Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.

OBJECTIVES: At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations. Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel. METHODS: We prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)). Results were compared with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients. RESULTS: A total of 76% of the patients with FAP with duodenal adenomas (n = 21) had additional adenomas in the proximal jejunum that could be detected by CE and PE. Moreover, 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by CE. In contrast, in FAP patients without duodenal polyps (n = 8), jejunal or ileal polyps occurred rarely (12%). CE detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed. Importantly, the findings of CE had immediate impact on further clinical management in all PJS patients. CONCLUSIONS: Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure.

Antitumoral and antimetastatic effects of continuous particle-mediated cytokine gene therapy.

We established a mice tumor model to investigate the effects of continuous cancer gene therapy, including antigen-presenting cell (APC) engineering and local stimulation of the immune system. B16 melanoma or Lewis lung carcinoma cells were injected intradermally on the back of C57/BL6 mice. The overlaying dermis or the tumor was shot with a gene gun (particle-mediated gene transfer) starting 8 days after tumor implantation in the case of the melanoma (Lewis lung carcinoma start day 7), continuing every fourth day thereafter until death. Control groups were mice without any therapy (A) or gene therapy with the empty plasmid (B). Therapy groups (Melanoma) received the genes as follows: group C--day 8, IL-12; day 12, IL-2...; group D--day 8, IFN-gamma/B7.1; day 12, IFN-gamma/B7.1...; group E--day 8, IFN-gamma/B7.1; day 12, IL-12, day 16, IL-2.... Melanoma: Mean survival time was enhanced in all therapy groups significantly, whereby the greatest survival time was found in group C. Tumor growth was reduced in all therapy groups similarly (C and D significant). Lewis Lung: Only mice of group C had an enhanced survival and reduced tumor growth (both significant). An antimetastatic effect was seen in all therapy groups.

Complex cancer gene therapy in mice melanoma.

OBJECTIVE: We investigated the effects of continuous cancer gene therapy, including APC engineering and local stimulation of the immune system in a mice melanoma model. MATERIALS AND METHODS: B16 melanoma cells were injected into C57/Bl6 mice intradermally. The overlying dermis or the tumor were shot with different plasmids using a gene gun every 4th day starting 8 days after tumor implantation. Control groups were mice without any therapy or gene therapy as described above with the empty plasmid. Therapy was: group I, IL-12 and IL-2; group II, IFN-gamma/B7.1; group III, IFN-gamma/B7.1, IL-12, and IL-2. RESULTS: The median survival time of all therapy groups was significantly enhanced. The longest median survival was in the IL-12/IL-2 group. Tumor growth was reduced in all therapy groups. Control groups suffered a higher rate of metastasis and had fewer inflammatory cells at the tumor site. CONCLUSIONS: Continuous therapy with the gene gun is easy to handle and shows good results. Therapy with genes for IL-12 and IL-2 was superior to that with additional IFN-gamma/B7.1 or IFN-gamma/B7.1 alone. APC engineering is clearly less sufficient in the case of the B16 melanoma.