Histology and cytochemistry of human skin. XI. The distribution of beta-glucuronidase

1. Various amounts of beta-glucuronidase activity may be found in all of the cutaneous appendages. 2. In the epidermis, the basal layer and the Malpighian layer contain a moderate amount of it, but a band of cells, including the stratum granulosum and the cells immediately above it, is rich in beta-glucuronidase. 3. The cells of the duct of eccrine sweat glands have moderately strong enzyme activity, but those in the secretory coil are strongly reactive; small and large reactive granules are crowded in the reactive cytoplasm. 4. The cells of the secretory coil of the apocrine glands contain more beta-glucuronidase than any other cutaneous appendage. 5. In the sebaceous glands, a very strong concentration of enzyme activity is found in the undifferentiated peripheral cells, a smaller amount of it is found in the differentiating cells. 6. In active hair follicles, the largest amount of beta-glucuronidase is found in the outer root sheath and in the bulb. In the outer sheath, the strongest concentration is found around the level of the keratogenous zone of the cortex. The dermal papilla is strongly reactive. In quiescent hair follicles, the outer root sheath has a moderate amount of enzyme concentration, but the dermal papilla is unreactive. 7. In the dermis, the fibroblasts in the papillary layer, the smooth muscle cells of the arrectores pilorum and the tunica media of arteries, and the fat cells all exhibit enzyme activity. Mast cells show a great concentration of beta-glucuronidase.     

Isolation and characterization of the major form of beta-glucuronidase from human seminal plasma

Human seminal plasma contain two forms of beta-glucuronidase (beta-D-glucuronidase glucuronosohydrolase, EC 3.2.1.31) which are present in the ratio of 4:1. The major form of beta-glucuronidase with a slow moving band in electrophoresis was purified to homogeneity as revealed by polyacrylamide gel electrophoresis, double immunodiffusion and immunoelectrophoresis. The major form of beta-glucuronidase shows dual optimum pH at 4.3 and 4.7 with a dip in the activity at pH 4.5. The Km of this form of beta-glucuronidase is dependent on pH and was found to be 0.95, 3.08 and 0.67 mM at pH 4.4, 4.5 and 4.7, respectively. The major form of beta-glucuronidase from seminal plasma is stable at 55 degrees C for 30 min but it denatures at 65 degrees C. Heat denaturation is faster at acidic pH (4.7) than at alkaline pH (7.8). However, the activity of enzyme increased linearly with increase in temperature up to 70 degrees C during incubation with substrate. Cu, Ag, Hg and Ni salts inhibited enzyme activity significantly at 0.1 and 1.0 mM concentration, but the inhibition of HgCl2 was protected by cysteine. 1,4-D-Saccharic acid lactone and ascorbic acid inhibited seminal beta-glucuronidase competitively, yielding Ki values of 1.7 . 10(-3) mM and 10.3 mM, respectively. Though fructose and mannose also showed significant inhibition of beta-glucuronidase at 10-100 mM, glucose did not show any effect. The molecular weight of the major form of beta-glucuronidase was found to be 279 000, and it appears to be composed of four subunits each having a molecular weight of 74 000.     

Directed evolution of a beta-galactosidase from <Emphasis Type="Italic">Pyrococcus woesei</Emphasis> resulting in increased thermostable beta-glucuronidase activity

We performed directed evolution on a chemically synthesized 1,533-bp recombinant beta-galactosidase gene from Pyrococcus woesei. More than 200,000 variant colonies in each round of directed evolution were screened using the pYPX251 vector and host strain Rosetta-Blue (DE3). One shifted beta-galactosidase to beta-glucuronidase mutant, named YG6762, was obtained after four rounds of directed evolution and screening. This mutant had eight mutated amino acid residues. T29A, V213I, L217M, N277H, I387V, R491C, and N496D were key mutations for high beta-glucuronidase activity, while E414D was not essential because the mutation did not lead to a change in beta-glucuronidase activity. The amino acid site 277 was the most essential because mutating H back to N resulted in a 50% decrease in beta-glucuronidase activity at 37°C. We also demonstrated that amino acid 277 was the most essential site, as the mutation from N to H resulted in a 1.5-fold increase in beta-glucuronidase activity at 37°C. Although most single amino acid changes lead to less than a 20% increase in beta-glucuronidase activity, the YG6762 variant, which was mutated at all eight amino acid sites, had a beta-glucuronidase activity that was about five and seven times greater than the wild-type enzyme at 37 and 25°C, respectively. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Interaction of tumor and surrounding tissue of mice inoculated B16 melanoma variants in terms of enzyme activity

