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Biomedical subjects

A Melcher

Publications and source records attributed to A Melcher.

At least 19 recordsLinked to original sources

Fusogenic membrane glycoprotein-mediated tumour cell fusion activates human dendritic cells for enhanced IL-12 production and T-cell priming.

Fusogenic membrane glycoproteins (FMG) are a family of viral genes that, when expressed in tumour cells, trigger extensive cell to cell fusion and subsequent cell death. Gene therapy approaches using FMG are also potentially immunogenic, since syncitia generated ex vivo can be therapeutic as antitumour vaccines in murine models. This study has addressed the mechanisms responsible for the immunogenicity of FMG-mediated cell death, and its applicability to human immune priming. We show that fusion of human Mel888 melanoma cells following transfection with FMG can reverse the suppressive effects of Mel888 on dendritic cells (DC) phenotype, and potentiate IL-12 production by DC on activation in a cell contact-dependent manner. DC loaded with fusing, but not intact, tumour cells primed a naive, tumour-specific cytotoxic T-cell response, which was MHC class I-restricted and associated with production of high levels of IFNgamma and, later, IL-5. Fusing cells were an effective source of antigen for DC cross-priming and presentation of the melanoma-specific antigen gp100 to a specific T-cell clone. These data show, in a human system, that FMG represent an immunogenic, as well as cytotoxic, gene therapy for cancer, reversing the inhibitory effects of tumour cells on DC to potentiate IL-12 production and naive T-cell priming.

B7-2 Antigen↗

Synchronous bilateral ductal carcinoma in situ of the male breast associated with gynecomastia in a 30-year-old patient following repeated injections of stanozolol.

We report a rare case of synchronous bilateral and multifocal ductal carcinoma in situ (DCIS) in a 30-year-old patient operated on for gynecomastia following repeated injections of stanozolol, a non-aromatizable androgen. The familial medical history was negative for breast cancer and work-up of serum hormone levels was normal. The patient underwent a modified radical mastectomy without axilla dissection 6 weeks following the primary procedure and recovered uneventfully. The role of synthetic androgens in the development of male breast neoplasia warrants further scrutiny.

Adult↗

Immunosuppressive effects of radiation on human dendritic cells: reduced IL-12 production on activation and impairment of naive T-cell priming.

Dendritic cells (DC) are professional antigen-presenting cells (APC) of the immune system, uniquely able to prime naive T-cell responses. They are the focus of a range of novel strategies for the immunotherapy of cancer, a proportion of which include treating DC with ionising radiation to high dose. The effects of radiation on DC have not, however, been fully characterised. We therefore cultured human myeloid DC from CD14+ precursors, and studied the effects of ionising radiation on their phenotype and function. Dendritic cells were remarkably resistant against radiation-induced apoptosis, showed limited changes in surface phenotype, and mostly maintained their endocytic, phagocytic and migratory capacity. However, irradiated DC were less effective in a mixed lymphocyte reaction, and on maturation produced significantly less IL-12 than unirradiated controls, while IL-10 secretion was maintained. Furthermore, peptide-pulsed irradiated mature DC were less effective at naive T-cell priming, stimulating fewer effector cells with lower cytotoxicity against antigen-specific targets. Hence irradiation of DC in vitro, and potentially in vivo, has a significant impact on their function, and may shift the balance between T-cell activation and tolerization in DC-mediated immune responses.

Apoptosis↗

Radiation-induced cell death and dendritic cells: potential for cancer immunotherapy?

Dendritic cells are key orchestrators of the immune system. There is considerable interest in their use for treating cancer. Whether they initiate an effective cytotoxic response against antigen-bearing cells, or produce tolerance, depends on the context in which those antigens are presented. Ionising radiation, and the cell death it causes, has several properties that may facilitate such an effective response. A range of in-vitro and in-vivo data supports this, although potential problems exist that may require concurrent strategies.

Antigens, Neoplasm↗

Cell death associated with genetic prodrug activation therapy of colorectal cancer.

