Biomedical subjects
B P Himelstein
Publications and source records attributed to B P Himelstein.
High-level expression of angiogenic factors is associated with advanced tumor stage in human neuroblastomas.
Angiogenesis is essential for tumor growth and metastasis and depends on the production of angiogenic factors by tumor cells. Neuroblastoma (NB) is a common pediatric tumor of neural crest origin, which is biologically and clinically heterogeneous. Increased tumor vascular index correlates with poor outcome of NB. To determine which angiogenic factors contribute to NB angiogenesis and thereby support tumor progression, we examined the expression of eight angiogenic factors [vascular endothelial growth factor (VEGF), VEGF-B, VEGF-C, basic fibroblast growth factor, angiopoietin (Ang)-1, Ang-2, transforming growth factor alpha, and platelet-derived growth factor (PDGF)] by semiquantitative RT-PCR in 37 NB primary tumors and in 22 NB cell lines. We also analyzed the relationship between angiogenic factor expression and clinicopathological factors as well as patient survival. All eight angiogenic factors examined were expressed at various levels in NB cell lines and tumors, suggesting their involvement in NB angiogenesis. The expression levels of most angiogenic factors were correlated with each other, suggesting their synergy in regulating the angiogenic process. Significantly higher expression levels of VEGF, VEGF-B, VEGF-C, basic fibroblast growth factor, Ang-2, transforming growth factor alpha, and PDGF-A (P < 0.0001-0.026) were found in advanced-stage tumors (stages 3 and 4) compared with low-stage tumors (stages 1, 2, and 4S). Expression of PDGF-A was significantly associated with patient survival (P = 0.04). The redundancy in angiogenic factor expression suggests that inhibition of VEGF bioactivity alone might not be a sufficient approach for antiangiogenic therapy of human NB.
Studies of type IV collagenase regulation by hypoxia.
Recent data suggest that patients with more hypoxic solid tumors are more likely to develop metastases and die. We speculated that upregulation of the metastasis-associated type IV collagenase MMP-9 (gelatinase B) by hypoxia might be correlated with the increased risk of distant failure in patients with hypoxic tumors. The promoter for MMP-9 contains consensus binding sites for the transcription factors NFkappaB and AP-1 which are upregulated under hypoxic conditions in HeLa cells and these transcription factors are critical to transcriptional activation of the MMP-9 gene. A variety of tumor cell lines were examined for induction of MMP-9 and the related protease MMP-2 under hypoxic conditions. Although hypoxia did upregulate MMP-9 in one alveolar rhabdomyosarcoma cell line, we were unable to demonstrate a consistent hypoxia-mediated increase in MMP-9 protein, RNA, or transcriptional activity measured with reporter constructs. These results suggest that MMP-9 expression is not directly affected by exposure to hypoxia in vitro.
Matrix metalloproteinase-9 (MMP-9) expression in childhood osseous osteosarcoma.
BACKGROUND: Over 80% of patients with osteosarcoma treated with excision alone develop pulmonary metastases, suggesting that the majority of patients with this disease harbor "micrometastases" at diagnosis. There are no histologic or molecular variables which can predict the presence or absence of micrometastasis. Matrix metalloproteinases (MMPs) are a class of matrix- and basement membrane-degrading enzymes whose expression is associated with tumor cell invasive and metastatic behavior. One of these enzymes, MMP-9 or gelatinase B, is expressed in developing and remodeling bone and in osteosarcoma cell lines. We speculated that MMP-9 expression might be associated with the micrometastatic behavior of osteosarcoma. PROCEDURE: We examined a series of pediatric primary osseous osteosarcomas and metastases for the expression of MMP-9, using a monoclonal antibody. RESULTS: We found intense MMP-9 immunostaining in most tumor cells in all samples of pretreatment osteosarcomas. In all postchemotherapy resection samples, tumor cells stained similarly, but there were fewer positively staining cells overall. In 4 of 5 metastastic lesions examined, intense immunostaining for MMP-9 was detected. CONCLUSIONS: These results suggest that MMP-9 expression is common in osteosarcoma, and that further study of the role of MMP-9 in pediatric osteosarcoma behavior is warranted.
