Non-Hodgkin lymphoma following Hodgkin's disease. A case report

A 40-year-old male developed 66 months after diagnosis of Hodgkin's disease a non-Hodgkin lymphoma of high grade malignancy. Initially he had been treated by irradiation because of Hodgkin's disease PS IIA. After 2 years of remission he had relapsed and had received MOPP and CCNU. After 2 years without any therapy he developed the secondary neoplasm. With increasing frequency of long term survivors late complications, either therapy related or caused by immunologic defects, are observed.     

Alterations in immune responses in prenatally irradiated dogs

Immunologic responses were studied in beagle dogs following prenatal (35 days gestation) irradiation to evaluate the effects of ionizing radiation on the developing immune system. Each dog received 1.5 Gy 60Co gamma irradiation or sham irradiation. Prenatally irradiated dogs exhibited a significant reduction in primary humoral antibody responses to inoculated sheep red blood cells, a T-dependent antigen, and a concurrent decrease in T-helper lymphocyte subpopulations in the peripheral blood at 3 to 4 months of age. Similarly, irradiated fetuses have been shown to have defects in epitheliostromal development of the thymus. It is suggested that the postnatal immunologic deficits may relate to the prenatal thymic injury.     

Telomere Profiling: Toward Glioblastoma Personalized Medicine

Despite a standard of care combining surgery, radiotherapy (RT), and temozolomide chemotherapy, the average overall survival (OS) of glioblastoma patients is only 15 months, and even far lower when the patient cannot benefit from this combination. Therefore, there is a strong need for new treatments, such as new irradiation techniques. Against this background, carbon ion hadrontherapy, a new kind of irradiation, leads to a greater biological response of the tumor, while minimizing adverse effects on healthy tissues in comparison with RT. As carbon ion hadrontherapy is restricted to RT-resistant patients, photon irradiation resistance biomarkers are needed. Long telomeres and high telomerase activity have been widely associated with photon radioresistance in other cancers. Moreover, telomere protection, telomere function, and telomere length (TL) also depend on the shelterin protein complex (TRF1, TRF2, TPP1, POT1, TIN2, and hRAP1). We thus decided to evaluate an enlarged telomeric status (TL, telomerase catalytic subunit, and the shelterin component expression level) as a potential radioresistance biomarker in vitro using cellular models and ex vivo using patient tumor biopsies. In addition, nothing was known about the role of telomeres in carbon ion response. We thus evaluated telomeric status after both types of irradiation. We report here a significant correlation between TL and the basal POT1 expression level and photon radioresistance, in vitro, and a significant increase in the OS of patients with long telomeres or a high POT1 level, in vivo. POT1 expression was predictive of patient response irrespective of the TL. Strikingly, these correlations were lost, in vitro, when considering carbon irradiation. We thus propose (1) a model of the implications of telomeric damage in the cell response to both types of irradiation and (2) assessment of the POT1 expression level and TL using patient tumor biopsies to identify radioresistant patients who could benefit from carbon hadrontherapy.     

A model for assessing cognitive impairment after fractionated whole-brain irradiation in nonhuman primates

To investigate the effect of fractionated whole-brain irradiation on nonhuman primates, 6-9-year-old male rhesus monkeys were irradiated with 40 Gy delivered as two 5-Gy fractions/week for 4 weeks. Cognitive function was assessed 5 days/week for 4 months prior to fractionated whole-brain irradiation and for 11 months after irradiation using a Delayed-Match-to-Sample (DMS) task at both low and high cognitive loads. Local rates of cerebral glucose metabolism were measured prior to and 9 months after irradiation using [(18)F]-2-deoxy-2-fluoro-d-glucose positron emission tomography. Low cognitive load trials did not reveal a significant reduction in performance until 7 months after irradiation; performance then declined progressively. In high cognitive load trials, the initial impairment was observed ～1 month after irradiation. This was followed by a transient recovery period over the next 1-2 months, after which performance declined progressively through 11 months after irradiation. Nine months after irradiation, glucose uptake during the DMS task was decreased in the cuneate and prefrontal cortex and was increased in the cerebellum and thalamus compared with the levels prior to irradiation. Results from this pilot study suggest that the radiation-induced changes in cognition and brain metabolism observed in rhesus monkeys may be similar to those observed in brain tumor patients receiving brain irradiation.     

