Biomedical subjects

J L Klein

Publications and source records attributed to J L Klein.

At least 55 records · Page 3Linked to original sources

PubMed1995

Environmental health science research and human risk assessment.

Environmental health science research, with its focus on fundamental science and disease prevention, is important for the development of rational and cost-effective public health and regulatory policies related to environmental protection. Environmentally related diseases are preventable, yet they impose a major burden on society in terms of human suffering and costs related to health care. Similarly, the expenditure of hundreds of billions of dollars for regulatory compliance is a major economic concern. There is considerable debate regarding current regulatory risk assessment practices for environmental agents. Implicit in all risk assessment schemes is the need to extrapolate from high-exposure studies to low-exposure situations and from known risks in rodents to probable risks in people. Both extrapolations are fraught with uncertainties. These uncertainties are accommodated in risk-assessment schemes by the incorporation of arbitrary "safety factors" and other default approaches. Since these factors are not derived experimentally, they may overestimate or under estimate actual risks. Risk-assessment methodology, its relevance to the human condition, and its use in protecting human health will greatly improve when our expanding knowledge of the basic biology of environmental effects is incorporated into toxicological testing and risk-assessment schemes. Moreover, exciting opportunities now exist to advance our understanding of the environmental and genetic bases of many common diseases and to design effective prevention and intervention strategies to combat their development. This report discusses some of the current opportunities and challenges.

Cell Communication↗

PubMed1995

Biodistribution and tumor localization of 111In-labeled unmodified and modified F(ab')2 fragments of human monoclonal IgM (16.88) in a nude mouse model.

Unmodified F(ab')2 and modified Fab'-BMH-Fab' fragments of human monoclonal IgM (16.88) were compared for biodistribution and tumor localization in nude mice bearing LS-174T human colon carcinoma xenografts. Although both unmodified and modified fragments of IgM cleared rapidly from the blood, the radioactivity retentions for each fragment in liver and kidney were significantly different. Kidney uptake of the modified fragment was about 4-fold lower than kidney uptake of the unmodified fragment. Radioactivity uptake in liver was 2-4-fold higher for the modified fragment. Lower liver and higher kidney uptake of unmodified fragments reflected the labile disulfide linkage of F(ab')2 in their hinge region and the subsequent behavior of the Fab' fragments resulting from the reduction of the disulfide linkage. Higher liver and lower kidney retention of modified fragments, on the other hand, resulted from the different cleavage mechanism of the stable thioether linkage. Tumor targeting was similar for unmodified and modified fragments at approx. 4% of injected dose per gram. These results indicate that the changes in fragment linkage chemistry may provide different pharmacokinetic patterns in vivo and improve the therapeutic application of radiolabeled fragments in human patients.

Animals↗

PubMed1995

Survival of patients with resistant Hodgkin's disease after polyclonal yttrium 90-labeled antiferritin treatment.

PURPOSE: A follow-up study was initiated of patients with Hodgkin's disease who were treated with yttrium 90-labeled antiferritin. Prescription method, pharmacokinetics, acute and late side effects, and survival were evaluated. METHODS: Patients had measurable disease and failed > or = two multiagent chemotherapy regimens previously (N = 44). All patients received 5-mCi indium 111-labeled antiferritin 2 mg intravenously and were scanned repeatedly by gamma camera. In five patients, polyclonal antiferritin (rabbit, pig, or baboon) failed to target the tumor. Thirty-nine patients were injected intravenously with 10-, 20-, 30-, 40-, or 50-mCi yttrium 90-labeled antiferritin 2 to 5 mg. Patients received between one and five cycles. Some patients were supported with 5 x 10(7) autologous bone marrow cells per kilogram. RESULTS: Yttrium 90-labeled polyclonal antiferritin does not produce immunologic, pharmacologic, or microbiologic complications in vivo. Bone marrow toxicity is the only side effect observed. Overall response rate is 20 of 39, or 51%. Two patients had stable disease. A significant positive correlation is found between blood radioactivity level 1 hour after radioimmunoconjugate administration and subsequent response of Hodgkin's disease. A dosage in millicuries per kilogram provides a higher positive correlation with blood radioactivity levels 1 hour after administration than a dosage in millicuries per square meter of body-surface area or in total millicuries. Fifty percent of patients survive for > or = 6 months. CONCLUSION: The low-dose protein used (2 to 5 mg) indicates that the high response rate is due to radiation and not to immunologic effects of the antibody. High-activity administrations followed by bone marrow transplantation are not required for tumor response. The therapeutic ratio of radiolabeled antiferritin is higher than the therapeutic ratio observed in most phase I studies of chemotherapeutic agents. This analysis does not identify a superior mode of treatment for patients with end-stage Hodgkin's disease. However, in a heavily pretreated patient population, prolonged survival is observed after relatively inexpensive treatment. Preclinical research with yttrium 90-labeled antiferritin indicates that significant increases in tumor dose can be obtained in the future without an increase in normal tissue toxicity.

