A truncated cytoplasmic topoisomerase IIalpha in a drug-resistant lung cancer cell line is encoded by a TOP2A allele with a partial deletion of exon 34.

To study the problem of acquired resistance to widely used anti-cancer drugs that target the 170 kDa topoisomerase IIalpha (topo IIalpha), a drug-resistant human small-cell lung cancer cell line, H209/VP, was selected in VP-16. H209/VP cells express reduced levels of the 170 kDa topo IIalpha that is localized normally in the nucleus and also express lower levels of a 160 kDa topo IIalpha-related protein that is located predominantly in the cytoplasm. Band depletion immunoblotting experiments suggest that the H209/VP nuclear 170 kDa topo IIalpha is able to form ternary complexes with DNA and VP-16 in intact cells, but the ability of the cytoplasmic 160 kDa protein to do so is greatly diminished. Sequence analysis of the 3; end of the H209/VP mutant topo IIalpha mRNA and the TOP2A gene indicates that the mRNA is missing 200 nt that corresponds to exon 34 because the partial loss of the minimal 3; splice-acceptor sequence at the beginning of exon 34 results in splicing of exon 33 to exon 35. The protein predicted to be encoded by this mutant mRNA does not contain the COOH-terminal 109 amino acids of the wild-type enzyme that we have demonstrated contain a strongly functional nuclear localization signal sequence. Consequently, our data explain both the size and the cytoplasmic localization of the H209/VP mutant topo IIalpha. The mutant TOP2A allele in H209/VP cells differs from those in previously characterized cell lines with cytoplasmic topo IIalpha and extends the number of types of resistance-associated deletions in this region to 4. These findings indicate that this region of the TOP2A gene may be a hot spot for mutations.

Two COOH-terminal truncated cytoplasmic forms of topoisomerase II alpha in a VP-16-selected lung cancer cell line result from partial gene deletion and alternative splicing.

Topoisomerase II alpha is a nuclear enzyme involved in chromosome segregation and other essential cellular processes. It is also the target of several clinically important antineoplastic agents such as the epipodophyllotoxin, VP-16 (etoposide). We have previously described a VP-16-selected lung cancer cell line, H209/V6, that expresses reduced levels of two species of topoisomerase II alpha-related mRNAs and a catalytically active, predominantly cytoplasmic topoisomerase II alpha-related protein that is 10 kDa smaller than the wild-type protein [Mirski, S. E. L., et al. (1993) Cancer Res. 53, 4866-4873; Feldhoff, P. W. et al. (1994) Cancer Res. 54, 756-762]. The smaller H209/V6 4.8 kb mRNA is missing 988 nucleotides of contiguous coding and non-coding sequence at its 3' end resulting in an mRNA predicted to encode a truncated polypeptide missing three previously unrecognized potential COOH-proximal bipartite nuclear localization signals [Mirski, S. E. L., & Cole, S. P. C. (1995) Cancer Res. 55, 2129-2134]. We have now determined the structure of the larger 6.2 kb topoisomerase II alpha-related mRNA and show that it is missing 684 nucleotides of contiguous 3' coding and non-coding sequence between nucleotide positions 4267 and 4951. This sequence is replaced by 847 nucleotides of new sequence, containing an in-frame stop codon after 41 nucleotides. The translation product of the 6.2 kb mRNA is predicted to contain 13 new amino acids replacing the COOH-terminal 109 residues of wild-type topoisomerase II alpha, producing a truncated polypeptide of approximately 160 kDa. Immunoblot analyses using antisera against the unique COOH-terminal 13 and 34 amino acids encoded by H209/V6 6.2 kb and 4.8 kb mRNAs, respectively, confirmed that both mRNAs are translated. Restriction enzyme analysis and sequencing of the 3'-proximal region of the TOP2A gene in the H209 and H209/V6 DNA revealed that a partial deletion has occurred in H209/V6 and the novel sequence identified in the H209/V6 6.2 kb mRNA is derived from the adjacent 3' intron as a consequence of read-through at a concensus splice donor site. These observations suggest a mechanism for the generation of the two mutant topoisomerase II alpha mRNAs in H209/V6 cells and provide the first reported example of a drug resistant cell line containing two different cytoplasmic forms of topoisomerase II alpha.