Tumor cell contact mediated transcriptional activation of the fibroblast matrix metalloproteinase-9 gene: involvement of multiple transcription factors including Ets and an alternating purine-pyrimidine repeat.
The 92-kDa type IV collagenase (MMP-9) is a metalloproteinase frequently localized in both tumor stroma and in tumor cells, particularly at the tumor invasion front. To explore the factors regulating transcriptional activation of MMP-9 in stromal cells, we used a model system in which fibroblast MMP-9 expression can be upregulated by cell-cell contact with metastatic transformed rat embryo cells. Using transient transfection of reporter gene constructs containing 5'-deleted or mutated MMP-9 promoter fragments, as well as electrophoretic mobility shift assays, the upstream NFkappaB, SP-1, and Ets sites and the downstream AP-1 site and retinoblastoma binding element were shown to be necessary for basal transcriptional activity of fibroblast MMP-9. In contrast only Ets or SP-1 appeared to be involved in contact-mediated induction of MMP-9. Mutation of the upstream AP-1 site increased both basal and contact-stimulated promoter activation. Deletion of the alternating purine-pyrimidine repeat in the downstream promoter decreased transcriptional activity. Together these findings suggest that Ets and SP-1 are the central transcriptional activators of MMP-9 gene expression in fibroblasts specifically responding to tumor cell contact, and that promoter conformation may regulate MMP-9 expression.
Osteosarcoma and other bone cancers.
In this review, recent advances in the clinical therapy of osteosarcoma, including results from the European Osteosarcoma Intergroup trial demonstrating the efficacy of a short intensive two drug protocol are discussed as well the evolving role of ifosfamide. Biologically, the area of interest on chromosome 3q, which may contain an osteosarcoma tumor suppressor gene, is being narrowed, and several promising new therapeutic approaches including tumor vaccine have been explored. In chondrosarcoma research, abnormalities in hereditary multiple exostoses genes, which encode protein products essential for normal cartilage development, and a potential mechanism for the characteristic chemotherapy resistance of cartilaginous tumors (overexpression of P-glycoprotein) have been described. Surgical advances include testing of total en bloc spondylectomy for vertebral tumors as well as a noninvasively extendable long bone endoprosthesis. Finally, new insights in diagnostic imaging, including the evolving role of 201Tl, 99mTc-MIBI (methoxyisobutylisonitrile), and newer variations on magnetic resonance imaging are reviewed.
Transcriptional activation of the matrix metalloproteinase-9 gene in an H-ras and v-myc transformed rat embryo cell line.
The 92 kd type IV collagenase/gelatinase (MMP-9) is important in mediating basement membrane and extracellular matrix degradation in metastasis. Because MMP-9 is made in tumor cells, but not in quiescent normal cells, we wished to identify the transcriptional elements responsible for its synthesis in tumor cells. We chose to characterize transcriptional regulation of the MMP-9 gene in a highly metastatic H-ras and v-myc transformed rat embryo cell line which overexpresses MMP-9. Using transient transfection of reporter gene constructs containing either 5'-deleted or mutated MMP-9 promoter fragments, as well as electrophoretic mobility shift assays, we have demonstrated that multiple transcription factor consensus binding motifs in the promoter, including those for NFkappaB, SP-1, Ets, AP-1, and a retinoblastoma binding element, participate in transcriptional regulation of MMP-9 expression in this cell line. Also, deletion of an alternating purine-pyrimidine tract in the downstream promoter was found to decrease transcriptional activity, suggesting that promoter conformation may be important in MMP-9 regulation. Thus multiple pathways leading to activation of NFkappaB, SP-1, Ets, AP-1, and retinoblastoma binding factors in tumor cells all may contribute to MMP-9 transcription and hence to metastasis.
Chemoreduction in the initial management of intraocular retinoblastoma.
