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Biomedical subjects

J Marquet

Publications and source records attributed to J Marquet.

At least 19 recordsLinked to original sources

Fluorouracil combined with the pure (6S)-stereoisomer of folinic acid in high doses for treatment of patients with advanced colorectal carcinoma: a phase I-II study.

BACKGROUND: Potentiation of the antitumor activity of fluorouracil (5-FU) by folinic acid has been demonstrated in patients with colorectal adenocarcinoma. Modulation is due to the interaction of thymidylate synthase, fluorodeoxyuridine monophosphate, and methylene tetrahydrofolate, which leads to the formation of a stable ternary complex with concomitant enzyme inactivation. Folinic acid consists of a mixture of equal parts of two stereoisomers differing in chirality at the C-6 carbon of the pteridine ring. Only the levorotatory (6S)-stereoisomer of folinic acid is transformed into active folate cofactors. However, the (6R)-stereoisomer of folinic acid is not inert; it was shown to interfere with the (6S) form at the cellular level. PURPOSE: The possibility of a deleterious effect of the unnatural stereoisomer on the modulation of 5-FU led us to carry out a phase I-II study of 5-FU combined with the (6S)-stereoisomer of folinic acid given in high doses for treatment of patients with advanced colorectal carcinoma. We also determined the plasma pharmacokinetics of folates after intravenous (IV) injection of (6S)-folinic acid at the dose used in this study. METHODS: Treatment consisted of 5-FU (350-550 mg/m2 per day by IV infusion for 2 hours) and (6S)-folinic acid (100 mg/m2 per day by IV bolus injection) given for 5 consecutive days; the treatment was repeated every 21 days. Twenty-five patients with advanced colorectal carcinoma, who had had no prior chemotherapy, were evaluated for antitumor activity. The quantity of folates in plasma was measured using a microbiological assay. RESULTS: The median follow-up time was 9 months (range, 3.5-15.2 months). The response rate was 52% (complete response, 12%; partial response, 40%). The median time to disease progression for responding patients was 9.2 months (range, 5.9-15+ months). The estimated probability of survival at 12 months was 73%. Palliative improvement in quality of life was achieved in most patients who had symptoms due to the tumor before the start of treatment. The dose-limiting toxic effects were grade 3 diarrhea, dermatitis, and oral mucositis. Grade 4 toxicity did not occur. Myeloid toxicity was minor. After IV injection, (6S)-folinic acid was rapidly cleared from plasma (mean half-lives: alpha = 7.2 minutes and beta = 126 minutes). The mean concentration of the unchanged compound 2 hours after injection was 5.8 mumol/L. CONCLUSION: The (6S)-form of folinic acid potentiates the antitumor effect of 5-FU given concomitantly. IMPLICATION: Our results justify a more complete exploration of the pure active stereoisomer as a modulator of the fluoropyrimidines.

Adult

A hairy polyp of the middle ear and mastoid cavity.

A case of a 'hairy polyp', a dermoid tumor of the middle ear and the mastoid cavity is described, which is very unusual location. The radiological, surgical and histological features are discussed. Comment is made on the differentiation between dermoid cysts and teratomas and on the scarcity of both tumors in the area of the temporal bone.

Dermoid Cyst

Enhancement of anti-neoplastic activity of cytosine arabinoside against human HL-60 myeloid leukemic cells by 3-deazauridine.

Drug resistance is one of the major reasons for failure of chemotherapy of acute leukemia with cytosine arabinoside (ARA-C). In order to overcome this problem we have investigated the interaction of ARA-C with 3-deazauridine (3-DU) against HL-60 myeloid leukemic cells. 3-DU is an interesting agent to use in combination with ARA-C, since drug-resistant cells that are deficient in deoxycytidine kinase are very sensitive to this uridine analogue. We have observed that for both short and long drug exposure there was a potent synergistic interaction between ARA-C and 3-DU with respect to their cytotoxic effects on HL-60 leukemic cells. This synergy could be explained by an increased cellular uptake of ARA-C to ARA-CTP by the leukemic cells in the presence of 3-DU, due to the reduction in the pool of dCTP produced by this latter analogue. Since dCTP is a potent feedback inhibitor of the phosphorylation of ARA-C by deoxycytidine kinase, the reduction in the dCTP produced by 3-DU results in an increased rate of phosphorylation of the arabinosyl analogue. Our results suggest that ARA-C and 3-DU may be an interesting drug combination to circumvent drug resistance in the chemotherapy of acute leukemia.

