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1.
Cancer Gene Ther ; 19(4): 229-37, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22193629

ABSTRACT

Oncolytic viruses are a promising method of cancer therapy, even for advanced malignancies. HF10, a spontaneously mutated herpes simplex type 1, is a potent oncolytic agent. The interaction of oncolytic herpes viruses with the tumor microenvironment has not been well characterized. We injected HF10 into tumors of patients with recurrent breast carcinoma, and sought to determine its effects on the tumor microenvironment. Six patients with recurrent breast cancer were recruited to the study. Tumors were divided into two groups: saline-injected (control) and HF10-injected (treatment). We investigated several parameters including neovascularization (CD31) and tumor lymphocyte infiltration (CD8, CD4), determined by immunohistochemistry, and apoptosis, determined by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Median apoptotic cell count was lower in the treatment group (P=0.016). Angiogenesis was significantly higher in treatment group (P=0.032). Count of CD8-positive lymphocytes infiltrating the tumors was higher in the treatment group (P=0.008). We were unable to determine CD4-positive lymphocyte infiltration. An effective oncolytic viral agent must replicate efficiently in tumor cells, leading to higher viral counts, in order to aid viral penetration. HF10 seems to meet this criterion; furthermore, it induces potent antitumor immunity. The increase in angiogenesis may be due to either viral replication or the inflammatory response.


Subject(s)
Breast Neoplasms/therapy , Herpesvirus 1, Human/genetics , Neoplasm Recurrence, Local/therapy , Oncolytic Viruses/genetics , Tumor Microenvironment/genetics , Aged , Apoptosis/genetics , Breast Neoplasms/genetics , Breast Neoplasms/surgery , Female , Gene Order , Genetic Therapy , Genetic Vectors/administration & dosage , Humans , Mastectomy , Middle Aged , Neovascularization, Pathologic/immunology , Neovascularization, Pathologic/pathology , Oncolytic Virotherapy , Treatment Outcome , Tumor Microenvironment/immunology
2.
Curr Cancer Drug Targets ; 7(2): 169-74, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17346108

ABSTRACT

We reviewed our clinical trial using mutant herpes simplex virus "HF10". We have evaluated the safety and effect of HF10 against recurrent breast cancer since 2003 and also applied HF10 to non-resectable pancreatic cancer since 2005. An oncolytic herpes simplex virus type 1, mutant HF10, has been isolated and evaluated for anti-tumor efficacy in syngeneic immunocompetent mouse models. From long time before clinical trial, we have found that the mutant virus can have remarkable potential to effectively treat cancer in experimental studies using animals, and that all of the surviving mice acquire resistance to rechallenge of the tumor cells. A number of studies have shown that HF10 is effective and safe for use in localized or peritoneally disseminated malignant tumors of non-neuronal origin in animals. Pilot studies using HF10 have been initiated in patients with metastatic breast cancer. For each patient, 0.5 ml HF10 diluents at various doses were injected into test nodule, and 0.5 ml sterile saline was injected into a second nodule. All patients were monitored for local and systemic adverse effects, and the nodules were excised 14 days after viral injection for histopathological studies. All patients tolerated the clinical trial well. While no adverse effects occurred, there was cancer cell death and 30-100% regression histopathologically in recurrent breast cancer. As mentioned above, intratumoral injection of mutant herpes simplex virus HF10 for recurrent metastatic breast cancer was safe and effective. Also a trial for non-resectable pancreatic cancer being carried out on the basis of the above result has proved to be innocuous and has been in progress to assess the clinical benefit and enhance the potentiality of HF10 against cancer.


Subject(s)
Breast Neoplasms/therapy , Herpesvirus 1, Human/genetics , Mutation , Oncolytic Virotherapy , Pancreatic Neoplasms/therapy , Aged , Animals , Breast Neoplasms/pathology , Female , Herpesvirus 1, Human/physiology , Humans , Male , Middle Aged , Pancreatic Neoplasms/pathology , Research Design , Treatment Outcome , Virus Replication
4.
Biomed Pharmacother ; 56 Suppl 1: 120s-125s, 2002.
Article in English | MEDLINE | ID: mdl-12487267

ABSTRACT

We performed simultaneous bilateral laparoscopic total adrenalectomy in two patients with Cushing's syndrome due to ACTH-independent macronodular adrenocortical hyperplasia (AIMAH). Preoperative serum cortisol in the patients was 29.5 and 53.2 microg/dl, respectively. The clinical symptoms of the latter patient were advanced, and respiration was labored with orthopnea. Laparoscopic adrenalectomies were performed transabdominally in the sequential lateral decubitus positions with extension of the lateral abdominal wall of the affected side. Three 12-mm and three 5-mm trocars were positioned, and two trocar sites in the midline were used on both sides. The flexible fiberscope was inserted through the umbilical port. The adrenal glands were large, fragile, and multinodular. The maximal diameters of the removed glands were 7.8 and 8.7 cm, respectively. In both patients, the adrenal glands were successfully removed without fragmentation. The operation times were 505 and 320 min, and the estimated blood loss was 150 and 5 ml, respectively. Neither intraoperative nor postoperative complications occurred, although the latter patient required muscle training before ambulation on postoperative day 42. The procedures resulted in marked clinical improvements. Compliance with the substitutive therapy remained excellent, and the patients expressed a very high degree of satisfaction with the laparoscopic adrenal surgery. The procedures of bilateral laparoscopic adrenalectomy were successful, and provided increased experience with the laparoscopic techniques.