Adolescent↗

PubMed1995

The misclassification of family history status in studies of children of alcoholics.

OBJECTIVE: The search for genetic and phenotypic markers associated with future alcoholism risk often centers on comparisons of children of alcoholics and controls. Such studies require large samples to compensate for the rate of expression of alcoholism in less than half of children of alcoholics, the importance of environmental influences, the complex types of inheritance likely to be involved and the lack of precision of many of the measurements used. An additional problem is the change in family history status over time. METHOD: This study uses personal interviews with subjects and an additional informant during a 9.3-year follow-up of 223 men to demonstrate the impact of the problem of family history misclassification. RESULTS: On follow-up, 7% of the men who had been originally classified as family history negative (FHN) were found to have a close relative who developed alcoholism during the follow-up period, and another 6% had gained knowledge of a preexisting alcohol use disorder in their relatives during the interval since testing. Also, 5% of the 223 men had originally been identified as sons of alcoholics but were found to have been incorrectly categorized based on more thorough information at follow-up. CONCLUSIONS: These findings underscore the conclusion that relatively large samples are required in this research to overcome the minimum of a 7% error rate in family history assignment likely to occur from the future development of alcoholism in the family of family history negative subjects along with additional errors in reporting or interpreting original histories.

Adolescent↗

PubMed1994

Lack of effect of lovastatin on restenosis after coronary angioplasty. Lovastatin Restenosis Trial Study Group.

BACKGROUND: Experimental and clinical observations suggest that lowering serum lipid levels may reduce the risk of restenosis after coronary angioplasty. We report the results of a prospective, randomized, double-blind trial evaluating whether lowering lipid levels with lovastatin can prevent or delay restenosis after angioplasty. METHODS: Seven to 10 days before angioplasty, we randomly assigned eligible patients to receive lovastatin (40 mg orally twice daily) or placebo. Patients who underwent successful, complication-free, first-time angioplasty of a native vessel (the index lesion) continued to receive therapy for six months, when a second coronary angiogram was obtained. The primary end point was the extent of restenosis of the index lesion, as assessed by quantitative coronary arteriography. Of 404 patients randomly assigned to study groups, 384 underwent angioplasty; 354 of the procedures were successful, and 321 patients underwent angiographic restudy at six months. RESULTS: At base line, the patients in the lovastatin group (n = 203) and the placebo group (n = 201) were similar with respect to demographic clinical, angiographic, and laboratory characteristics. At base line the mean (+/- SD) degree of stenosis, expressed as a percentage of the diameter of the vessel, was 64 +/- 11 percent in the lovastatin group, as compared with 63 +/- 11 percent in the placebo group (P = 0.22). Despite a 42 percent reduction in the serum level of low-density lipoprotein cholesterol in the lovastatin group, after six months of treatment the amount of stenosis seen in the second angiogram was 46 +/- 20 percent in the placebo group, as compared with 44 +/- 21 percent in the lovastatin group (P = 0.50). Similarly, there were no significant differences in minimal luminal diameter or other measures of restenosis. A trend was noted toward more myocardial infarctions in the lovastatin group, as a result of acute vessel closure or restenosis at the site of angioplasty, but there were no other important differences between the two groups in the frequency of fatal or nonfatal events at six months. CONCLUSIONS: Treatment with high-dose lovastatin initiated before coronary angioplasty does not prevent or delay the process of restenosis in the first six months after the procedure.

