Improving Breast Conserving Surgery Using the Faxitron® OR Specimen Radiography System - A Complication Analysis, Cost Evaluation and Literature Review.

BACKGROUND/AIM: The combination of pre-surgical clip placement and hook-wire guided surgery is considered the gold standard for adequately locating non-palpable lesions during breast conserving surgery. After surgical removal of the segment, radiography is required to confirm clip removal, increasing surgical time, post-surgical complication rates, and cost. PATIENTS AND METHODS: We performed a retrospective analysis, using the Faxitron® in-theater specimen radiography system, of the following primary endpoints: surgical time and complication rates. The secondary endpoints were cost effectiveness and clip-location rates. The Control cohort included breast conserving surgery patients prior to May 2019 (n=150) and the Validation cohort included breast conserving surgery patients after May 2019 (n=53). RESULTS: The analysis showed an improvement in surgical time when using the Faxitron® system, which is directly linked to a benefit in cost effectiveness. A numerical benefit in complication rates was also shown. A subgroup analysis showed a significant advantage in surgical time for breast conserving surgery plus sentinel node biopsy and open breast biopsies. CONCLUSION: Use of the Faxitron® system significantly reduces surgical time, which increases cost efficiency while maintaining a low complication rate.

The rate of estrogen receptor-conversion associated with tumor progression in estrogen receptor-positive breast cancer patients following adjuvant Tamoxifen administration.

BACKGROUND: Hormone Receptor (HR)-discordance between primary breast cancer and metastasis is a known biological phenomenon. Discordance studies usually comprise a heterogeneous group of HR-positive and negative patients and allow for the comparison of changes in HR-status from the primary to the recurrent disease. However, in a clinical setting, the rate of estrogen receptor-conversion following endocrine therapy with agents such as Tamoxifen (TAM) in estrogen receptor-positive cancers is of primary interest as opposed to total receptor discordance. AIM: To investigate the rate of estrogen receptor-conversion associated with tumor progression in estrogen receptor-positive breast cancer patients following adjuvant TAM administration and to compare the results with the meta-analysis data of HR-discordance studies. METHODS AND RESULTS: A retrospective double-center review of biomarkers in 67 estrogen receptor-positive breast cancer patients who underwent TAM treatment in the adjuvant setting. The estrogen and progesterone receptor-status were compared at the time of diagnosis and following relapse and the Disease-free Survival, mean duration of TAM treatment as well as the operative, radiation, and cytotoxic therapies registered before TAM treatment, were recorded. Initially, all patients were estrogen receptor-positive. The average age at the time of diagnosis was 52.8 ± 12.4 years. After recurrence, only 47 patients (70.1%) were still estrogen receptor-positive with a highly significant loss of estrogen receptor-expression in 29.9% of cases. The mean duration of TAM treatment was 40.7 ± 19.9 months. 45 patients (i.e., 67.2%) progressed during the TAM treatment and the remaining 22 patients (32.8%) developed relapse after the TAM treatment had finished. Initially, there were 82.1% progesterone receptor-positive and 17.9% progesterone receptor-negative, but after relapse the progesterone receptor-positive cases diminished significantly to 53.7%, showing a progesterone receptor-loss of 28.4%. CONCLUSION: The rate of estrogen receptor-loss associated with tumor progression following TAM treatment is approximately 30%, which is of clinical relevance in order to evaluate further endocrine efficacy in these patients. This rate of receptor conversion is roughly 6-13% higher compared to the recently published meta-analysis data of discordance studies. This discrepancy could possibly be due to anti-hormonal therapy with TAM accentuating receptor conversion.

Patient with ovarian insufficiency: baby born after anticancer therapy and re-transplantation of cryopreserved ovarian tissue.