Subject(s)
Adrenal Glands/surgery , Adrenalectomy/methods , Cushing Syndrome/surgery , Laparoscopy/methods , Adrenal Glands/metabolism , Adrenal Glands/pathology , Adrenalectomy/instrumentation , Adrenocorticotropic Hormone/metabolism , Aged , Cushing Syndrome/metabolism , Cushing Syndrome/pathology , Female , Humans , Hyperplasia , Male , Middle Aged
5.
Hum Gene Ther ; 12(11): 1429-41, 2001 Jul 20.
Article in English | MEDLINE | ID: mdl-11485634

ABSTRACT

Trans splicing of messenger RNA has been used in experimental settings to replace mutant RNA sequences. We investigated the feasibility of utilizing trans splicing to replace a mutant RET protooncogene sequence known to inappropriately activate this tyrosine kinase receptor. We constructed a pre-trans-splicing molecule (PTM) consisting of a binding domain complementary to the target intron, the 3' splicing signal sequence (3'ss), derived from adenovirus major late transcript intron 1 and a molecular tag sequence. Accurately targeted trans splicing between the human RET exons and the PTM was demonstrated in NIH 3T3 cells cotransfected with the human RET minigene and the PTM. The efficiency of specific trans splicing was estimated to be no more than 15% in the cotransfection experiment. However, in addition to the targeted trans splicing, nontargeted trans splicing to RET exons was observed. Furthermore, the rapid amplification of 5' cDNA ends (5' RACE) analysis demonstrated that nontargeted trans splicing occurred with endogenously expressed pre-mRNAs in TT cells and that specific trans splicing to RET was a rare event. Attempts to reduce nonspecificity by the addition of a stem-loop to the trans-splicing construct designed to suppress nonspecific splicing failed to have the desired effect. These observations suggest that overexpression of a trans-splicing construct containing a 3'ss results in promiscuous trans splicing and raise significant questions about the specificity and usefulness of currently used trans-splicing approaches. In addition, these findings raise the possibility that nonspecific spliced products may be produced by a variety of gene therapy constructs.


Subject(s)
Drosophila Proteins , Proto-Oncogene Proteins/genetics , RNA Precursors/genetics , Receptor Protein-Tyrosine Kinases/genetics , Spliceosomes/genetics , Trans-Splicing/physiology , 3T3 Cells , Animals , Base Sequence , Cells, Cultured , DNA-Binding Proteins/genetics , Gene Transfer Techniques , Genetic Therapy , Humans , Mice , Molecular Sequence Data , Plasmids/genetics , Proto-Oncogene Proteins c-ret , RNA Precursors/metabolism , RNA Splice Sites/genetics , Reverse Transcriptase Polymerase Chain Reaction , Sequence Tagged Sites , Transcription Factors/genetics , Transfection , Tumor Cells, Cultured , Viral Proteins
6.
Ann Surg ; 234(1): 85-91, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11420487

ABSTRACT

OBJECTIVE: To examine whether inhibition of endogenous adrenocorticotropin (ACTH) secretion in patients with Cushing syndrome affects the expression of the ACTH receptor (ACTH-R) gene in adrenocortical adenoma and attached atrophic normal gland. SUMMARY BACKGROUND DATA: ACTH increases adrenal cell growth and steroidogenesis by means of ACTH-R. In vivo and in vitro studies have shown that expression of ACTH-R is upregulated by its own ligand ACTH in several species. In patients with Cushing syndrome resulting from adrenocortical adenoma, there is autonomous production of cortisol from the adenoma. This strongly inhibits endogenous ACTH secretion, giving rise to the speculation that the expression of the ACTH-R gene in these patients is also suppressed. However, previous studies have shown that administration of exogenous ACTH to these patients leads to a further increase in the production of cortisol, suggesting the expression of functional ACTH-R in the adenoma. The authors, therefore, examined the expression of the ACTH-R gene in these patients. METHODS: Fourteen patients with Cushing syndrome were studied. Glucocorticoid excess resulting from autonomous production from the adenomas was ascertained, and unilateral adrenalectomy was performed. The levels of ACTH-R and cytochrome P450 side chain cleavage enzyme (P450scc) mRNAs were determined by Northern blot analysis. The entire coding region of the ACTH-R gene in these patients was sequenced. RESULTS: ACTH-R mRNA abundance in the attached atrophic normal adrenals was suppressed and invariably less than that in the normal gland obtained from a patient with renal cancer. However, the expression of ACTH-R mRNA was not suppressed in any of the adenomas. Expression of ACTH-R mRNA in the adenomas was four- to sixfold greater than that in the attached atrophic gland. No mutation in the coding sequence of the ACTH-R gene in the adenoma was detected in any of the patients. The mRNA in the adenomas appeared to be translated into functionally active receptor because intramuscular administration of ACTH resulted in significant increases in plasma cortisol before surgery but not 3 months after surgery. In addition, there was a positive linear correlation between the expressions of ACTH-R and P450scc mRNAs in the adenoma tissue. CONCLUSIONS: Suppressed ACTH secretion in patients with Cushing syndrome results in reduction of the ACTH-R mRNA expression in nonneoplastic adrenocortical cells. However, the regulatory mechanism of ACTH-R expression might be different in adenoma. Persistent expression in the adenoma of ACTH-R alone, even in the absence of ACTH, might result in increased basal adenyl cyclase activity, as observed in the case of thyroid-stimulating hormone receptor, and thereby might play a role in the autonomous production of cortisol.


