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K H Kurth

Publications and source records attributed to K H Kurth.

At least 37 records · Page 2Linked to original sources

[Changes in the cytokine concentration during immunotherapy of superficial bladder tumors].

A growing number of data support the importance of urinary cytokines in the BCG immunotherapy of superficial bladder tumours. To investigate kinetics and stability, urinary levels of IL-8, IL-2 and IL-6 cytokines after BCG treatment, were determined. Significant elevation in the level of IL-8 was established immediately following the first BCG instillation and it reached its highest value 4-6 hours after the treatment. During the first three weeks of the treatment and follow-up period IL-8 peaked significantly earlier than IL-2 or IL-6. Its early appearance associated with high stability makes IL-8 a good candidate for being considered as an effective agent with high predictive value in BCG immunotherapy.

BCG Vaccine↗

Initial experiences with the retroperitoneal approach for endoscopic nephrectomy with the patient in the prone position.

Retroperitoneal endoscopic nephrectomy with the patient in the prone position was performed in 12 patients. Indications for this procedure were end-stage kidneys with ureteropelvic junction stenosis or distal ureteric obstruction, nonfunctional kidneys with drug resistant renin-mediated hypertension, and distal ureter malignancy. The retroperitoneal area was exposed using an open surgical technique in combination with the use of a liquid-filled dissection balloon. Removal of kidney tissue was performed with a morcellator through one of the ports. On average, the operating time was 210 min (range 160-480 min) to complete a one-sided nephrectomy. No major complications occurred. Mean hospital stay in this series was 6.6 days, and the follow-up period was uncomplicated in all cases. Retroperitoneal endoscopic nephrectomy with the patient in the prone position is an acceptable alternative to open nephrectomy in selected indications.

Adult↗

BCG-induced interleukin-6 upregulation and BCG internalization in well and poorly differentiated human bladder cancer cell lines.

Intravesical bacillus Calmette-Guerin (BCG) is a successful therapy for superficial bladder cancer. However, the working mechanism of BCG after intravesical instillation is not completely understood. A functional role of urothelial (tumor) cells in the initiation of the BCG-induced immune reaction should be considered. Here, the possibility of a causal relationship between BCG-induced interleukin-6 (IL-6) synthesis and BCG internalization by urothelial tumor cells was examined in a series of human transitional bladder cancer (TCC) cell lines with different degrees of differentiation. The results showed that the well differentiated TCC cell lines, RT4, SBC-2, and SBC-7, did not possess the capacity to internalize BCG, which was associated with an inability to upregulate IL-6 synthesis when stimulated with BCG. Moreover, these cell lines expressed a low level of constitutive IL-6 synthesis. In contrast, the poorly differentiated TCC cells, T-24, TCC-SUP and J-82, were able to internalize BCG. In T24 and J82, but not in TCC-SUP cells, BCG internalization appeared to result in an upregulation of IL-6 synthesis. Constitutive IL-6 synthesis of the high grade cell lines was found to be cell line-dependent: both TCC-SUP and J82 cells exhibited a high level of constitutive IL-6 synthesis, whereas T24 cells exhibited a low level. The possible relationship between BCG internalization and IL-6 upregulation was studied in detail with the T24 cell line, which exhibited a low constitutive and high BCG-inducible IL-6 synthesis, using anti-BCG antibodies (alphaBCG) and Cytochalasin B as internalization inhibitors. Upregulation of IL-6 synthesis was significantly inhibited by alphaBCG or Cytochalasin B, indicating that internalization is a prerequisite for BCG-induced upregulation of IL-6 synthesis. In conclusion, upregulation of IL-6 production due to BCG internalization by poorly differentiated bladder carcinoma cells may be part of the mode of action of intravesical BCG therapy.

Administration, Intravesical↗

Role of interleukin-8 in onset of the immune response in intravesical BCG therapy for superficial bladder cancer.