Angioplasty, Balloon, Coronary↗

PubMed1994

Growth suppression of transformed BALB/c 3T3 cells by transforming growth factor beta 1 occurs only in the presence of their normal counterparts.

Transforming growth factor beta 1 (TGF-beta 1) enhances the yield of transformed foci of BALB/c 3T3 cells, but the continuous presence of TGF-beta 1 after foci formation inhibits the growth of transformed foci. The focus-forming ability of Ha-ras-, v-src- and PyMT-transformed cells growing on a monolayer of non-transformed cells was completely suppressed by TGF-beta 1, whereas growth of the transformed cells was little inhibited by TGF-beta 1 in the absence of their normal counterparts. The inhibition by TGF-beta 1 of focus formation by transformed BALB/c 3T3 cells on a normal cell monolayer remained when TGF-beta 1 was removed from the culture medium after 2 weeks. However, the transformed cells were not killed, since they grew in culture conditions under which only transformed cells are able to grow (soft agar). These results suggest that TGF-beta 1 suppresses growth of transformed cells in the presence of normal cells. Furthermore, when non-transformed cells were treated with TGF-beta 1 before co-culture with Ha-ras-transformed cells, formation of transformed foci was inhibited. When normal and transformed cells were cultured in the same dish but separated physically, focus formation was still inhibited. On the other hand, TGF-beta 1 enhanced the growth and changed the morphology of non-transformed cells only in the presence of transformed counterparts. The growth inhibitory effect of TGF-beta 1 on transformed cells and its growth stimulatory effect on non-transformed cells in co-culture conditions suggest the induction of reciprocal paracrine growth regulatory factors. As TGF-beta 1 inhibits the growth of transformed BALB/c 3T3 cells only in the presence of their normal counterparts, a paracrine negative growth control mechanism appears to be operating.

3T3 Cells↗

PubMed1994

The prognostic importance of blackouts in young men.

In order to test the commonly held perception that blackouts are an early diagnostic sign of alcoholism, we evaluated a sample of 230 nonalcoholic young men longitudinally over an 8-12 year follow-up period. Consistent with the literature, blackouts were a common occurrence in this cohort, with 26% of the men reporting blackouts by their early twenties, and 30% of the subjects experiencing blackouts over the approximately 10-year follow-up. Alcohol-related amnestic episodes were associated with the quantity and frequency of drinking, and men with blackouts (especially four or more) were more likely to have other problems related to their heavy drinking. Although few alcoholics will report not having had such amnestic spells, blackouts are not sensitive indicators of the risk for developing alcoholism. The data suggest that blackouts should be viewed as an important warning sign of problem drinking, but not as the "hallmark" of alcoholism.

Adolescent↗

PubMed1994

Increases in alcohol-related problems for men on a college campus between 1980 and 1992.

A questionnaire concerning alcohol and drug use was mailed to a random sample of male students at the University of California at San Diego in 1980, and similar procedures were used in 1992. Both mailings yielded response rates of approximately 70% (1980: N = 1,024; 1992: N = 721). The data revealed that while the rates of illicit substance use and associated problems decreased significantly between the two time points, the quantity of alcohol consumed per occasion and the prevalence of alcohol-related problems significantly increased during those 12 years. These increases suggest a need for an expanded emphasis on alcohol education at colleges and universities.

Adult↗

PubMed1994

Predictors of drinking and driving in healthy young men: a prospective study.

This paper explores the ability of information about alcohol use and problem patterns in men's early 20s to predict drinking and driving by their early 30s. The sample consisted of 231 healthy young men who were students or nonacademic staff at a university. Subjects were evaluated initially with questionnaires and interviews, and subsequently followed-up using interviews with themselves and with a resource person. The reported rate of drinking and driving at follow-up was nearly 38%. Using logistic regression, the combination of variables that best predicted drinking and driving included prior alcohol-related auto accidents, a measure of typical drinking, and a measure of drinking-related problems. The overall prediction employing this combination was 72%, the specificity was 86%, and the sensitivity was 48%.

Accidents, Traffic↗

PubMed1994

Controlled trial of orally administered immunoglobulin following bone marrow transplantation.