Subject(s)
Adenoma/genetics , Adrenal Cortex Neoplasms/genetics , Cushing Syndrome/genetics , Gene Expression Regulation, Neoplastic , Hydrocortisone/blood , Receptors, Corticotropin , Adrenal Cortex Function Tests , Adult , Female , Humans , Male , Middle Aged
7.
Biochem J ; 354(Pt 3): 573-9, 2001 Mar 15.
Article in English | MEDLINE | ID: mdl-11237861

ABSTRACT

We have recently demonstrated that nuclear factor kappaB (NF-kappaB) mediates the tumour necrosis factor alpha (TNF-alpha)-dependent expression of the gene encoding interleukin 6 (IL-6) in rat thyroid FRTL-5 cells cultured in the presence of thyrotropin (TSH). In the present study we investigated how TSH is involved in the activation of NF-kappaB by TNF-alpha in the cells. Electrophoretic mobility-shift assay revealed that, in the absence of TSH, TNF-alpha activated a single protein-DNA complex containing the p50 subunit but not other NF-kappaB subunits such as p65. In contrast, two distinct protein-DNA complexes were activated in the presence of TSH: the faster-migrating complex contained only p50 subunit; the slower-migrating complex consisted of p65-p50 heterodimer. This TSH effect was mimicked by forskolin and thyroid-stimulating antibodies obtained from patients with Graves's disease, suggesting that an increase in intracellular cAMP is responsible for the induction of different NF-kappaBs by TNF-alpha. A transient transfection study with a luciferase reporter gene driven by multimerized NF-kappaB sites demonstrated that TNF-alpha increased the luciferase activities only in the presence of TSH, and that this increase was inhibited by the co-transfection of mutant p65, which prevented the function of wild-type p65 in a dominant-negative manner. Accordingly, TNF-alpha activated the expression of the IL-6 gene in the presence of TSH but not in its absence. Although the expression of the p105 gene, another known target for NF-kappaB, was increased by TNF-alpha in the absence of TSH, the presence of TSH further increased the mRNA level. Taken together, these observations indicate that the presence of TSH is crucial for the NF-kappaB-mediated actions of TNF-alpha on thyroid follicular cells.


Subject(s)
NF-kappa B/metabolism , Thyroid Gland/metabolism , Thyrotropin/pharmacology , Tumor Necrosis Factor-alpha/pharmacology , Animals , Cell Line , Colforsin/pharmacology , Genes, Reporter , Humans , Immunoglobulins, Thyroid-Stimulating/pharmacology , Interleukin-6/biosynthesis , Interleukin-6/genetics , NF-kappa B/biosynthesis , NF-kappa B/genetics , RNA, Messenger/biosynthesis , Rats , Transcriptional Activation
8.
J Bone Miner Res ; 15(9): 1707-15, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10976991