Genetic prodrug activation therapy (GPAT) is a form of cancer gene therapy that has potential use against tumours such as colorectal malignancy. The characterization of such therapies using laboratory models provides a basis for clinical trials. In this study the gene encoding Herpes Simplex Virus thymidine kinase (HSVtk) was delivered to colorectal tumour cells using an Adenoviral (Ad) vector in vitro. In this way the cells were made susceptible to killing with the prodrug ganciclovir to various degrees depending on cell infectability with Ad. Bystander killing effect appeared minimal both in vitro and when transduced cells were injected in vivo. Mechanisms of cell death, measured in vitro using anti-BrDU (DNA-break labelling) and propidium iodide staining variously showed a combination of apoptosis in the G1 cell cycle phase and late apoptotic or necrotic sub-G1 DNA fragmentation, depending on the tumour cell line. These findings suggest that gene therapy of colorectal cancer by GPAT gives rise to therapeutic forms of direct cell death, but requires improvements in transduction, and possibly immune augmentation.

Adenoviridae↗

Enhanced left ventricular endocardial border delineation with an intravenous injection of SonoVue, a new echocardiographic contrast agent: A European multicenter study.

The safety and efficacy of SonoVue (also referred to as BR1), a new contrast agent for delineating endocardial border of the left ventricle after intravenous administration, was assessed. Two hundred and eighteen patients with suspected coronary artery disease undergoing fundamental echocardiography for the assessment of left ventricle were enrolled in a prospective multicenter, single blind, cross-over study with random sequence allocation of four different doses of SonoVue. Endocardial border definition in the apical and parasternal views was scored as 0 = not visible, 1 = barely visible, and 2 = well visualized before and after contrast enhancement. Analysis was performed by two pairs of off-site observers. Safety of SonoVue was also assessed. Results of our study indicated that the mean improvements in the endocardial border visualization score were as follows: 3.1 +/- 7.8 (95% CI, 2.5 and 3.7) for 0.5 ml, 3.4 +/- 8.0 (95% CI, 2.8 and 4.0) for 1 ml, 3.4 +/- 7.9 (95% CI, 2.8 and 4.0) for 2 ml, and 3.7 +/- 8.0 (95% CI, 3.1 and 4.3) for 4 ml (P < 0.05 for all doses from baseline). Changes from baseline in endocardial visualization scores were also seen in the apical views (P < 0.05) and they were dose-dependent (P < 0.001). Similar enhancements of endocardial visualization scores were observed in the apical views in patients with suboptimal baseline echocardiographic images. Diagnostic confidence for assigning a score and image quality also were significantly better following contrast enhancement. No significant changes in the laboratory parameters and vital signs were noted following contrast enhancement, and the side effects were minimal. It was concluded that SonoVue is safe and effective in delineating endocardial border, including in patients with suboptimal baseline images.

Aged↗

Adoptive transfer of immature dendritic cells with autologous or allogeneic tumor cells generates systemic antitumor immunity.

Dendritic cells (DCs) are potent antigen-presenting cells that are capable of priming systemic antitumor immune responses in animal tumor models. However, many of the model tumor systems tested need definition of the specific tumor antigens involved. To use DCs in situations that are more relevant to the majority of human cancers, where the antigens are unknown, we have tested the adoptive transfer of immature DCs in mouse colorectal and melanoma models of varying immunogenicity but with undefined antigens. When DCs admixed with a syngeneic primary tumor inoculum were seeded s.c., the growth of the primary tumor was unchanged; however, if the primary tumor was then surgically excised and the animal was rechallenged with the same tumor, significant protection (75%) was generated when DCs were present in the original primary inoculum of a moderately immunogenic colorectal model (CMT93tk). This effect was not observed when a nonimmunogenic melanoma (B16) was tested in an identical protocol. Next, DCs were injected directly into 6-9-mm established tumors; again, protection (55%) was achieved against a secondary tumor challenge following excision of the primary, but only in the CMT93tk model of moderate immunogenicity. To increase the clinical relevance of this approach still further, we tested irradiated allogeneic K1735 melanoma cells mixed with syngeneic DCs as a vaccine against subsequent challenge with the poorly immunogenic syngeneic melanoma B16. The allogeneic vaccine alone was ineffective, but when admixed with DCs, a significant number of animals rejected a subsequent B16 challenge, suggesting that DCs are able to prime an immune response against melanoma antigens shared between K1735 and B16. The generation of systemic antitumor immunity by adoptive transfer of DCs has significant clinical potential because it is technically straightforward and does not require the definition of specific tumor antigens.

