Biomarkers of normal tissue toxicity after pelvic radiotherapy.

PURPOSE OF REVIEW: To review the evidence for candidate biomarkers of gastrointestinal toxicity following pelvic radiotherapy to highlight recent findings of potential interest to those involved in the treatment of pelvic malignancies or the management of gastrointestinal consequences of cancer treatments. RECENT FINDINGS: Multiple serum and faecal biomarkers have been studied for use in the detection of gastrointestinal toxicity following pelvic radiotherapy. There is no single biomarker that has been shown to be useful and studies have been hampered by the lack of a 'gold standard' test to confirm the presence of toxicity. Given the complex effects of pelvic radiotherapy on the gastrointestinal tract, it is likely that a panel of biomarkers would be necessary in clinical practice. SUMMARY: Biomarkers for gastrointestinal toxicity have a potential role in determining the outcomes of current and evolving radiotherapy techniques, identifying those patients at risk of greater degrees of toxicity to facilitate individualized treatment and determining whether symptoms that develop following treatment are related to the previous radiotherapy. Outcome measurement of pelvic radiotherapy has been plagued by inaccurate terminology and crude outcome measures. An accurate and acceptable biomarker or panel of biomarkers has the potential to revolutionize cancer management from treatment planning to posttreatment care. Several candidate biomarkers show promising results, but further robust research is required to clearly identify reliable biomarkers that can be translated into clinical practice.

Effect of flash-heat treatment on antimicrobial activity of breastmilk.

BACKGROUND AND OBJECTIVES: The World Health Organization recommends human immunodeficiency virus (HIV)-positive mothers in resource-poor regions heat-treat expressed breastmilk during periods of increased maternal-to-child transmission risk. Flash-heat, a "low tech" pasteurization method, inactivates HIV, but effects on milk protein bioactivity are unknown. The objectives were to measure flash-heat's effect on antimicrobial properties of lactoferrin, lysozyme, and whole milk and on the digestive resistance of lactoferrin and lysozyme. METHODS: Flash-heated and unheated breastmilk aliquots from HIV-positive mothers in South Africa were "spiked" with Staphylococcus aureus and Escherichia coli and then cultured for 0, 3, and 6 hours. Lysozyme and lactoferrin activities were determined by lysis of Micrococcus luteus cells and inhibition of enteropathogenic E. coli, respectively, measured spectrophotometrically. Percentages of proteins surviving in vitro digestion, lactoferrin and lysozyme activity, and bacteriostatic activity of whole milk in heated versus unheated samples were compared. RESULTS: There was no difference in rate of growth of E. coli or S. aureus in flash-heated versus unheated whole milk (p = 0.61 and p = 0.96, respectively). Mean (95% confidence interval) antibacterial activity of lactoferrin was diminished 11.1% (7.8%, 14.3%) and that of lysozyme by up to 56.6% (47.1%, 64.5%) by flash-heat. Digestion of lysozyme was unaffected (p = 0.12), but 25.4% less lactoferrin survived digestion (p < 0.0001). CONCLUSIONS: In summary, flash-heat resulted in minimally decreased lactoferrin and moderately decreased lysozyme bioactivity, but bacteriostatic activity of whole milk against representative bacteria was unaffected. This suggests flash-heated breastmilk likely has a similar profile of resistance to bacterial contamination as that of unheated milk. Clinical significance of the decreased bioactivity should be tested in clinical trials.

Oxidative radioiodination damage to human lactoferrin.

Oxidative iodination of human lactoferrin (Lf) as commonly performed by using the chloramine-T, the Iodogen or the lactoperoxidase method produces an unreliable tracer protein because of excessive and heterogeneous polymer formation. Before iodination a minor tetramer fraction may be demonstrable in iron-saturated Lf only. Iodination-induced polymerization of iron-poor as well as iron-saturated Lf occurs independently of the presence or absence of 10 mM-EDTA and the 125I-/Lf molar ratio used for iodination. 125I-Lf polymers are mainly covalently linked, as suggested by the lack of substantial dissociation in SDS/polyacrylamide-gel electrophoresis. Damage to the 125I-Lf monomer may be another consequence of oxidative iodination. This is demonstrated in SDS/polyacrylamide-gel electrophoresis where 50% of the radioactivity of apparently normal monomer (Mr 75,000) is displaced to a lower-Mr region (30,000-67,000) after reduction with dithiothreitol. Non-oxidative iodination by the Bolton-Hunter technique produces an antigenetically stable tracer that is not being subjected to polymerization and monomer degradation as judged by high-performance gel chromatography and SDS/polyacrylamide-gel electrophoresis with and without dithiothreitol treatment. It is concluded that oxidation in itself leads to covalent non-disulphide cross-linking between human Lf molecules and, possibly, to intramolecular peptide-bond breaking becoming unmasked under reducing conditions. In biological experiments with human 125I-Lf this problem should be carefully considered.