ABSTRACT

Recently, we showed that tumor necrosis factor alpha (TNF-alpha) stimulates expression of the intercellular adhesion molecule 1 (ICAM-1) and interleukin-6 (IL-6) genes through activation of p65-p50 heterodimer nuclear factor KB (NF-kappaB) in rat osteoblast-like ROS17/2.8 cells. In the present study, we investigated effects of a synthetic glucocorticoid, dexamethasone (Dex), on TNF-alpha-dependent activation of NF-kappaB and expression of the ICAM-1 gene. ROS17/2.8 cells were pretreated with Dex for 6 h and then exposed to TNF-alpha. Electrophoretic mobility shift assay (EMSA) revealed that TNF-alpha-dependent activation of NF-kappaB was almost completely suppressed by Dex treatment. Increase in ICAM-1 messenger RNA (mRNA) level by TNF-alpha also was markedly suppressed by Dex. Western blot and immunocytochemical analyses showed that Dex attenuated the TNF-alpha-induced nuclear translocation of p65. Treatment with protein synthesis inhibitor cycloheximide (CHX) reversed the Dex effect, indicating that Dex requires de novo protein synthesis for its action. Northern blot analysis revealed that Dex increased IkappaB-alpha mRNA level synergistically with TNF-alpha, whereas it decreased p65 mRNA level. The p105 and IkappaB-beta mRNA levels were not altered by Dex. Consistent with the mRNA level, Dex increased the amount of IkappaB-alpha protein in the cytoplasm in either the presence or the absence of TNF-alpha. Considering a role of IkappaB to sequester NF-kappaB in the cytoplasm, it was suggested that an increase in IkappaB-alpha protein and the concomitant decrease in p65 synthesis account for the Dex-induced suppression of NF-kappaB activation in osteoblastic cells.


Subject(s)
Dexamethasone/pharmacology , Gene Expression Regulation/drug effects , I-kappa B Proteins , Intercellular Adhesion Molecule-1/genetics , NF-kappa B/metabolism , Osteoblasts/drug effects , Tumor Necrosis Factor-alpha/pharmacology , Animals , Cell Line , Cycloheximide/pharmacology , DNA/genetics , DNA/metabolism , DNA-Binding Proteins/biosynthesis , DNA-Binding Proteins/genetics , Dimerization , Humans , Immunohistochemistry , Intercellular Adhesion Molecule-1/metabolism , NF-KappaB Inhibitor alpha , NF-kappa B/genetics , NF-kappa B p50 Subunit , Nuclear Proteins/metabolism , Osteoblasts/metabolism , Protein Precursors/genetics , Protein Transport/drug effects , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats , Transcription Factor RelA
9.
Biomed Pharmacother ; 54 Suppl 1: 140s-145s, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10915011

ABSTRACT

Patients with Cushing's syndrome (137 total) who underwent adrenalectomy from 1957 through 1999 were reviewed for survival and complications. Of the 137 patients, 83 had adrenocortical adenoma, 30 Cushing's disease, seven primary pigmented nodular adrenocortical disease (PPNAD), eight adrenocorticotropin (ACTH)-independent macronodular hyperplasia, five adrenocortical carcinoma, and four ectopic ACTH syndromes. Seventy-eight patients with adrenocortical adenoma are alive, and their survival rate was equal to the age-matched control population, when patients who died of postoperative complications were excluded. Of the patients with Cushing's disease, 20 are alive, and ten of 16 patients (63%) who were followed and evaluated, had skin pigmentation. Four of 16 patients (25%) developed Nelson's syndrome. Five PPNAD patients and six with ACTH-independent macronodular hyperplasia are alive. All five adrenocortical carcinoma patients and four with ectopic ACTH syndrome died within two years after operation. The prognosis for patients with adrenocortical adenoma after unilateral adrenalectomy is excellent, though it is important to avoid operative complications. The rapid disappearance of signs and symptoms of glucocorticoid excess after total adrenalectomy is assured, and the prognosis is satisfactory under careful glucocorticoid replacement, making total adrenalectomy an alternative treatment for Cushing's disease.


Subject(s)
Adrenalectomy , Cushing Syndrome/surgery , Adenoma/complications , Adenoma/surgery , Adrenal Cortex Diseases/complications , Adrenal Cortex Diseases/surgery , Adrenal Cortex Neoplasms/complications , Adrenal Cortex Neoplasms/surgery , Adrenocorticotropic Hormone/physiology , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Hormone Replacement Therapy , Humans , Male , Survival Analysis
10.
Gan To Kagaku Ryoho ; 26(13): 2091-4, 1999 Nov.
Article in Japanese | MEDLINE | ID: mdl-10584578

ABSTRACT

Docetaxel is an anti-tumor agent which promotes the congregation and stabilization of microtubules, there by preventing cell division. It is reported to have anti-tumor activity against breast or non-small cell lung carcinomas which have been resistant to other anti-tumor agents. On the other hand, it causes peripheral edema and effusion in the pleural or peritoneal cavities. Thus, pleural or peritoneal effusions, which require drainage have been considered to be contraindications for the administration of docetaxel. OK-432 is an agent which causes adhesion by evoking a local inflammatory reaction. We experienced two cases of recurrent breast carcinoma with malignant pleural effusion. We successfully managed their pleural effusion with the intrapleural administration of OK-432. Thereafter, we safely administered docetaxel, and obtained good outcomes. The present paper also discussed the synergistic action between these agents.


Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Paclitaxel/analogs & derivatives , Picibanil/administration & dosage , Pleural Effusion, Malignant/drug therapy , Taxoids , Docetaxel , Drug Administration Schedule , Female , Humans , Middle Aged , Paclitaxel/administration & dosage , Pleura
11.
Jpn J Cancer Res ; 90(9): 922-7, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10551319

ABSTRACT

We examined the anti-tumor proliferation effects of wakame seaweed on 7,12-dimethylbenz(a)-anthracene (DMBA)-induced rat mammary tumor. DMBA was administered to 8-week-old female Sprague-Dawley rats, and rats which developed mammary tumors were assigned randomly to three groups. Commercial rat feed was used in a control group (group I-A), and two feed mixtures were prepared, which contained commercial rat feed blended with wakame at 1.0% (group I-B) and 5.0% (group I-C) by weight. The respective feeds were given to each group for 8 weeks, and changes in mammary tumor size were compared. At the end of the experiment, mammary tumors and thyroid glands were resected to compare their weights. Serum total iodine and thyroxin (T4) levels were measured. Immunohistochemical studies for bromodeoxyuridine (BrdU) labeling, transforming growth factor (TGF)-beta, and apoptosis were carried out in the resected tumor. Significant suppression of tumor growth was observed in groups I-B and I-C compared with I-A. In groups I-B and I-C, the weights of resected mammary tumors were significantly lower and serum total iodine concentration was significantly higher than in I-A. BrdU indices were significantly lower in groups I-B and I-C, compared with I-A. TGF-beta and apoptotic index were inversely related to BrdU. These results suggest that iodine is transported from the serum into mammary tissues and induces apoptosis through the expression of TGF-beta. In conclusion, wakame suppressed the proliferation of DMBA-induced mammary tumors.


Subject(s)
Mammary Neoplasms, Experimental/drug therapy , Phaeophyceae , Seaweed/chemistry , 9,10-Dimethyl-1,2-benzanthracene , Animals , Apoptosis , Body Weight/drug effects , Bromodeoxyuridine/analysis , Cell Division/drug effects , Endocrine Glands/drug effects , Eosine Yellowish-(YS)/metabolism , Female , Hematoxylin/metabolism , Immunohistochemistry , In Situ Nick-End Labeling , Iodine/blood , Mammary Neoplasms, Experimental/blood , Mammary Neoplasms, Experimental/chemically induced , Neoplasm Transplantation , Plant Extracts/adverse effects , Plant Extracts/therapeutic use , Rats , Rats, Sprague-Dawley , Thyroid Gland/drug effects , Thyroxine/blood , Transforming Growth Factor beta/analysis
12.
Endocr J ; 46(2): 279-84, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10460012

ABSTRACT

Some of the recently identified coactivators which interact with members of nuclear hormone receptors contain a stretch of homopolymeric glutamines (poly-Q). Length of poly-Q in several genes are known to be polymorphic in healthy subjects, and extraordinary expansion of poly-Q in specific genes is known to cause neurodegenerative disorders. In the present study, we investigated whether such polymorphism can be observed in two coactivators, CBP (CREB [cyclic AMP responsive element binding protein]-binding protein) and AIB1/ACTR (amplified in breast cancer-1/ACTR, also called RAC3/TRAM-1). The genomic regions encoding the poly-Q were amplified by means of PCR using fluorescence labeled primer and analyzed by an automatic sequencer. While contiguous glutamine residues inAIB1/ACTR ranged from 26 to 32 with a heterozygosity of 54%, no polymorphism could be observed in poly-Q of CBP among 54 unrelated subjects. These results suggest that the residue in CBP may play a critical role in the function so that individuals with CBP containing different sizes of poly-Q might have been eliminated. It has been reported that AIB1/ACTR is overexpressed in some of the cell lines derived from breast cancer. If the length of poly-Q alters the stability of AIB1/ACTR and/or potency to enhance hormone action through nuclear receptors, the length of poly-Q is likely to be one of the genetic factors affecting not only susceptibility to breast cancers but also the sensitivity to hormones. This polymorphism should also be tested in patients with neurodegenerative disorders of unknown cause.


Subject(s)
Acetyltransferases/genetics , Glutamine/genetics , Nuclear Proteins/genetics , Polymorphism, Genetic/genetics , Saccharomyces cerevisiae Proteins , Trans-Activators/genetics , Transcription Factors/genetics , Base Sequence/genetics , CREB-Binding Protein , Cell Nucleus/metabolism , Heterozygote , Histone Acetyltransferases , Humans , Nuclear Receptor Coactivator 1 , Polymers , Receptors, Cell Surface/metabolism
13.
Am J Surg ; 178(1): 50-3; discussion 54, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10456703

