Ring chromosomes in human neoplasias.

Though reported from a wide variety of human neoplasias, ring chromosomes, in general, are a rare finding in these diseases. The majority were detected by chance when tumors were screened for chromosomal aberrations. In most cases they are a part of highly complex karyotypic alterations and therefore part of unfavourable prognostic factors. However, in some tumor entities (e.g. tumors of mesenchymal origin) they are of such high prevalence (up to 70% of these tumors) and of such extraordinary specificity that they can even serve as cytogenetic hallmarks for differential diagnosis and for prognostic purposes. The well-known technical problems in malignant cells of achieving high banding quality to define all single chromosomal alterations have severely hampered clear identification of the chromosomes involved in rings until recently. Substantial progress of ring identification could only be achieved when molecular cytogenetic techniques became available. By these techniques it could not only be shown that certain breakpoint regions nonrandomly contribute to ring rearrangements which--at least in certain malignancies--are of basic importance, but also the molecular consequences of these changes could be defined in some cases. The present review summarizes a great number of reports on a total of 760 ring chromosomes in human neoplasias at different sites, but includes only cases with clearly identified rings. In addition, the molecular consequences of ring formation are addressed wherever pertinent information has recently been presented in the literature.

Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus.

OBJECTIVES: Normal-pressure hydrocephalus (NPH) syndrome is treatable by implantation of a cerebrospinal fluid (CSF) shunt. However, diagnosis of NPH by clinical and radiological findings alone is unreliable, and co-existing structural dementia can contribute to low success rates after shunt implantation. The aim of our study was to investigate whether long-term results after shunt implantation in NPH improve when surgical candidates are selected by continuous intraventricular pressure monitoring (CIPM). PATIENTS AND METHODS: Ninety-two consecutive patients who were admitted with suspected NPH received CIPM for 48 h including an intraventricular steady-state infusion test to determine the resistance outflow. With positive CIPM, shunt implantation was performed and the patients were prospectively followed up for 1 to 10 years (median 6.5 years). RESULTS: CIPM was negative in 37 patients. Fifty-five patients had a positive CIPM and received CSF shunt. 96.1% of them improved from gait disturbance, 77.1% from cognitive impairment and 75.7% from urinary dysfunction. Clinical improvement remained during long-term follow-up in all but 3 patients who showed a decline at 4, 5 and 7 years, respectively. CIPM-related complications (ventriculitis) occurred in only one patient. CONCLUSION: CIPM is a safe and valuable tool to establish a reliable diagnosis of NPH and to identify promising surgical candidates.

FISH studies on the telomeric regions of the T-cell acute lymphoblastic leukemia cell line CCRF-CEM.

So far, the problem of an influence of translocations on the telomeres of the involved chromosomes has not been addressed yet in human cells. Therefore, the telomeres of a karyotypically rather well characterized T-cell acute lymphoblastic leukemia (T-ALL) cell line (CCRF-CEM) with several marker chromosomes were examined using peptide nucleic acid (PNA) telomere FISH probes to compare the telomere length of these markers with that of the chromosome arms of their origin. In addition, chromosome libraries, centromeric probes, and subtelomeric DNA probes were used to further define the marker chromosomes. Two markers could be newly defined and a concise karyotype of the cell line could be obtained by these detailed examinations: 42-47,X,-X,del(5) (q35?),t(5;15)(q14;q13.2),t(8;9)(p11;p24),del(9)(:p13-->qter)/inv(9)(pter-->p12::q21-->p12::q21-->qter),+13,+20,+der(22)(p+ [HSR?])[cp]. The relative telomere length of all chromosomes showed considerable interchromosomal, intercellular, and inter-passage variation. However, it could be shown, that in four different passages of the examined cell line the observed differences between relative telomere lengths of the markers and the chromosomes of their origin, with two exceptions (short arms of del/inv9 and der22), were not significant. On the other hand, because of its mentioned variability, telomere length alone is not sufficient to reliably define the derivation of markers.

Are telomeres a specific target for mutagenic attack by cytostatics in neoplastic cells?