3-Deazauridine

Mechanism of inhibition of DNA ligase in Ara-C treated cells.

The activity of DNA ligase, the enzyme involved in ligation of DNA fragments and also in DNA repair is inhibited by Ara-C. The exposure of two human leukemic cell lines, K562 and HL-60 to 10(-5) M Ara-C for 3 h, induces a decrease of DNA ligase activity by 40% in K562 and 92% in HL-60. This decreased activity is due to an inhibition by Ara-CTP of the ligase-adenylate complex generation, the crucial step in the action of this enzyme. The activity of the semi-purified ligase as well as the formation of ligase-adenylate complex are decreased in the presence of Ara-CTP. These results demonstrate that Ara-C via its active form Ara-CTP inhibits DNA ligase activity through the inhibition of the ligase-adenylate complex. Other inhibitors of DNA synthesis, such as hydroxyurea, do not exert the same inhibitory effect. The inhibition of DNA ligase activity may be partly responsible for the cytotoxicity of Ara-C.

Adenosine Monophosphate

Dehiscence of the facial canal: developmental aspects.

In a series of human fetuses, the course of the facial canal in the temporal bone was investigated by the use of light and scanning electron microscopy. The normal development of the facial canal was correlated to clinical aspects of facial nerve dehiscences. Our observations demonstrate a more complex way of facial canal development not limited to the 'simple' ossification of the otic capsule. Endochondral ossification of the otic capsule does not virtually change the shape of the primitive facial sulcus. The fibrous layers surrounding the facial nerve seem to be responsible for the final architecture of the facial canal and not the otic capsule ossification by itself. The time sequence of their histological development is equally important and permitted us to distinguish three phases in facial canal development. The role of disturbances in epigenetic control for the initiation of dehiscences is discussed.

Cartilage

Comparative effect of 6S, 6R and 6RS leucovorin on methotrexate rescue and on modulation of 5-fluorouracil.

The comparative efficacy of the pure diastereoisomers of leucovorin, the natural (6S) and the unnatural (6R) forms was compared to the racemic form (6RS). A protective effect in methotrexate-treated CCRF-CEM cells was obtained with 6S at concentrations 100-fold higher than those of methotrexate and with 6RS at concentrations 2-fold greater than those of 6S; however, at low concentrations of methotrexate, 6S was more effective than 6RS in preventing the cytotoxicity of methotrexate; on the opposite, 6R exhibited a protective effect at concentrations 10(4) higher than those of methotrexate. On the same cell line, 6S was shown to enhance the cytotoxic effect of 5 Fluorouracil exactly as 6RS while 6R did not exhibit any enhancing effect on cells exposed to 5 Fluorouracil.

Analysis of Variance

Keratinization of middle ear cholesteatomas. I. A histochemical study of epidermal transglutaminase.

A histochemical study was performed to determine the involvement of epidermal transglutaminase (ETgase) in the keratinization of middle ear cholesteatomatous lesions, and to compare it with its role in the middle ear mucosa and epidermis. In a first assay, we localized the (E)Tgase activity in situ. A second immunohistochemical assay revealed the distribution of the particulate form of ETgase, which is involved in cross-linked envelope formation. A remarkable difference between strongly keratinized epidermal tissues and the cholesteatoma matrix is the frequent observation in the latter of the remnants of (E)Tgase activity in cytosol, even in advanced stages of differentiation. As a consequence, the cell-membrane-associated ETgase activity, and thus the extent of cross-linking within the envelope, is at a lower level than expected. This aspect is reminiscent of the keratinization phenomenon manifested by thin epidermal tissues. In addition, our findings are the first to show that ETgase is a substantial marker of middle ear mucosa.

Cholesteatoma

Keratinization of middle ear cholesteatomas. II. A histochemical study of epidermal transglutaminase substrates.

