A phase IIA dose-finding study of PVP-hypericin fluorescence cystoscopy for detection of nonmuscle-invasive bladder cancer.

PURPOSE: To determine the optimum dosage and instillation time for water-soluble polyvinylpyrrolidone (PVP)-hypericin for photodynamic diagnosis of bladder cancer and to monitor its use in regard to patient safety. PATIENTS AND METHODS: Forty patients with a cystoscopically suspected bladder neoplasm were enrolled in this prospective phase IIA study. Different combinations of PVP-hypericin dosage (225 µg and 75 µg and instillation time (120, 60, 30, 15 min) were used to evaluate the optimal conditions. After a run-in cohort of five patients to validate the test method, each group comprised seven patients. All intravesical lesions were documented, and their fluorescence characteristics were recorded. Dose finding was the primary, safety the secondary end point. RESULTS: Fluorescence intensities for the first two groups (225 µg PVP-hypericin for 120 and 60 min, respectively) were not different. For group three (225 µg for 30 min), both specific fluorescence and background noise were reduced. A shorter instillation time (225 µg for 15 min) or lower dose (75 µg for 30 min) was considered insufficient for lesion identification. A dose of 225 µg PVP-hypericin instilled for 30 minutes was determined as appropriate for the detection of lesions. Of the total 93 identified lesions, 62 were detected with both white light and fluorescence, 25 were seen with blue light only, and six with white light only. It was possible to identify additionally two carcinoma in situ, eight pTa, and one pT1 lesions with PVP-hypericin and blue light. PVP-hypericin was safe and well tolerated. CONCLUSION: The optimum combination of dosage of PVP-hypericin and its instillation time was established and will be used to determine sensitivity and specificity of PVP-hypericin cystoscopy in a larger multicenter phase IIB study. The preliminary data of this study hint to a higher sensitivity of hypericin-assisted fluorescence cystoscopy.

Plectin isoform 1b mediates mitochondrion-intermediate filament network linkage and controls organelle shape.

Plectin is a versatile intermediate filament (IF)-bound cytolinker protein with a variety of differentially spliced isoforms accounting for its multiple functions. One particular isoform, plectin 1b (P1b), remains associated with mitochondria after biochemical fractionation of fibroblasts and cells expressing exogenous P1b. Here, we determined that P1b is inserted into the outer mitochondrial membrane with the exon 1b-encoded N-terminal sequence serving as a mitochondrial targeting and anchoring signal. To study P1b-related mitochondrial functions, we generated mice that selectively lack this isoform but express all others. In primary fibroblasts and myoblasts derived from these mice, we observe a substantial elongation of mitochondrial networks, whereas other mitochondrial properties remain largely unaffected. Normal morphology of mitochondria could be restored by isoform-specific overexpression of P1b in P1b-deficient as well as plectin-null cells. We propose a model where P1b both forms a mitochondrial signaling platform and affects organelle shape and network formation by tethering mitochondria to IFs.

Plectin 1f scaffolding at the sarcolemma of dystrophic (mdx) muscle fibers through multiple interactions with beta-dystroglycan.

In skeletal muscle, the cytolinker plectin is prominently expressed at Z-disks and the sarcolemma. Alternative splicing of plectin transcripts gives rise to more than eight protein isoforms differing only in small N-terminal sequences (5-180 residues), four of which (plectins 1, 1b, 1d, and 1f) are found at substantial levels in muscle tissue. Using plectin isoform-specific antibodies and isoform expression constructs, we show the differential regulation of plectin isoforms during myotube differentiation and their localization to different compartments of muscle fibers, identifying plectins 1 and 1f as sarcolemma-associated isoforms, whereas plectin 1d localizes exclusively to Z-disks. Coimmunoprecipitation and in vitro binding assays using recombinant protein fragments revealed the direct binding of plectin to dystrophin (utrophin) and beta-dystroglycan, the key components of the dystrophin-glycoprotein complex. We propose a model in which plectin acts as a universal mediator of desmin intermediate filament anchorage at the sarcolemma and Z-disks. It also explains the plectin phenotype observed in dystrophic skeletal muscle of mdx mice and Duchenne muscular dystrophy patients.

Targeted ablation of plectin isoform 1 uncovers role of cytolinker proteins in leukocyte recruitment.

Plectin, a typical cytolinker protein, is essential for skin and skeletal muscle integrity. It stabilizes cells mechanically, regulates cytoskeleton dynamics, and serves as a scaffolding platform for signaling molecules. A variety of isoforms expressed in different tissues and cell types account for this versatility. To uncover the role of plectin 1, the major isoform expressed in tissues of mesenchymal origin, against the background of all other variants, we raised plectin isoform 1-specific antibodies and generated isoform-deficient mice. In contrast to plectin-null mice (lacking all plectin isoforms), which die shortly after birth because of severe skin blistering, plectin isoform 1-deficient mice were viable at birth, had a normal lifespan, and did not display the skin blistering phenotype. However, dermal fibroblasts isolated from plectin 1-deficient mice exhibited abnormalities in their actin cytoskeleton and impaired migration potential. Similarly, plectin 1-deficient T cells isolated from nymph nodes showed diminished chemotactic migration in vitro. Most strikingly, in vivo we found that leukocyte infiltration during wound healing was reduced in the mutant mice. These data show a specific role of a cytolinker protein in immune cell motility. Single isoform-deficient mice thus represent a powerful tool to unravel highly specific functions of plectin variants.

Plectin 5'-transcript diversity: short alternative sequences determine stability of gene products, initiation of translation and subcellular localization of isoforms.

Plectin is a large cytoskeletal linker protein expressed as several different isoforms from a highly complex gene. This transcript diversity is mainly caused by short 5'-sequences contained in alternative first exons. To elucidate the influence of these sequence differences and to determine potential differential functionality of the resulting protein forms, we conducted a systematic investigation of plectin isoforms on transcript and protein levels. Isoform expression was highly dependent on the different 5' ends, largely due to effects of the 5'-untranslated regions. Initiation of translation downstream of the expected start site led to loss of actin- and integrin beta4-binding in some isoforms. The small alternative N-terminal sequences (5-180 residues) profoundly affected the subcelluar localization of this >500 kDa protein. Specifically, plectin 1f was concentrated at focal adhesion contacts and plectin 1b was exclusively targeted to mitochondria, providing a connection of these organelles to intermediate filaments. Thus, with plectin as a model, we demonstrate a role for 5'-untranslated regions and alternative 5'-splicing as an important regulatory mechanism of protein expression and protein function.