Limitations of Chromogranin A in clinical practice

Context: Usefulness of circulating Chromogranin A (CgA) for the diagnosis of neuroendocrine tumors (NEN) is controversial. The aim of the present study was to assess the actual role of this marker as diagnostic tool. Methods: Serum blood samples were obtained from 42 subjects affected with NEN, 120 subjects affected with non-endocrine neoplasias (non-NEN) and 100 non-neoplastic subjects affected with benign nodular goitre (NNG). Determination of CgA was performed by means of immunoradiometric assay. Results: The CgA levels among NEN-patients were not significantly different from NNG and non-NEN subjects. The Receiver operating characteristic (ROC) curves analysis failed to identify a feasible cut-off value for the differential diagnosis between NEN and the other conditions. Conclusion: Serum CgA is not helpful for the first-line diagnosis of NEN.     

Chromogranin A as a determinant of midgut carcinoid tumour volume

Neuroendocrine (NE) tumours are characterized by their capacity to synthesize, store and release hormonal products. These substances are stored in neurosecretory vesicles together with chromogranin A (CgA). The concentration of plasma CgA in patients with NE tumours is thought to reflect the degree of NE differentiation, total tumour burden and effect of medical treatment. The aim of this study was to analyse the correlation between tumour weight and plasma CgA levels as well as the influence of treatment with a long-acting somatostatin analogue (octreotide) using nude mice with xenografted human ileal carcinoid tumours. There was a correlation between tumour weight and plasma CgA levels in all animals (p<0.00001). In octreotide-treated mice, plasma CgA levels were significantly reduced versus untreated animals (p=0.037).

In conclusion, this study demonstrates that plasma CgA levels are closely correlated to tumour burden, and that plasma CgA is well suited for monitoring the clinical course and outcome of treatment in patients with NE tumours.     

Chromogranin A Synthesis and Secretion in Chromaffin Cells

A sensitive and selective radioimmunoassay for chromogranin A (Chrg A) has been developed to quantitate content, release, and biosynthesis of this secretory protein in neuroendocrine tissues. An antiserum raised against Chrg A from bovine adrenal medulla was found to detect predominantly only the Mr 70-75 kilodalton Chrg A in its native form, allowing the use of this antiserum as a quantitatively specific probe for Chrg A in cell-free extracts of the adrenal medulla and chromaffin cells. Chrg A comprises about 10% of the total protein of the chromaffin cell. It is released in parallel with Met-enkephalin and catecholamines from the bovine chromaffin cell in primary culture in response to nicotine and nicotinic cholinergic agonists. From 14 to 22% of total Chrg A is released from the cell during a 15-min exposure to a maximally stimulatory dose of nicotine (10-100 microM). Chrg A release on nicotinic stimulation is blocked by D-600 and hexamethonium to the same extent as Met-enkephalin and catecholamine release. The parallel time course and percent release of Chrg A and Met-enkephalin indicate that these secretory polypeptides are contained in, and released from, functionally identical cellular compartments. Chrg A and Met-enkephalin pentapeptide sequences are present in the chromaffin cell at a ratio of about 2:1, although Chrg A is far more abundant on a mass basis. Chrg A and Met-enkephalin biosynthesis appear to be differentially regulated within the chromaffin cell, since chronic treatment of cells with nicotine and forskolin causes an elevation of Met-enkephalin pentapeptide without a concomitant elevation of intracellular levels of Chrg A.     

质子泵抑制剂对冠心病患者嗜铬粒蛋白A影响的临床意义

目的：本研究旨在探讨质子泵抑制剂（vii）对心内科拟诊断为冠心病患者的嗜铬粒蛋白A（CgA）水平影响的临床意义。方法：113名拟诊冠心病的住院患者,分为PPI组（药物治疗中加入PPI,共62例）和非PPI组（药物治疗中无PPI,共51例）,收集其外周血清,用ELISA法检测样本血清中CgA水平,同时应用化学发光法检测样本血清中NT—proBNP水平。比较PPI组和非PPI组CgA、NT．proBNP水平的差异。结果：因为CgA、NT．proBNP均为非正态分布资料,两者均通过对数转换为正态分布资料;PPI组的LNCgA的均数显著高于非PPI组（4．62±0．97和3．91±0．89,P=0．000）。而两组LNNT-proBNP的均数无显著差异（5．41±1．46和5．59±2．00,P=0．580）。结论：在心功能等临床特征具有可比性的情况下,是否使用PPI对CgA水平的影响很大;而对BNP无明显影响。评价CgA在心功能分级或冠心病预后等方面的应用,不能忽略PPI联用对CgA数值的影响。     