In intravesical therapy for superficial bladder carcinoma urothelial cells may, through the production of cytokines, contribute to the bacillus Calmette-Guerin (BCG)-induced local immunological reaction and associated antitumor efficacy. The aim of this study was to investigate such a role for the neutrophil-attracting cytokine interleukin-8 (IL-8). The appearance of IL-8 in patients urine after BCG therapy was compared with BCG-induced IL-6 and IL-2 and the stability of IL-8 in urine was tested. Compared to IL-6 and IL-2, a rapid induction of IL-8 was observed, occurring after the first BCG instillation. Urinary IL-8 was highly stable, even after 24 h incubation at 37 degrees C. The IL-8 concentration after the first instillation seemed to be associated with subsequent development of an immune response. Consequently, IL-8 seems an attractive candidate for investigation of its prognostic value for a clinical response to BCG therapy.

Administration, Intravesical↗

Quality of life in patients with prostatic carcinoma: a review and results of a study in N+ disease. Prostate-specific antigen as predictor of quality of life.

Clinical evaluation in oncology has typically focused on outcome indicators, while less attention has been paid to how treatment affects quality of life (QOL) of the patient. In this article some general aspects of quality of life are discussed, a short review of published data on QOL in patients with prostate cancer is given and results of a QOL study executed by the authors on patients with lymph node positive prostatic cancer are presented. The purpose of the study was to examine the impact of immediate or delayed treatment (after objective progression) in patients with prostatic carcinoma (T1-3 N1-3 M0) on quality of life parameters. To this end an extended questionnaire was constructed. Fifty-five patients participated. Assessment was performed twice, in 1994 and 1995. The comparison between patients with and patients without treatment showed in 1994 as well as in 1995 significant differences for hormonal treatment side effects such as sexual functioning and hot flushes, all of which were experienced more frequently by treated patients. In 1994 the treated patients experienced more psychological distress while in 1995 they showed worse physical function, less energy and more fatigue when compared to patients under surveillance. The premise that active treatment would improve the psychological quality of life was not sustained. In addition global health status and quality of life were identified as independent factors for progression in untreated patients with lymph node positive prostate cancer. Finally, an increase in prostate-specific antigen (PSA) in hormonally treated patients not only indicated hormonal escape but also a decrease in QOL.

Humans↗

Role of proteoglycans in cell adhesion of prostate cancer cells: from review to experiment.

Development and progression of prostate cancer is a multistep process of cumulative genetic damage, acquired during a life-time. However, the altered genotype acts against an appropriate background of epigenetic control mechanisms. Several mechanisms of mitotically heritable, epigenetic control of differential gene transcription have been noted, such as stromal-epithelial and cell-cell interactions. In prostate cancer, an important, supporting and/or inhibiting role of stromal-epithelial interaction has been implicated in tumor growth, angiogenesis and metastasis, which includes cell proliferation, adhesion and motility. Within these processes, data mainly obtained in systems other than the prostate have shown a crucial (regulatory) role of proteoglycans (PGs) acting at the level of cell-cell and cell-pericellular matrix interactions. Although little information has been recorded from normal, benign hyperplastic and malignant prostate tissue, PGs are components of both the cell surface and the extracellular matrix (ECM) that form associations with other molecules, such as fibronectin and laminin. On the basis of cell-ECM adhesion/interaction as a prerequisite for both cell proliferation and motility, and the involvement of PGs, the purpose of this study was to investigate the possible biological relevance of (free) glycosaminoglycans (GAGs), as major functional substructures of PGs, on cell adhesion of a series of human prostatic cell lines cultured in vitro. The effects of a series of exogenously applied GAGs on cell adhesion and proliferation were studied in the human cell lines LNCaP, DU 145 and PC-3, cultured on tissue culture plastic as substratum. The applied GAGs were the natural GAGs heparin, heparan, dermatan, chondroitin-4 and chondroitin-6 sulfate, and the semisynthetic, GAG-like pentosan polysulfate (PPS). Addition of GAGs (1-300 micrograms/ml) to cultures that were allowed to adhere for 24 h prior to GAG addition did not affect cell proliferation. In contrast, whereas the natural GAG added during cell adhesion had no effect. PPS strongly inhibited proliferation of LNCaP and DU145, but not the less anchorage-dependent PC-3 cells. Under the latter conditions, after 6 days of culturing the IC50 of proliferation were determined to be < 1 and 50 micrograms PPS/ml for LNCaP and DU145, respectively, corresponding with a profound effect on cell morphology. Direct measurements of cell adhesion confirmed that, in contrast to the natural GAGs, PPS inhibited cell adhesion. In conclusion, the interference of a nonnatural, GAG-like structure with cell adhesion may be interpreted as the involvement of PGs of the cell surface in cell adhesion, possibly affecting the various processes (proliferation, angiogenesis and metastasis) of prostate tumor progression. Although similar interferences of nonnatural GAGs with cell-adhesion-associated proliferation of anchorage-dependent cells remain to be established under in vivo conditions, this type of compounds deserves further attention as a tool with which to study the role of cell adhesion in the progression of prostate cancer and as a potential candidate for the development of a stromal-epithelial targeted therapy.