A histochemical study was performed to clarify further the role played by epidermal transglutaminase (ETgase) in the keratinization of aural cholesteatoma. Weakly and strongly keratinized epidermal tissues and healthy middle ear mucosa were included as references. A first assay revealed the distribution of non-specified acyl donor substrates. In a second assay, the topography of involucrin was assessed immunohistochemically. In both epidermal and cholesteatoma matrix tissues, the presence of acyl donors was not restricted to the sites of (E)Tgase activity, but was almost uniformly extended throughout living layers. In reference tissues, residual acyl donors were poorly detected in horny layers, while they were more abundant in the stratum corneum of the cholesteatomas studied. The presence of involucrin along the cell membrane was observed at varying distances throughout the spinous and granular layers, depending upon the epidermal and matrix configurations. In thick epithelia, involucrin rapidly became concentrated at the cell periphery (in spinous keratinocytes), while in thin epithelia it was usually associated with cell flattening. This latter staining profile was observed more frequently in cholesteatomatous tissues. In addition, we regularly noticed an immediately suprabasal accumulation of involucrin, suggesting a locally hyperproliferative state of the matrix. An insufficient availability of acyl donors, especially involucrin, could not be used to explain the defective ETgase-mediated cross-linking of cholesteatoma cell membranes during terminal stages of differentiation. The present investigation may be the first to demonstrate the presence of involucrin in middle ear mucosa.

Cholesteatoma

Two-stage repair of extensive subglottic tracheal stenosis.

The authors describe an open technique that has been used over the past 25 years to reconstruct the subglottic tracheal region in two stages after extensive laryngotracheal stenosis. After submucosal resection of fibrous tissue and reconstruction of the subglottic and tracheal skeleton by means of two autologous osseous grafts, a large laryngotracheostomy is created during the initial stage. Some weeks later, in the second stage, the anterior wall is closed, using two cervical hinge-door flaps. Ten patients have undergone this procedure, with a minimum follow-up of 3 years. All of the patients were decannulated upon completion of the treatment without recurrence of stenosis during the follow-up period.

Bone Transplantation

Aminoglycoside-induced ototoxicity.

One of the major side effects of aminoglycoside antibiotics (AG) is ototoxicity. The authors review the literature revealing many controversies on every aspect of this side-effect. Although epidemiological studies have to face the problem of reliable evaluation techniques, the incidence of cochleo- and vestibulotoxic side-effects has been estimated at 7.5% for each. Netilmicin appears to be less ototoxic. No definite risk factors can be proposed, although age, length of therapy, bacteremia, fever, liver and renal dysfunction are probably very important parameters. Most pathological changes at the cochlear level follow a clear spatial sequence, showing unspecific, degenerative lesions, involving every structure of the cochlea. This makes it impossible to draw etiopathological conclusions. Recent pharmacokinetic studies have rejected the 'accumulation theory' of AGs in perilymph, while also in endolymph no accumulation can be found. Only a few data are available on inner ear tissue levels. Among the different pharmacodynamic hypotheses on the action of AGs, binding of the drug to acidic glycosaminoglycans in the stria vascularis, and interference by the drug with phosphoinositide metabolism in the hair cells seem to be of major importance.

Aminoglycosides

Early bone formation in the human fetal otic capsule. A methodological approach.

The present study was concentrated on the use of energy-dispersive X-ray analysis and backscattered electron imaging as practical tools for advanced autopsy of human fetuses when diagnostic evaluation of ear pathology is required. These methods were used to revisit the primary calcification front of the fetal otic capsule between 18 and 36 weeks' gestational age. Energy-dispersive X-ray analysis indicates an equal Ca/P ratio in all the three layers of the otic capsule. These results are discussed in view of calcium homeostasis and inner ear function.

Calcification, Physiologic

[Acoustic neuroma: a histopathological study].

In view of recent controversy concerning the preservation of hearing in acoustic neuroma surgery, a histologic study of the nerve-tumour interface was undertaken in order to investigate cochlear nerve involvement. Twelve intact acoustic neuromas were studied by means of Masson's trichrome stain, the Luxol fast blue technique, Verhoeff's stain and an immunohistochemical technique using monoclonal antibodies to human neurofilaments. In nine out of twelve specimens, macroscopically visible adherences were present between the cochlear nerve and the tumour. The microscopical correlate was found to be the absence of a clear cleavage plane between the cochlear nerve and the tumour on the one hand, and the presence of cochlear nerve fibers, surrounded by tumoural cells, past the assumed nerve-tumour interface on the other hand.