ABSTRACT

BACKGROUND: Few studies have been done regarding laparoscopic transperitoneal lateral adrenalectomy compared with open transretroperitoneal lateral adrenalectomy in a case-controlled fashion. METHODS: A case-controlled study of 40 laparoscopic and 40 open adrenalectomies was done in patients who were matched for age, gender, endocrine disorder, side and size of tumor, and area of body surface. Follow-up was complete in 92.5% of the patients, with a mean follow-up period of 30 months. RESULTS: Statistically significant differences (P <0.05) were present (laparoscopic versus open) when the following results were compared: estimated blood loss (40 g versus 172 g), operating time (147 versus 79 minutes), analgesic equivalents (2.9 versus 5.2 times), hospital stay (12 versus 18 days), and late morbidity (0% versus 47.5%). There were no statistically significant differences between the laparoscopic and open groups with regard to time to oral intake, time to walking, intraoperative and early complications, and total cost. CONCLUSIONS: Laparoscopic adrenalectomy is a safe technique that results in greater patient comfort, decrease in estimated blood loss, and earlier discharge than open adrenalectomy, with no increase in cost. It should be adopted as the technique of choice for the removal of functioning adenomas and for adrenal masses less than 6 cm in diameter.


Subject(s)
Adenoma/surgery , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Laparoscopy , Case-Control Studies , Female , Hemorrhage , Humans , Length of Stay , Male , Middle Aged , Postoperative Complications , Treatment Outcome
14.
Surgery ; 125(5): 504-8, 1999 May.
Article in English | MEDLINE | ID: mdl-10330938

ABSTRACT

BACKGROUND: Permanent hypoparathyroidism is a major complication of thyroidectomy. Autotransplantation of parathyroid glands has been attempted to prevent this complication. However, no direct data have been available to assess grafted parathyroid function after long-term follow-up in terms of the serum intact parathyroid hormone (PTH) concentration. METHODS: Eighty-four consecutive patients with differentiated thyroid carcinoma who underwent total thyroidectomy and bilateral modified neck dissection from 1992 to 1996 were enrolled. They concomitantly underwent total parathyroidectomy and autotransplantation of all parathyroid glands to the pectoralis major muscle. The serum intact PTH concentration was periodically measured as an index of grafted parathyroid function. RESULTS: The mean follow-up was 34 months. In all autotransplanted patients serum intact PTH concentrations fell below detectable limits immediately after surgery. They were restored to the normal range within 1 month postoperatively and were maintained during observation in 80 (95%) of 84 patients. Seventy-eight of 80 patients with normal intact PTH values were normocalcemic without any treatment and the remainder were normocalcemic with 1 microgram of 1 alpha-vitamin D3. Four hypoparathyroid patients were normocalcemic with 2 micrograms of 1 alpha-vitamin D3. The postoperative average serum intact PTH concentration of patients having more than 2 autotransplanted parathyroid glands was almost equal to that of patients with preservation of the parathyroid glands in situ. The incidence of permanent hypoparathyroidism was inversely correlated with the number of autotransplanted parathyroid glands. CONCLUSIONS: The recovery patterns of the intact PTH concentration indicate that the glands were grafted successfully and functioned for a long period. This feasible method of parathyroid autotransplantation bears comparison with the previous reports in terms of the incidence of permanent postoperative hypoparathyroidism, and it can be performed simply and is reproducible.


Subject(s)
Parathyroid Glands/transplantation , Thyroid Neoplasms/surgery , Thyroidectomy , Adolescent , Adult , Aged , Aged, 80 and over , Calcium/blood , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Parathyroid Glands/physiopathology , Parathyroid Hormone/blood , Phosphorus/blood , Transplantation, Autologous , Vitamin D/pharmacology
15.
Surgery ; 125(4): 396-402, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10216530

ABSTRACT

BACKGROUND: No reports have yet precisely determined corticotropin (ACTH) responsiveness in virilizing adrenocortical adenoma. METHODS: Five women with an androgen-secreting adrenal adenoma were reviewed. Three of them were examined by in vitro steroidogenesis. Two of these 3 patients were studied by immunohistochemistry of steroidogenic enzymes and for the gene expression of ACTH receptor by Northern blot analysis. RESULTS: In preoperative hormonal determinations plasma and urine androgens had increased. Dexamethasone did not suppress plasma and urinary androgens, nor did ACTH increase them. In vitro steroidogenesis revealed that the adenoma cells produced mainly dehydroepiandrosterone and a small amount of testosterone. ACTH did not increase the in vitro production of androgens. In immunohistochemical staining 5 enzymes involved in adrenal steroidogenesis were all expressed, especially 17 alpha-hydroxylase, which was strongly expressed in tumor cells. ACTH receptor messenger RNA was not detected in virilizing tumor tissues, whereas it was expressed in attached adrenal tissues. CONCLUSIONS: The lack of response to ACTH is the result of a deficiency of ACTH receptor expression in the virilizing tumor cells. Androgens were autonomously produced in adrenal adenoma cells without ACTH regulation.