1. The interactions of B16-F1 and B16-F10 tumors with their surrounding tissues in terms of enzyme activities such as cathepsin B, hemoglobin(Hb)-hydrolase, acid phosphatase, beta-glucuronidase and plasminogen activator were investigated when said tumors proliferated locally and at secondary sites throughout the host's circulatory system. 2. In the case of B16-F1 and B16-F10 tumor cells proliferating under the skin, statistical differences were not detected between the enzyme activities of the skin surrounding the tumors and control skin, nor between B16-F1 and B16-F10 tumors, except for beta-glucuronidase. 3. In the case of B16-F1 and B16-F10 tumor cells metastasizing to lung, statistical differences were detected between numerous enzyme activities of the lung tissues surrounding the tumors and control lung tissue, and also between B16-F1 and B16-F10 tumors. 4. The activities of cathepsin B and acid phosphatase of lung tissue surrounding B16-F1 tumor were lower than those of the control lung. 5. beta-Glucuronidase activity of lung tissue surrounding B16-F10 tumor was higher than that of the control lung. 6. The activities of cathepsin B, Hb-hydrolase and beta-glucuronidase of the B16-F10 tumor were higher than those of the B16-F1 tumor. 7. Results indicate that metastasized B16 melanoma tumor cells interact with surrounding lung tissues, and that cathepsin B, Hb-hydrolase and beta-glucuronidase might play important roles in the metastasis of the malignant tumor.     

Acquisition of a lysosomal enzyme by myoblasts in tissue culture

Skeletal muscle myoblasts from different sources acquired high levels of the lysosomal enzyme beta-glucuronidase, when they were cultured together with mitogen-activated lymphocytes. Immunofluorescent staining, thermal stability, and electrophoretic mobility showed that the increase in enzyme activity in the myoblasts was due to the presence of the lymphocyte form of the enzyme. Although myoblasts were able to take up exogenous beta-glucuronidase from the culture medium by mannose 6-phosphate receptor-mediated endocytosis, enzyme acquisition during co-culture with lymphocytes was independent of this pathway. Enzyme transfer from the lymphocytes was found to require direct cell-cell contact with the muscle cells, and was accompanied by an increase in beta-glucuronidase activity in the lymphocytes themselves. Since this additional activity was also due to the presence of the lymphocyte form of the enzyme, these results indicate that interaction with the muscle cells induced the de novo synthesis of beta-glucuronidase in the lymphocytes.     

Rat liver beta-glucuronidase. cDNA cloning, sequence comparisons and expression of a chimeric protein in COS cells.

A cDNA for rat liver beta-glucuronidase was isolated, its sequence determined and its expression after transfection into COS cells studied. The deduced amino acid sequence of the rat liver clone showed 77% homology with that from the cDNA for human placental beta-glucuronidase and 47% homology with that deduced from the cDNA for Escherichia coli beta-glucuronidase. Several differences were found between the cDNA from rat liver and that previously reported from rat preputial gland. Only one change leads to an amino acid difference in the mature enzyme. A chimeric clone was constructed by using a fragment encoding the first 18 amino acid residues of the signal sequence from the human placental cDNA clone and a fragment from the rat clone encoding four amino acid residues of the signal sequence, all 626 amino acid residues of the mature rat enzyme, and all of the 3' untranslated region. After transfection into COS cells the chimeric clone expressed beta-glucuronidase activity that was specifically immunoprecipitated by antibody to rat beta-glucuronidase. The Mr value of 76,000 of the expressed gene product was characteristic of the glycosylated rat enzyme. It was proteolytically processed in COS cells to Mr 75,000 6 h after metabolic labelling. At least 50% of the expressed enzyme was secreted at 60 h post-transfection, but the secreted enzyme did not undergo proteolytic processing. These results provide evidence that the partial cDNA isolated from a rat liver library contains the complete coding sequence for the mature rat liver enzyme and that the chimeric signal sequence allows normal biosynthesis and processing of the transfected rat liver enzyme in COS cells.     