Long-lasting depression of rabbit aortic prostacyclin formation by single-dose irradiation

Male rabbits were exposed to a single irradiation dose of 1000-5000 rad when 12, 15, 16, and 17 months old and were killed when 18 months old (i.e., 1, 2, 3, and 6 months after irradiation). Even after this long interval after irradiation, abdominal aortic prostacyclin formation was significantly depressed, whereas the nonirradiated thoracic aortic segment exhibited no significant alteration in vascular PGI2 generation. The data show that the severe decrease in PGI2 synthesis was not caused by deendothelialization induced by irradiation alone. The data support the view that a deterioration in the prostaglandin system regulating hemostatic balance is an important determinant in the development of radiation-induced vasculopathy.     

Combined reserpine and pituitary irradiation therapy for Cushing's disease patients following unsuccessful transsphenoidal microsurgery

The effectiveness of treatment with reserpine and pituitary irradiation, and with reserpine alone was evaluated in three female patients with Cushing's disease whose transsphenoidal pituitary microsurgery (TPM) had been unsuccessful. In these patients, endocrinological examination after the surgery demonstrated a recurrence of the disease although the microadenomas had apparently been curetted out from the pituitary in all patients. The first patient therefore received 1.0-2.0 mg/day of reserpine with 60 Gy x-ray irradiation, and there was complete remission within 3 months and the patient remained asymptomatic even when reserpine was reduced to 0.1 mg/day 10 years later. The second case was treated with low dose x-ray (20 Gy) and reserpine (0.5-2.0 mg/day), which were also effective. However, 2 weeks discontinuation of the drug caused urinary 17-hydroxycorticosteroids (17-OHCS) and serum cortisol to increase abnormally again, but these were finally re-normalized by an additional administration of reserpine. The third case was given reserpine alone (1.0-2.0 mg/day). She also had a remission in 3 months and the treatment was continued for one year, requiring no further treatment. These results suggest that additional treatment with reserpine and pituitary irradiation or with reserpine alone after unsuccessful TPM may be an effective alternative for patients with Cushing's disease.     

Radiation injury in rat lung. I. Prostacyclin (PGI2) production, arterial perfusion, and ultrastructure

Pulmonary prostacyclin (PGI2) production, arterial perfusion, and ultrastructure were correlated in rats sacrificed from 1 day to 6 months after a single exposure of 25 Gy of gamma rays to the right hemithorax. PGI2 production by the irradiated lung decreased to approximately half the normal value 1 day after irradiation (P less than 0.05), then increased steadily throughout the study. By 6 months postirradiation, the right lung produced two to three times as much PGI2 as did either shielded left lung or sham-irradiated lungs (P less than 0.05). Perfusion scans revealed hyperemia of the right lung from 1 to 14 days after irradiation. From its peak at 14 days postirradiation, however, perfusion of the irradiated lung decreased steadily, then reached a plateau from 3 to 6 months at less than half that in the shielded left lung. Electron micrographs of the right lung revealed perivascular edema from 1 to 30 days after irradiation. The right lung then exhibited changes typical of radiation pneumonitis followed by progressive interstitial fibrosis. Platelet aggregates were not observed at any time. Thus, decreased PGI2 production is an immediate but transient response of the lung to radiation injury. Then from 2 to 6 months after irradiation, the fibrotic, hypoperfused lung produces increasing amounts of the potent vasodilator and antithrombotic agent, PGI2. Pulmonary PGI2 production and arterial perfusion are inversely correlated for at least 6 months after hemithoracic irradiation.     