BACKGROUND: The second major cause of death is cancer. In fact, the effectiveness of anticancer treatments and positive long-term prognosis for young women has increased. However, the problem of post-cancer infertility plays a significant role, because chemotherapy can be gonadotoxic and lead to the functional death of ovaries. There is potential key solution to this problem: cryopreservation of ovarian tissue before cancer therapy with re-implantation after convalescence. Data regarding cryopreservation and re-transplantation of ovarian tissue from patients with ovarian insufficiency is limited. The aim of this treatment was the re-transplantation of cryopreserved ovarian tissue after anticancer therapy of patient with ovarian insufficiency (56 IU/l FSH, 8 ng/l ß-estradiol, < 1.1 ng/ml anti-Mullerian hormone, 1 primary follicle per 10mm3). CASE PRESENTATION: After the operation, four tissue fragments (10-16 × 8-13 × 1.0-1.2 mm) were cooled to 5 °C in the freezing medium (culture medium+ 6% ethylene glycol+ 6% dimethyl sulfoxide+ 0.15 M sucrose) for 24 h, frozen and thawed. Freezing was performed in four standard 5 ml cryo-vials with ice formation at - 9 °C, cooling from - 9 to - 34 °C at a rate of - 0.3 °C/min and plunging at - 34 °C into liquid nitrogen. After thawing in a 100 °C (boiling) water bath, the removal of cryoprotectants was performed in 0.5 M sucrose with 20 min. exposure in sucrose and 30 min. stepping rehydration. After thawing of one cryo-vial, part (5 mm3) of experimental ovarian tissue after 7 day in vitro culture was histological evaluated and two ovarian fragments (8 × 7 × 1.0 mm and 7 × 6 × 1.0 mm) were re-transplanted. The quantity of follicles after cryopreservation and in vitro culture was not increased (P > 0.1): it was found 1 primordial follicle in 5 mm3 of tissue. Thirty seven days after the re-transplantation of ovarian tissue, the restoration of the menstrual cycle of Patient W. was noted. Three months after the transplantation, the patient became spontaneously pregnant and delivered a healthy baby girl at term. CONCLUSIONS: Described protocol of conventional cryopreservation of ovarian tissue can be used for treatment of patients with ovarian insufficiency.

First Reported Use of Radiofrequency Identification (RFID) Technique for Targeted Excision of Suspicious Axillary Lymph Nodes in Early Stage Breast Cancer - Evaluation of Feasibility and Review of Current Recommendations.

BACKGROUND/AIM: The purpose of this study was to evaluate, whether radio frequency identification (RFID) labeling of axillary lymph nodes (LNs) for the use of targeted resection is feasible in primary breast cancer patients with suspicious LNs. PATIENTS AND METHODS: We analyzed 10 consecutive patients where RFID technique was used for intraoperative detection of suspicious LNs without preceding neoadjuvant chemotherapy (NACT). We compared the specifics of these procedures to 10 consecutive sentinel lymph node biopsies (SLNB) in the cN0 situation. RESULTS: Intraoperative detection rate (DR) for the RFID-labeled target lymph node (TLN) was 100%. Perioperative complications were infrequent and comparable to SLNB. Average time for location of the RFID labeled TLN was quicker than for the SLN. In 71.4% the chip bearing TLN equaled a SLN. CONCLUSION: The use of the RFID technique for intraoperative localization of axillary LNs for targeted excision seems feasible. RFID technique for targeted axillary dissection (TAD) following NACT should be investigated in a prospective manner.

Long-term (24h) cooling of ovarian fragments in the presence of permeable cryoprotectants prior to freezing: Two unsuccesful IVF-cycles and spontaneous pregnancy with baby born after re-transplantation.