Damage to telomeres induced by cytostatic therapy theoretically could generate telomere shortening and, subsequently, induce an additional genomic instability in neoplastic cells. Model experiments were carried out to examine this hypothesis. Cells of the T-ALL derived cell line CCRF-CEM were exposed to various different concentrations of Bleomycin (BLM) or Mitomycin C (MMC) for various times. Telomere lengths of metaphase chromosomes of the exposed cells were compared with those without this exposure (controls). In addition, telomerase activity was determined with a TRAP assay under the given conditions using the BLM experiments as a model. Although slight changes of total telomere length could be found in single experiments, the differences between exposed and non-exposed cells were not significant. Also, a considerable telomerase activity was shown which, however, did not substantially differ between exposed and non-exposed cells. From these data it may be concluded that, at least in the examined cell line, telomeres are not a preferential target for this kind of mutagenic attack.

Studies on the action of mitomycin C and bleomycin on telomere lengths of human lymphocyte chromosomes.

In order to address the problem of the action of cytostatics on chromosome ends, telomere length was measured in human lymphocyte cultures exposed to mitomycin C (MMC) and bleomycin (BLM). Telomere-specific PNA probes were used for the quantitative estimation of the relative telomere length of each individual chromosome by fluorescence in situ hybridization. A high inter-cellular and inter-individual variability of relative telomere lengths was found throughout all experiments. Different responses could be observed with respect to the action of the examined mutagens: The total average fluorescence intensity of labeled telomere repeats was decreased under the action of MMC in two of the experiments, while two revealed no significant alteration. BLM caused no significant change of total average telomeric signal intensity in four, a clear decrease in one of the six experiments, and an increase in another. Although all chromosome ends contributed to the observed trends, single telomeres were affected in a very distinct way. The highest concentration of MMC (1 microg/ml) induced significant shortening of telomeres of the chromosome arms; 2q, 3p, 5q, 7p, 10q, 11p, 13q, 17p, 18p&q, and 21q in two independent experiments. In one BLM experiment with 8 microg/ml, the most distinct decrease (p< or =0.005) of telomeric fluorescence was found at the ends of chromosome arms; 1q, 6p, 17p, 20p&q, and 22q. The increase of telomeric signal intensity affected the telomeres of some individual chromosome arms more than others, e.g. 4q, 6p, 7p, 8p, 13p, and 18q. Although the telomere length of the individual chromosome arms varied widely, clear trends could be observed with respect to the rank which was occupied by telomeric length of the various chromosome arms. The telomeres of the 1p, 3p, 4q, 5p, 12q, and 13q chromosome arms throughout all experiments were among the longest; and those of 13p, 15p, 21p, and 22p were among the shortest telomeres of the karyotype. From these data, it can be concluded that MMC affects the telomeric repeat area of chromosomes more than BLM, which mostly had no significant effect on telomere length in the performed experiments.

The order of PNA-FISH-detected chromosomal telomere lengths in human T-cells is rather stable, even under the influence of strong mutagens.

The nucleo-protein structure of an intact telomere protects each chromosome from being recognized as a break and subsequently being degraded. The DNA component of this structure, the telomeric repeats, undergo attrition with every cell division, as well as in response to endogenous events, like oxidative stress. Exposure to exogenous damage promotes this process and leads to growth arrest, apoptosis and eventually to malignant transformation. It was thought that the shortest chromosome ends in humans are the most susceptible ones to become dysfunctional telomeres, and have therefore an important role in cell death and cancer. Here, we show that a stable hierarchy exists in the form of a telomere length profile of the whole human karyotype. This rank order is conserved between different human cell types and individuals, is maintained throughout a lifetime, and seems to be genetically determined. As a particular feature, this telomere length profile differs only marginally when normal human cell cultures and malignant transformed cells are compared. The profile is moreover stable when these different human cells are exposed to mutagens such as bleomycin or mitomycin C. From these findings, the question arises if also the stably long telomeres have a basic biological function.

Comet-assay in combination with PNA-FISH detects mutagen-induced DNA damage and specific repeat sequences in the damaged DNA of transformed cells.