Status of allogeneic bone marrow transplantation in childhood in the GDR

Of 25 HLA-identical, MLC negative transplants 10 patients had acute lymphoblastic leukaemia (ALL), 8 acute nonlymphoblastic leukaemia (ANLL), 3 severe aplastic anaemia, 2 malignant histiocytosis, 1 patients neuroblastoma and 1 Fanconi anaemia. 3 HLA nonidentical, MLC positive transplants were performed, two children had malignant infantile osteopetrosis and 1 child had a severe combined immunodeficiency disease. Patients with ALL and ANLL received cyclophosphamide and single dose total body irradiation. 3 patients received fractionated TBI. The results for the allogeneic group overall indicate that the actuarial disease free survival rate is 0.62. 16 of 25 patients are in continuous complete remission (CCR) periods of 3-78 months posttransplant. All three transplanted children with severe aplastic anaemia alive disease-free for periods of 21-81 months. 10 patients with ALL were transplanted (2 in first remission for high risk ALL, 8 in second remission). 7 of 10 patients are alive and disease-free (CCR rate 0.67). 8 patients underwent BMT for ANNL while in first remission in 7 patients and in third partial remission in 1 patient. 4 of 8 patients are alive and disease-free for periods of 25-56 months (CCR rate 0.50). 1 patient with neuroblastoma stage IV survives 24 months, 1 child with Fanconi anemia died on day +25 of GVHD and septicaemia. 1 of the 2 patients transplanted for malignant histiocytosis relapsed 3 months posttransplant, 1 patient is alive and disease-free 5 months posttransplant. In none of the HLA-nonidentical and MLC positive transplantations T-cell depleted marrow engrafted.     

Disseminated coccidioidomycosis: clinical,immunologic and therapeutic aspects.

A patient with disseminated coccidioidomycosis initially had pulmonary and skin manifestations and survived for 14 years before dying of meningitis due to Coccidioides immitis. In addition to several courses of amphotericin B therapy the patient received injections of transfer factor derived from appropriate donors and miconazole nitrate therapy. The immunologic defence mechanisms of the patient during the course of his disease were studied and the possibility of a cell-mediated immunologic defect, potentially reversible by transfer factor, was demonstrated.     

Irradiation potentiation of cellular transfer of EAE: time course and locus of effect in irradiated recipient Lewis rats.

Further studies of the potentiating effect of 500 rads total body irradiation on cellular transfer of experimental allergic encephalomyeliatis (EAE) in Lewis rats have revealed two findings bearing on underlying mechanisms. First, the effect is transitory, potentiation of disease being observed in recipients irradiated 1 or 4 days before transfer of syngeneic sensitized donor lymphoid cells but not among animals irradiated 7 or 14 days before cell transfer. Second, lead shielding selectively excluding the central neuraxis from irradiation results in relatively little augmentation of EAE compared to that observed in non-shielded irradiated animals. We believe irradiation potentiation of EAE results from transitory alterations in central nervous system target tissue rendering it more vulnerable to host immunologic attack.     

Phospholipid metabolism in lymphoid cells at long-term periods following sublethal gamma-irradiation of rats

Dynamics of phospholipid metabolism in rat thymocytes and bone marrow cells was studied 1-6 months after fractionated irradiation. The rate of total and individual lipid synthesis was shown to increase in the exposed cells. The rate of lipid synthesis increased 1 and 2 months after irradiation and was normalized 3 and 6 months after irradiation.     

Radiation injury in rat lung. IV. Modification by D-penicillamine

To determine whether D-penicillamine, known to reduce fibrosis in irradiated rat lung (W. F. Ward, A. Shih - Hoellwarth , and R. D. Tuttle , Radiology 146, 533-537, 1983), also ameliorates radiation injury in the pulmonary endothelium, we measured angiotensin-converting enzyme (ACE) activity, plasminogen activator (PLA) activity, and prostacyclin (PGI2) production in the lungs of penicillamine-treated (10 mg/day, po, continuous after irradiation) and untreated rats from 2 weeks to 6 months after a single dose of 25 Gy of 60Co gamma rays to the right hemithorax. Both ACE and PLA activity in the irradiated right lung of untreated rats decreased dramatically between the 1st and 2nd months after exposure, then reached a plateau through 6 months at approximately 25 and 50% of the normal level, respectively. For the first 2 months after irradiation, penicillamine-treated animals exhibited significantly (P less than 0.05) higher activities of both ACE and PLA than did untreated rats. From 3 to 6 months after irradiation, however, the only significant drug effect on these enzymes was a 25% increase in PLA activity at 6 months. PGI2 production by the irradiated lung of untreated rats increased continuously, and at 6 months was approximately 10 times higher than normal. Penicillamine significantly (P less than 0.05) reduced this hypersecretion, and at 6 months after irradiation, PGI2 production by the lungs of drug-treated rats was only half that of untreated animals. In contrast, the drug had no significant effect on enzyme activities in the lungs of sham-irradiated rats. Thus the antifibrotic agent D-penicillamine delays the onset of radiation-induced enzyme dysfunction in the pulmonary endothelium. In addition at 6 months after irradiation, the lungs of penicillamine-treated rats exhibit 25% more PLA activity and only half as severe a hypersecretion of PGI2 as do the lungs of untreated animals. The drug is most effective in ameliorating endothelial damage during the first 2 months after irradiation, preceding the development of interstitial fibrosis. However, the effect of this penicillamine regimen on pulmonary endothelial function is not as large as its effect on collagen accumulation in irradiated rat lung.     