Cancer is the second major cause of death in the world. The problem of post-cancer infertility plays a significant role, because chemotherapy can be gonadotoxic. Cryopreservation of ovarian tissue before cancer therapy with re-implantation after convalescence is the potential key solution to this problem. The aim of this study was to test the viability of cryopreserved human ovarian cortex after long-term cooling in culture medium composed of permeable cryoprotectants. Ovarian fragments from sixteen patients were randomly divided into two groups. After the operation, tissue pieces assigned to both groups were cooled to 5 °C for 22-24 h, frozen and thawed. Group 1 pieces (n = 32) were cooled before cryopreservation in the standard culture medium, and Group 2 pieces (n = 32) were cooled in the freezing medium (culture medium+6% ethylene glycol+6% dimethyl sulfoxide+0.15 M sucrose). Freezing was performed in standard 5 ml cryo-vials with ice formation at -9 °C, cooling from -9 to -34 °C at a rate of -0.3 °C/min and plunging at -34 °C into liquid nitrogen. After thawing in a 100 °C (boiling) water bath, the removal of cryoprotectants was performed in 0.5 M sucrose with 20 min exposure in sucrose and 30 min stepping rehydration. The effectiveness of the pre-freezing cooling of tissue was evaluated by the development of follicles (histology). Six months after the autotransplantation, oocytes from the twenty-seven-year old, hormonally stimulated patient were retrieved and fertilized with her partner sperm through the intracytoplasmic spermatozoa injection (ICSI). For groups 1 and 2, 93.5 ± 1.9% and 96.4 ± 2.0% of the preantral follicles, respectively, were morphologically normal (P > 0.1) (with a tendency toward increasing in quality in Group 2). Six months after the auto-transplantation, two ICSI cycles resulted in the gathering and transplantation of high quality embryos, but no pregnancy had been established. Thirteen months after the auto-transplantation, the patient became spontaneously pregnant and delivered a healthy baby girl at term. Long-term (24 h) cooling of ovarian tissue to 5 °C before cryopreservation in the presence of permeable cryoprotectants simplifies the protocol of cryopreservation and has a tendency of increasing of the cells viability after thawing.

Comparison of Subpectoral versus Prepectoral Immediate Implant Reconstruction after Skin- and Nipple-Sparing Mastectomy in Breast Cancer Patients: A Retrospective Hospital-Based Cohort Study.

INTRODUCTION: Implant-based immediate breast reconstruction (IBR) is a common surgical procedure in breast cancer patients. Comparative analysis concerning the placement of implants is still lacking. Hence, we aimed to analyze pre- versus subpectoral IBR in breast cancer patients. PATIENTS: A single-center experience with implant-based IBR following skin/nipple-sparing mastectomy was evaluated. Patient demographics, incidence of major complications, and quality of life assessed with BREAST-Q were compared between the pre- and subpectoral cohort. RESULTS: A total of 63 patients were included in this analysis of whom 29 underwent subpectoral and 34 underwent prepectoral IBR. Median duration of surgery was prolonged in the subpectoral versus the prepectoral group (104 ± 28 vs. 80 ± 91 min; p < 0.05). The mean number of major complications was significantly increased in the subpectoral group (1.41 ± 1.76 vs. 0.47 ± 0.75 per patient; p < 0.05). Detailed analysis showed a significantly increased incidence of implant dislocation (p < 0.05) and a trend concerning capsular contracture (p = 0.086, not significant) and necrosis (p = 0.092, not significant) in the subpectoral group. Quality of life was equal in both groups. CONCLUSION: The mean number of major complications in the subpectoral group should be considered when IBR is indicated. Prepectoral IBR seems to be a feasible alternative surgical treatment option with less major complications in selected patients.

Construction of human artificial ovary from cryopreserved ovarian tissue: Appearance of apoptosis and necrosis after enzymatic isolation of follicles.