The Comet-assay was applied to three transformed cell lines (HT1080, CCRF-CEM line and CHO) which were treated with the cytostatics bleomycin (BLM) or mitomycin C (MMC). In addition, PNA probes for the telomere repeat (TTAGGG)(n) were used for detection of telomeric DNA sequences in the damaged DNA. Data were compared with previously obtained results from peripheral leukocytes. The amount of migrating DNA increased in all cell types in a dose-dependent manner after BLM exposure. CHO cells reacted sensitively at low doses of the mutagen, and leukocytes had the highest dose-related effect up to 25 IU/ml which, however, did not further increase. A rather linear dose response characterized the HT1080 cells, the effect was lowest for the CCRF-CEM cells. While MMC at lower doses increased the percentage of migrating DNA in a dose-dependent manner, the higher doses induced shorter comets, on average, than the lower ones in all cell lines. With PNA-Comet-FISH obvious differences were found between the studied cell lines with respect to quantitative head/tail distribution of telomeric signals after BLM exposure. A large number of signal spots of various sizes were found in CHO cells, very small signals could be detected in the comets of both neoplasia cell lines. Dose-dependence of telomeres in the tail was most pro-nounced in CCRF-CEM and normal leukocytes, less in HT1080. The steepest dose-related increase of telomeric signals in the tail was found in CHO cells. The ratio between the migrated DNA and the telomeric signals in the tail varied distinctly between the examined cell types from 3:1 to 1:1. Taken together, Comet-FISH can detect mutagenic effects on specific DNA sequences. This may be of high practical value if amplified DNA sequences will be addressed by those examinations in future.

Therapy with OKT3 monoclonal antibody in refractory T cell acute lymphoblastic leukemia induces interleukin-2 responsiveness.

Administration of cytokines to patients with leukemia or lymphoma may recruit dormant malignant cells into cell cycle and thus make them more susceptible to chemotherapy. We treated a patient with refractory T cell acute lymphoblastic leukemia (ALL) with OKT3 monoclonal antibody and observed a dramatic but transient decrease of lymphoblasts. The T ALL cells were rather mature by morphology and immunophenotyping, expressing CD7, CD4, CD8 and CD3 surface antigens and nuclear TdT. Cytogenetic analysis revealed inversion of chromosome 14(q11q32.1). A total of 500 mg OKT3 (maximum dose 50 mg/day) was given. A decrease of lymphoblasts in the blood and a reduction of spleen size was observed. Complement levels dropped remarkably. Despite increasing serum levels of tumor necrosis factor, treatment was well tolerated overall. CD3 therapy induced strong IL-2 responsiveness of the lymphoblasts. Thus, OKT3 antibody treatment not only significantly decreased CD3-positive tumor cells, but also induced IL-2-mediated proliferation. This may also allow sequential application of CD3 and IL-2 to render certain T cell tumors more susceptible to chemotherapy.

Comparative genomic hybridization (CGH): ten years of substantial progress in human solid tumor molecular cytogenetics.

Data from ten years of research using comparative genomic hybridization (CGH) for the detection of chromosomal alterations in human solid tumors are concisely reviewed. By use of a basic methodology with some variations more or less specific patterns of genomic imbalances were found in a large number of tumors of various entities. Specific gains and losses of genomic material have not only opened the way to the detection of a series of cancer-related genes but also to clinical implications. Not only several areas of basic oncogenetic research, but also differential diagnosis, prognosis of disease progression, and therapeutic decisions have profited by CGH.

Loss of 9p21 is embedded in a complex but consistent pattern of genomic imbalances in oral squamous cell carcinomas.

35 oral squamous cell carcinomas examined previously by comparative genomic hybridization (CGH) exhibited 5 up to 47 copy number alterations (CNAs). 13 of those cases showed a loss of parts of the short arm of chromosome 9, band p21 being affected in all of these cases. A highly complex but strikingly consistent pattern of genomic imbalances with an average 31.5 CNAs per tumor was associated with this deletion, and gains clearly dominated over losses of genomic material. Comparable patterns, however, could also be found in tumors with a high number of CNAs (24 CNAs) but without the deletion. Low numbers of imbalances were accompanied by low consistency of the CNA patterns. None of these latter cases showed the deletion 9p21. 66.7% of the dim(9p21)-positive tumors were of class pT4 (vs. 22% in dim(9p21)-negative cases), 77% of stage III or IV (vs. 47% in the group without the deletion), but only 8% of the dim(9p21)-positive tumors were classified as grade 3 (vs. 41% in the negative group). Other clinicopathologic features like prevalence of relapse, or survival time could not be as clearly associated with the deletion. For instance, short relapse-free survival was clearly associated with a high number of CNAs, rather independent of presence or absence of dim(9p21) in the affected tumor. From these findings it is concluded that previously found associations of 9p21 deletion with clinical parameters can reasonably be estimated only in the context of the pattern and complexity of the genomic imbalances accompanying this chromosomal loss in the examined tumors.