Animals↗

Heat shock protein expression in target cells infected with low levels of replication-competent virus contributes to the immunogenicity of adenoviral vectors.

A significant limitation of adenoviral vectors is their associated immunogenicity. Since we, and others, have shown that the immunogenicity of cells can be increased by the induction of heat shock proteins (hsp), and because infection with several viruses induces hsp, we investigated whether the immunogenicity of adenoviral gene transfer might be mediated through induction of hsp expression. Neither plasmid DNA nor a recombinant retroviral vector induced hsp expression in transduced B16 melanoma cells. However, hsp70 was upregulated after infection with two of six adenoviral vectors; this induction of hsp70 did not correlate with the adenoviral transgene or with the viral backbone (Ad2 or Ad5). In previous assays, no replication-competent adenovirus (RCA) had been detected in any of these viruses. However, using sensitive assays for RCA, induction of hsp70 was found to correlate with the transfer of E1A and low levels of RCA. Moreover, target cells expressing hsp70 at levels similar to those induced by RCA infection protected syngeneic mice against rechallenge with parental cells, demonstrating that cells induced to express hsp70 by inadvertant transfer of RCA will become immunogenic. These results reveal a novel mechanism contributing to the immunogenicity of adenoviral vectors. If careful screening for RCA is not used when using laboratory-prepared viral stocks, the validity of the resulting experimental data might be significantly affected, especially when the immune stimulatory effects of the transgene are being studied.

Adenoviruses, Human↗

Apoptosis or necrosis for tumor immunotherapy: what's in a name?

Here we discuss how the mechanisms by which tumor cells are killed in vivo by gene transfer affects their immunogenicity. Our own work has shown that necrotic cell death induces immunological activation signals which recruit, load, activate and mature appropriate subsets of antigen-presenting cells. In contrast, for apoptotic cell death to be immunogenic, signals additional to cell death alone must be provided within the milieu of the dying tumor. Our conclusion is that the immunogenicity of tumor killing is determined by a combination of factors, including the mechanism of killing, the levels of cell death, the local environment that exists within the dying tumor and, as a result, the nature of the immune/scavenger cells which are present at the time of antigen release. Knowledge of how these factors can influence the immune system and lead to the breaking of tolerance to tumor-associated antigens, can potentially be exploited in the design of effective immunotherapies for cancer using gene transfer.

Animals↗

Flow dependence of forearm noradrenaline overflow, as assessed during mental stress and sodium nitroprusside infusion.