Between May 1987 and September 1989, 72 patients undergoing marrow transplantation at a single institution were randomized to receive 50 mg/kg of a commercial gammaglobulin preparation or placebo daily in four divided doses for 28 days following transplantation. Patients receiving oral gammaglobulin had significantly increased concentrations of stool IgG (p = 0.01) compared with the placebo group. There was no difference in the amount of diarrhea, frequency of GVHD, duration of hospitalization or survival in the two groups. The present study demonstrates that orally administered IgG can survive passage through the gastrointestinal tract of bone marrow transplantation recipients but there was no effect of oral administration of immunoglobulin on morbidity or mortality following bone marrow transplantation.

Administration, Oral↗

PubMed1993

Growth of only highly tumorigenic cell lines is inhibited by EAP, a human placental fraction.

We have previously shown that a fraction from a human placental extract, EAP, inhibited growth in soft agar of a human lung squamous adenocarcinoma cell line, A-2182, and of Ha-ras oncogene-transfected murine BALB/c 3T3 cells. We report here the activities of this extract on several cell lines which have different degrees of transformed phenotype. Human esophagus and colorectal cell lines were derived from tumors at different stages of neoplasic progression, and murine BALB/c 3T3 cells were transfected with various oncogenes. In all three models, growth of the most highly tumorigenic cells was inhibited by the presence of EAP in soft agar medium, while growth of non- and low tumorigenic counterparts was not affected or was stimulated by the placental extract. In addition, EAP did not significantly affect the doubling time of anchorage-dependent cell growth, suggesting that EAP specifically suppresses tumorigenic characteristics of cells such as their ability to grow in soft agar medium. These effects appear to be in contrast to those of transforming growth factor beta, which exerts its most profound effect on less tumorigenic cells.

3T3 Cells↗

PubMed1993

Current status of cancer immunodetection with radiolabeled human monoclonal antibodies.

The use of radiolabeled murine monoclonal antibodies (MoAbs) for cancer immunodetection has been limited by the development of human antimouse antibodies (HAMA). Human monoclonal antibodies do not elicit a significant human antihuman (HAHA) response. The generation and production of human monoclonal antibodies met with technical difficulties that resulted in delaying their clinical testing. Human monoclonal antibodies of all isotypes have been obtained. Most were immunoglobulin (Ig) M directed against intracellular antigens. Two antibodies, 16.88 (IgM) and 88BV59 (IgG3k), recognize different epitopes on a tumor-associated antigen, CTA 16.88, homologous to cytokeratins 8, 18, and 19. CTA 16.88 is expressed by most epithelial-derived tumors including carcinomas of the colon, pancreas, breast, ovary, and lung. The in vivo targeting by these antibodies is related to their localization in nonnecrotic areas of tumors. Repeated administration of 16.88 over 5 weeks to a cumulative dose of 1,000 mg did not elicit a HAHA response. Two of 53 patients developed a low titer of HAHA 1 to 3 months after a single administration of 88BV59. Planar imaging of colorectal cancer with Iodine-131 (131I)-16.88 was positive in two studies in 9 of 12 and 16 of 20 patients preselected by immunohistochemistry. Tumors less than 2 cm in diameter are usually not detected. The lack of immunogenicity and long tumor residence time (average = 17 days) makes 16.88 a good candidate for therapy. Radioimmunlymphoscintigraphy with indium-111 (111In)-LiLo-16.88 administered by an intramammary route was used in the presurgical staging of primary breast cancer. The negative predictive value of lymph node metastases for tumors less than 3 cm was 90.5%. Planar and single photon emission computed tomography imaging of colorectal carcinoma with technetium-99m (99mTc) 88BV59 was compared with computed tomography (CT) scan in 36 surgical patients. The antibody scan was more sensitive than the CT scan in detecting abdominal and pelvic tumors: 68% versus 40% (P < .05). The combination of antibody scan and CT scan was superior to CT scan alone: 80% versus 40% (P < .01). Lesions as small as 0.5 cm in diameter were detected by antibody scan. The CT scan appears superior to the antibody scan for liver metastases. Patients with a high serum titer of HAMA from previous exposure to murine antibodies were successfully imaged. Antibody scans obtained with 99mTc-88BV59 have imaging characteristics similar to murine antibody scans obtained with radiolabeled IgGs. The absence or weak immunogenicity of the human monoclonal antibodies makes them good candidates for radioimmunodetection and radioimmunotherapy.