Beneficial effects of high daily dose bromocriptine treatment in Cushing's disease.

Treatment with a high daily dose bromocriptine was evaluated in 6 Cushing's disease patients (4 females and 2 males; aged 23 to 56 years). The highest doses administered were 40 mg to patient 1, 55 mg to patient 2, 35 mg to patient 3, 25 mg to patient 4, 25 mg to patient 5, and 17.5 mg to patient 6. The former 3 cases, 2 (patients 1 and 2) of whom were previously reported and further followed up, showed clinical and biochemical improvement with the regimen. Patient 1 who obtained remission with 40 mg/day has been on remission for further 14 months with a total of 36 months. Patient 2, who had a reduction in pituitary tumor size with 35 mg daily, relapsed thereafter. The therapy, however, resolved the paradoxical responses of plasma ACTH and cortisol to arginine. Readministration of bromocriptine resulted into another clinical and biochemical improvement with 45 to 55 mg/day. Patient 3, a relapsed case after a remission with reserpine plus pituitary irradiation, showed an improvement in the 24-h urinary free cortisol excretion with 35 mg/day. Patient 4 was the only case who had a marked decrease in plasma cortisol (basal; 16.3, nadir; 1.9 micrograms/dl) after a single-dose bromocriptine test among the 5 cases tested. The patient had favorable response with 25 mg/day for 2 months but the dose was not increased after an escape. Patient 5 received the drug in 4 occasions, 7.5 to 25 mg/day, in combination with several agents, which failed to induce clinical remission. The last patient did not respond to a maximum dose of 17.5 mg/day. These observations suggest that, regardless of the result of a single-dose bromocriptine test, treatment with a high daily dose of bromocriptine, 35 mg or more, may be necessary to obtain a favorable clinical response and normal cortisol secretion.     

Immunity,Age and Loss of Immunohomeostasis1

An interpretative discussion on the cellular basis of the association between immunosenescence and loss of immunologic homeostasis was developed from results of studies performed to resolve the issues (a) of whether cells in certain stages of differentiation are more vulnerable to aging than those in other stages and (b) whether the regulatory cells participating in modulating immune responses are prime targets of aging. Young and old mice were exposed to (1) 6-thioguanine (6-TG) to study the activity of their mitotically active and inactive cells and (2) 500R of irradiation to study regeneration of their immune cells. Many alterations were detected in old mice including the existence of a relatively large pool of mitotically inactive pluripotent stem cells in the bone marrow, heightened stem cell regenerative activity, and altered patterns of immunologic regeneration. These kinetic abnormalities reflect age-related changes in stem cells and their progenies, and in the lymphohematopoietic stromal cells.     

Treatment of Cushing's disease with low dose radiation therapy.

Nineteen patients with Cushing''s disease were treated with low dose external pituitary irradiation (20 Gy (2000 rad) in eight fractions over 10 days). While awaiting the effects of pituitary irradiation all patients were treated with metyrapone. Seven patients had a complete remission of their disease within six to 12 months of irradiation. They did not require any further treatment and were followed up for a mean of three and a half (range one to eight) years. Another patient had a complete remission after a second course of pituitary irradiation. A further two patients showed a significant biochemical improvement after irradiation, although they were not rendered eucorticoid. There were no complications after this dose of irradiation. These results compare favourably with those reported after pituitary irradiation at conventional doses (40-50 Gy (4000-5000 rad) over four or five weeks) but were not associated with any complications. It is therefore recommended that low dose external pituitary irradiation be used as definitive first line treatment for Cushing''s disease.     