OBJECTIVE: To evaluate the influence of blood flow on measurements of regional sympathetic nerve activity by radiotracer methodology ([3H]noradrenaline). DESIGN: Ten healthy men were studied under two conditions of elevated forearm blood flow: mental stress (Stroop colour word conflict test) and an intra-arterial infusion of sodium nitroprusside. METHODS: Arterial blood pressure was measured invasively and forearm blood flow with strain-gauge plethysmography. Arterial and venous plasma adrenaline and noradrenaline were measured with high-performance liquid chromatography, and regional and total noradrenaline spillover were calculated. RESULTS: During mental stress, mean arterial pressure increased by 17%, heart rate by 16 beats/min, forearm blood flow by 117%, while forearm vascular resistance decreased by 44% (P < 0.001 for all). Sodium nitroprusside increased forearm blood flow dose-dependently, but elicited only minor effects on systemic haemodynamics. Mental stress increased arterial plasma noradrenaline by 52% (P < 0.001), and total body noradrenaline spillover by 75% (P < 0.001). During sodium nitroprusside infusion, arterial plasma noradrenaline increased only slightly and total body noradrenaline spillover was unaffected Forearm noradrenaline overflow increased from 5.4 +/- 0.9 to 16.9 +/- 2.6 pmol/min per I (P < 0.001) during mental stress and from 6.6 +/- 0.8 to 16.9 +/- 3.7 pmol/min per I (P < 0.001) during the second dose-step of sodium nitroprusside infusion. By intra-individual comparisons of forearm noradrenaline overflow increases during mental stress and during sodium nitroprusside infusion, with similar forearm blood flow increases, the flow dependence of forearm noradrenaline overflow was estimated. During mental stress, about 60% (median value, range 29-112%) of the increase in forearm noradrenaline overflow was attributed to the increase in forearm blood flow, whereas 40% was considered to reflect increased sympathetic nerve activity. CONCLUSIONS: There seems to be a considerable flow dependence of the regional overflow of noradrenaline, that is, a component of simple wash-out of noradrenaline from the forearm tissues during vasodilation. However, the present results still indicate that sympathetic nerve activity in the forearm is increased during mental stress, justifying the radiotracer technique for semiquantitative measurements, also during vasodilation.

Adult↗

Tumor immunogenicity is determined by the mechanism of cell death via induction of heat shock protein expression.

In situ killing of tumor cells using suicide gene transfer to generate death by a non-apoptotic pathway was associated with high immunogenicity and induction of heat shock protein (hsp) expression. In contrast, a syngeneic colorectal tumor line, CMT93, killed predominantly by apoptosis, showed low levels of hsp expression and less immunogenicity. When apoptosis was inhibited in CMT93 cells by overexpression of bcl-2, hsp was also induced. Furthermore, when cDNA encoding hsp70 was stably transfected into B16 and CMT93 cells, its expression significantly enhanced the immunogenicity of both tumors. Increased levels of hsp, induced by non-apoptotic cell killing, may provide an immunostimulatory signal in vivo which helps break tolerance to tumor antigens. These findings have important implications for the development of novel anti-cancer therapies aimed at promoting patients' immune responses to their own tumors.

Animals↗

Ischaemia monitoring with on-line vectorcardiography during dobutamine stress echocardiography in patients after an episode of unstable coronary artery disease.

OBJECTIVES: This study investigated the ability of on-line vectorcardiography (VCG) to detect myocardial ischaemia as assessed by dobutamine stress echocardiography after an episode of unstable coronary artery disease. DESIGN: Dobutamine stress test (incrementally infused doses of 5, 10, 20, 30 and 40 microg kg(-1) per minute) was performed during simultaneous VCG monitoring. QRS vector difference (QRS-VD), ST vector magnitude (ST-VM), ST change vector magnitude (STC-VM) and T change vector magnitude (TC-VM) were monitored. A new wall motion abnormality or worsening of abnormal wall motion was regarded as indicating a positive dobutamine stress test. SUBJECTS: Fifty-five patients with unstable angina pectoris and 16 patients with an acute non-Q-wave myocardial infarction were studied 5-8 days after admission. RESULTS: A positive dobutamine stress test was observed in 37 patients (52%). The sensitivity, specificity and total accuracy of identifying patients with a positive dobutamine stress test by VCG were: 38%, 91% and 63% for QRS-VD; 59%, 88% and 73% for ST-VM; 84%, 79% and 82% for STC-VM; and 86%, 23% and 56% for TC-VM. Patients with a positive dobutamine stress test showed higher maximum VCG values than patients with a negative dobutamine stress test (QRS-VD, P < 0.01; ST-VM, P < 0.001; STC-VM, P < 0.001). The maximum VCG values were related to the number of segments showing new or worsening wall motion abnormality (QRS-VD: r=0.41, P < 0.001; ST-VM: r=0.44, P < 0.001; STC-VM: r=0.57, P < 0.001). CONCLUSION: STC-VM and ST-VM seem to be the best VCG variables for detection of myocardial ischaemia as assessed by dobutamine stress echocardiography.

