Normal cells of patients with high cancer risk syndromes lack transforming activity in the NIH/3T3 transfection assay.

Oncogenes capable of transforming NIH/3T3 cells are often present in human tumors and tumor cell lines. Such oncogenes were not detected in normal fibroblast lines derived from patients with several clinical syndromes associated with greatly increased cancer risk. Thus, germ-line transmission of these oncogenes does not appear to be the predisposing factor responsible for these high cancer risk syndromes.

Activation of c-Ki-ras in human gastrointestinal dysplasias determined by direct sequencing of polymerase chain reaction products.

Activation of c-Ki-ras by point mutation within exon 1 was studied in 33 specimens of dysplastic gastrointestinal lesions or of cancers presumed to arise from dysplasia. Samples were obtained from patients with underlying ulcerative colitis or Barrett's esophagus, two diseases associated with dysplasia and increased rates of colonic or esophageal adenocarcinoma, respectively. Genomic DNA was amplified using primers bounding this exon in the polymerase chain reaction. Polymerase chain reaction products were analyzed by direct dideoxy sequencing. Three point mutations in codon 13 of c-Ki-ras were found, all in colonic specimens (two high-grade dysplasias and one adenocarcinoma arising in ulcerative colitis). No point mutations were observed in the second exon of c-Ki-ras or in and around codons 12, 13, and 61 of c-N-ras and C-Ha-ras in a partial sampling of the specimens. These data indicate that ras family protooncogene activation is an uncommon event at this level of malignant progression in these disease states. Carcinogenesis in ulcerative colitis and Barrett's esophagus may proceed via different pathways than in sporadic colon cancer, perhaps involving loss or inactivation of suppressor genes.

Cloning and sequence analysis of the human acidic fibroblast growth factor gene and its preservation in leukemia patients.

Acidic fibroblast growth factor (aFGF), also known as heparin-binding growth factor 1, is a mitogen for a variety of mesoderm- and neuroectoderm-derived cells. Several different aFGF mRNA species resulting from alternative splicing have been reported. These results suggest that the gene structure and regulatory mechanism for gene expression of aFGF are complex. As a first step toward understanding aFGF gene structure, we have isolated nine overlapping genomic DNA clones spanning 54 kbp and determined the complete DNA sequences of all three coding exons. Comparison of the nucleotide sequences between the human and bovine DNA showed that the sequence similarity extended 2400 bp downstream from the coding region. Cloning of the aFGF gene allowed us to characterize this locus in acute nonlymphocytic leukemia (ANLL) patients. A fraction of ANLL patients (10-20%) have a deletion in the long arm of chromosome 5, whose distal breakpoint overlaps the aFGF locus. Therefore, a prospective cohort of eight ANLL patients was screened using three different repetitive sequence-free probes derived from the aFGF locus. Using beta-globin gene as a normalization probe for hybridizing band intensities, we conclude that there is no allelic loss or gross rearrangement within the 40 kbp stretch of the aFGF gene locus in ANLL patients with or without 5q- deletion. Consistent with this observation, the aFGF mRNA was not detected in the mononuclear cells derived from either an ANLL patient or a normal individual as judged by the reverse transcription and polymerase chain reaction. We also identified a DNA fragment, 10.7 kbp upstream from the first coding exon of human aFGF, whose sequence is conserved in both the primate and rodent genomes. Further characterization of this fragment is likely to provide insight into the significance of this high degree of conservation.

Infrequent ras activation in chronic myelogenous leukemia (CML): activating 61st codon mutation in the CML-derived cell line, IM-9.

The proto-oncogene c-N-ras frequently bears point mutations in ANLL cell DNA which endow it with the capacity to transform NIH/3T3 cells in vitro. Chronic myelogenous leukemia (CML) is a neoplasm highly related to ANLL since it involves the same hematopoietic progenitor cells and ultimately transforms to a neoplasm virtually indistinguishable from acute nonlymphoblastic leukemia (ANLL). Thus, we and others have examined ras genes in CML. This report confirms that ras gene activation is a very infrequent event in CML. However, a lymphoblastic cell line derived from a patient with CML did exhibit a novel second exon 61st codon activating mutation of c-N-ras.

12th codon mutation resulting in c-N-ras activation in acute myelogenous leukemia.