BACKGROUND: Chemoreduction is a method of reducing tumor volume to allow for more focused, less damaging therapeutic measures. OBJECTIVE: To determine whether chemoreduction could be used to decrease the size of retinoblastoma so that enucleation or external beam radiotherapy could be avoided and more conservative modalities employed. METHODS: A prospective pilot study was performed to assess the effectiveness of a 2-month chemoreduction regimen of vincristine sulfate, etoposide, and carboplatin in patients with retinoblastoma. The study included 20 patients with 54 tumors in 31 eyes. RESULTS: At the initial examination, the mean tumor base was 12 mm and the thickness, 7 mm. Vitreous seeds were present in 14 eyes (45%). A secondary retinal detachment was present in 24 eyes (77%) and, when present, involved a mean of 71% of the retina. In 11 eyes (36%) the retina was totally detached with serous subretinal fluid. After 2 months of chemoreduction, all 54 tumors showed regression in size, and 48 (89%) showed evidence of calcification. The mean tumor base was 8 mm and the thickness, 4 mm. Overall, there was a mean 35% decrease in base and 49% decrease in thickness of the tumor at the end of the treatment period. A complete response was found in 25 tumors (46%) and a partial response in 29 (54%). The subretinal fluid had resolved completely in 50% of the cases (12/24 eyes), and, in the 11 eyes with total retinal detachment, the subretinal fluid had completely resolved, leaving flat retina, in 6 eyes (54%). The vitreous seeds demonstrated some degree of regression in all cases, and in 5 eyes there was 90% to 100% calcification of the seeds. Short-term systemic toxic effects were mild (transient bone marrow suppression). Enucleation was avoided in all cases; external beam radiotherapy was necessary in 9 eyes because of diffuse vitreous seeds. The remaining 22 eyes were treated with local methods after chemoreduction. CONCLUSION: Tumor shrinkage with chemoreduction may allow treatment with less invasive measures, such as cryotherapy, laser photocoagulation, thermotherapy, or plaque radiotherapy, thereby avoiding enucleation and external beam radiotherapy.
Induction of matrix metalloproteinase 9 expression in breast carcinoma cells by a soluble factor from fibroblasts.
Tumor-stromal interactions appear to play an important role in the induction of metalloproteinase expression in malignant tumors. We describe a tissue culture system in which expression of MMP-9 (gelatinase B or the 92 kDa type IV collagenase/gelatinase) was induced by co-cultivation of fibroblasts with breast cancer cell lines. While neither the breast cancer cells nor the normal rat embryo fibroblasts made MMP-9 alone in culture, human MMP-9 was made in the co-cultures. The MMP-9 was secreted in a latent form. The induction occurred at least in part through increases in the MMP-9 mRNA levels in the breast cancer cells. These increases did not appear to require protein synthesis. Conditioned medium from the fibroblasts could duplicate the induction of MMP-9 in the breast cancer cell lines. The active factor in the medium was inactivated by heat or by trypsin suggesting that it was a protein. This protein was in the size range of 30-100 kDa. Thus, fibroblasts could secrete a factor which was able to regulate the expression of MMP-9 in breast cancer cells.
Topical application of lidocaine-prilocaine (EMLA) cream reduces the pain of intramuscular infiltration of saline solution.
OBJECTIVE: Intramuscular injections may be painful. Some of this pain may be caused by the infiltration of medication into the muscle, separate from the pain of skin puncture. We hypothesized that topical application of lidocaine/prilocaine (EMLA) cream would reduce the pain of intramuscular infiltration. METHODS: A double-blinded, placebo-controlled study was performed in 40 adult volunteers to compare the pain of needle puncture and of infiltration of saline into the deltoid muscle after application of EMLA cream or placebo. Each subject served as his or her own control. Pain scores were obtained by using a 100 mm visual analog scale (VAS). RESULTS: Pain associated with needle puncture was significantly reduced by EMLA cream as compared with placebo (median VAS score, 7.5 vs 19.5; p = 0.0043), as was pain associated with intramuscular infiltration (median VAS score, 2.5 vs 11; p < 0.00005). CONCLUSIONS: Our results suggest that further clinical studies of EMLA cream for modifying perceived pain from intramuscular injection in children are warranted.
Malignant bone tumors of childhood.