Breast Neoplasms↗

PubMed1993

Association of viral oncogene-induced changes in gap junctional intercellular communication and morphological transformation in BALB/c3T3 cells.

In order to study the relationship between altered gap junctional intercellular communication (GJIC) and induction of cell transformation by oncogenes, we transfected six viral oncogenes into BALB/c3T3 A31-1-1 cells. BALB/c3T3 cells with v-src, v-ras or polyoma middle T (PyMT) genes grew in soft agar and formed distinct transformed foci in the absence or presence of a vast excess of non-transfected cells. On the other hand, those with v-myc, v-fos or polyoma large T (PyLT) genes expressed less distinctly transformed phenotypes (less transformed morphology, higher saturation density than non-transfected counterparts and less growth in soft agar), and did not form distinct foci in coculture with non-transformed cells. When their homologous GJIC capacities were examined by the microinjection/dye transfer assay, no decrease in GJIC was observed in any of the v-onc-transformed cells. Non-transformed and all v-onc-transformed cell lines expressed similar levels of connexin 43 mRNA. v-myc-, v-fos- and PyLT-transformed cells, but not v-ras-, v-src- and PyMT-transformed cells were able to communicate heterologously with non-transformed cells. Tumor promoting phorbol esters strongly inhibited GJIC of non-transformed and all v-onc-transformed BALB/c3T3 cell lines. In cocultures of v-myc-, v-fos- or PyLT-transformed cells with non-transformed BALB/c3T3 A31-1-1 cells, 12-O-tetradecanoylphorbol-13-acetate (TPA) increased the number of transformed foci. However, when these v-onc-transformed cells were co-cultured with non-transformed BALB/c3T3 A31-1-13 cells (which lose GJIC at growth confluence, as if TPA had been added), no morphologically transformed foci appeared. These results suggest that factors other than GJIC are involved in the suppression of oncogene-transformed cells by surrounding normal counterparts.

3T3 Cells↗

PubMed1993

Lack of correlation between the gap junctional communication capacity of human colon cancer cell lines and expression of the DCC gene, a homologue of a cell adhesion molecule (N-CAM).

In many human colorectal cancers, the DCC gene encoding for a homologue of the neural cell adhesion molecule (N-CAM) is found to be deleted. Previous work suggested that gap junctional intercellular communication (GJIC) might play an important role in carcinogenesis and could be regulated by the expression of cell adhesion molecules such as E-cadherin in some epithelial cell systems. In order to examine whether the deletion of the putative cell adhesion molecule DCC is related to the level of GJIC, which might, in turn, be important in human colorectal cancers, we compared levels of expression of the DCC gene with the GJIC capacity of a panel of human colorectal adenocarcinoma cell lines isolated from different stages of tumor progression. While the level of GJIC varied between the cell lines studied, we found no correlation between their communication capacity and DCC expression revealed by a reverse-transcriptase/polymerase chain reaction method. This lack of correlation suggests that DCC is not a crucial regulator of GJIC.

Adenocarcinoma↗

PubMed1993

Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels.

BACKGROUND: Patients with hypertension and myocardial hypertrophy may have signs and symptoms of myocardial ischemia in the absence of obstructive coronary disease. Prior investigations have demonstrated impaired coronary flow reserve and have led to speculation that microvascular dysfunction might contribute to ischemia in these patients. Experimental studies have shown that the endothelium, an important regulator of microvascular tone, can be damaged by hypertension and is dysfunctional in cardiomyopathy. We hypothesized that endothelium-dependent vasodilation is impaired in the coronary microvasculature of patients with hypertension and ventricular hypertrophy. METHODS AND RESULTS: We studied coronary microvascular responses in 10 patients with left ventricular hypertrophy secondary to essential hypertension (HTN) (mean arterial pressure at catheterization, 151/94 mm Hg; mean posterior wall thickness, 1.4 +/- 0.1 cm) and nine normal control subjects with no history of hypertension (mean arterial pressure at catheterization, 128/75 mm Hg; mean posterior wall thickness, 1.0 +/- 0.02 cm) using the intracoronary Doppler catheter and quantitative angiography to assess changes in coronary blood flow (CBF). All patients had normal left ventricular systolic function. To assess microvascular endothelial function, we infused the endothelium-dependent vasodilator acetylcholine (10(-8)-10(-6) M) and the endothelium-independent vasodilator adenosine (10(-6)-10(-4) M) into the left anterior descending coronary artery. In response to acetylcholine, CBF increased only 32 +/- 25% in HTN patients, whereas CBF increased 192 +/- 39% in normal control subjects (p = 0.003). CBF increased 465 +/- 93% in HTN patients and 439 +/- 41% in normal control subjects in response to adenosine (p = NS). The proportion of coronary flow reserve attributable to endothelium-dependent dilation (obtained from peak acetylcholine/peak adenosine flow response) was 48 +/- 9% in normal control subjects but only 7 +/- 8% in HTN patients (p = 0.008). CONCLUSIONS: Endothelium-dependent vasodilation is markedly impaired in the coronary microvessels of patients with hypertension and ventricular hypertrophy. Loss of this vasodilator mechanism may contribute to disordered coronary flow regulation and the ischemic manifestations of hypertensive heart disease.

