Elimination of Ehrlich tumours by ATP-induced growth inhibition, glutathione depletion and X-rays.

ATP-induced tumour growth inhibition is accompanied by a selective decrease in the content of the tripeptide glutathione (GSH) within the cancer cells in vivo. Depletion of cellular GSH sensitizes tumours to chemotherapy and radiation, but the usefulness of this depletion depends on whether the levels of GSH can be reduced in the tumour relative to normal tissues. We report here that administration of ATP in combination with diethylmaleate and X-rays leads to complete regression of 95% of Ehrlich ascites tumours in mice. This shows that an aggressive tumour can be eliminated by using a therapy based on modulation of GSH levels in cancer cells.

Mitochondrial glutathione depletion by glutamine in growing tumor cells.

The effect of L-glutamine (Gln) on mitochondrial glutathione (mtGSH) levels in tumor cells was studied in vivo in Ehrlich ascites tumor (EAT)-bearing mice. Tumor growth was similar in mice fed a Gln-enriched diet (GED; where 30% of the total dietary nitrogen was from Gln) or a nutritionally complete elemental diet (SD). As compared with non-tumor-bearing mice, tumor growth caused a decrease of blood Gln levels in mice fed an SD but not in those fed a GED. Tumor cells in mice fed a GED showed higher glutaminase and lower Gln synthetase activities than did cells isolated from mice fed an SD. Cytosolic glutamate concentration was 2-fold higher in tumor cells from mice fed a GED ( approximately 4 mM) than in those fed an SD. This increase in glutamate content inhibited GSH uptake by tumor mitochondria and led to a selective depletion of mitochondrial GSH (mtGSH) content (not found in mitochondria of normal cells such as lymphocytes or hepatocytes) to approximately 57% of the level found in tumor mitochondria of mice fed an SD. In tumor cells of mice fed a GED, 6-diazo-5-norleucine- or L-glutamate-gamma-hydrazine-induced inhibition of glutaminase activity decreased cytosolic glutamate content and restored GSH uptake by mitochondria to the rate found in EAT cells of mice fed an SD. The partial loss of mtGSH elicited by Gln did not affect generation of reactive oxygen intermediates (ROIs) or mitochondrial functions (e.g., intracellular peroxide levels, O(2)(-)(*) generation, mitochondrial membrane potential, mitochondrial size, adenosine triphosphate and adenosine diphosphate contents, and oxygen consumption were found similar in tumor cells isolated from mice fed an SD or a GED); however, mitochondrial production ROIs upon TNF-alpha stimulation was increased. Our results demonstrate that glutamate derived from glutamine promotes an inhibition of GSH transport into mitochondria, which may render tumor cells more susceptible to oxidative stress-induced mediators.

Blood glutathione as an index of radiation-induced oxidative stress in mice and humans.

The effect of x-rays on GSH and GSSG levels in blood was studied in mice and humans. An HPLC method that we recently developed was applied to accurately determine GSSG levels in blood. The glutathione redox status (GSH/GSSG) decreases after irradiation. This effect is mainly due to an increase in GSSG levels. Mice received single fraction radiotherapy, at total doses of 1.0 to 7.0 Gy. Changes in GSSG in mouse blood can be detected 10 min after irradiation and last for 6 h within a range of 2.0-7.0 Gy. The highest levels of GSSG (20.1 +/- 2.9 microM), a 4.7-fold increase as compared with controls) in mouse blood are found 2 h after radiation exposure (5 Gy). Breast and lung cancer patients received fractionated radiotherapy at total doses of 50.0 or 60.0 Gy, respectively. GSH/GSSG also decreases in humans in a dose-response fashion. Two reasons may explain the radiation-induced increase in blood GSSG: (a) the reaction of GSH with radiation-induced free radicals resulting in the formation of thyl radicals that react to produce GSSG; and (b) an increase of GSSG release from different organs (e.g., the liver) into the blood. Our results indicate that the glutathione redox ratio in blood can be used as an index of radiation-induced oxidative stress.

Changes in glutathione status and the antioxidant system in blood and in cancer cells associate with tumour growth in vivo.