Cell Adhesion↗

Immunostimulation in the urinary bladder by local application of Nocardia rubra cell wall skeleton preparation (Rubratin) for superficial bladder cancer immunotherapy--a phase I/II study.

OBJECTIVES: Twelve patients with superficial papillary transitional cell carcinoma of the bladder (pTa, pT1) were treated with six consecutive weekly intravesical instillations of Rubratin (in a dose of 1.5, 3.0, or 4.5 mg), a cell wall skeleton preparation of Nocardia rubra (NCW). The main objective of this study was to look for local immunomodulating effects of NCW and in the first four patients the effect on a marker lesion was also investigated. METHODS: Local immunostimulation in all 12 patients was determined by (1) measurement of cytokine induction [interleukin 1 beta (IL1 beta), IL2, IL6, and tumor necrosis factor alpha (TNF alpha)], (2) leukocyte influx into the urine, and (3) phenotypic analysis of the lymphocyte fraction of these leukocytes. RESULTS: Significantly elevated levels of Rubratin-induced IL1 beta (P < 0.001), IL2 (P < 0.001), IL6 (P < 0.01), and TNF alpha (P < 0.001) were found compared to control pretherapy levels. Rubratin also induced leukocyte influx into the urine. Fluorescence-activated cell sorter (FACS) analysis of the urinary leukocytes indicated T-cell activation (IL2 receptor and HLA-DR expression), while in two out of five patients the CD4/CD8 ratios were increased. Urinary cytokine induction by Rubratin was comparable with cytokine induction observed in nonresponding bacillus Calmette-Guérin (BCG) patients (recurrent tumor within 6 months), but less compared with responding BCG patients (no recurrent tumor within 6 months). Clinical results showed no response on the marker lesion and in five out of eight patients early recurrence was found after complete transurethral resection (TUR) of the bladder tumors. This biological response modifier caused no local or systemic side effects at the doses used. CONCLUSION: Although local immunostimulation by intravesical Rubratin administration can be induced, the amount of immunocompetent cells attracted to the bladder is not as high as observed in BCG-responding patients, resulting in lower amounts of cytokines produced. This could also explain the lack of clinical efficacy.

BCG Vaccine↗

Comparison of inguinal and laparoscopic approaches in the treatment of varicocele.

To determine the pros and cons of inguinal and laparoscopic varix ligation techniques, we reviewed 53 patients who underwent inguinal (n = 35) and laparoscopic (n = 18) varicocelectomy at two centers. Intraoperative complications were not observed in either of the groups. There was 1 recurrence and 1 persistence in the laparoscopically treated patients. The inguinal approach had the advantage of shorter operating time (19.1 versus 52.8 min), ability to ligate the external spermatic veins, and it could be performed as an outpatient procedure. However, the laparoscopic approach seemed superior for preserving the spermatic artery (88.8% versus 68.5%) and had lesser postoperative morbidity.