The impact of complex chromosomal rearrangements on the detection of radiosensitivity in cancer patients.

BACKGROUND AND PURPOSE: Lymphocytes of a small fraction of cancer patients responded to in vitro irradiation with an extreme chromosomal reaction. A large portion of the observed chromosome aberrations were complex chromosomal rearrangements (CCR). The present study is an attempt to define the impact of CCR on the predictive detection of an intrinsic clinical radiosensitivity in cancer patients in more detail. MATERIALS AND METHODS: A three-colour 'FISH-painting' technique (chromosome in situ suppression (CISS) hybridization) was used for the detection of chromosomal rearrangements, induced by in vitro irradiation, in 81 samples of peripheral blood lymphocytes from 66 cancer patients. Thirty-three of those were assigned for radiation therapy, the others having just undergone radiation therapy. Seven healthy individuals served as controls. RESULTS: CCRs are a very rare event in non-irradiated cells. Lymphocytes of patients who had just undergone therapeutic irradiation, however, not only exhibited high basic frequencies of CCR but also responded to in vitro irradiation with a more drastic increase of CCR than did the lymphocytes of non-exposed patients. A high inter-individual variability of the reaction to in vitro irradiation could be generally stated. The lymphocytes of patients with clinical signs of an outstanding radiosensitivity responded with an unusually high frequency of CCR. The total number of CCRs detected by CISS was found to be dependent on the interval from a previous radiation therapy and was slightly influenced by previous cytostatic therapy. Irrespective of these influences, patients with clinically defined radiation hypersensitivity were those with the highest radiosensitivity also in cytogenetic terms (including CCR). CONCLUSION: The successful use of FISH-painting for the detection of CCR, in addition to the general breakage frequency, highlights its suitability in the identification of individual hypersensitivity to ionizing radiation. The time-consuming cytogenetic examination can be considerably reduced by its use.

Cytogenetic studies in lymphocytes of patients with rectal cancer.

Spontaneous and clastogen-induced chromosomal instability in a high-risk group (i.e, 33 patients with rectal carcinomas) was investigated using peripheral blood lymphocytes as target cells. In addition to the analysis of spontaneous and clastogen-induced chromosome aberrations, this study also included classical karyotype analysis and scoring of sister chromatid exchanges (SCE) in some of the patients. Diepoxybutane (DEB), 4-nitroquinoline-1-oxide (NQO), and bleomycin were used as standard clastogens. Lymphocytes of healthy control individuals were studied in parallel with each cancer patient. While only slight but significant differences could be detected of the average spontaneous, DEB- and bleomycin (G2)-induced chromosome breakage between patient and control lymphocytes, individual patients and two of the control individuals showed a more distinct increase in the frequency of the studied end points. These increases were documented by a variegated mosaicism of karyotypic changes and by an increased breakage rate induced by the clastogens. Neither the bleomycin-exposure in the G1 phase nor SCE was capable of detecting differences between the patients and controls. Of particular interest in the sense of high-risk individuals were seven patients and two control persons whose lymphocytes exhibited increased chromosomal sensitivity under more than one of the studied experimental conditions.

Patterns of genomic imbalances in human solid tumors (Review).