Subject(s)
Adrenal Cortex Neoplasms/metabolism , Adrenocortical Adenoma/metabolism , Cytochrome P-450 Enzyme System/genetics , Receptors, Corticotropin/genetics , Virilism/metabolism , 17-alpha-Hydroxypregnenolone/analysis , Adolescent , Adrenal Cortex Neoplasms/genetics , Adrenal Cortex Neoplasms/surgery , Adrenalectomy , Adrenocortical Adenoma/genetics , Adrenocortical Adenoma/surgery , Adrenocorticotropic Hormone/analysis , Adrenocorticotropic Hormone/biosynthesis , Adrenocorticotropic Hormone/metabolism , Adult , Blotting, Northern , Cytochrome P-450 Enzyme System/analysis , Dehydroepiandrosterone/analysis , Dehydroepiandrosterone/biosynthesis , Dehydroepiandrosterone/metabolism , Female , Follow-Up Studies , Gene Expression Regulation, Enzymologic , Gene Expression Regulation, Neoplastic , Humans , Hydrocortisone/analysis , Hydrocortisone/biosynthesis , Hydrocortisone/metabolism , Immunohistochemistry , RNA, Messenger/analysis , Receptors, Corticotropin/analysis
16.
Surg Endosc ; 13(4): 343-5, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10094744

ABSTRACT

BACKGROUND: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described. METHODS: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors were evaluated by preoperative thin-slice computed tomography (CT) scan. (c) Solitary lesions were reconfirmed with intraoperative ultrasonography. (d) Partial adrenalectomy was performed with at least a 5-mm margin using a vascular stapler. RESULTS: Laparoscopic partial adrenalectomy was performed in five patients using the vascular stapler. Hemostasis was perfect in all five patients. The tumor was located in the inferior part of the right adrenal gland in three cases and in the upper pole of the left adrenal gland in two cases. The postoperation pathologic diagnosis was adrenocortical adenoma in all five patients, and excessive hormonal levels or symptoms all disappeared. CONCLUSIONS: Laparoscopic partial adrenalectomy can be performed safely using a vascular stapler.


Subject(s)
Adenoma/surgery , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Laparoscopy , Adenoma/diagnostic imaging , Adrenal Gland Neoplasms/diagnostic imaging , Adult , Aged , Female , Humans , Male , Middle Aged , Surgical Staplers , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography
17.
Endocr J ; 46(5): 681-6, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10670754

ABSTRACT

We studied the role of phosphorus retention in parathyroid cell proliferation and parathyroid hormone (PTH) oversecretion in severe secondary parathyroid hyperplasia. Mice transplanted with human parathyroid tissue from a patient who had undergone parathyroidectomy for severe secondary hyperparathyroidism were divided into four groups; each group was given a diet with a different phosphorus content (0.4, 0.7, 1.0, and 1.2%) to alter serum phosphorus concentrations. Histologic examinations of grafts by hematoxylin-eosin or by bromodeoxyuridine (BrdU) immunohistochemical staining were performed to assess parathyroid cell proliferation. Changes in serum phosphorus concentrations unidirectionally affected PTH secretion from the graft, because human PTH did not cross-react with mouse PTH. Serum phosphorus concentrations of 1.0P and 1.2P groups were significantly higher than those of 0.4P and 0.7P groups (p<0.05). Serum phosphorus concentrations were significantly correlated with the gradient of human PTH elevation with a coefficient of 0.48 and a p<0.05. Furthermore, serum phosphorus concentrations and the gradient of human PTH elevation were significantly higher in mice with BrdU-immunoreactive cells in the parathyroid graft than in mice without immunoreactive cells in the graft. These results indicate that uncontrolled hyperphosphatemia may accelerate the proliferation of parathyroid cells, exacerbating PTH oversecretion.


Subject(s)
Cell Division , Hyperparathyroidism, Secondary/pathology , Hyperparathyroidism, Secondary/physiopathology , Parathyroid Glands/pathology , Parathyroid Hormone/metabolism , Phosphorus/blood , Animals , Bromodeoxyuridine/metabolism , Diet , Female , Humans , Immunohistochemistry , Mice , Mice, Nude , Parathyroid Glands/transplantation , Phosphorus/administration & dosage
18.
J Endocrinol Invest ; 21(1): 43-7, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9633022

ABSTRACT

The suppression of parathyroid hormone (PTH) secretion by the administration of 1,25-dihydroxyvitamin D [1,25(OH)2D3] and 22-oxacalcitriol (OCT) was evaluated in nude mice transplanted with human hyperplastic parathyroid tissue. The parathyroid tissue was obtained for transplantation from a patient with severe secondary hyperparathyroidism who had undergone a parathyroidectomy. Tissue specimens were transplanted into the gluteus muscle of female nude mice. Animals were divided into two groups; one group was fed a normal diet, and the other group was fed a low calcium diet during the administration of OCT and 1,25(OH)2D3. OCT and 1,25(OH)2D3 were intraperitoneally administered two times every week, for a total of eight times. Serum calcium and phosphate levels were significantly higher in the mouse administered 1,25(OH)2D3 than in the mouse administered OCT. Serum alkaline phosphatase activity was elevated similarly in the mouse administered either OCT or 1,25(OH)2D3. OCT strongly suppressed human PTH secretion from the graft in mice with normal serum calcium levels as did 1,25(OH)2D3. However, human PTH secretion from the graft was stimulated by the administration of a low-calcium diet, despite OCT and 1,25(OH)2D3 administration. In summary, OCT and 1,25(OH)2D3 suppress PTH secretion even from severe secondary hyperplastic parathyroid tissue only in mice with normal or high calcium serum levels.