Adolescent↗

Effects of isoniazid on the proliferation and cytokine production of bladder cancer cells in vitro induced by bacille Calmette-Guérin.

OBJECTIVE: To determine the effects of isoniazid (isonicotinic acid hydrazide), used to reduce the serious side-effects of immunotherapy of superficial bladder cancer with bacille Calmette-Guérin (BCG), on the proliferation and constitutive BCG-induced synthesis of interleukins 6 (IL6) and 8 (IL8) in human bladder cancer cells cultured in vitro. MATERIALS AND METHODS: Three poorly differentiated human cell lines, T24, TCC-SUP and BT-B, were used to study the effect of isoniazid on cell proliferation. Cells were inoculated in tissue culture plates and various concentrations of isoniazid added to the medium. Cell density was then monitored for up to 6 days using a colorimetric assay. To determine the effects of isoniazid on constitutive and BCG-induced cytokine synthesis, cells were cultured in medium containing no additions, BCG, isoniazid or BCG with isoniazid, at various concentrations. Samples of medium were collected regularly for 6 h and the cytokine content (IL6 and IL8) determined using enzyme-linked immunosorbent assays. RESULTS: Continuous incubation of proliferating T24, TCC-SUP and BT-B cells with isoniazid at concentrations of 0-100 micrograms/mL did not affect the rate of proliferation. Unlike TCC-SUP and BT-B cells, T24 cells released more IL6 and IL8 during incubation with BCG. At 6 h after the addition of BCG, the cumulative mean (SD) IL6 and IL8 production of T24 cells was 2.6 (0.1) and 2.3 (0.4) ng per 3 x 10(5) cells, compared with a constitutive level of 0.1 (0.0) and 1.3 (0.2) ng, respectively. There was no significant effect of isoniazid (1-100 micrograms/mL) on either the constitutive or BCG-induced synthesis of IL6 and IL8 in T24 cells. CONCLUSION: Assuming an essential role of (tumour) epithelial cells in the local immune response induced by BCG, these in vitro results suggest that the administration of isoniazid does not interfere with this part of the mechanisms by which BCG operates.

Antitubercular Agents↗

Multichannel urethral pressure profiles: reproducibility and three-dimensional representation.

Urethral pressure profilometry (UPP) is used to investigate the pressure distribution in the urethra. Single UPP is dependent on the orientation of the catheter during the study. To circumvent this problem, we developed a system for multichannel profilometry (MCUPP) that can be used in daily clinical practice. In the study reported in this article, 29 healthy female volunteers (mean age 34.6 years) underwent MCUPP. The mean time needed to make five pressure profiles ranged from 4 to 12 minutes (mean 7.6). The system is patient- and user-friendly. The volunteers scored the discomfort on a 1 to 10 scale, with 10 meaning no discomfort at all, rendering a mean score of 7.6. The Symmetry Index (SI) is a calculated variable expressing the asymmetry in the pressure profiles. An SI of 1 means a completely symmetrical pattern of pressure distribution. The mean SI for the whole group was 0.7 (range 0.407-0.930). The standard deviation was 0.109. Within-subject SI was highly reproducible (Greenhouse-Geisser epsilon = 0.98292).

Adult↗

Diagnosis and treatment of superficial transitional cell carcinoma of the bladder: facts and perspectives.

The detection of potentially highly curable low-grade bladder cancers by noninvasive techniques remains an unsolved problem. Conventional cytology detects such tumors with 50% sensitivity, the addition of DNA image analysis cytometry in patients with previous transitional cell superficial bladder carcinoma increases the chance to detect low-grade tumors. The specificity and sensitivity of detection of low-grade bladder tumors can be further improved by quantitative fluorescence image analysis using antibodies directed against tumor-associated antigens. The chance of subsequent tumor following initial complete resection is significantly lowered compared to resection alone by either intravesical adjuvant chemotherapy or immunotherapy. BCG is superior to chemotherapy in patients with high risk for recurrence, adjuvant intravesical chemotherapy does not prevent progression to > T1 when compared with resection alone, BCG may delay progression and the need for cystectomy in high-risk patients (T1, Cis or Cis associated with papillary Ta/T1, > 3 recurrences/year, grade 3 tumors). Oral medication with bropirimine (an interferon inducer) induced complete response in patients with carcinoma in situ, oral Lactobacillus casei prolonged the recurrence-free interval to 1.8 times that in the control group. New compounds for adjuvant treatment of superficial bladder tumors are best first tested on their ablative effects (marker lesion, Cis) prior to be used for prophylaxis.