Activation of the cellular oncogene c-N-ras has been frequently observed in DNA from leukemic cells in acute myeloid leukemia (AML). Ras gene activation sufficient to mediate in vitro transformation and rodent tumorigenesis usually results from point mutations and amino acid substitutions in the 12th or 61st codons. In AML and the related myelodysplastic syndromes, amino acid substitution at the 13th codon has been observed. An activated c-N-ras gene from a 45-year-old patient with AML was isolated by transfection analysis and subjected to molecular cloning and sequence analysis. A point mutation of the 12th codon (GGT to GAT) resulting in aspartic acid substitution for glycine was observed. In other neoplasms such as colon cancer, specific ras mutations occur predominantly (e.g., K-ras, codon 12). This predominance has been of demonstrable value in analyzing large cohorts for ras activation with techniques that are rapid and economical, such as oligonucleotide hybridization. It had previously been thought that such a predominance for activation of c-N-ras at codon 13 existed in AML; however, this study in concert with others underscores the importance of 12th codon c-N-ras mutations, along with 13th and 61st codon mutations in the molecular pathogenesis of AML. Guanylate to adenylate transition mutations are commonly observed in AML and may provide insight into potential environmental leukemogens. Addressing all commonly prevalent ras activating mutations bears impact in the future design of molecular surveys of the role of ras activation in leukemogenesis.

c-myc amplification coexistent with activating N-ras point mutation in the biphenotypic leukemic cell line RED-3.

While activation of the protooncogene c-N-ras is observed regularly in acute myelogenous leukemia, amplification of c-myc in AML cells or derived lines is uncommon. In particular, concurrent ras/myc activation, which has been shown to be critical in several elegant models of malignancy, has been demonstrated in a very small number of human tumors or derivative cell lines. A cell line, RED-3, is described which was derived from cells of a patient with aggressive acute leukemia which exhibits many markers of lineage infidelity. DNA from this cell line contains an activating point mutation of c-N-ras as well as 20-30-fold amplification of c-myc. After HL-60, this is the second example of ras/myc activation in AML derived cells and demonstrates that this lesion is not unique to HL-60. Rather, it may be important in leukemogenesis in a small proportion of AML patients.

Direct radioactive labeling of unpurified PCR products using Klenow fragment.

We describe a method for rapid radioactive labeling of PCR product. The method, employing the Klenow fragment of DNA polymerase I, consumes little product, requires no product purification and takes under 30 minutes.

Quantitation of the ras gene product in leukemic blast cells using enzymatic staining.

Few studies have focused on the significance of ras protein levels in human malignancy, in part because of the inherent difficulty in quantitation of the ras gene product. We have developed a method for the enzymatic determination of the ras gene product and have used this method for the quantitation of ras gene product levels in 19 patients with acute leukemia. This technique provides a practical means to assess p21 expression in leukemic cells ex vivo while avoiding the use of radioactive reagents. In addition, the mobility of the ras species of interest is determined. This assay should be easily modified for the use of other antibodies such as those reported to be specific for various ras species (i.e., H-, K- and N-ras), for specific ras mutations or for other nonras proteins. Because of the use of electrophoresis prior to quantitation of protein, the antibody used does not need to possess high specificity for the protein of interest.

Sequencing products of the polymerase chain reaction directly, without purification.

An improvement over current protocols for sequencing products of the polymerase chain reaction is described. This method allows sequencing products of the reaction without performing costly, time-consuming purification steps which often result in unacceptable loss of product. Conservation of small amounts of polymerase chain reaction products which can be obtained from limited DNA sources, such as tissue biopsies, is achieved. Clarity of autoradiograms obtained utilizing this adaptation is comparable to that obtained with the original method. In addition to streamlining the amplification-sequencing procedure, this procedure can potentially be subjected to total automation.

Immunoprecipitation of cell lysates with RAP-5 does not specifically detect ras oncogene product p21.

In the process of developing accurate quantitation of the ras protein (p21), we have screened available anti-ras antibodies for their utility in immunoprecipitation. Immunoprecipitation with the anti-ras antibody RAP-5 consistently failed to precipitate p21 present in two different cell lines (HSIC-5 and MCF-7), but did precipitate numerous other proteins present in these cell lines. Specificity in immunoprecipitation could not be achieved by varying the concentration of RAP-5. In addition, immunohistochemical staining of the nuclei of occasional polymorphonuclear leukocytes is seen, further supporting the contention that RAP-5 is binding to proteins other than ras p21. We conclude that while RAP-5 may recognize an epitope present on the ras protein, this epitope also appears to be present on a wide variety of other cellular proteins and, as such, RAP-5 is of no use in the immunoprecipitation of p21.

Systemic lupus erythematosus complicated by disseminated sarcoidosis. Report of a case associated with circulating immune complexes.