Aged↗

Attenuation of forearm vasodilator responses to mental stress by regional beta-blockade, but not by atropine.

Forearm blood flow during mental stress (Stroop's colour word conflict test) was studied in 18 healthy men before and during regional beta-adrenoceptor blockade (propranolol 0.5 mg), muscarinic receptor blockade (atropine 0.2 mg) and combined blockade, and compared with results obtained in untreated controls. Forearm blood flow was measured with venous occlusion plethysmography, and forearm vascular resistance was calculated. Arterial and venous blood sampling was performed for determination of adrenaline and noradrenaline in plasma. Mental stress increased heart rate, systolic and diastolic blood pressures and forearm blood flow, and lowered the forearm vascular resistance, to the same degree as in our previously studied controls. Neither of the intra-arterially administered drugs had any discernible systemic effects. Beta-blockade increased forearm vascular resistance by 32% and decreased forearm blood flow by 21% compared with unblocked levels during mental stress, whereas forearm vasodilation was maintained throughout the stress test in the control group (P < 0.05). Intra-arterial atropine had no certain effects. Arterial adrenaline levels during mental stress were similar in the receptor-blocked and control groups. In conclusion, the sustained forearm vasodilation during mental stress appears to be partly mediated via beta 2-adrenoceptor stimulation (i.e. by adrenaline), but we obtained no support for a cholinergic vasodilating mechanism.

Adrenergic beta-Antagonists↗

Plasma angiotensins and human forearm circulation: effects of sympatho-adrenal activation.

Complex interactions appear to exist between the renin-angiotensin system and sympathetic neurotransmission, and sympathetic activity may influence local angiotensin II formation. Arterial and forearm venous plasma levels of angiotensin I and II were therefore studied in 11 healthy males at rest during sympathetic activation elicited by mental stress, and during adrenaline induced vasodilation. Specific assays for angiotensin-(1-8) octapeptide and for angiotensin-(1-10) decapeptide (i.e. angiotensin II and I, respectively), were used. Special precautions to minimize ex vivo formation and/or degradation of angiotensins were employed. Mental stress increased regional noradrenaline overflow three-fold, with a concomitant three-fold increase in forearm blood flow, whereas intravenous adrenaline infusion increased forearm blood flow two-fold and noradrenaline overflow four-old. There was a constant positive veno-arterial concentration difference for angiotensin I under all conditions tested, compatible with local angiotensin I formation. We found no veno-arterial concentration difference for angiotensin II or regional net angiotensin II overflow under the conditions tested. These results in the forearm circulation support previous animal experimental evidence in skeletal muscle and provide no evidence in favour of a de novo formation of angiotensin II in skeletal muscle in vivo during basal conditions. Furthermore, sympathetic nerve stimulation does not seem to enhance angiotensin II generation importantly in this vascular bed.

Adrenal Glands↗

Blockade of endogenous nitric oxide production results in moderate hypertension, reducing sympathetic activity and shortening bleeding time in healthy volunteers.