Improvements in diagnosis and treatment have increased survival for many children with malignant bone tumors. New molecular genetic discoveries are providing insights into the mechanisms of tumorigenesis and may provide novel therapeutic modalities based on interfering with aberrant transcriptional activation by hybrid transcripts.
Metastatic retinoblastoma. Recent progress of interest to orthopaedic surgeons.
Retinoblastoma is the most common malignant intraocular neoplasm of childhood. Distant metastases to bone and bone marrow occur. The authors report on a retinoblastoma patient with metastases to the extraaxial skeleton. Implications for the orthopaedic surgeon and alternative diagnostic modalities are discussed. The case presented here exemplifies the potential role for the orthopaedic surgeon in making such a diagnosis in a child previously treated for retinoblastoma. Secondary nonocular malignant tumors should be considered in the differential diagnosis of patients with a history of retinoblastoma who have a painful extremity. Radiation treatment of the primary tumor increases the risk for nonocular secondary neoplasms. The structural alterations in the retinoblastoma gene in patients with osteosarcomas and the possible role of the retinoblastoma gene in the origin of osteosarcomas are also discussed.
Induction of fibroblast 92 kDa gelatinase/type IV collagenase expression by direct contact with metastatic tumor cells.
Previous studies have correlated release of the 92 kDa type IV collagenase/gelatinase by tumor cells in culture with metastatic potential. We have now demonstrated that the ability of tumor cells that do not express the 92 kDa gelatinase to induce release of this metalloproteinase from normal fibroblasts may also be associated with the metastatic phenotype. A transformed rat embryo cell line, 2.8, failed to release the 92 kDa gelatinase alone in culture, but gave rise to metastatic tumors whose explants contained the 92 kDa gelatinase. In contrast, a non-metastatic transformed cell line, RA3, did not express the 92 kDa gelatinase alone in culture or in tumor explants. To explore the mechanisms that might govern host-tumor cell interactions in this system, we have studied the effects of co-culture of these transformed cell lines with rat embryo fibroblasts (REF) in culture. 92 kDa gelatinase expression was induced by co-culture of 2.8 with REF, but co-culture of the non-metastatic line RA3 with REF did not result in induction of the 92 kDa gelatinase. The 92 kDa gelatinase in these co-cultures was released by the fibroblasts; methanol-fixed 2.8 cells induced 92 kDa gelatinase expression in REF, but fixed REF cells did not induce enzyme expression in 2.8 cells. This suggested that cell contact was required for induction, which was confirmed by showing that 92 kDa gelatinase induction in co-culture was abolished by separating REF from 2.8 by solute-permissive membranes. In addition, REF could not be stimulated to produce the 92 kDa gelatinase by 2.8-derived conditioned medium, by 2.8-derived extracellular matrix, or by isolated matrix components. These data indicate that metastatic tumor cells can induce 92 kDa gelatinase expression in fibroblasts through a mechanism dependent upon cell contact. In situ hybridization of nude mouse tumors derived from these transformed cell lines revealed 92 kDa gelatinase expression in the stroma of tumors from 2.8, but not in tumors from RA3. Therefore, the experiments based on in vitro co-culture of tumor cells and fibroblasts, together with the in situ localization of mRNA to host cells, suggest that host production of the 92 kDa gelatinase may occur in response to direct contact with metastatic tumor cells.
T-cell-depleted maternal bone marrow transplantation for siblings with X-linked severe combined immunodeficiency.
Prenatal diagnosis of X-linked severe combined immunodeficiency in a male fetus made possible elective neonatal bone marrow transplantation before onset of symptoms. Bone marrow transplantation was performed by using T-cell-depleted maternal marrow that had been cryopreserved 2 years earlier, at the time that his older affected brother underwent transplantation. The second patient had less morbidity and more rapid reconstitution of his immune function.
The kinetics of assembly of normal and variant human oxyhemoglobins.