Acetylcholine↗

PubMed1993

Yttrium 90-labeled antiferritin followed by high-dose chemotherapy and autologous bone marrow transplantation for poor-prognosis Hodgkin's disease.

PURPOSE: This study was undertaken to examine the feasibility of combining radiolabeled antibody therapy with high-dose chemotherapy followed by autologous bone marrow transplantation in patients with poor-prognosis Hodgkin's disease. PATIENTS AND METHODS: Patients were entered onto this protocol if they had chemotherapy-resistant disease, bulky disease, or extensive prior therapy. Patients received yttrium-labeled antiferritin on day -13, -12, or -11, followed by high-dose cyclophosphamide, carmustine, and etoposide (CBV) on days -6 to -3, and then bone marrow infusion on day 0. RESULTS: Twelve patients received both radiolabeled antibody and high-dose chemotherapy followed by autologous transplantation. Two additional patients started the study, but were unable to complete all therapy. Four of 12 patients experienced early transplant-related mortality. Four patients are alive more than 2 years following transplantation and three are free from disease progression at 24+, 25+, and 28+ months following transplantation. The progression-free survival rate at 1 year is estimated to be 21%. Considering the poor prognostic characteristics of these patients, toxicity on this protocol was not necessarily greater than that observed with high-dose chemotherapy alone. CONCLUSION: This report demonstrates the feasibility of combining radiolabeled antibody therapy with high-dose chemotherapy and autologous bone marrow transplantation.

Adolescent↗

PubMed1993

Three-dimensional coronary angiography.

For at least two decades coronary cine-angiograms have been reviewed on film projectors. The cardiologist most often reviews the multiple two-dimensional projections of the coronary arterial tree on a screen, and then mentally create a three-dimensional (3-D) model of the patient's arteries. The ability to synthesize this data and grasp the three-dimensionality of a patient's specific anatomy is quite difficult and requires extensive training and experience to perfect. Fortunately, with advances in computer hardware and software, cardiologists, with all levels of experience, will have assistance with this difficult task. It is now possible, with the use of computers, to reconstruct and display a patient's coronary angiogram in 3-D, allowing the cardiologist to review this data in ways not previously available. In the near future, enhancements in the technique will allow this technology to be placed on-line, directly in the cardiac catheterization laboratory, greatly facilitating the ability to diagnose abnormalities and more appropriately plan treatment strategies.

Cineangiography↗

PubMed1993

Allogeneic bone marrow transplantation following busulfan and 90 mg/kg of cyclophosphamide.

Ten patients with AML or CML aged 40-55 years underwent allogeneic marrow transplantation from HLA-identical siblings following a preparation regimen of busulfan 16 mg/kg and cyclophosphamide (CY) 90 mg/kg. The CY dose was substantially lower than has been previously used in combination with busulfan. All 10 individuals engrafted. Cytogenetic analysis of marrow and peripheral blood cells demonstrated similar patterns of chimerism to those previously described using higher CY doses. This study demonstrates that when administered with busulfan 16 mg/kg a dose of 90 mg/kg CY is adequately immunosuppressive to permit consistent engraftment of marrow from HLA-identical sibling donors.

Adult↗