质子泵抑制剂与肿瘤耐药研究

恶性肿瘤对抗癌药物的耐药性是肿瘤患者治疗失败的主要原因。肿瘤细胞外微环境的高度酸化是肿瘤细胞对化疗药物产生耐药的机制之一。改变肿瘤细胞内外的pH梯度是逆转耐药的一种有效方法。作为抗酸剂治疗胃病的质子泵抑制剂能够通过抑制质子泵的功能,改变pH梯度而阻断肿瘤微环境的酸化,达到提高肿瘤对化疗药物敏感性的目的。     

Chromogranin C: A Third Component of the Acidic Proteins in Chromaffin Granules

We characterized a group of acidic proteins of bovine chromaffin granules with an antiserum raised against a protein described by Rosa and Zanini [Eur. J. Cell Biol. 31, 94-98 (1983)] in pituitary gland. In adrenal medulla the proteins reacting with this antiserum are confined to chromaffin granules. Their largest component has a Mr of 86,000 and a pI of 5.0. In addition six proteins of lower molecular weight are recognized by this antiserum. In a cell-free system only one protein is synthesized that can be precipitated with this antiserum. The properties of these proteins are very similar to those of the previously described chromogranins A and B; however, there is no immunological cross-reaction between these protein groups. We suggest this third group of acidic proteins of chromaffin granules be named chromogranins C.     

The presence of immunoglobulins in the gastric juice of patients infected with Helicobacter pylori is related to a reduced secretion of acid

Background. It has been reported that treatment with proton pump inhibitors (PPI) leads to partial elimination and suppression of Helicobacter pylori. In theory, since acid is known to denature immunoglobulins, this antibacterial activity of PPI may be due to a reduction in the acid output favouring humoral immunity. Materials and methods. We analysed prospectively fasting gastric juice in 54 consecutive patients attending upper endoscopy for pH and levels of IgG, IgA and IgM. In addition, two antral and two corpus biopsies were obtained and histologically examined for the presence of H. pylori. Results. 41/54 patients were infected with H. pylori. Immunoglobulines in the gastric juice of these patients were found in 25/41 (IgG), 27/41 (IgA), and 29/41 (IgM) patients. There was a highly significant difference in the gastric pH when H. pylori infected patients with measurable IgG, IgA, or IgM were compared with those in whom no immunoglobulines were found (median pH: 6 vs. 2 in each group; p < .001) Conclusions. There is a close correlation between a high gastric pH and the presence of IgG, IgA, and IgM antibodies. Hence, it may be speculated that the efficacy of humoral immunity following H. pylori infection depends on a high pH such as resulting from PPI treatment.     

Comparative Incorporation of Proenkephalin-Derived Peptides, Chromogranin A, and Dopamine β-Hydroxylase into Chromaffin Vesicles

The incorporation of enkephalin-containing peptides (ECPs) derived from proenkephalin into chromaffin vesicles was examined in primary cultures of adrenal medullary chromaffin cells. Cells were pulse-labeled with [35S]methionine and chased for periods up to 24 h. Chromaffin vesicles in cell homogenates were then fractionated by density gradient centrifugation and the presence of [35S]Met-enkephalin sequences in gradient fractions determined. 35S-ECPs were incorporated into particles suggestive of immature vesicles within 1-2 h after radiolabeling. Vesicle maturation, measured by co-equilibration of 35S-ECPs and total ECPs in the gradients, was complete within 9-12 h and was unaffected by treatments that increase proenkephalin synthesis. Incorporation of [35S]chromogranin A into chromaffin vesicles followed a similar time course, but 35S-labeled dopamine beta-hydroxylase was much more slowly incorporated, possibly reflecting differences in incorporation of membrane and soluble components. In summary, the data demonstrate that ECPs are rapidly sequestered in immature chromaffin vesicles, a process unaltered by changing rates of proenkephalin synthesis.     