The kinetics of assembly have been monitored spectrophotometrically for normal and variant human oxyhemoglobins in 0.1 M Tris, 0.1 M NaCl, 1 mM Na2EDTA, pH 7.4, at 21.5 degrees C. Oxyhemoglobin versus oxy chain static difference spectra were performed and revealed subtle but significant absorption changes in both the visible and Soret regions. Kinetic experiments were performed by rapidly mixing equivalent (in heme) concentrations of alpha and beta A chains and following the change in absorbance at 583 nm with time. Over a protein concentration range of 10-100 microM in heme prior to mixing, these time courses were homogeneous and followed first-order kinetics, yielding a value of 0.069 s-1 for the apparent rate constant of dissociation of oxygenated beta A chain tetramers. Under these conditions, the overall assembly of oxyhemoglobins S (beta 6Glu----Val) and N-Baltimore (beta 95Lys----Glu) were also governed by the rates of dissociation of their respective oxygenated beta S and beta N-Baltimore chain tetramers with the apparent first-order rate constants of 0.044 and 0.15 s-1, respectively. In the Soret region, the alpha, beta monomer combination reaction could be observed if the protein concentration (heme basis) was lowered and if protein nonequivalency (beta chain exceeded alpha chain concentration) mixing experiments were performed. A kinetic oxyhemoglobin A, oxy-alpha, oxy-beta A monomer difference spectrum could be generated, and simple second-order kinetics were observed (415 nm) yielding rate constants of 2.3, 3.3, and 4.8 X 10(5) M-1 s-1 for the assembly of oxyhemoglobins S, A, and N-Baltimore, respectively. To our knowledge, this is the first kinetic study to reveal significant differences between the rate of association of alpha and beta monomers of hemoglobin A and those of two distinctly charged hemoglobin variants.
Intraocular Ki-1 lymphoma in a 2-year-old boy.
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The effect of chemoreduction on retinoblastoma-induced retinal detachment.
BACKGROUND: Retinoblastoma with total retinal detachment traditionally has been managed with enucleation. We employed a chemoreduction protocol in an effort to reduce the tumor size to allow for focal treatment and salvage of the eye. METHODS: A prospective study was performed to assess the effects of a 2-month chemoreduction regimen of vincristine, etoposide, and carboplatin on massive retinoblastoma with total retinal detachment. RESULTS: We treated 17 eyes with total retinal detachment from retinoblastoma in 13 patients over a 14-month period. At the initial examination, the mean tumor base was 15 mm and mean thickness was 10 mm. The eyes were classified as Reese-Ellsworth group V in 16 cases (94%) and group III in one case (6%). The retina was totally detached with serous subretinal fluid in all cases. After 2 months of chemoreduction, all tumors showed a response, and the tumors decreased to a mean base of 10 mm and thickness of 5 mm. Overall, a mean of 33% decrease in base and 47% decrease in thickness was noted. The subretinal fluid had resolved completely in seven eyes (41%), leaving flat retina. In three eyes (18%), partial resolution was achieved; in seven eyes (41%), minimal resolution of the subretinal fluid at the 2-month period was noted. By last follow up, at a mean of 10 months after initiation of chemoreduction, complete resolution of the subretinal fluid occurred in 13 eyes (76%) and partial resolution of subretinal fluid occurred in four eyes (24%). CONCLUSION: Preliminary observations suggest that chemoreduction may be an important tool in the initial management of retinoblastoma, even for large tumors with total retinal detachment. Tumor shrinkage may be dramatic and subretinal fluid resolution may be complete.
Metalloproteinases in tumor progression: the contribution of MMP-9.
Many enzymes capable of proteolytic degradation of extracellular matrix and basement membranes have been implicated in tumor progression, including the matrix metalloproteinases, cathepsins, plasminogen activators, and heparanase. Matrix metalloproteinases, a family of zinc-dependent proteases, participate in several steps in tumor progression, including invasion, metastasis, and angiogenesis. In this review, we will give a brief overview of this protease family, and we will review in vitro and in vivo evidence implicating a particular metalloproteinase, the 92-kD type IV collagenase/gelatinase (MMP-9 or gelatinase B), as well as other metalloproteinases, in cancer progression. Finally, using recent studies from our laboratory, we will demonstrate the importance of both tumor cell and host stromal cell production of MMP-9 in tumor progression.