Subject(s)
Calcitriol/analogs & derivatives , Hyperparathyroidism, Secondary/physiopathology , Parathyroid Hormone/metabolism , Alkaline Phosphatase/blood , Animals , Calcitriol/pharmacology , Calcium/blood , Female , Humans , Hyperplasia , Kidney Failure, Chronic/complications , Mice , Mice, Nude , Parathyroid Glands/pathology , Parathyroid Glands/transplantation , Parathyroidectomy , Phosphates/blood
19.
Endocrinology ; 139(4): 1715-22, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9528954

ABSTRACT

ABSTRACT Tumor necrosis factor-alpha (TNF-alpha) exerts pleiotropic effects on thyroid follicular cells. However, the intracellular signaling pathway for the TNF-alpha action has not been well elucidated. The present study examined the effects of TNF-alpha on the activation of nuclear factor-kappa B (NF-kappaB) and on the expression of interleukin (IL)-6 gene in rat thyroid FRTL-5 cells. The treatment of the cells with TNF-alpha resulted in the nuclear translocation of p65-p50 heterodimer as well as p50-p50 homodimer NF-kappaBs. The treatment with the antioxidants 20 mM N-acetyl-L-cysteine (NAC) and 10 microM pyrrolidine dithiocarbamate (PDTC) inhibited the TNF-alpha-dependent activation of p65-p50 heterodimer but not the p50-p50 homodimer, indicating that generation of oxidants is required for the activation of the heterodimer NF-kappaB. When the plasmid containing the multimerized NF-kappaB sites upstream of a luciferase reporter gene was transfected into FRTL-5 cells, the treatment with NAC or PDTC prevented the TNF-alpha-dependent increase in the luciferase activities, indicating that the p65-p50 heterodimer is a transcriptionally active NF-kappaB. Accordingly, the TNF-alpha-dependent increase in IL-6 messenger RNA and in secretion of the protein was prevented by the treatment with NAC. These results strongly suggest that TNF-alpha increases the IL-6 gene expression through the activation of NF-kappaB in the thyroid cells, and that antioxidants suppress the TNF-alpha-dependent IL-6 expression by inhibiting the activation of the transcriptionally active NF-kappaB.


Subject(s)
Antioxidants/pharmacology , NF-kappa B/metabolism , Thyroid Gland/metabolism , Tumor Necrosis Factor-alpha/pharmacology , Animals , Biological Transport , Cell Line , Cell Nucleus/metabolism , Dimerization , Gene Expression , Humans , Interleukin-6/genetics , Luciferases/genetics , NF-kappa B/antagonists & inhibitors , NF-kappa B/genetics , RNA, Messenger/metabolism , Rats , Recombinant Fusion Proteins , Transfection
20.
Biochem Biophys Res Commun ; 236(1): 71-4, 1997 Jul 09.
Article in English | MEDLINE | ID: mdl-9223428

ABSTRACT

Thyrotropin (TSH) induces the expression of fos and jun family genes in thyroid cells. The DNA-binding activity of these gene products (AP-1) has been shown to be enhanced by ubiquitous nuclear redox factor-1 (Ref-1). We thus examined whether TSH regulates Ref-1 gene expression in rat thyroid FRTL-5 cells. Northern blot analysis revealed that the abundance of Ref-1 mRNA significantly increased within 3 hours after TSH followed by a sustained increase until 12 hours. The increase was also induced by treatment with forskolin but not in the presence of cycloheximide, indicating that the TSH effect on Ref-1 mRNA is mediated by intracellular cAMP and requires de novo protein synthesis. Consistent with the elevation of the mRNA level, Western blot analysis showed an increase in Ref-1 protein 3 hours after TSH. The level continued to increase until 12 hours. These results suggested that increased Ref-1 by TSH might regulate the binding activity of AP-1 in thyroid cells. Considering that Ref-1 also has a DNA repair function, Ref-1 may play dual roles in gene regulation and DNA repair processes in thyroid cells.


Subject(s)
Carbon-Oxygen Lyases , DNA-(Apurinic or Apyrimidinic Site) Lyase , Nuclear Proteins/biosynthesis , RNA, Messenger/biosynthesis , Thyroid Gland/metabolism , Thyrotropin/pharmacology , Animals , Blotting, Western , Cell Line , Rats
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