Cochlear Nerve

A scanning electron-microscopic study of different tympanic grafts.

The surface architecture of dried temporalis fascia autografts and preserved tympanic allografts was investigated by scanning electronmicroscopy. During the storage in formaldehyde-cialit solutions the outer epithelial as well as the inner mucosal layer of tympanic allografts are progressively detached, and finally the lamina propria with outer radial and inner circular fiber arrangement remains. Due to dehydration phenomena irregular "crater-like" defects, surrounded by an amorphous structure, appear in dried fascia autografts. While a real lamina propria graft may induce migration and differentiation of the host's canal wall epithelium into a specific tympanic epithelium, one may imagine epithelial spreading toward the middle ear along the observed defects in dried fascia grafts. This latter observation gives new evidence for the immigration cholesteatoma theory.

Fascia

A study of the mechanisms of cytotoxicity of Ara-C on three human leukemic cell lines.

The main biochemical determinants involved in cytosine arabinoside (Ara-C) metabolism were studied in one lymphoblastic (Reh) and two myeloid (HL60 and K562) human leukemic cell lines exhibiting various sensitivities to Ara-C, Reh being the most and HL60 the least sensitive. The level of intracellular Ara-C accumulation and Ara-CTP formation was far more important in Reh cells than in myeloid cell lines but was not closely related to deoxycytidine kinase activity or to deoxycytidine triphosphate pool size. The level of Ara-C incorporated into DNA was similar in the three cell lines. Ara-CTP formation correlated better with the cytotoxicity to clonogenic cells than did Ara-C incorporation into DNA. DNA polymerase alpha was moderately inhibited to various degrees, depending on the cell line; this moderate inhibition does not seem sufficient to explain the inhibition of DNA synthesis. The activity of DNA ligase, the enzyme joining the Okazaki fragments, which was not detected in Reh cells, was strongly inhibited by Ara-C in HL60 and to a lesser degree, in K562 cells. The inhibition of DNA ligase probably also contributes to the inhibition of DNA synthesis and, thus, to the cytotoxic effect of Ara-C and may explain the smaller size of DNA fragments observed following Ara-C treatment. The variations in each critical determinant observed in these three cell lines increase the complexity and plurality of the mechanisms of Ara-C action.

Arabinofuranosylcytosine Triphosphate

The involvement of the cochlear nerve in neurinomas of the eighth cranial nerve.

In view of recent controversies concerning the preservation of hearing in acoustic neurinoma surgery, we examined the courses of the vestibular and cochlear nerve fibers in 12 intact acoustic neurinomas studied in our department. Due to its lack of specificity, the Luxol fast blue stain was found to be inadequate for our study of the nerve fibers. In contrast, Verhoeff's stain proved to be satisfactory when combined with a highly specific immunohistochemical technique. There were macroscopically visible adherences between the tumor and the cochlear nerve in 9 out of the 12 specimens. From those specimens, histological sections were obtained in which both the cochlear nerve and tumor could be clearly identified. In these specimens the cochlear nerve was involved in the tumoral process and there was no clear cleavage plane between the nerve and the tumor. However, all these patients suffered only from minimal losses of hearing as a result of their tumors.

Cochlear Nerve

Early ossification within the human fetal otic capsule: morphological and microanalytical findings.

Besides the use of conventional techniques such as light and polarization microscopy, the present paper proposes the combined use of transmission electron microscopy, secondary and backscattered electron imaging, energy dispersive X-ray analysis and computed tomography for the diagnostic evaluation of ear pathology in the human fetus. These methods were used to revisit the primary calcification front of the fetal otic capsule between 16 and 23 weeks gestational age. Ultramicroscopic evaluation demonstrates similar fetal bone formation to that found in other bones of the human fetus. The formation of the endosteal and periosteal layers is a typical example of early intra-membranous ossification. The enchondral layer is made up of fibrillar bone, laid down around the calcified cartilage remnants. Microchemical analysis indicates a significantly higher Ca/P ratio in the endochondral layer with respect to the endosteum and periosteum. The consequences of a lower Ca/P ratio in the endosteal layer are discussed in view of calcium homeostasis and inner ear function.

Ear Cartilage