Based on comparative studies on CGH-detected genomic imbalances in head and neck squamous cell carcinomas and in ovarian tumors it was supposed that the patterns of genomic imbalances in human tumors are not only related to the oncogenic progress and tumor progression or specific for the tissue of origin, but also could be influenced by environmental (mutagenic) factors present in the environment of the evolving cancer. To base this hypothesis on a more solid ground, data obtained by use of comparative genomic hybridization (CGH) which were reported up to early 1999 from a large variety of more than 2400 human solid tumors, representing 18 different organs of origin or physical localizations, were collected and comparatively analyzed. Patterns of inter- and intra-chromosomal distribution of DNA sequence copy number changes pointed to high conformity on several chromosomal segments, but also revealed striking differences between the tumor types, the latter suggesting tumor specific, tissue specific and/or environment specific influences on the generation of genomic imbalance in human neoplasia. The clinical relevance of these findings must be examined further on by increasing the studied material.

Interphase cytogenetics by fish on archival paraffin material and cultured-cells on human ovarian-tumors.

Fluorescence in situ hybridization (FISH) studies were carried out on interphase nuclei of 15 ovarian tumors. Thin sections of paraffin-embedded archival tumor material and slides prepared from tumor cell suspensions were comparatively examined for chromosomal aneusomies using chromosome specific alphoid DNA probes. While the detection of hyposomies was less reliable in the paraffin material than in classical cytogenetic slides, hypersomies were detected more readily in the former. The practical advantages of interphase cytogenetics on histologic slides, however, under certain aspects may outweigh the technical shortcomings of FISH analyses on this material, particularly, if new methods combine the merits of both, classical cytogenetic preparation and thin section, and reduce the present methodological problems.

Use of fluorescence in-situ hybridization (fish) for the estimation of the aberrant cell clone in leukemias with trisomy-8 or monosomy-7 detected by karyotyping.

The sizes of leukemic cell clones with hypersomies of the chromosome #8 or monosomy #7, which primarily were detected by classical karyotyping, were estimated by fluorescence in situ hybridization (FISH) with centromeric DNA probes in interphase cell populations of the bone marrow of 31 leukemia patients. Particularly, the data obtained by both routes of analysis were compared quantitatively. As most prominent result, all aberrations found by classical karyotyping were redetected by interphase cytogenetics, but additional aberrant clones could be observed among the interphase cell populations. The frequencies of the cell clones with hypersomies #8, in general, were higher in metaphase than' in interphase, and, vice versa, cells monosomic for #7, in the majority of cases, were found to be more frequent in interphase than in metaphase. These data support the idea that metaphase data per se may not sufficiently reflect the actual portions of aneuploid cell clones in the whole leukemic cell population. This may be of practical importance in diagnostic and prognostic respects but also for the choice of specific therapies.

Amplification of protooncogenes in human ovarian carcinomas.

Amplification of the proto-oncogenes c-myc, c-erbB2, c-K-ras2, c-H-ras1, c-erbA1, c-int2 and c-fms was studied by Southern-blot analysis of DNA extracted from 27 primary ovarian carcinomas. In addition, karyotype analysis and interphase cytogenetics using fluorescence in situ hybridization (FISH) were applied to control the chromosomal variability of the tumors. By these additional analyses the possibility of a false estimation of the grades of amplification should be diminished. In nearly 50% of the studied tumors a low to moderate (2- to 10-fold) amplification of one or more oncogenes was detected. The proto-oncogene amplified most frequently was c-myc (11 tumors), followed by c-erbB2 and c-Kras2 (3 tumors each), c-fms (2 tumors), and c-int2 (1 tumor). Neither an amplification of c-erbA1 nor of c-H-ras1 could be detected in any of the tumors. Some of the tumors showed a simultaneous amplification of two or three oncogenes. The pattern of proto-oncogene amplification clearly differentiates the studied ovarian cancers from breast tumors, but also differs from some previous results obtained from ovarian carcinomas.

Apc gene-mutations in familial adenomatous polyposis-coli identified at the DNA and protein level.