R-Type Ca<Superscript>2+</Superscript>-channel Activity Is Associated with Chromogranin A Secretion in Human Neuroendocrine Tumor BON Cells

This electrophysiological study was undertaken to investigate the role of voltage-operated Ca(2+) channels (VOCCs) in cultivated human neuroendocrine tumor (NET) cells. Patch-clamp techniques, measurements of intracellular Ca(2+) ([Ca(2+)](i)), and secretion analysis were performed using cultured human NET BON cells. Ba(2+) inward currents through R-type channels (Ca(V)2.3) were measured and identified by SNX-482 (10 n M), a novel voltage-sensitive R-type Ca(2+) channel antagonist. In the presence of nifedipine (5 micro M), omega-Conotoxin GVIA (100 n M) and omega-Agatoxin IVA (20 n M), R-type channel currents were also detectable. Release of Ca(2+) from intracellular Ca(2+) stores by intracellular application of inositol-1,4,5-trisphosphate (InsP(3); 10 micro M) via the patch pipette during whole-cell configuration as well as induction of capacitative Ca(2+) entry (CCE), a passive maneuver to release Ca(2+) from intracellular Ca(2+) stores, led to an increase in [Ca(2+)](i). This effect could be reduced by SNX-482 (20 n M). In addition, SNX-482 (25 n M) also decreased chromogranin A (CgA) secretion, whereas omega-Conotoxin GVIA (500 n M) and nifedipine (5 micro M) failed to reduce CgA secretion. We conclude that these data reveal neuronal R-type channel activity (Ca(V)2.3), for the first time associated with CgA secretion in BON cells. Influx of Ca(2+) by activation of R-type channels may lead to an increase of intracellular Ca(2+), which stimulates CgA secretion. Thus, R-type channels could play an important role in certain clinical characteristics of NETs, such as the hypersecretion syndrome.     

The TETRA study: a prospective evaluation of Helicobacter pylori 'test-and-treat' strategy on 736 patients in clinical practice

AIMS: To prospectively evaluate the effectiveness of the test-and-treat strategy in a large group of dyspeptic patients in clinical practice. METHODS: Patients with ulcer-like dyspepsia, < 45 years, without alarm symptoms, were prospectively studied. Helicobacter pylori infection was diagnosed with the 13C-urea-breath-test, and eradication or symptomatic treatment was prescribed accordingly. 'Symptomatic improvement' was defined as the percentage of patients with a decrease of > or = 2 levels in the dyspepsia-severity-score or with no symptoms after treatment. Health status and use of health resources were also assessed. Endoscopy was performed in therapeutic failures. RESULTS: Out of 736 patients initially included, 422 received eradication, and 314 symptomatic therapy; 87% returned at 6 weeks and 67% at 6 months. At 6 months, 'symptomatic improvement' was achieved in 73% and 54% of the patients, in eradication and symptomatic groups, respectively (p < .001), and overall in 66%. A reduction of 78% in mean self-assessment visual analogical score was observed at 6 months. More than 50% of patients were 'much better' at control visits. Endoscopy (18%) and physician's visits (13%) were the main health resources used. No gastric or oesophageal cancer was diagnosed. CONCLUSION: This large prospective study shows that the test-and-treat strategy is effective and safe for management of dyspeptic patients in clinical practice.     

Ames试验假阳性的判断方法

目的:确立一种判断Ames试验假阳性的可靠方法。方法:在Ames平皿掺入试验中发现经受试物处理的TA97和TA1535的菌落数相比溶媒对照组明显增加,为了证实其是因为受试物致突变性导致的回变菌落数增加还是由受试物毒性导致的菌落数增加,对分别经受试物和阳性对照物处理的Ames菌落进行增菌培养后接种于无组氨酸的培养基上,观察比较细菌的生长情况。结果:经受试物处理的菌株不能生长在无组氨酸的培养基中,而经阳性对照物处理的菌株则可以生长在无组氨酸的培养基上,说明经受试物处理的菌株没有发生突变。结论:此方法能可靠地验证菌株是否为突变菌株,由本研究可以发现经受试物处理的菌株没有发生突变,Ames平皿掺入试验中所观察到的菌落数增加是由于受试物毒性造成的假阳性。     

Carboxypeptidase E,an essential element of the regulated secretory pathway,is expressed and partially co-localized with chromogranin A in chicken thymus