The relationship among cancer growth, the glutathione redox cycle and the antioxidant system was studied in blood and in tumour cells. During cancer growth, the glutathione redox status (GSH/GSSG) decreases in blood of Ehrlich ascites tumour-bearing mice. This effect is mainly due to an increase in GSSG levels. Two reasons may explain the increase in blood GSSG: (a) the increase in peroxide production by the tumour that, in addition to changes affecting the glutathione-related and the antioxidant enzyme activities, can lead to GSH oxidation within the red blood cells; and (b) an increase of GSSG release from different tissues into the blood. GSH and peroxide levels are higher in the tumour cells when they proliferate actively, however GSSG levels remain constant during tumour growth in mice. These changes associate with low levels of lipid peroxidation in plasma, blood and the tumour cells. The GSH/GSSG ratio in blood also decreases in patients bearing breast or colon cancers and, as it occurs in tumour-bearing mice, this change associates with higher GSSG levels, especially in advanced stages of cancer progression. Our results indicate that determination of glutathione status and oxidative stress-related parameters in blood may help to orientate cancer therapy in humans.

Glutamine potentiates TNF-alpha-induced tumor cytotoxicity.

L-glutamine (Gln) sensitizes tumor cells to tumor necrosis factor (TNF)-alpha-induced cytotoxicity. The type and mechanism of cell death induced by TNF-alpha was studied in Ehrlich ascites tumor (EAT)-bearing mice fed a Gln-enriched diet (GED; where 30% of the total dietary nitrogen was from Gln). A high rate of Gln oxidation promotes a selective depletion of mitochondrial glutathione (mtGSH) content to approximately 58% of the level found in tumor mitochondria of mice fed a nutritionally complete elemental diet (standard diet, SD). The mechanism of mtGSH depletion involves a glutamate-induced inhibition of GSH transport from the cytosol into mitochondria. The increase in reactive oxygen intermediates (ROIs) production induced by TNF-alpha further depletes mtGSH to approximately 35% of control values, which associates with a decrease in the mitochondrial transmembrane potential (MMP), and elicits mitochondrial membrane permeabilization and release of cytochrome c. Mitochondrial membrane permeabilization was also found in intact tumor cells cultured with a Gln-enriched medium under conditions of buthionine sulfoximine (BSO)-induced selective GSH synthesis inhibition. Enforced expression of the bcl-2 gene in tumor cells could not avoid the glutamine- and TNF-alpha-induced cell death under conditions of mtGSH depletion. However, addition of GSH ester, which delivers free intracellular GSH and increases mtGSH levels, preserved cell viability. These findings show that glutamine oxidation and TNF-alpha, by causing a change in the glutathione redox status within tumor mitochondria, activates the molecular mechanism of apoptotic cell death.

Growth-associated changes in glutathione content correlate with liver metastatic activity of B16 melanoma cells.

B16 melanoma (B16M) was used to study the relationship between glutathione (GSH) metabolism and the metastatic activity of malignant cells. GSH content increased in B16M cells during the initial period of exponential growth in vitro, to reach a maximum of 37 +/- 3 nmol/10(6) cells 12 h after plating, and then gradually decreased to control values (10 +/- 2 nmol/10(6) cells) when cultures approached confluency. On the contrary, glutathione disulphide (GSSG) levels (0.5 +/- 0.2 nmol/10(6) cells) and the rate of glutathione efflux (GSH + GSSG) (2.5 +/- 0.4 nmol/10(6) cells per h) remained constant as B16M grew. Changes in enzyme activities involved in GSH synthesis or the glutathione redox cycle did not explain shifts in the glutathione status (GSH/GSSG). However, two facts contributed to explain why GSH levels changed within B16M cells: a) high intracellular levels of GSH induced a feed-back inhibition of its own synthesis in B16M cells from cultures with low cellular density (LD cells); b) transport of cyst(e)ine, whose availability is the major rate-limiting step for GSH synthesis, was limited by cell-cell contact in cultures with high cellular density (HD cells). Intrasplenic injection of B16M cells with high GSH content (exponentially-growing cultures) showed higher metastatic activity in the liver than cells with low GSH content (cells at confluency). However, when low GSH-content cells (HD cells) were incubated in the presence of GSH ester, which rapidly enters the cell and delivers free GSH, their metastatic activity significantly increased. Our results demonstrate that changes in GSH content regulate the metastatic behaviour of B16M cells.

Possible mechanisms for tumour cell sensitivity to TNF-alpha and potential therapeutic applications.

