGF1 among the near-diploid GM; c-sis was not expressed at all. However, the amount of PDGF-A which was secreted in response to TGF1 was insufficient to prevent TGF's arrest of the near-diploid cultures in G₁ phase. Thus, the emergence of hyperdiploidy was associated with qualitative and quantitative differences in TGF's modulation of PDGF-A and c-sis, which provided a mechanism by which the aneuploid glioma cellsmight achieve clonal dominance. We hypothesize that TGF may serve as an autocrine promoter of GM progression by providing a selective advantage to the hyperdiploid subpopulation through the loss of a tumor suppressor gene which mediates TGF's inhibitory effect.     

Extracellular matrix biosynthesis by cultured fetal rat lung epithelial cells. I. Characterization of the clone and the major genetic types of collagen produced

A new cell line of fetal rat lung origin has been established using the outgrowth procedure. One clone (2G3) isolated by this procedure exhibited during early passages some of the transmission electron microscopic features (e.g., lamellar bodies) indicative of type II pneumocytes and was selected for further study. This cell line has a stable modal chromosome number of 44 and has not been found to develop tumors in athymic rodents. The clone exhibits a biphasic growth curve with an initial generation time of approximately 22 hours at 37 degrees C. The cultures are not contact inhibited but rather develop an organized secondary growth pattern. Initially after subculture, a monolayer is formed consisting of cells which exhibit a cobblestone appearance. After development of this monolayer, a secondary growth pattern emerges. This latter phase of growth is characterized by spindle-shaped cells displaying a pattern of organization that delimits lumina on top of the initial monolayer. At the ultrastructural level, desmosomes are observed, and concurrent with the development of the secondary growth pattern, there is the appearance of dense cytoplasmic structures which resemble lamellar bodies. Based upon the origin, growth properties, and morphologic features of the cells, this clone has been designated fetal rat lung epithelial (FRLE) cells. The collagens secreted into the culture medium and present in the cell layers of FRLE cell cultures, which have developed the secondary growth pattern, were isolated using limited pepsin digestion and differential salt fractionation. Polyacrylamide gel electrophoresis under denaturing conditions indicated that FRLE cells synthesized components corresponding to the chains present in types I, III, IV, and V collagen molecules with no major differences occurring between the profiles of cell-associated and secreted molecules. Carboxymethyl-trisacryl chromatographic analysis revealed that approximately 80% of the collagen synthesized was type I and that approximately 20% of this genetic type of collagen was recovered as the type I homotrimer. Types III, IV, and V molecules accounted for 16, 2, and 3%, respectively, of the total collagen synthesized. Additionally, the type V collagen synthesized by FRLE cells was found to have the molecular compositions alpha 1(V) alpha 2(V) alpha 3(V) and [alpha 1(V)]3. These observations suggest that the collagen biosynthetic profile of the fetal or immature type II cell may differ from that of the fully differentiated type II pneumocyte. Furthermore, it is proposed that cultured FRLE cells may be a useful in vitro model system for investigating the regulation of macromolecular synthesis in and the differentiation and maturation of the fetal alveolar epithelial cell.