Histoplasmosis en un varón inmunocompetente manifestada 45 años después de la infección

We report a case of a lung reactivation of a latent histoplasmosis in a 68 year-old patient without immunologic dysfunction living in Barcelona (Spain).The Histoplasma capsulatum var. capsulatum infection was probably acquired in a previous stay in Equatorial Guinea 48 years before.Diagnosis of mild chronic pulmonary histoplasmosis was performed by histopathology of lung biopsy plus antibodies detection against H. capsulatum. Treatment with oral itraconazol during three months leaded to a complete clinical cure, and antibodies disappeared after four years of follow up.     

Failure of cyprohepatdine to inhibit vasopressin-stimulated cortisol release in a patient with Cushing's disease.

A case of a 21-year-old woman with Cushing's disease due to a pituitary tumor is described. The patient was treated with cyprohepatadine for 4 weeks immediately following pituitary alpha-particle irradiation. A standard vasopressin test to measure ACTH-mediated cortisol release was performed four times: prior to pituitary irradiation, after irradiation, after 4 weeks of cyproheptadine therapy, and off cyproheptadine for 2 weeks. Cyproheptadine failed to modify vasopressin-stimulated cortisol release in the patient described. This study suggests that cyproheptadine, which has previously been shown to decrease ACTH secretion, probably acts principally at the hypothalamic, rather than at the pituitary level.     

Cytogenetic study of the bone marrow and peripheral blood lymphocytes in monkeys in long-term gamma irradiation

A comparative study of chromosome structures of bone marrow and peripheral blood cells has been carried out in 8 rhesus macaques (2-7 years of age), 4 of which survived after prolonged low-capacity (3.87 microA/kg) gamma irradiation, the total dose being 7.97 Gy (LD50/60). It has been established that prolonged low-capacity gamma irradiation was of a high mutagenic activity. Various tissues of irradiated monkeys showed differences in the frequency (4 months) and types (4-33 months) of aberrations within the period of 4 to 33 months following irradiation. Mutagenic effect characteristic of the early period after the irradiation was retained in the peripheral blood of irradiated monkeys within the period of observation.     

Spontaneous and induced apoptosis in systemic lupus erythematosus: multiple assays fail to reveal consistent abnormalities

The immunologic basis of systemic lupus erythematosus (SLE) is multifactorial and still elusive. Recent advances in the field of apoptosis have suggested new paradigms for the development of lupus autoimmunity. In the present studies we examined the possibility that individual populations of T and B cells are abnormally resistant to apoptosis or that they stand out in over- or underexpressing Fas. Fas was generally overexpressed in cells freshly isolated from SLE patients but the apoptotic response to FasL was normal. We did not find increased spontaneous ongoing apoptosis in SLE lymphocytes. Normal cleavage of PARP similarly implied that the final biochemical pathway of apoptosis is relatively intact in SLE. Finally we placed special emphasis on the response of SLE patient cells to UV irradiation, especially cells from photosensitive patients, and found no difference in Fas expression. In conclusion our results indicate that SLE patients do not suffer from a major apoptotic abnormality. The results also raise questions concerning the dynamic expression of Fas and the significance of ongoing apoptosis as a risk for autoimmune disease.     

Whole-body X-irradiation of mice accelerates polyploidization of hepatocytes

Male C57BL/6 mice were whole-body irradiated with 4.75 Gy of X-rays at the age of 2 months and killed at 2, 6, 12 and 19 months after irradiation. The percentage survival began to decline earlier and faster in the irradiated group than the controls up to 19 months after exposure when the study was terminated. The nuclear DNA content of individual hepatocytes was measured by a Feulgen-DNA microfluorometric method, and hepatocytes were classified into various ploidy classes. In the irradiated mice, the degree of polyploidization was significantly higher than the controls by 2 months after exposure and steadily increased up to 6 months after exposure. Thereafter, however, a slow return to the control level was found up to 19 months after irradiation. These results appear to support a hypothesis that radiation accelerates the ageing process as judged from hepatocyte polyploidization.