TNF is a macrophage/monocyte-derived cytokine with cytostatic and cytotoxic anti-tumour activity. TNF-alpha can cause haemorrhagic necrosis and regression of experimental tumours. Nevertheless, the TNF-alpha doses required to cure tumour-bearing mice lead to injury of normal tissues and, eventually, may cause a lethal shock syndrome. This toxicity implies severe limitations for the therapeutic use of TNF-alpha. Reactive oxygen intermediates (ROls) are involved in TNF-alpha-induced cell killing. Different studies are consistent with the hypothesis that tumour cell sensitivity to TNF-alpha is related to its capacity to buffer oxidative attack. Recently, we have demonstrated that the sensitivity of Ehrlich ascites tumor (EAT) cells to TNF depends on their glutathione (GSH, the most prevalent nonprotein thiol in mammalian cells) content and their rate of proliferation. This is important because tumour cell populations under active proliferative states may show higher GSH levels, and drug- and/or radiation-resistant tumours have increased cellular levels of GSH. TNF-alpha induces a shift towards oxidation in the mitochondrial glutathione (mtGSH) status, a fact that is consistent with the hypothesis that mtGSH plays a key role in scavenging TNF-induced ROIs. GSH, which is not synthesized within mitochondria but is neccessary for their normal function, needs to be taken up from the cytosol through a high affinity multicomponent transport system. In consequence, different approaches that lead to depletion of mtGSH may improve the anticancer efficacy of TNF-alpha both in vitro and in vivo. As an example, EAT-bearing mice fed a glutamine-enriched diet (GED) show a selective increase of glutamate content witihin the tumour cells. Glutamate inhibits GSH uptake by tumour mitochondria and leads to a selective depletion of mtGSH content (not found in mitochondria of normal cells) to approx. 57% of the level found in tumour mitochondria of mice fed a standard diet (SD). Administration of rhTNF-alpha, which increases generation of mitochondrial ROIs, to EAT-bearing mice fed a SD does not affect significantly the rate of tumour growth. However, when tumour-bearing mice fed a GED where treated with rhTNF-alpha the number of viable tumour cells was decreased to approx. 38% of controls.

Regulation of tumour cell sensitivity to TNF-induced oxidative stress and cytotoxicity: role of glutathione.

Glutathione (GSH) and the rate of cellular proliferation determine tumour cell sensitivity to tumour necrosis factor (TNF). Buthionine sulphoximine (BSO), a selective inhibitor of GSH synthesis, inhibits tumour growth and increases recombinant human TNF (rhTNF)-alpha cytoxicity in vitro. Administration of sublethal doses of rhTNF-alpha to Ehrlich ascites-tumour (EAT)-bearing mice induces oxidative stress (as measured by increases in intracellular peroxide levels, O2.- generation and mitochondrial GSSG). ATP-induced selective GSH depletion, when combined with rhTNF-alpha administration, affords a 61% inhibition of tumour growth and results in a significant extent of host survival. Administration of N-acetylcysteine (NAC) or GSH ester abolishes the rhTNF-alpha and ATP-induced effects on tumour growth by maintaining high GSH levels in the cancer cells. TNF-induced mitochondria GSH depletion appears critical in the cascade of events that lead to cell death.

[Validity of clinical tests to confirm or exclude the diagnosis of acute myocardial infarction]. / Validez de las pruebas diagnósticas para confirmar o descartar un infarto agudo de miocardio.

BACKGROUND: To know the clinical usefulness of the diagnostic tests habitually used to diagnose an acute myocardial infarction (MI), in a group of patients in which this diagnosis is clinically highly suspected. PATIENTS AND METHODS: A cross sectional study was designed. The sample (n = 114) was randomized and selected by term and specific of days from the patients attending the Emergency Service at Elda General Hospital (Alicante, Spain) in a year period. The method we used was is a validity study, making 2 x 2 tables. The clinical outcome was the gold standard and was cross matched with some of the clinical criteria habitually used to diagnose acute myocardial infarction: thoracic pain character, irradiation, ECG findings and CK-MB levels. RESULTS: Clinical suspicion of MI was confirmed in only 27.8% (IC--95%: 19.3-36.3). The best validity indexes of clinical usefulness to confirm the MI diagnosis were obtained from ECG findings (CP+ = infinity) and CK-MB (CP+ = 24.2 at the end of the observational period and CP = 17.9 at the beginning). The best negative clinical validity indexes were CK values obtained at the end of the observational period (CP- = 0.07) and the ECT findings obtained at the end of the observational period (CP- = 0.10). CONCLUSION: Clinical carefulness is essential to avoid a diagnostic mistakes in MI patients, since the symptoms we used as a diagnostic guide do not offer good validity indexes. Changes in ECG or CK-MB levels could confirm the MI diagnosis but normal findings in both tests did not discard this diagnosis. We should keep the possibility of a mistake till the end of the observational period.

[Validity of clinical tests to confirm or to exclude the diagnosis of acute appendicitis]. / Validez de las pruebas diagnósticas para confirmar o descartar una apendicitis aguda.