Animals↗

Influence of urological morbidity on quality of life in patients with prostate cancer.

OBJECTIVE: To evaluate the prevalence of urological morbidity in patients with prostate cancer and its influence on global quality of life (QL). METHODS: 379 patients with prostate cancer completed several questionnaires (EORTC QLQ-C33, I-PSS, PAIS [sexuality]) and were grouped according to the type of treatment they had undergone: observation only (n = 57), androgen deprivation (n = 112), radiotherapy (n = 114) and radical prostatectomy (n = 96). A group of 86 urologists also completed the questionnaires, imagining that they had stable prostate cancer and had been undergoing androgen deprivation for at least 1 year. Their responses were compared with those from patients who had undergone androgen deprivation. RESULTS: In all patient groups urinary symptoms were mostly mild to moderate but 12% of patients who had undergone radiotherapy and 11% of hormonally treated patients described severe symptoms. Severe urinary leakage occurred in 16% of patients who had undergone radical prostatectomy. 22% of all patients were impotent before treatment; after treatment sexual life was considerably disturbed in all patients except those who had undergone observation only. Fatigue was a general problem in all patients. In the logistic regression analysis fatigue and lower urinary tract symptoms (LUTS), but not disturbance of sexual life or urinary leakage, were correlated with global QL. In the doctor-patient comparison, doctors underestimated the disturbance of sexual life in patients who had undergone androgen deprivation therapy but overestimated the impairment of QL and psychological distress experienced by these patients. CONCLUSIONS: LUTS and fatigue are independent predictive factors for global QL after initial treatment in patients with prostate cancer. Radiotherapy of the prostate leads to more significant morbidity than was generally anticipated by doctors. The disagreement between doctors' and patients' assessments of QL following treatment indicates the necessity for further systematic QL evaluation in these patients.

Aged↗

The role of interleukin-6 in the induction of hypercalcemia in renal cell carcinoma transplanted into nude mice.

Hypercalcemia is a well known complication of renal cell carcinoma (RCC). As RCCs can produce IL-6, and IL-6 may stimulate bone resorption and cause mild hypercalcemia, we examined whether IL-6 is involved in renal cancer-associated hypercalcemia in vivo. Three human renal cell carcinoma tumor lines (RC-8, RC-9, and NC-65) growing in nude mice were studied. Tumors were implanted s.c., and parameters of bone metabolism and serum human IL-6 levels were determined in relation to tumor volume (TV). All three tumor lines secreted human IL-6, although in different quantities. The maximum level of IL-6 in RC-8 was 434 pg/ml (TV, 200 mm3), that in RC-9 was 81 pg/ml (TV, 1800 mm3), and that in NC-65 was 2368 pg/ml (TV, 1800 mm3). Hypercalcemia developed in RC-8 and RC-9 tumor-bearing animals, but not in NC-65-bearing animals. The hypercalcemia in both RC-8 and RC-9 tumor lines was associated with elevated levels of PTH-related peptide (PTHrP) and loss of trabecular bone volume. Serum calcium and phosphate concentrations showed an almost linear relationship with plasma PTHrP independently of the tumor line and serum IL-6 levels. No hypercalcemia occurred in the NC-65 animals, which had the highest levels of IL-6, but no detectable plasma PTHrP and PTHrP messenger RNA expression in the tumor. Administration of neutralizing antibodies to IL-6 to RC-8 animals normalized serum calcium concentrations and PTHrP values and induced a significant inhibition of tumor growth. No such effect on tumor growth of anti-IL-6 was seen in the other two tumor lines. The normalization of serum calcium in RC-8 mice is most likely attributed to the growth-inhibiting effect of anti-IL-6 on RC-8 tumor. We conclude that IL-6 secreted by RCC does not contribute directly to hypercalcemia, but may enhance hypercalcemia by stimulating the tumor growth of a subpopulation of PTHrP-secreting carcinomas.