BACKGROUND: Short-term infusion of NG-monomethyl-L-arginine (L-NMMA) reversibly inhibits endogenous nitric oxide (NO) production in humans. We studied responses to more long-lasting (60 min) infusions, at doses high enough to cause effective inhibition of endogenous NO. METHODS: Eight healthy volunteers had catheters (pulmonary, arterial and venous) placed. Measurements included hemodynamics, endogenous NO levels in nasal air, bleeding time, and cyclic guanosine monophosphate (cGMP) and catecholamines in plasma. L-NMMA was infused at 0.3 mg.kg-1.min-1 during 30 min, followed by 0.15 (n = 6) or 0.3 (n = 2) mg.kg-1.min-1 during 30 min. RESULTS: L-NMMA significantly elevated mean arterial pressure by 12 +/- 3%, due to an increase in systemic vascular resistance. Cardiac output decreased by 23 +/- 3%, due to a decrease in stroke volume. Pulmonary vascular resistance (P < 0.05) increased, but mean pulmonary arterial pressure was stable. Forearm vascular resistance (P < 0.05) decreased. Bleeding time was shortened by 31 +/- 4% (P < 0.01). L-NMMA infusion reduced NO concentrations in nasal air by 64 +/- 2% (P < 0.01). Arterial pressure remained elevated and nasal NO remained depressed 90 min after the infusion, whereas most other responses were reversed at that time. Plasma cGMP showed only minor changes. Plasma norepinephrine decreased, suggesting reflexogenic inhibition of sympathetic activity, whereas epinephrine levels were low and stable throughout the experiment. CONCLUSION: Dosage of (13.5 mg.kg-1 in 60 min) L-NMMA infusion in humans was well tolerated. Pronounced and long-lasting inhibition of endogenous NO production, as evidenced by measurements in nasal air, resulted in unevenly distributed vasoconstriction, a transient decrease in cardiac output, and reflexogenic sympathetic withdrawal. Furthermore, bleeding time was shortened, suggesting platelet activation.

Adolescent↗

Nisoldipine CC: clinical experience in ischaemic heart disease.

Nisoldipine coat core (CC) is a long-acting calcium channel blocker (CCB) with a slow and smooth onset of action. It is effective in the treatment of angina pectoris, increasing exercise duration, time to ST segment depression and time to onset of angina. The results of two studies reviewed here, in which patients received concomitant treatment with a beta-blocker, showed that the anti-anginal efficacy of nisoldipine CC, 40 mg once daily, measured at trough was comparable with amlodipine, 10 mg once daily, and with diltiazem retard, 120 mg twice daily, and that efficacy was maintained over a 24-hour period. The third trial reviewed here showed that nisoldipine CC was at least as effective as three-times-daily treatment with diltiazem (total dose 240 mg). To date, the effects of nisoldipine CC have been investigated in over 4,000 patients with hypertension and angina pectoris. Clinical experience suggests that once-daily nisoldipine CC is at least as well tolerated as other CCBs, provides consistent efficacy and is a useful treatment in the management of patients with angina pectoris. The CCBs show promising beneficial effects in experimental atherosclerosis and a small number of clinical trials show some effect on the progression of atherosclerosis in coronary artery disease and restenosis following coronary angioplasty. An ongoing long-term trial with nisoldipine CC after coronary angioplasty is discussed.

Amlodipine↗

Sustained forearm vasodilation in humans during mental stress is not neurogenically mediated.

To evaluate the possible neurogenic influence on forearm vasodilation during mental stress (Stroop's colour word conflict test), haemodynamic and catecholamine responses were registered in 12 healthy men after axillary blockade. Forearm blood flow was measured with venous occlusion plethysmography and forearm vascular resistance was calculated, with intraarterial blood pressure data. Blood samples for arterial and venous adrenaline and noradrenaline determinations were collected. Basal forearm blood flow increased markedly after axillary blockade, but the relative responses of forearm blood flow and forearm vascular resistance to mental stress were the same as in previously studied unblocked individuals (about +125% and about -40%, respectively). There was no increase in noradrenaline overflow from the forearm during mental stress in the nerve blocked arm. Heart rate and arterial systolic pressure responses as well as catecholamine responses to mental stress were augmented in the nerve blocked group, presumably due to a certain arousal caused by the experimental procedure. Increases in forearm blood flow and decreases in forearm vascular resistance during infusion of adrenaline were similar in the nerve blocked and in the control arm. In conclusion, vasodilation in the forearm during mental stress occurs in the absence of nervous control of the vascular bed. The reactivity of the vascular bed to an exogenous vasodilator (adrenaline) remains unchanged after axillary blockade.

Adrenergic Agonists↗