Effect of ayurvedic medicines on beta-glucuronidase activity of Brunner's glands during recovery from cysteamine induced duodenal ulcers in rats

Biochemical and histochemical studies revealed decreased beta-glucuronidase activity in the Brunner's glands of duodenal ulcerated rats. The enzyme activity showed gradual increase during recovery. Rats treated with a mixture of Ayurvedic medicines (Glycyrrhiza glabra, Terminalia chebula, Piper longum and Shanka Bhasma) recovered faster with concomitant increase in beta-glucuronidase activity in the Brunner's glands. It can be concluded that Ayurvedic medicines used do not act as antacid but improve the secretory status of Brunner's glands involved in the protection against duodenal ulcer.     

Effect of a new non-steroidal anti-inflammatory agent on lysosomal stability in adjuvant induced arthritis

The effect of new non-steroidal anti-inflammatory agents on lysosomal stability was studied by determining the activity of beta-glucuronidase, a typical lysosomal enzyme, in various sub-cellular fractions and its release from the lysosome-rich fraction. Adjuvant arthritic animals showed a significant increase in the beta-glucuronidase activity in sub-cellular fractions. The increased rate of the release of beta-glucuronidase from lysosome-rich fraction clearly suggested that arthritic syndrome caused decreased stability of the lysosomes. Administration of boswellic acids or salai-guggal to arthritic animals was found to increase the lysosomal stability by inhibiting the rate of release from lysosome-rich fraction and reducing beta-glucuronidase activity in various sub-cellular fractions. Of the two anti-inflammatory agents tested, salai-guggal was found to afford more therapeutic value than boswellic acids.     

Cytochemical distribution of beta-glucuronidase activity in experimental brain tumors and brain tissue in vivo and in vitro

Summary Activity of beta-glucuronidase in experimental brain tumors and in nervous tissue was studied. The activity of the enzyme was detected both in gliomas and sarcomas exhibiting a high degree of anaplasia and dysplasia. Reactive glia showed high enzymatic activity; whereas activity in normal nervous tissue was absent. In tissue culture the activity of beta-glucuronidase was observed mainly in astrocytes, and its intensity expressed the degree of cellular maturation and differentiation.The investigation was carried out under a grant from PL 480 US Public Health Service Program, Agreement 05-004-1.     

Glycyrrhizin stimulates growth of Eubacterium sp. strain GLH, a human intestinal anaerobe

Eubacterium sp. strain GLH was isolated from human feces and produced two kinds of beta-D-glucuronidase (EC 3.2.1.31), one new enzyme specific for glycyrrhizin (GL) and the other for phenyl beta-D-glucuronides. GL or p-nitrophenyl-mono-beta-D-glucuronide (pNPG) stimulated the production of GL or pNPG beta-glucuronidases and the growth of strain GLH in a basal medium lacking carbohydrate. D-Glucuronic acid also stimulated the growth of the bacterium, but glycyrrhetic acid did not. The increase of GL beta-glucuronidase paralleled the growth of the Eubacterium strain in pure culture. These results suggest that glucuronides such as GL and pNPG stimulate the growth of the Eubacterium strain in a nutrient-poor medium by providing D-glucuronic acid through the activity of beta-glucuronidases. The increase in GL beta-glucuronidase activity in the presence of GL was observed during the cultivation of human intestinal flora in a general anaerobic medium. During mixed cultivation of the Eubacterium strain with Streptococcus faecalis, which does not produce GL beta-glucuronidase, GL beta-glucuronidase was also increased by GL or pNPG, but not by glycyrrhetic acid and p-nitrophenol. It is suggested that GL stimulates the growth of strain GLH even in the mixed culture.     

beta-Glucuronidase release from human monocytes induced with aggregated immunoglobulins of different classes