Animals↗

Double fluorescent flow cytometric assessment of bacterial internalization and binding by epithelial cells.

This study describes a new flow cytometric method for assessment of phagocytosis of specific bacteria (bacillus Calmette-Guérin (BCG) and Escherichia coli) by bladder epithelial cells. The internalization assay consisted of labeling bacteria chemically with fluorescein isothiocyanate (FITC). Subsequent to incubation of fluoresceinated bacteria with internalizing cells, adherent nonphagocytosed bacteria were marked by two-step labeling using specific antibodies and phycoerythrin (PE)-conjugated antibodies. Double fluorescent FACS analysis differentiated between bacterial phagocytosis and adherence. The validity of the method was shown by inhibition of BCG phagocytosis at 4 degrees C by cytochalasin B, by removal of excess free bacteria, and by anti-BCG antibodies. BCG-phagocytizing and -nonphagocytizing cell lines were discriminated by applying this technique to a series of bladder carcinoma cell lines. There seemed to be a relationship between phagocytic capacity and grade of differentiation in these cell lines, which may have implications for topical BCG immunotherapy in superficial bladder cancer. In conclusion, a new, reliable, rapid, and relatively simple double fluorescent method is described for quantification of specific bacterial internalization by large numbers of (bladder) epithelial cells. This method should be generally applicable to the study of in vitro interaction between bacteria and different types of host cells.

Coloring Agents↗

Feasibility, toxicity, and preliminary results of weekly loco-regional hyperthermia and cisplatin in patients with previously irradiated recurrent cervical carcinoma or locally advanced bladder cancer.

PURPOSE: The biological rationale for combining locoregional hyperthermia (HT) with cisplatin (CDDP) is the potentiating effect of HT on CDDP uptake and cytotoxicity. Feasibility, toxicity, and preliminary results of a clinical trial of weekly loco-regional HT in combination with cisplatin are described in this article. METHODS AND MATERIALS: Patients with previously irradiated unresectable local recurrent cervical carcinoma or locally advanced bladder carcinoma were treated with weekly cycles of locoregional HT (70 MHz four antenna phased array system) for 1 h and CDDP 50 mg/m(2) IV for a maximum of 12 courses. RESULTS: Fourteen patients, 10 patients with recurrent cervical carcinoma and 4 with locally advanced bladder carcinoma, were entered in this study. A total of 100 cycles were given. Overall toxicity was acceptable; Grade 3 (WHO) toxicity (gastrointestinal, hematological, and neurotoxicity) was observed in 5 out of 14 patients. No Grade 4 toxicity was seen. Subcutaneously fatty necrosis due to HT occurred in 11% of the cycles, while two patients developed skin burns. Two out of 10 patients with recurrent cervical carcinoma were not evaluable for response. Four out of eight evaluable cervical carcinoma patients responded (two pathologic complete responses, one pathologic confirmed partial response, one partial response): response rate 50% (95% confidence interval 15.7-84.3%). Salvage surgery became possible in three out of four responding patients, whose tumors were previously considered unresectable. Two out of the four evaluable patients with locally advanced bladder carcinoma responded (two partial responses). CONCLUSIONS: Weekly loco-regional HT and CDDP 50 mg/m(2)/week for a maximum of 12 courses is feasible with an acceptable toxicity, which seems not to be enhanced by the addition of loco-regional HT. The encouraging preliminary results of this treatment schedule warrant further study, especially in patients with previously irradiated recurrent cervical carcinomas.

Adult↗