AIMS: The clinical usefulness of the diagnostic tests (usually employed to diagnose an acute appendicitis in a group of patients in which this diagnosis is clinically highly suspected). PATIENTS AND METHODS: A cross sectional study was designed. The sample (n = 116) was randomly selected by term and specific days from the patients attending the Emergency Service at Elda General Hospital in a year period. The method used was is a validity study making 2 x 2 tables. We have cross matched the habitual routine tests with: a) the clinical outcome if the patient was not surgically treated, or b) the result of the biopsy for those operated. Being these the gold standard. The validity indexes studied were sensibility (S), specificity (E). The 95% confidence index of the CF were calculated. RESULTS: Acute appendicitis clinical suspicion was confirmed in 29.4% (IC 95%: 20.8-38). The best validity indexes were: a) kind of pain (S = 81.3; E = 33.8); b) peritoneal inflammatory signs (S = 78.5%, E = 45.9%); c) presence of leucocytosis in blood exam (S = 100%, E = 54.5%), and d) a greater difference in axillary-rectum temperature (S = 13.6%, E = 96.6%). Only leucocytosis reached 0 for PP- and CP-; the blood leucocytosis (PP+ = 47.8%, CP+ = 2.20) and the axillary-rectum temperature (PP+ = 60%, CP+ = 4.0) dissociation were the test with most valuable indexes. CONCLUSIONS: Clinical suspicion of acute appendicitis in a group of patients having a great probability of suffering it over estimates this diagnosis. The symptoms or signs routinely used in the diagnosis did not reach high validity indexes in these patients. They are a poor help to stress or reject the diagnosis of acute appendicitis. To be careful is the main tool the doctors have. Blood leucocytosis is the test that has the best agreement indexes of clinical usefulness and it has the best countence with the gold standard.

Glutathione and the rate of cellular proliferation determine tumour cell sensitivity to tumour necrosis factor in vivo.

Low rates of cellular proliferation are associated with low GSH content and enhanced sensitivity of Ehrlich ascites-tumour (EAT) cells to the cytotoxic effects of recombinant human tumour necrosis factor (rhTNF-alpha). Buthionine sulphoximine, a selective inhibitor of GSH synthesis, inhibited tumour growth and increased rhTNF-alpha cytoxicity in vitro. Administration of sublethal doses (10(6)units/kg per day) of rhTNF-alpha to EAT-bearing mice promoted oxidative stress (as measured by increases in intracellular peroxide levels, O2(-); generation and mitochondrial GSSG) and resulted in a slight reduction (19%) in tumour cell number when controls showed the highest rate of cellular proliferation. ATP (1mmol/kg per day)-induced selective GSH depletion, when combined with rhTNF-alpha administration, afforded a 61% inhibition of tumour growth and resulted in a significant extension of host survival. Administration of N-acetylcysteine (1mmol/kg per day) or GSH ester (5mmol/kg per day) abolished the rhTNF-alpha- and ATP-induced effects on tumour growth by maintaining high GSH levels in the cancer cells. Our results demonstrate that the sensitivity of tumour cells to rhTNF-alpha in vivo depends on their GSH content and their rate of proliferation.

Human immunoglobulin preparations for intravenous use prevent endotoxin-induced uveitis in rats.

OBJECTIVE: We analyzed the preventive effect of immunoglobulins for intravenous use (IVIgs) in endotoxin-induced uveitis (EIU), a disease related to tumor necrosis factor alpha (TNF-alpha) production. MATERIALS AND METHODS: EIU was the experimental model in Lewis rats, injecting a systemic dose of 150 microg of lipopolysaccharide (LPS) into the rat's footpad. Half of them were treated with 5 serial intravenous doses of 100 mg of IVIg during the 5 days prior to LPS injection. Eyes were repeatedly examined with a slitlamp, rats were killed and their eyes enucleated for histopathologic study at the 2nd, 16th and 24th hours. TNF-alpha serum levels were measured in aqueous humor at several time intervals by a bioassay using L-929 mouse fibroblasts. Aqueous humor proteins were detected by the Bradford method. RESULTS: IVIg treatment prevented EIU development, treated animals showing a lower grade of ocular inflammation beyond the 2nd hour (Fisher test, p > 0.05). Inflammatory cell infiltration was significantly reduced in the iris, ciliary body and anterior chamber at a 24-hour interval (Wilcoxon test, p < 0.05). This protection was associated with lower levels of TNF-alpha in serum at all time intervals and in aqueous humor at 16 h (Student's t test, p < 0.05), while differences were not significant between the samples of aqueous humor collected at 2 h. Protein exudate was not reduced in the treated group. CONCLUSIONS: Repeated IVIg injections could be useful in the preventive treatment of EIU probably mediated by a decrease in TNF-alpha release.