We studied beta-glucuronidase release from human monocytes induced with aggregated immunoglobulins of the nine different human classes and subclasses. Release was induced in a time and dose-dependent manner by all aggregated IgG subclasses. Aggregated IgA1 caused a greater beta-glucuronidase release than aggregated IgM, IgD, and IgE, but the difference was not statistically significant. Release of beta-glucuronidase was not phagocytosis dependent since inhibition of phagocytosis by cytochalasin B or dihydrocytochalasin B did not diminish enzyme release. On the contrary, cells incubated with cytochalasin B prior to addition of aggregated IgG released approximately twice as much enzyme compared to untreated controls. Enzyme release induced by latex particles, a non-Fc receptor mechanism, was decreased by cytochalasin B. Monomeric IgG1, IgG2, IgG3, and IgG4 inhibited aggregated IgG1 enzyme release in a dose-dependent manner. The ability of monomeric IgG to inhibit beta-glucuronidase release correlated with previous reports describing the binding affinities of monomeric IgG to monocytes, i.e., IgG2 was relatively ineffective compared to the other subclasses. Monomeric IgA, IgE, and pentameric IgM were unable to diminish IgG-induced enzyme release. The data indicate that normal peripheral blood monocytes express predominantly Fc receptors for IgG and that all four IgG subclasses induce the release of the lysosomal enzyme beta-glucuronidase.     

Effect of Host Cell on Distribution of a Lysosomal Enzyme During Virus Infection

The time of appearance of a lysosomal enzyme, beta-glucuronidase, in the medium of cells infected with either measles virus or echovirus 6 varied with the host cell system. Replication and release of virus preceded leakage of beta-glucuronidase from green monkey kidney cells. In contrast, extracellular enzyme appeared before replication and release of virus in human amnion cells. Hydrocortisone depressed enzyme leakage but did not retard replication of measles virus or viral-induced cytopathology. The intracellular distribution of beta-glucuronidase in uninfected and measles virus-infected cells was also studied. Measles virus infection altered the position of particulate-bound beta-glucuronidase in linear sucrose gradients prior to substantial release of this enzyme intra- and extracellularly. At early stages in infection, most of the cell-associated virus banded with particulate-bound enzyme in the middle of the gradient. As infection progressed, separation of measles virus infectivity from enzyme activity occurred, and intracellular virus was recovered near the meniscus of sucrose gradients.     

Human beta-glucuronidase. Studies on the effects of pH and bile acids in regard to its role in the pathogenesis of cholelithiasis

Human bile contains a considerable amount of endogenous beta-glucuronidase. The effects of pH and bile acids on its activity have been studied in regard to its role in the pathogenesis of cholelithiasis. beta-Glucuronidase, purified from human liver to homogeneity, was structurally stable between pH 4 and 10, but was active only over a much narrower range of pH, with a pH optimum of 5.2. The inactivation below pH 4 was due to its irreversible denaturation, whereas the inactivation at higher pH was due to a true reversible pH effect on the enzyme velocity. Kinetic studies revealed that hydrogen ion acted as a substrate-directed activator of the free enzyme, but not the enzyme-substrate complex, with a molecular dissociation constant of 4 X 10(-6). The enzyme activity was not affected by unconjugated bile acids, primarily due to their extremely low water solubility. Conjugated bile acids, on the other hand, exerted heterogeneous and pH-dependent effects on the enzyme. At pH 5.2, taurocholic acid and glycocholic acid were substrate-directed activators of the enzyme; taurochenodeoxycholic acid and taurodeoxycholic acid, competitive inhibitors; and glycochenodeoxycholic acid and glycodeoxycholic acid, mixed inhibitors. At pH 7.0 all taurine and glycine conjugates behaved as substrate-directed activators. Though beta-glucuronidase activity at pH 7 was only 23% of its maximal activity at pH 5.2, conjugated bile acids tended to restore its activity to a certain extent at pH 7. Thus, endogenous beta-glucuronidase could play a significant role in pigment cholelithiasis.     

Development changes to gut microflora metabolism in mice.

Developmental changes in the activities of bacterial nitrate reductase, nitroreductase and beta-glucuronidase and their response to fermentable dietary fibre, were investigated in caecal contents from suckling mice (2-week-old) and in mice aged 4-24 weeks fed either a purified fibre-free diet or that diet supplemented with 5% (w/w) pectin. There was no apparent age-related trend common to the three enzymes studied. Nitrate reductase activity in the mice fed the fibre-free diet did not markedly alter with age. Pectin administration, however, was associated with a significant increase in nitrate reductase activity, particularly in 4-week-old mice. Nitroreductase activity exhibited an overall upward trend in mice from 2 to 12 weeks and thereafter decreased. Caecal beta-glucuronidase activity in mice increased sharply between 2 weeks and 4 weeks of age, thereafter not changing significantly until the 24th week. Pectin feeding had no consistent effect on activities either of nitroreductase or beta-glucuronidase. The changes in enzyme activities with age were not related to the concentration of bacteria in the caecum, which was highest in the 2-week-old mice. We conclude that the weaning is a period in which marked changes in caecal bacterial enzyme activities can occur.     