Although the functions of hormones and neuropeptides in the thymus have been extensively studied, we still do not know whether these intra-thymic humoral elements are released in a stimulated manner via the regulated secretory pathway or in a constitutive manner. Carboxypeptidase E (CpE) and chromogranin A (CgA) are functional and structural hallmarks of the regulated secretory pathway in (neuro)endocrine cells. Whereas we have previously shown a CgA-positive neuroendocrine population in the chicken thymus, the current study assesses the expression of CpE in the thymus, both at the mRNA and the protein level. Our immunohistochemical studies provide evidence for the co-existence of CgA and CpE in identical neuroendocrine cells in the thymus. CpE and CgA dual-positive cells have primarily been found in the transition zone between the cortex and medulla of the thymus, an area known to contain numerous arterioles and to be innervated by the autonomic nervous system. Our findings suggest that the diffuse neuroendocrine system serves as a relay for nervous stimuli delivered by the sympathetic and/or parasympathetic nervous system. Thus, these newly defined neuroendocrine cells might play an important role in the immuno-neuro-endocrine cross-talk in the thymus, potentially enabling thymopoiesis to be fine-tuned via the regulated secretory pathway by a variety of physical and environmental factors.     

Chromogranin A: Immunocytochemical localization in secretory granules of frog atrial cardiomyocytes

Chromogranin A (CgA) belongs to the granin family of acidic proteins that are present in the secretory granules of many endocrine, neuroendocrine, and nerve cells. CgA has been shown to be stored in cardiomyocyte secretory granules of the rat heart atrium together with atrial natriuretic peptide (ANP). CgA-derived peptides (vasostatins) are known to produce a cardiosuppressive effect on isolated and working in vitro frog and rat hearts. Recently, CgA-derived vasostatin-containing peptides have been identified in rat hearts, whereas no data are available so far about the presence of CgA in the frog heart. In our work, we have studied the subcellular CgA localization in atrial myocytes of the adult frog R. temporaria heart by using an ultraimmunocytochemical method. Immunocytochemical staining of the frog atrial tissue for CgA and ANP showed the presence of the CgA-immunoreactive material in two types (A and B) of large specific atrial secretory granules, whereas no gold particles were revealed over the small granules (D) with a high electron density core. Similar results were obtained during the immunocytochemical staining by an antibody to ANP of the drog atrial cardiomyocytes. The data of the present work allow for the suggestion that CgA revealed in frog atrial cardiomyocytes, like CgA in rat cardiomyocytes, can be considered to be a precursor of intracardial vasostatins that, together with ANP, can play an important cardioprotector role under conditions of stress.     

Adenosine A2A and A2B receptor expression in neuroendocrine tumours: potential targets for therapy

The clinical management of neuroendocrine tumours is complex. Such tumours are highly vascular suggesting tumour-related angiogenesis. Adenosine, released during cellular stress, damage and hypoxia, is a major regulator of angiogenesis. Herein, we describe the expression and function of adenosine receptors (A(1), A(2A), A(2B) and A(3)) in neuroendocrine tumours. Expression of adenosine receptors was investigated in archival human neuroendocrine tumour sections and in two human tumour cell lines, BON-1 (pancreatic) and KRJ-I (intestinal). Their function, with respect to growth and chromogranin A secretion was carried out in vitro. Immunocytochemical data showed that A(2A) and A(2B) receptors were strongly expressed in 15/15 and 13/18 archival tumour sections. Staining for A(1) (4/18) and A(3) (6/18) receptors was either very weak or absent. In vitro data showed that adenosine stimulated a three- to fourfold increase in cAMP levels in BON-1 and KRJ-1 cells. The non-selective adenosine receptor agonist (adenosine-5'N-ethylcarboxamide, NECA) and the A(2A)R agonist (CGS21680) stimulated cell proliferation by up to 20-40% which was attenuated by A(2B) (PSB603 and MRS1754) and A(2A) (SCH442416) receptor selective antagonists but not by the A(1) receptor antagonist (PSB36). Adenosine and NECA stimulated a twofold increase in chromogranin A secretion in BON-1 cells. Our data suggest that neuroendocrine tumours predominantly express A(2A) and A(2B) adenosine receptors; their activation leads to increased proliferation and secretion of chromogranin A. Targeting adenosine signal pathways, specifically inhibition of A(2) receptors, may thus be a useful addition to the therapeutic management of neuroendocrine tumours.     