Earlier it was shown that number of retrieved follicles was significantly higher in Tumor Dissociation Enzyme (TDE)-treatment group compare to standard Liberase TM-group. The aim of our present investigations was to examine the effect of TDE on appearance of apoptosis and necrosis in follicles and stromal cells after digesting of cryopreserved ovarian cortex. Fresh and frozen ovarian cortex fragments (OCF) from 14 patients (29 ±â€¯6 years old), sized 20-210 mm3 were randomly distributed into four treatment groups and digested with 16% TDE or 0.05 mg/ml Liberase TM: Group 1 frozen OCF digested with TDE; Group 2 frozen OCF digested with LiberaseTM; Group 3 fresh OCF digested with TDE; Group 4 fresh OCF digested with Liberase TM. To differentiate the live, early apoptotic, late apoptotic and necrotic cells in digested ovarian cortex suspension, a flow cytometric apoptosis/necrosis assay with FITC Annexin V Apoptosis Detection Kit and with 7-AAD was performed. Most of fresh (not frozen) cells digested with TDE or Liberase TM (95 ±â€¯2.4% vs. 90.4 ±â€¯3.1%, respectively) as well as in frozen ovarian cortex digested with TDE or Liberase TM (93.1 ±â€¯3.4% vs. 89.7 ±â€¯4.4%, respectively) has located in Q3 quadrant and these cells both negative to 7-AAD and Annexin V were considered as viable. It was established that both types of enzymatic treatment applying to fresh as well as to frozen ovarian cortex resulted to high rate of viable cells (Group 1: 93.8 ±â€¯3.4%; Group 2: 91.8 ±â€¯6.0%; Group 3: 90.5 ±â€¯6.9%; Group 4: 87.3 ±â€¯2.3%) and are non significantly different (P > 0.1) between all treatment groups. The amount of early apoptotic (Group 1: 3.5 ±â€¯1.6%; Group 2: 4.4 ±â€¯1.6%; Group 3: 1.6 ±â€¯1.1%; Group 4: 2.4 ±â€¯1.5%), late apoptotic (Group 1: 2.7 ±â€¯2.4%; Group 2: 44.0 ±â€¯1.9%; Group 3: 3.1 ±â€¯1.1%; Group 4: 2.8 ±â€¯0.7% and necrotic (Group 1: 0.9% ±â€¯0.1%; Group 2: 2.9 ±â€¯0.8%; Group 3: 3.4 ±â€¯4.5%; Group 4: 1.1 ±â€¯0.6%) cells was low and was not significantly different in all treatment groups (P > 0.1). It was concluded that the use of Tumor Dissociation Enzyme, effectiveness of which is higher than Liberase TM, does not lead to increasing of apoptosis and necrosis in follicles and stromal cells after enzymatic digesting of cryopreserved ovarian cortex.

Comparison of the enzymatic efficiency of Liberase TM and tumor dissociation enzyme: effect on the viability of cells digested from fresh and cryopreserved human ovarian cortex.

BACKGROUND: The aim of this study was to examine the effectiveness of Tumor Dissociation Enzyme (TDE) on the viability of follicles after digestion of fresh and cryopreserved ovarian cortex fragments (OCFs). METHODS: Fresh and thawed OCF from 14 patients (29 ± 6 years), sized 20 to 210 mm3 were randomly distributed into four treatment groups and digested with 16% TDE or 0.05 mg/ml Liberase TM: Group 1, frozen OCF digested with TDE; Group 2, frozen OCF digested with LiberaseTM; Group 3, fresh OCF digested with TDE; and Group 4, fresh OCF digested with Liberase TM. Evaluation of follicle viability was performed under light microscope after staining with Neutral red. For visualization of viable and dead cells under a confocal laser scanning microscope, the follicles were stained with Calcein AM and ethidium homodimer-1. RESULTS: The results showed that the number of retrieved follicles was significantly higher (990 vs 487; P < 0.01) in the TDE-treatment group compared to the Liberase TM-group. The presence of intense neutral red stained follicles was significantly higher in Group 1 and Group 3 compared to Group 2 and Group 4 (70.3% ± +/- 6.22 vs 53,1% ± 2.03 and 94.2% ± 6.6 vs 79.1% ± 2.1; P < 0.01). The percentage of Calcein AM stained follicles of class V1 was significantly higher in Group 1 and Group 3 compared to Group 2 and Group 4 (95.97% ± 7.8 vs 87.87% ± 2.4; 97.1% ± 6.8 vs 91.3% ± 2.3; P < 0.01). CONCLUSION: The enzymatic digestion of ovarian cortex with TDE provides recovery of a higher number of healthy preantral follicles in contrast to earlier described Liberase TM procedure.

Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis.

Purpose Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤ 2 %. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. Materials and Methods All first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥ 3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments. Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the retrospective consensus findings as well as with the reference diagnoses. Results The range of indications comprised a broad spectrum including staging and follow-up examinations of solid tumors/lymphoma (N = 701, 59.9 %) and vascular (190, 16.2 %), inflammatory (48, 4.1 %) and pulmonologic (22, 1.9 %) issues. BI-RADS 1/2 classifications were present in 92.5 % and BI-RADS 6 classifications were assessed in 1.7 % of the 1170 included examinations. 68 patients (5.8 %) had at least one lesion retrospectively classified as BI-RADS 3 - 5. The histological potential was known in 57 of these lesions as benign (46, 3.9 %) or malignant (11, 0.9 %). 13 BI-RADS 4/5 consensus assessments (1.1 %) were false-positive. 2 of the 10 lesions classified as being malignant based on the further clinical and radiological course were not mentioned in the written CT reports (0.2 %). Both false-negative CT reports were therapeutically and prognostically irrelevant. Conclusion The relative frequency of BI-RADS 3 - 5 findings was 5.8 %. It reflects the situation encountered in clinical imaging for primarily non-senologic questions and therefore differs from what would be expected in a dedicated screening program. The rates of known false-positive BI-RADS 4/5 findings in the retrospective evaluations (1.1 %) and of false-negative findings in the written CT reports (0.2 %) reflect the different diagnostic approaches of image-based senological screening and radiological examinations indicated in order to solve clinical problems not primarily concerning the breast region. Statements regarding the prevalence of clinically occult breast cancers can only be made with caution in the presented, highly selective group of patients due to the often incomplete visualization of breast tissue and the retrospective approach. Key points · Intramammary mass and non-mass lesions needing clarification may be present in up to 5.8 % of all contrast enhanced CT-examinations of the female chest.. · Irregular forms, unscharp/spiculated margins, inhomogeneous matrices and a pronounced contrast medium enhancement point towards a malignant genesis of an intramammary mass or non-mass lesion.. · The results of the study highlight the importance of paying systematical and targeted attention on senological additional findings in CT-examinations of the chest also in other clinical settings than that of the included patients in a clinic with oncological main focus.. Zitierweise · Krug KB, Houbois C, Grinstein O et al. Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis. Fortschr Röntgenstr 2017; 189: 977 - 988.

Cryopreservation and xenografting of human ovarian fragments: medulla decreases the phosphatidylserine translocation rate.

BACKGROUND: Phosphatidylserine is the phospholipid component which plays a key role in cell cycle signaling, specifically in regards to necrosis and apoptosis. When a cell affected by some negative factors, phosphatidylserine is no longer restricted to the intracellular side of membrane and can be translocated to the extracellular surface of the cell. Cryopreservation can induce translocation of phosphatidylserine in response to hypoxia, increasing intracellular Ca2+, osmotic disruption of cellular membranes, generation of reactive oxygen species and lipid peroxidation. As such the aim of this study was to test the level of phosphatidylserine translocation in frozen human medulla-contained and medulla-free ovarian tissue fragments. METHODS: Ovarian fragments from twelve patients were divided into small pieces of two types, medulla-free cortex (Group 1, n = 42, 1.5-3.0 × 1.5-3.0 × 0.5-0.8 mm) and cortex with medulla (Group 2, n = 42, 1.5-3.0 × 1.5-3.0 × 1.5-2.0 mm), pre-cooled after operative removal to 5 °C for 24 h and then conventionally frozen with 6 % dimethyl sulfoxide, 6 % ethylene glycol and 0.15 M sucrose in standard 5-ml cryo-vials. After thawing at +100 °C and step-wise removal of cryoprotectants in 0.5 M sucrose, ovarian pieces were xenografted to SCID mice for 45 days. The efficacy of tissues cryopreservation, taking into account the presence or absence of medulla, was evaluated by the development of follicles (histology with hematoxylin-eosin) and through the intensity of translocation of phosphatidylserine (FACS with FITC-Annexin V and Propidium Iodide). RESULTS: For Groups 1 and 2, the mean densities of follicles per 1 mm3 were 9.8, and 9.0, respectively. In these groups, 90 and 90 % preantral follicles appeared morphologically normal. However, FACS analysis showed a significantly decreased intensity of translocation of phosphatidylserine (FITC-Annexin V positive) after cryopreservation of tissue with medulla (Group 2, 59.6 %), in contrast with tissue frozen without medulla (Group 1, 78.0 %, P < 0.05). In Groups 1 and 2 it was detected that 21.6 and 40.0 % cells were viable (FITC-Annexin V negative, Propidium Iodide negative). CONCLUSION: The presence of medulla in ovarian pieces is beneficial for post-thaw development of cryopreserved human ovarian tissue.