Glycyrrhizin stimulates growth of Eubacterium sp. strain GLH, a human intestinal anaerobe.

Eubacterium sp. strain GLH was isolated from human feces and produced two kinds of beta-D-glucuronidase (EC 3.2.1.31), one new enzyme specific for glycyrrhizin (GL) and the other for phenyl beta-D-glucuronides. GL or p-nitrophenyl-mono-beta-D-glucuronide (pNPG) stimulated the production of GL or pNPG beta-glucuronidases and the growth of strain GLH in a basal medium lacking carbohydrate. D-Glucuronic acid also stimulated the growth of the bacterium, but glycyrrhetic acid did not. The increase of GL beta-glucuronidase paralleled the growth of the Eubacterium strain in pure culture. These results suggest that glucuronides such as GL and pNPG stimulate the growth of the Eubacterium strain in a nutrient-poor medium by providing D-glucuronic acid through the activity of beta-glucuronidases. The increase in GL beta-glucuronidase activity in the presence of GL was observed during the cultivation of human intestinal flora in a general anaerobic medium. During mixed cultivation of the Eubacterium strain with Streptococcus faecalis, which does not produce GL beta-glucuronidase, GL beta-glucuronidase was also increased by GL or pNPG, but not by glycyrrhetic acid and p-nitrophenol. It is suggested that GL stimulates the growth of strain GLH even in the mixed culture.     

Biochemical differences between two types of N-acetylglucosamine:-->6sulfotransferases in human colonic adenocarcinomas and the adjacent normal mucosa: specific expression of a GlcNAc:-->6sulfotransferase in mucinous adenocarcinoma

6-O-Sulfation of beta-GlcNAc is an initial step in the biosynthesis of N-linked and O-linked sulfated glycans, which are widely distributed in colonic tissues. However, the biochemical mechanism of this sulfation in human colonic carcinogenesis was still unclear. In this study, we found two types of GlcNAc:-->6sulfotransferases (SulT) in human colonic adenocarcinomas and the adjacent normal mucosa, and we determined their enzymatic characteristics. One SulT, named SulT-a, was present in the adjacent normal mucosa and in non-mucinous adenocarcinomas, whereas the other SulT, named SulT-b, was present only in mucinous adenocarcinomas and adenocarcinomas with a mucinous component. SulT-a preferentially acted on Galbeta1-->3(GlcNAcbeta1-->6)GalNAc(alpha1)-p-nitrophenyl (pNP) and GlcNAcbeta1-->2Man, whereas SulT-b could act not only on these two glycans, but also on GlcNAcbeta1-->3GalNAc(alpha1)-pNP and GlcNAcbeta1-->3Galbeta1-->4Glc. The levels of SulT-a activity were significantly lower in non-mucinous adenocarcinomas than in the adjacent mucosa. In contrast, SulT-b was expressed in mucinous adenocarcinomas and in adenocarcinomas with a mucinous component. These results indicate that there are at least two types of GlcNAc:-->6SulT, SulT-a and -b, in colonic mucosa and adenocarcinomas, and that the occurrence of these enzymes is closely correlated with colonic cancer and the presence of areas of mucin accumulation.     

A new type of exo-beta-glucuronidase acting only on non-sulfated glycosaminoglycans