Pharmacological characterization of multidrug resistant MRP-transfected human tumor cells.

We have previously identified and characterized a novel member of the ATP-binding cassette superfamily of transport proteins, multidrug resistance protein (MRP), and subsequently demonstrated that its overexpression is sufficient to confer multidrug resistance on previously sensitive cells (Cole et al., Science (Washington DC), 258: 1650-1654, 1992; Grant et al., Cancer Res. 54: 357-361, 1994). In the present study, we have transfected two different eukaryotic expression vectors containing MRP complementary DNA into HeLa cells to study the pharmacological phenotype produced exclusively by overexpression of human MRP. The drug resistance patterns of the two MRP-transfected cell populations were similar. They were characterized by a moderate (5- to 15-fold) level of resistance to doxorubicin, daunorubicin, epirubicin, vincristine, and etoposide, and a low (< or = 3-fold) level of resistance to taxol, vinblastine, and colchicine. The transfectants were not resistant to 9-alkyl anthracyclines, mitoxantrone, or cisplatin. The MRP-transfected cells were also resistant to some heavy metal anions including arsenite, arsenate, and trivalent and pentavalent antimonials but were not resistant to cadmium chloride. Accumulation of radiolabeled vincristine was reduced by 45% in the MRP-transfected cells and could be restored to the levels found in sensitive cells by depletion of ATP. Rates of vincristine efflux did not differ greatly in the sensitive and resistant cells. The cytotoxic effects of vincristine and doxorubicin could be enhanced in a dose-dependent fashion by coadministration of verapamil. Cyclosporin A also increased vincristine toxicity but had less effect on doxorubicin toxicity. The degree of chemosensitization by verapamil and cyclosporin A was similar in MRP-transfected cells and in cells transfected with the vector alone, suggesting that sensitization involved mechanisms independent of MRP expression. Verapamil and cyclosporin A caused a modest increase in vincristine accumulation in the resistant cells but did not restore levels to those of the sensitive cells. Taken together, these data indicate that drug-resistant cell lines generated by transfection with MRP complementary DNA display some but not all of the characteristics of MRP-overexpressing cell lines produced by drug selection in vitro. They further demonstrate that the multidrug resistance phenotype conferred by MRP is similar but not identical to that conferred by P-glycoprotein and includes resistance to arsenical and antimonial oxyanions.

Alternatives for cardiac rehabilitation patients unable to return to a hospital-based program.

OBJECTIVE: To determine the effectiveness of a home exercise program using transtelephonic exercise monitoring (TEM). DESIGN: Prospective, two-group experimental, random assignment. SETTING: Urban centered hospital and surrounding community. SUBJECTS: Twenty cardiac rehabilitation patients entering a Phase II cardiac rehabilitation program. OUTCOME MEASURES: Maximal oxygen consumption, blood pressure, pressure-rate product, workload. INTERVENTION: Twenty male cardiac patients were randomly enrolled in either a 12-week home- or hospital-based exercise program. Maximal exercise tolerance tests were conducted, before and after exercise intervention, on a computer-driven bicycle ergometer. Subjects trained 3 days per week for 12 weeks on a bicycle ergometer for a maximum of 35 minutes at 75% of maximum heart rate reserve or functional capacity. RESULTS: Posttraining results showed significant improvement in cardiac function for both groups. Two patients in the TEM group developed new arrhythmias while exercising that required medication changes; however, no medical emergencies arose in either exercise group. Independent Student t test showed no significant difference between groups before or after training. CONCLUSIONS: We conclude that TEM is an effective alternative for the rehabilitation of patients who are unable to return to a hospital-based program.

Percent body fat in obese white females predicted by anthropometric measurements.