The association of SLE with sarcoidosis has been reported infrequently. The case of a 47-year-old white woman who had the diagnosis of SLE made at our institution in October of 1979 is presented. In February 1980, the onset of bilateral hilar adenopathy prompted an investigation leading to the diagnosis of sarcoidosis. Circulating immune complexes were markedly elevated. The association of these two diseases has only recently been recognized and may be more widespread than previously suspected. Some animal and clinical data, in concert with our observations, suggest that humoral autoimmunity may give rise to both processes in the same patient.

Ras gene product expression in blood and marrow smears of patients with acute leukemia: importance of fixation.

Activation of ras protooncogenes by any of several possible mutations in codons 12, 13 or 61 has been demonstrated in a variety of human malignancies, including acute non-lymphoblastic leukemia (ANLL). In situ staining for the ras gene product, p21, has been demonstrated in carcinomas of several sites. High levels of p21 expression have been associated with histologic anaplasia in prostate cancer and regional lymph node metastasis in breast cancer. We examined 16 marrow aspirates and blood smears from patients with acute leukemia, predominantly ANLL, and eight controls. Marrow aspirates or blood were smeared on glass slides and fixed immediately in 10% buffered formalin. p21 was examined with avidin-biotin linked immunoperoxidase visualization. Particular attention must be paid to antibody selection and fixation protocol to demonstrate p21, owing to its rapid degradation ex vivo. Three of 16 patients exhibited occasional high p21 expression primarily in leukemic blasts, but in no case were more than 10% of blast cells positive. Normal reticuloendothelial and myeloid cells occasionally exhibited mild to moderately heavy staining, but megakaryocytes, erythroid precursors, lymphocytes and plasma cells were consistently negative. Most patients, 5 normal volunteers and 3 patients with non-malignant disease, exhibited no reactivity, or only a faint blush. These data suggest that while point mutation and concomitant activation of c-N-ras occurs regularly in ANLL, high levels of ras p21 expression are rarely found with this technique.

Catechol estrogens and thrombosis: differential effect of 2-hydroxyestradiol and estradiol on prostacyclin release.

High estrogen burden states, such as that seen in women who ingest oral contraceptive preparations, are associated with increased thrombosis. In other instances, however, estrogens decrease thrombogenicity. Variations in conversion to active metabolites could explain this paradox. Thus, we examined the influence of estradiol and a major metabolite, 2-hydroxyestradiol (catechol estrogen), on prostacyclin release from cultured human umbilical venous endothelium. In micromolar concentrations, both compounds inhibited prostacyclin (PGI2) release from bradykinin-, arachidonic acid-, and ionophore-stimulated, as well as unstimulated monolayers. However, when thrombin was used to stimulate release, estradiol enhanced, while 2-hydroxyestradiol inhibited, PGI2 formation. These sex steroids probably exert their influence at micromolar concentrations through a non-specific interaction with the cell membrane, and may be of importance in the predisposition to thrombosis suffered by those who use oral contraceptives.

PIP: High estrogen burden states, such as those seen in women who ingest oral contraceptive (OC) preparations are associated with increased thrombosis. In other instances, however, estrogens decrease thrombogenicity. Variations in conversion to active metabolites could explain this paradox. Thus, we examined the influence of estradiol and a major metabolite, 2-hydroxyestradiol (catechol estrogen), on prostacyclin release from cultured human umbilical venous endothelium. In micromolar concentrations, both compounds inhibited prostacyclin (PGI2) release from bradykinin-, arachidonic acid-, and ionophore-stimulated, as well as unstimulated monolayers. However, when thrombin was used to stimulate release, estradiol enhanced, while 2-hydroxyestradiol inhibited, PGI2 formation. These sex steroids probably exert their influence at micromolar concentrations through a nonspecific interaction with the cell membrane, and may be of importance in the predisposition to thrombosis suffered by those who use OCs.

Catechol estrogens and thrombosis: lack of a direct effect of 2-hydroxyestradiol on platelets.

Women who use the oral contraceptive pill are at risk for a variety of thromboembolic complications, but the precise mechanism is unclear. Since 2-hydroxyestradiol is a major metabolite of estradiol and possesses some of the structural and functional properties of catecholamines, we examined whether this compound might influence thrombogenesis, in particular whether it would exert an epinephrine-like effect on the platelet. In vitro, 2-hydroxyestradiol does not cause or potentiate aggregation or thromboxane release, nor does it prevent the rise in cyclic AMP caused by anti-aggregatory prostaglandins. While 2-hydroxyestradiol does not exert a direct effect on the platelet in vitro, it may play a role in thrombosis in women who take oral contraceptives through another mechanism.