Using chondroitin as a substrate, a new type of exo-beta-glucuronidase (EC 3.2.1.31) from rabbit liver was purified using a combination of ammonium sulfate fractionation, DEAE-cellulose chromatography, gel filtration on Sephracryl S-300, affinity chromatography through heparin-Sepharose CL-6B, and preparative polyacrylamide gel electrophoresis. This enzyme acts only on non-sulfated glycosaminoglycans and their oligosaccharides and was shown to be quite different from exo-beta-glucuronidase, which does act on p-nitro-phenyl-beta-D-glucuronide with regard to the following properties. 1) Neither sulfated glycosaminoglycanoligosaccharides nor p-nitrophenyl-beta-D-glucuronide were substrates for the enzyme. 2) The molecular weight was found to be about 130,000 by gel filtration, compared with a molecular weight of 280,000-300,000 for beta-glucuronidase, which acts on p-nitro-phenyl-beta-D-glucuronide. 3) The enzyme showed maximal activity at pH 5.0, compared with an optimum pH of 4.5 for beta-glucuronidase, which acts on p-nitro-phenyl-beta-D-glucuronide. 4) The enzyme showed maximal activity in 0.075 M NaCl but no activity above 0.25 M NaCl. 5) The enzyme was inhibited strongly by compounds bearing a sulfate group. 6) The enzyme did not react with an antibody against beta-glucuronidase acting on p-nitrophenyl-D-glucuronide. It is suggested that the enzyme may be involved in the catabolism of glycosaminoglycans, acting especially on chondroitin after the desulfation reaction and/or hyaluronic acid, but showing little involvement with the detoxification system.     

Impediments to Enhancement of CPT-11 Anticancer Activity by E. coli Directed Beta-Glucuronidase Therapy

CPT-11 is a camptothecin analog used for the clinical treatment of colorectal adenocarcinoma. CPT-11 is converted into the therapeutic anti-cancer agent SN-38 by liver enzymes and can be further metabolized to a non-toxic glucuronide SN-38G, resulting in low SN-38 but high SN-38G concentrations in the circulation. We previously demonstrated that adenoviral expression of membrane-anchored beta-glucuronidase could promote conversion of SN-38G to SN-38 in tumors and increase the anticancer activity of CPT-11. Here, we identified impediments to effective tumor therapy with E. coli that were engineered to constitutively express highly active E. coli beta-glucuronidase intracellularly to enhance the anticancer activity of CPT-11. The engineered bacteria, E. coli (lux/βG), could hydrolyze SN-38G to SN-38, increased the sensitivity of cultured tumor cells to SN-38G by about 100 fold and selectively accumulated in tumors. However, E. coli (lux/βG) did not more effectively increase CPT-11 anticancer activity in human tumor xenografts as compared to non-engineered E. coli. SN-38G conversion to SN-38 by E. coli (lux/βG) appeared to be limited by slow uptake into bacteria as well as by segregation of E. coli in necrotic regions of tumors that may be relatively inaccessible to systemically-administered drug molecules. Studies using a fluorescent glucuronide probe showed that significantly greater glucuronide hydrolysis could be achieved in mice pretreated with E. coli (lux/βG) by direct intratumoral injection of the glucuronide probe or by intratumoral lysis of bacteria to release intracellular beta-glucuronidase. Our study suggests that the distribution of beta-glucuronidase, and possibly other therapeutic proteins, in the tumor microenvironment might be an important barrier for effective bacterial-based tumor therapy. Expression of secreted therapeutic proteins or induction of therapeutic protein release from bacteria might therefore be a promising strategy to enhance anti-tumor activity.     

Argyrophilia in ovarian serous tumors. A comparative study in 127 epithelial ovarian tumors.

The distribution of argyrophil cells in epithelial ovarian tumors was studied in 127 cases. The results showed that not only mucinous tumors and endometrioid tumors contained argyrophil cells, but also some serous tumors expressed argyrophilia. 31% of serous tumors including 40% of serous adenocarcinomas contained variable numbers of argyrophil cells. Argyrophilia has been demonstrated in mucinous tumors, endometrioid tumors and Brenner tumors before. However, this is the first time the presence of argyrophilia in serous tumors has been noticed. Moreover, the argyrophil cells in 5 serous carcinomas showed reactivity with Neuroendocrine (chromogranin A) antibody but not with serotonin. The expression pattern of argyrophilia in the serous tumors was different from that of the mucinous tumors; in the former, argyrophil granules appeared in apical portions or throughout the cytoplasm of single or clustered cells. In addition, the argyrophilia in some serous tumors and endometrioid tumors decreased after diastase digestion. Ultrastructurally, no typical neurosecretory granule was found in the argyrophilic serous tumors. The findings in this study suggest that argyrophilia could be quite frequently found in ovarian epithelial tumors and in itself is not a very specific differential characteristic of carcinoid tumors. The argyrophilia found in a variety of epithelial ovarian tumors might lend additional support to the histogenesis and close relationship between the common epithelial tumors of the ovary.