The percent body fat (PBF) and 15 anthropometric measurements were measured in 221 obese white females randomly assigned to validation and cross-validation groups. Two new anthropometric equations for the prediction of the percent of body fat were generated by multiple regression. Equation 1 includes the residual lung volume (RV) as a factor and had a correlation coefficient (r) of 0.85 and a standard error of the estimate (SEE) of 3.9%. Equation 2 does not include the RV and has an r of 0.82 and an SEE of 4.3%. Both equations were more precise than two previous widely used equations. In a subgroup of 37 subjects who underwent weight loss, equation 1 gave a more precise estimate of the change in PBF. We conclude that the new equations permit a better prediction of the PBF in obese white females.

Low exercise ventilation in endurance athletes.

Previous studies have shown that endurance athletes are endowed with low ventilatory responses to chemical stimuli. The implications of this association have never been clear. Although recent evidence shows that exercise ventilation (VE) correlates with ventilatory chemoresponsiveness in a group of athletes, the extent to which non-athletes may differ from athletes in this regard is unknown. We have examined the relationship between ventilatory chemoresponsiveness and exercise VE in a group of 7 non-athletes, and contrasted these findings with those obtained previously from 8 endurance and 8 non-endurance athletes. Correlation lines of exercise VE with chemical responses were similar in slope and intercept for both athletes and non-athletes. However, we found that non-athletes had greater exercise VE per unit metabolic rate (VO2 or VCO2), and greater ventilatory responses to O2 and CO2, when compared with endurance athletes at equal relative work loads (P less than 0.05). The lower exercise VE/VCO2 of endurance athletes as compared with non-athletes persisted in hyperoxia, indicating that factors other than differences in hypoxic sensitivity explain the lower exercise VE of endurance athletes. Low exercise VE may be the link between low ventilatory chemosensitivity and outstanding endurance athletic performance.

Exercise ventilation correlates positively with ventilatory chemoresponsiveness.

To determine the relationship of ventilatory responsiveness to hypoxia and hypercapnia to exercise hyperpnea, these responses and steady-state exercise ventilation (VE) were measured in 16 athletes during light (1/3 VO2 max) and heavy (2/3 VO2 max) exercise. Both the hypoxic and hypercapnic ventilatory responses correlated positively with VE per unit metabolic rate (VE/VCO2) at both exercise levels (P less than 0.05). The contribution of the hypoxic response to normoxic exercise VE was quantified by comparing VE in normoxia to VE during a brief (1 min) exposure to high O2 (PAO2 = 200 Torr). High O2 reduced normoxic exercise VE by a mean of 20% at either exercise intensity. Among individuals this reduction was directly dependent upon the intensity of the hypoxic response, and ranged from 7 to 42% of normoxic VE. After the variable reduction of normoxic VE by hyperoxia, all correlations of ventilatory response with exercise VE were lost except for the correlation of hypercapnic response with heavy exercise VE/VCO2. These findings indicate that the extent of VE in light or heavy exercise is modified by the strength of the hypoxic ventilatory response, and that the hypercapnic response independently correlates with VE during heavy exercise.

The adipokinetic effect of hyperthermic stress in man.

The purpose of this investigation was to assess the alteration in serum free fatty acid concentrations during heat stress and dehydration. Each subject was exposed to heat stress in an environment chamber on 2 separate occasions. During the first exposure the subjects remained seated until the core temperature was elevated 1.4degreesC resulting in a mean weight loss of 1.66 kg due to dehydration. The second condition involved water replacement equal to the weight loss of the initial dehydration condition. Blood samples were obtained prior to heat exposure, when the core temperature was elevated 0.7degreesC and 1.4degreesC. They were subsequently analyzed for free fatty acids (FFA), glucose and lactin acid. Heart rates and core temperatures were monitored at 4 min intervals. During the dehydration condition the mean change in serum FFA was 0.9 muEq/ml in contrast to 0.2 muEq/ml for the rehydration condition. Serum levels of glucose increased moderately throughout the exposure (8 mg-%).