Transplantation of cryopreserved human ovarian tissue: restoration of reproductive function after two cycles of radio- and chemo-therapeutic treatments.

BACKGROUND: Patient S. was born in 1983, developed a Ewing-Sarcoma and obtained low dose chemotherapy in 1996. In 2007, Patient S. received high-dose chemotherapy because lung-metastases were diagnosed. The aim of the study was to investigate the health of cryopreserved ovarian tissue and also to examine whether this ovarian tissue can restore the reproductive function of patient after two cycles of radio-and chemo-therapeutic treatments. METHODS: Twenty pieces of ovarian tissue (total of approximately 200 mm2) were conventionally frozen with 6% (v/v) dimethyl sulfoxide, 6% (v/v) ethylene glycol and 0.15 M sucrose and kept for five years before 8 pieces were thawed and transplanted back into the patient. Two small (1 x 2 x 1 mm) pieces of this thawed tissue were cultured in a chicken embryonic chorioallantoic membrane (CAM)-system for 5 days to assess the tissue viability. RESULTS: The ovarian tissue that was grafted re-established spontaneous menstrual bleeding within five months and serum 17-beta estradiol increased from 19 to 330 pg/mL. Ultrasound revealed a dominant follicle at the site of the transplanted tissue in the follicular phase after the menstrual bleed. Analysis of the CAM cultured tissue established that 88% of the primordial follicles had degenerated and there was limited growth of blood vessels. CONCLUSIONS: In spite of the damage caused by the cryopreservation the surviving follicles could restore ovarian function after re-transplantation.

Viability of human ovarian tissue confirmed 5 years after freezing with spontaneous ice-formation by autografting and chorio-allantoic membrane culture.

To achieve optimal and uniform outcomes, slow cooling protocols for human ovarian tissues generally initiate ice formation at high sub-zero temperatures (-6 to -9 °C). The aim of the study was to investigate the function of ovarian tissue that had unintentionally self seeded at -20 °C during the freezing step, by examining its development following chicken embryonic chorioallantoic membrane (CAM) grafting and after transplantation back to the patient. Ovarian tissue was frozen in 6% (v/v) dimethyl sulfoxide, 6% (v/v) ethylene glycol and 0.15M sucrose which had self-seeded at -20 °C. Five years after cryopreservation, 8 pieces were thawed and transplanted back to the patient. Two small (1 × 2 × 1 mm) pieces of this thawed tissue were cultured in a CAM-system for 5 days to assess the tissue viability. The autografted ovarian tissue re-established spontaneous menstrual bleeding within five months and raised serum 17-ß Estradiol from 19 to 330 pg/ml. Ultrasound revealed a dominant follicle at the site of the transplanted tissue in the follicular phase after the menstrual bleed. Analysis of the CAM cultured tissue established that 88% of the primordial follicles are degenerated and there was limited in growth of blood vessels. In conclusion, in spite of the damage caused by the cryopreservation with spontaneous ice-formation the viability could be confirmed by CAM culture and the restoration of ovarian function after auto-transplantation.

