New stable isotope method to measure protein digestibility and response to pancreatic enzyme intake in cystic fibrosis.

BACKGROUND & AIMS: Adequate protein intake and digestion are necessary to prevent muscle wasting in cystic fibrosis (CF). Accurate and easy-to-use methodology to quantify protein maldigestion is lacking in CF. OBJECTIVE: To measure protein digestibility and the response to pancreatic enzyme intake in CF by using a new stable isotope methodology. DESIGN: In 19 CF and 8 healthy subjects, protein digestibility was quantified during continuous (sip) feeding for 6 h by adding (15)N-labeled spirulina protein and L-[ring-(2)H5]phenylalanine (PHE) to the nutrition and measuring plasma ratio [(15)N]PHE to [(2)H5]PHE. Pancreatic enzymes were ingested after 2 h in CF and the response in protein digestibility was assessed. To exclude difference in mucosal function, postabsorptive whole-body citrulline (CIT) production rate was measured by L-[5-(13)C-5,5-(2)H2]-CIT pulse and blood samples were taken to analyze tracer-tracee ratios. RESULTS: Protein digestibility was severely reduced in the CF group (47% of healthy subjects; P < 0.001). Intake of pancreatic enzymes induced a slow increase in protein digestibility in CF until 90% of values obtained by healthy subjects. Maximal digestibility was reached at 100 min and maintained for 80 min. Stratification into CF children (n = 10) and adults showed comparable values for protein digestibility and similar kinetic responses to pancreatic enzyme intake. Whole-body citrulline production was elevated in CF indicating preserved mucosal function. CONCLUSION: Protein digestibility is severely compromised in patients with CF as measured by this novel and easy-to-use stable isotope approach. Pancreatic enzymes are able to normalize protein digestibility in CF, albeit with a severe delay. Registration ClinicalTrials.gov = NCT01494909.

High dose rate intraluminal radiation in a combined modality treatment plan for carcinoma of the esophagus.

We have previously reported results for treatment of adenocarcinomas and squamous cell carcinomas of the mid and distal esophagus as well as the use of intraluminal high-dose rate radiation (HDR-RT) for palliation of carcinoma of the esophagus. In this report we describe the results of a chemotherapy/HDR-RT/esophagectomy management program. Examination of the surgical specimens revealed a complete response in only 13% of patients and locoregional recurrence was disappointing. There were no operative deaths nor were there major complications attributable to the preoperative treatment. Two-year survival was 33%, only slightly better than that previously achieved by us with either primary surgery or primary external beam radiation among "curative" candidates with locoregional disease. HDR in combination with our selected chemotherapy regimen is insufficient for locoregional control and must be supplemented either by esophagectomy or external beam radiation for even modest long-term survival.

Kidney glomerular explants in serum-free media: demonstration of intracellular antioxidant enzymes and active oxygen metabolites.

Guinea pig glomeruli were grown for 22 d in a serum-free medium composed of Waymouth's MB 752/l supplemented with sodium pyruvate, nonessential amino acids, and antibiotics (the basic medium). Intracellular cellular activity of the antioxidant enzymes superoxide dismutase (SOD; both copper-zinc [Cu,Zn] and manganese [Mn] forms) and catalase, and intracellular active oxygen metabolites (hydrogen peroxide [H2O2] and superoxide [O2-.]) were measured with time in culture. The results were compared to results obtained from glomeruli grown in different serum-free media, including the basic medium plus fibronectin (FN), the basic medium plus transferrin and FN, and a complex medium containing insulin, transferrin, selenium (Se), triiodothyronine, and FN (complete medium). In general, although the intracellular activity of antioxidant enzymes and active oxygen metabolites varied over time in culture in all media, there were only a few statistically significant differences among different media. Both CuZn SOD and Mn SOD activity were demonstrated in isolated glomeruli. The CuZn SOD activity per DNA ratio decreased slightly with time in culture in all media tested except the complete medium, in which CuZn SOD activity per DNA ratio remained more constant. The Mn SOD activity per DNA ratio did not vary significantly over time in culture. Catalaselike activity was very low in isolated glomeruli and declined sharply with time in culture in all media except the complete medium. Both H2O2 and O2-. were detected intracellularly in glomerular culture. Our results indicate that intracellular antioxidant enzymes and active oxygen metabolites in glomeruli vary with time in culture and, in some instances, with culture conditions.

Kidney glomerular explants in serum-free media: role of individual medium components in cell outgrowth.

Guinea pig glomeruli were grown for 22 days in a serum-free medium composed of Waymouth's MB 752/1 supplemented with sodium pyruvate, nonessential amino acids, and antibiotics. To this basic medium was added insulin, transferrin, selenium (Se), tri-iodothyronine, or fibronectin (FN) - either singly, or in various combinations - and sequential quantitative studies of the glomerular outgrowths were performed. Total cells in glomerular outgrowths, mitotic index, and glomerular attachment rate were determined and compared with values for glomerular outgrowths in media containing either no additions or all of the above components. FN was required for whole glomerular attachment, while transferrin plus FN was required for mitosis in glomerular cell outgrowths. Insulin and tri-iodothyronine slightly increased glomerular cell outgrowth by slightly increasing whole glomerular attachment, but had little effect on mitosis in glomerular outgrowths. The effect of Se was complex. Se did not affect whole glomerular attachment or mitosis in the presence of transferrin plus FN. However, in a medium containing transferrin, FN, and 3-amino-1,2,4-triazole (AT) (an inhibitor of catalase and glutathione peroxidase), Se increased total cell number but had little effect on the glomerular attachment rate or the mitotic index. Morphologic analysis of glomeruli early in culture suggested that Se may act by decreasing the amount of or delaying the time of cell death. In all of the media tested, total DNA was relatively constant over the course of 22 days, suggesting the possibility that glomerular cells cultured in a serum-free medium are part of a cell renewal system.

Kidney glomerular explants in serum-free media. Sequential morphologic and quantitative analysis of cell outgrowths.

Guinea pig glomeruli were grown in vitro for 22 days in a serum-free medium composed of Waymouth's MB 752/1 supplemented with sodium pyruvate, nonessential amino acids, antibiotics, insulin, transferrin, selenium, triiodothyronine, and fibronectin (FN), and sequential morphologic and quantitative studies of cell outgrowth were performed. Glomeruli grown in serum-free medium showed preservation of glomerular visceral epithelial cells but extensive necrosis of endocapillary cells (endothelial and mesangial cells). Morphologic analysis demonstrated progressive morphologic changes in cultured glomerular cells; however, most cell types observed in culture appeared to grow from the epithelial side of the glomerular basement membrane. Mitosis was a prominent component of glomerular cell outgrowth in vitro, and total DNA increased slightly during glomerular culture. FN was required for glomerular cell outgrowth, and studies using FN fragments demonstrated that the carboxy-terminal portion of FN was required for whole glomerular attachment. These results are used to develop a model for glomerular cell outgrowth in vitro.

Carcinoma of the cervix--anaemia, radiotherapy and hyperbaric oxygen.

Further analyses of the material contained in trials of the hyperbaric oxygen chamber in the radiotherapy of carcinoma of the cervix have shown that patients who were severely anaemic prior to radiotherapy, and who required blood transfusion, showed very poor local tumour control when conventionally treated after transfusion, but very good local tumour control when treated in hyperbaric oxygen. The finding of a special sub-group where hypoxia would seem to be an important cause of radiation failure, and where hyperbaric oxygen was successful in overcoming it, may have importance in the evaluation of other methods for overcoming the hypoxia, including the use of chemical sensitising agents.