Inhibition of cancer growth and selective glutathione depletion in Ehrlich tumour cells in vivo by extracellular ATP.

We have investigated the effect of extracellular ATP on tumour-cell proliferation and GSH levels in Ehrlich-ascites-tumour-bearing mice. After daily administration of exogenous ATP (1 mmol/kg) during 7 days, we found a 56% inhibition of tumour growth, precisely when controls show the highest rates of cell proliferation and the highest levels of GSH. This effect is accompanied by a decrease in GSH content in the tumour, but not in normal tissues. The decrease in GSH concentration within the cancer cells is associated with a decrease in gamma-glutamylcysteine synthetase activity and in protein synthesis. Growth inhibition is mediated by generation of extracellular adenosine, which subsequently increases intracellular levels of ATP and decreases intracellular levels of UTP in the cancer cells. Our results suggest that inhibition of tumour growth by ATP is due to an adenosine-dependent pyrimidine starvation effect.

Tumoricidal activity of endothelial cells. Inhibition of endothelial nitric oxide production abrogates tumor cytotoxicity induced by hepatic sinusoidal endothelium in response to B16 melanoma adhesion in vitro.

The mechanism of NO- and H(2)O(2)-induced tumor cytotoxicity was examined during B16 melanoma (B16M) adhesion to the hepatic sinusoidal endothelium (HSE) in vitro. We used endothelial nitric-oxide synthetase gene disruption and N(G)-nitro-l-arginine methyl ester-induced inhibition of nitric-oxide synthetase activity to study the effect of HSE-derived NO on B16M cell viability. Extracellular H(2)O(2) was removed by exogenous catalase. H(2)O(2) was not cytotoxic in the absence of NO. However, NO-induced tumor cytotoxicity was increased by H(2)O(2) due to the formation of potent oxidants, likely ( small middle dot)OH and (-)OONO radicals, via a trace metal-dependent process. B16M cells cultured to low density (LD cells), with high GSH content, were more resistant to NO and H(2)O(2) than B16M cells cultured to high density (HD cells; with approximately 25% of the GSH content found in LD cells). Resistance of LD cells decreased using buthionine sulfoximine, a specific GSH synthesis inhibitor, whereas resistance increased in HD cells using GSH ester, which delivers free intracellular GSH. Because NO and H(2)O(2) were particularly cytotoxic in HD cells, we investigated the enzyme activities that degrade H(2)O(2). NO and H(2)O(2) caused an approximately 75% (LD cells) and a 60% (HD cells) decrease in catalase activity without affecting the GSH peroxidase/GSH reductase system. Therefore, B16M resistance to the HSE-induced cytotoxicity appears highly dependent on GSH and GSH peroxidase, which are both required to eliminate H(2)O(2). In agreement with this fact, ebselen, a GSH peroxidase mimic, abrogated the increase in NO toxicity induced by H(2)O(2).

Glutathione protects metastatic melanoma cells against oxidative stress in the murine hepatic microvasculature.

Calcein-labeled B16 melanoma (B16M) cells were injected intraportally, and in vivo video microscopy was used to study the distribution and damage of cancer cells arrested in the liver microvasculature over a period of 4 hours. The contribution of glutathione (GSH)-dependent antioxidant machinery to the possible oxidative stress-resistance mechanism of B16M cell was determined by in vitro incubation with the selective inhibitor of GSH synthesis L-buthionine (S,R)-sulphoximine (BSO) before B16M cell injection in untreated and 0.5-mg/kg lipopolysaccharide (LPS)-treated mice. In addition, untreated and LPS-treated isolated syngeneic hepatic sinusoidal endothelial cells (HSE) were used to determine in vitro their specific contribution to B16M cell damage. Trauma inherent to intrasinusoidal lodgement damaged 35% of B16M cells in both normal and LPS-treated mouse liver. The rest of the arrested B16M cells remained intact in normal liver for at least 4 hours, although their damaged cell percentage significantly (P < .05) increased since the second hour in normal mice injected with BSO-treated cells and since the first hour in LPS-treated mice given untreated cells. Recombinant human interleukin-1 receptor antagonist (rHuIL-1-Ra) given to mice 15 minutes before LPS significantly (P < .05) abrogated B16M cell damage. On the other hand, 40% of the B16M cells co-cultured with unstimulated HSE and 70% of the co-cultured with LPS-treated HSE became sensitive to endothelial cell-mediated damage after BSO treatment. These results demonstrate that a high intracellular level of GSH protects B16M cells from possible in vivo and in vitro sinusoidal cell-mediated oxidative stress, contributing to the mechanism of metastatic cell survival within the hepatic microvasculature.