Effects of the antiestrogens tamoxifen and raloxifene on the estrogen receptor transactivation machinery.

The influence of 17beta-estradiol (E2), tamoxifen (TAM) and raloxifen (RLX) on the proliferation of breast (BC) and endometrial carcinoma cell lines (EC) and the expression of different compounds of the estrogen receptor (ER)-transactivation machinery were studied. E2 stimulated the proliferation of BC, but had no effect on the EC. TAM showed a biphasic effect on ER-positive cell lines. RLX showed an antagonistic suppression or no effect. The expression of ERalpha was down-regulated by E2, but not affected by selective estrogen receptor modulators. ERbeta and progesterone receptor expressions were up-regulated by E2, TAM and OHT. This supports the hypothesis that ERbeta expression is also regulated via the ERalpha-pathway. The steroid receptor coactivator (SRC) AIB1 expression was slightly decreased by E2 but not by antiestrogens (antiE). TIF2 expression was increased by E2, TAM and RLX, but SRC-1 expression was not. In comparison, the expressions of ERbeta and progesterone receptor were strongly influenced by antiE, while the expression of SRCs was only slightly affected.

Estradiol or estradiol/progesterone treatment in older women: no strong effects on cognition.

The relevance of estrogens for cognition in older women is still debated. In this double-blind experiment hysterectomized women (age 58-75 years) received placebo (n = 13), estradiol (n = 12) or estradiol/progesterone (n = 10) treatment. Cognitive testing (nine different tests) took place at baseline, after 4 and 24 weeks of treatment. Strong hormone increases occurred in both active treatment groups. However, no beneficial effects in any of the cognitive tests could be detected. This study, therefore, does not support the notion that treatment with sex hormones has beneficial effects on cognition in older hysterectomized women. The human brain might loose its responsiveness to gonadal steroids with aging or prolonged hormone depletion.

In vivo cervical cancer growth inhibition by genetically engineered cytotoxic T cells.

PURPOSE: The CD44 v7/8 splice variant that is frequently expressed in cervical carcinoma and rarely expressed in normal tissues displays promising properties as a target antigen for cancer immune therapy. In this study, cytotoxic T lymphocytes (CTLs) were genetically engineered to gain CD44v7/8 target specificity. METHODS: Clone 96 (Cl96), an established murine cytotoxic T-cell line, and naïve murine T cells were retrovirally transduced with a fusion gene construct encoding for the single chain fragment scFv of the monoclonal antibody VFF17 and for the zeta chain of the T-cell receptor (TCR). The therapeutic potential of genetically engineered T cells was tested in vitro and in vivo. RESULTS: Surface expression of the chimeric TCR on infected Cl96 and naïve T cells was shown by FACS analysis. CD44v7/8-positive target cells were efficiently lysed by transduced Cl96 and naïve T cells, demonstrating the functionality and specificity of the chimeric TCR. In a xenograft BALB/c mouse model, efficient growth retardation of CD44v7/8-positive tumours was mediated by genetically engineered Cl96(VFF17)cyYZ cells. CONCLUSIONS: We were able to reprogramme the target specificity of recombinant Cl96 and naïve CTLs resulting in efficient cytolysis of CD44v7/8-positive cervical cancer cells. High transduction rates and the specific cytolysis of CD44v7/8-redirected CTLs are promising tools for an immune gene therapy approach for advanced cervical cancer.

Estrogen receptor-alpha and Sp1 interact in the induction of the low density lipoprotein-receptor.