Peripheral blood cell DNA of patients suffering from Familial Adenomatous Polyposis coli (FAP) were subjected to SSCP screening analyses. Here, we report on a patient, who was diagnosed at the age of 31 years suffering from a severe form of adenomatous polyposis coli. The germline mutation was identified to result from a 5-bp germline microdeletion surrounding Adenomatous Polyposis Coli (APC) codon 1309. Examination of DNA derived from pooled adenomas of the same patient confirmed the inherited mutation. Western blot analysis with an APC N-terminus specific antiserum (anti-APC123) applied to tumor-derived proteins identified a polypeptide chain of 140 kD corresponding to the truncation induced by the APC germline mutation. We further examined DNA isolated individually from eight adenomas of the same patient. The analysis revealed the surprising observation, that three out of eight tumor samples analyzed, gave rise to a predominant PCR-amplified band of normal size, implicating that the allele containing the germline deletion had been lost, and instead hemi-/homozygosity for the somatic, not for the germline mutation had been aquired as a tertiary event. A similar mutational mechanism has been reported for the Rb-1 tumor suppressor gene in the retinoblastoma model.

FISH monitoring of 100 courses of human leukemias: the cytogenetic viewpoint.

Interphase fluorescence in situ hybridization (I-FISH) analyses were performed from 2 up to 13 times along the course of 100 human leukemias (36 chronic myeloid leukemias, 38 acute myeloblastic leukemias, 17 acute lymphoblastic leukemias, and 9 additional hematopoietic neoplasias) in order to control clonality, evolution, and disappearance of the basic cytogenetic changes. The relevance of these data to confirm clinical remission or to detect minimal residual disease and/or relapse was evaluated. Fifty-four patients were monitored following hematopoietic stem cell transplantation, and 46 cases after chemotherapy. Various chromosome or aberration specific DNA probes were applied for follow-up in the time frame of 1 month up to 13 years. From the cytogenetic point of view, the aim was to determine the power of resolution of the I-FISH technique in the detection of clinically significant changes in the course of disease and its usefulness in daily routine cyto-genetics as compared with classical cytogenetics. In addition, reliability standards of the various DNA probes should be established. In 75 patients with remissions during the entire period of I-FISH monitoring no conspicuous signal constitution was detected. Of 25 relapses or progresses of disease, which were clinically confirmed, 22 were reliably detected by I-FISH, in only 1 case I-FISH monitoring failed to detect the aberrant clone. In 2 patients conventional karyotype analysis confirmed the relapse by detecting complex chromosomal aberrations, but specific probes for I-FISH confirmation were not available. These data suggest that I-FISH analyses in the follow-up of leukemias is a simple and in most cases sufficiently sensitive and highly reliable way of monitoring the outcome of therapy. It may well serve to close the gap between conventional karyotyping and the highly sensitive molecular techniques.

Chromosome gain and loss in paraffin sections from malignant melanomas of the skin.

Alphoid DNA probes specific for the chromosomes #6, #7, #9, and #17 were used to screen interphase nuclei for numerical chromosome aberrations in histologic thin sections obtained from archival paraffin material of 25 human melanomas of different type, thickness and stage of progression. An alphoid probe for chromosome #3 was applied in four of these tumors. Besides a general large variation of the number of subpopulations of cells characterized by gains and losses of the studied chromosomes, there was a trend to higher variability in metastatic melanomas as compared to small (<1.5 mm thickness) non-metastatic ones and, particularly, to normal skin tissue. Chromosomes #6 and #9 were those often affected by loss in thick melanomas (>2 mm), while subpopulations showing a gain of these chromosomes, and, in addition, of chromosome #7 seemed more frequently to be associated with thin and non-metastatic ones. The frequency of cases showing gain of chromosome #17 clearly exceeded those with loss of this chromosome in the studied melanomas, but was most pronounced in thicker metastatic tumors.

The peripheral myelin protein 22 kDa (PMP22) gene is amplified in cell lines derived from glioma and osteogenic sarcoma.

Two glioma (SF188, SF763) and two osteogenic sarcoma cell lines (RH30, SA1) were examined for the presence of an amplification of the PMP22 gene by means of fluorescence in situ hybridization (FISH). In one cell line of both cell types, we found about 10 copies of the PMP22 (peripheral myelin protein 22 kDa) gene, located on different marker chromosomes within homogeneously staining regions. Surrounding chromosome 17p material was found to be coamplified, but coamplification of TP53 (17p13) and erbB2/Her2 (17q11.12) were excluded by FISH for both cell lines, SF763 and RH30. This is the first report of a PMP22 amplification in cell lines derived from human tumors.