Basic principles of chemotherapy in the treatment of metastatic head and neck cancer.

For patients who fail to achieve control of head and neck cancer with local therapy, chemotherapy offers limited benefit at present. Better understanding of the phenomena which surround tumor cell killing by active agents should allow for the rational design of more effective programs. For example, as tumors grow larger, many cells cease to engage in DNA synthesis and are refractory to drugs like methotrexate. In such a case, alkylating agents might be more effective. Tritiated thymidine uptake and nuclear DNA fluorescence studies can be exploited to analyze the kinetic and metabolic behavior of tumor cells, and are described. For animal models these studies have allowed the design of "kinetic" regimens of enhanced efficacy. Methotrexate, hydroxyurea, cyclophosphamide, vinblastine, and cis-platinum have appreciable antitumor activity in head and neck carcinoma. Combining active agents in a rational sequence could be facilitated by kinetic analysis of a patient's tumor, giving rise to specific regimens with more cytoreduction, less toxicity and resistance, and ultimately, better survival.

Durable remission of pure red cell aplasia after treatment with high-dose intravenous gammaglobulin and prednisone.

Pure red cell aplasia (PRCA) is a rare disorder of erythrocyte production believed to have an autoimmune basis in most cases. Responses to a variety of immunosuppressive regimens are regularly observed, but toxicity is considerable. Brief responses to high-dose intravenous immunoglobulin (IVIg) have been previously reported. This case demonstrates a durable clinical remission of PRCA treated with IVIg and glucocorticoids.

A comparative study of thromboxane and prostacyclin release from ex vivo and cultured bovine vascular endothelium.

Thromboxane B2, 6-keto-Prostaglandin F1 alpha, and Prostaglandin E2 release have been quantitated from cultured adult bovine endothelial cell monolayers and from ex Vivo vascular segments employing specific radioimmunoassays and thin layer chromatography. Release of all three prostaglandins was demonstrable from both endothelial cell systems under basal conditions and following exposure to the ionophore A23187 and arachidonic acid. In culture, the quantity of 6-keto-PGF1 alpha released was diminished compared to amounts released from the vessel segments while thromboxane B2 and prostaglandin E2 release were similar in the two endothelial model systems. However, the amount of thromboxane B2 assayed was small and the quantity of thromboxane A2 it represents is probably of little in vivo significance compared to prostacyclin.

Enrichment of human platelet phospholipids with linoleic acid diminishes thromboxane release.

We have investigated whether exposure of human platelets to elevated concentrations of linoleic acid, the principal dietary polyunsaturate, would influence platelet thromboxane A2 release. Platelets were incubated with albumin-bound linoleic acid at 30 degrees C for 24 h, with prostaglandin E1 added to prevent aggregation. The linoleic acid supplemented platelets released, on average, 50% less thromboxane A2 in response to stimulation with thrombin than corresponding control platelets. Other fatty acids were without appreciable effect. The inhibition of thrombin-stimulated thromboxane A2 release was dependent on the time and temperature of incubation, as well as on the concentration of added linoleic acid. Supplementation increased the amount of linoleic acid in the platelet phospholipids, but the arachidonic acid content of the phospholipids was reduced. [1-14C]Linoleic acid was not converted to arachidonic acid by the platelets. Linoleic acid was released exclusively from the inositol phosphoglycerides when the enriched platelets were stimulated with thrombin. The linoleate-enriched platelets converted less [1-14C]arachidonic acid to all prostaglandin products, suggesting that the platelet cyclooxygenase was partially inhibited.

Pulmonary embolism in patients with acute leukemia and severe thrombocytopenia.

While pulmonary thromboembolism has been reported in patients with acute leukemia complicated by severe thrombocytopenia, it has been studied infrequently and its pathogenesis remains imprecisely understood. Findings of 80 consecutive autopsies of patients with acute leukemia showed that three had pulmonary thromboembolism. All three patients had been severely thrombocytopenic and had received numerous platelet transfusions. Serial sections of thrombi were evaluated with electron microscopy. In no instance were platelet aggregates detected. However, Candida organisms were prominent in thrombotic specimens from each patient. These findings suggest that thromboembolism in such patients may involve occult fungal infection. Because pulmonary thromboembolism can complicate the course of acute leukemia and severe thrombocytopenia, it should be considered when clinical data suggest its occurrence.