Both estrogen and selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifene have been demonstrated to lower plasma low density lipoprotein (LDL)-cholesterol concentrations by stimulation of LDL receptor gene expression. To determine the molecular mechanisms of estradiol- and tamoxifen-induced LDL receptor expression, we performed transient transfection experiments with luciferase reporter gene-constructs under transcriptional control of the human LDL receptor promoter. We demonstrate, that estradiol and tamoxifen stimulate LDL receptor gene expression in human HepG2 hepatoma cells only when estrogen receptor (ER)-alpha but not when ER-beta is cotransfected. Deletion mutants and point mutations of the LDL receptor promoter reveal that estradiol- and tamoxifen-stimulated expression of this gene depends on an intact repeat 3 in the LDL receptor promoter, a cis-element previously shown to interact with Sp1. Gel mobility analyses demonstrated estradiol- and tamoxifen-stimulated binding of nuclear proteins to repeat 3 (bp -56 to bp -36) of the LDL receptor promoter. These data provide an alternative mechanism of LDL receptor gene expression by non-classical estradiol- and tamoxifen-stimulated induction through an ER-alpha/Sp1 complex.

Novel cGMP liposomal vectors mediate efficient gene transfer.

Viral vector systems are the most commonly used gene transfer tools for clinical gene therapy. However, lipofection systems are potential alternatives because of lower immunogenicity and easier cGMP production, but in vivo stability and transduction efficacy need to be improved. Therefore, we investigated gene transduction efficiency of our novel cGMP cationic lipids, CCQ22 and CCQ32, by FACS analysis. Toxicity analysis was performed to determine the cytotoxic side effects of the novel lipids. To evaluate the stability of the compounds in the context of local delivery to patients with intraperitoneally metastatic ovarian cancer, gene transfer was also tested in the presence of malignant ascites. Our novel cGMP standard lipids mediated gene transfer rates of more than 50%. However, for most cell lines cytotoxic side effects were similar to our reference lipofection system. In general, ascites had no major influence on gene transduction rates with the novel lipids. Our results suggest that CCQs may compare favorably with commercially available lipofection systems. These promising results facilitate further analysis of the compounds.

Role of tyrosine kinase signaling in estrogen-induced LDL receptor gene expression in HepG2 cells.

The expression of the low-density lipoprotein receptor (LDL-r) gene is stimulated by estrogen in vivo, although its promoter does not contain a classical estrogen-responsive element, suggesting an alternative mechanism of estrogen-regulated expression of this gene. The aim of this work was to assess whether estrogen-stimulated transcription of the LDL-r gene depends on tyrosine kinase (TK) and protein kinase C (PKC) activation, both signaling pathways being activated by estrogen in vivo and in hepatoma cells. Therefore, in HepG2 cells cotransfected with estrogen receptor-alpha, estrogen-stimulated transcription of LDL-r-promoter reporter plasmid was analyzed in the absence and presence of TK and PKC inhibitors. The expression of LDL-r was also compared with the transcription of the complement gene, which contains a classical estrogen-responsive element sequence. Our results demonstrate that the induction of LDL-r expression by estrogen requires longer stimulation than that necessary for complement induction. Moreover, basal transcription of the LDL-r gene depends on PKC activity, while estrogen-stimulated activation of the LDL-r-promoter requires TK activity, pointing to a role of these non-classical estrogen-stimulated pathways in the transcriptional regulation of the LDL-r.

[Role of estrogen receptor isoforms in the pathogenesis and treatment of endometrial cancer]. / Charakterisierung und Bedeutung verschiedener Ostrogenrezeptortypen unter besonderer Berücksichtigung des Endometriumkarzinoms.

Estrogens play a crucial role in the regulation of the physiology of breast tissue and endometrium. Furthermore, estrogen has been implicated in the initiation and progression of neoplasms of these tissues. Estrogens mediate their effects through various estrogen receptor isoforms and isotypes. In breast tissue and in the endometrium the classical estrogen receptor ERalpha represents the mainly expressed ER isoform, whereas in the ovary the alternative estrogen receptor ERbeta is predominantly expressed. This review briefly describes the structure, function and expression of these receptors with special regard to endometrial cancer. Recent data indicate that alterations of the physiological ERalpha/ERbeta ratio in endometrial cancer correlates with poor clinical outcome. The potential clinical relevance of differential ER-isotype expression is also discussed with respect to an antihormonal therapy.