400例消化系统恶性肿瘤患者血清TSGF检测的临床分析

目的探讨肿瘤特异性生长因子（TSGF）在消化系统恶性肿瘤诊断上的价值及其临床意义。方法用生化比色定量法及TSGF检测试剂盒测定血清中TSGF的含量。结果400例消化系统恶性肿瘤患者血清TS-GF的含量（71．37±11．24u／ml）显著高于正常对照组血清TSGF的含量（59．75±4．45u／ml）（P〈0.01）,阳性检出率达79．80％。另外,在60例进行化疗的患者中,18例有效者化疗后血清TSGF的含量（61．28±6．05u／ml）较化疗前（83．01±4．57u／ml）明显下降（P〈0．01）,6例化疗无效者化疗后血清TSGF的含量（86．51±5．82u／ml）显著高于化疗前（65．76±5．92u／ml）（P〈0．01）。结论TSGF是一种新的、敏感性高的肿瘤标志物,对于消化系统恶性肿瘤的诊断、评价疗效和判断预后,均有临床意义。     

A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice

Several antihypertensive drugs, such as diuretics and β-blockers, can negatively affect sexual function, leading to diminished quality of life and often to noncompliance with the therapy. Other drug classes, however, such as angiotensin II receptor blockers (ARBs) are able to improve patients’ sexual function. Sufficient knowledge about the effects of these widely used antihypertensive drugs will make it possible for cardiologists and general practitioners to spare and even improve patients’ sexual health by switching to different classes of cardiac medication. Nevertheless, previous data (part I) indicate that most cardiologists lack knowledge about the effects cardiovascular agents can have on sexual function and will thus not be able to provide the necessary holistic patient care with regard to prescribing these drugs. To be able to improve healthcare on this point, we aimed to provide a practical overview, for use by cardiologists as well as other healthcare professionals, dealing with sexual dysfunction in their clinical practices. Therefore, a systematic review of the literature was performed. The eight most widely used classes of antihypertensive drugs have been categorised in a clear table, marking whether they have a positive, negative or no effect on sexual function.     

Promoter hypomethylation contributes to the expression of MUC3A in cancer cells

MUC3A is a membrane-bound glycoprotein that is aberrantly expressed in carcinomas and is a risk factor for a poor prognosis. However, the exact mechanism of MUC3A expression has yet to be clarified. Here, we provide the first evidence that MUC3A gene expression is controlled by the CpG methylation status of the proximal promoter region. We show that the DNA methylation pattern is intimately correlated with MUC3A expression in breast, lung, pancreas and colon cancer cell lines. The DNA methylation status of 30 CpG sites from −660 to +273 was mapped using MassARRAY analysis. MUC3A-negative cancer cell lines and those with low MUC3A expression (e.g., MCF-7) were highly methylated in the proximal promoter region, corresponding to 9 CpG sites (−345 to −75 bp), whereas MUC3A-positive cell lines (e.g., LS174T) had low methylation levels. Moreover, 5-aza-2′-deoxycytidine and trichostatin A treatment of MUC3A-negative cells or those with low MUC3A expression caused elevation of MUC3A mRNA. Our results suggest that DNA hypomethylation in the 5′-flanking region of the MUC3A gene plays an important role in MUC3A expression in carcinomas of various organs. An understanding of epigenetic changes in MUC3A may contribute to the diagnosis of carcinogenic risk and to prediction of outcome in patients with cancer.     

不同质子泵抑制剂对冠脉支架植入术后氯吡格雷联合阿司匹林抗血小板作用的研究

目的:通过比较奥美拉唑和泮托拉唑对冠状动脉支架术(PCI)后患者血小板功能指标和主要不良心血管事件与出血并发症发生情况,探讨不同质子泵抑制剂对PCI后氯吡格雷联合阿司匹林抗血小板作用的影响。方法:60例实施PCI后常规联合抗血小板治疗(氯吡格雷75mg/d+阿司匹林100mg/d)患者随机分为奥美拉唑组(40mg/d,20例),泮托拉唑组(40mg/d,20例)和对照组(20例),连续用药30d。分别在服药前1d及服药15d,30d用血栓弹力图检测ADP途径诱导的血小板抑制率值和比浊法检测ADP途径诱导的血小板最大聚集率(MPAR)。并观察30d各组主要不良心血管事件和出血并发症的发生情况。结果:①奥美拉唑组和泮托拉唑组与对照组相比,服药前1d及服药15d,30d用血栓弹力图检测的血小板抑制率和比浊法检测的血小板最大聚集率(MPAR)均无明显变化;奥美拉唑与泮托拉唑组间比较,差异也无统计学意义。服药15d,30d与服药前1d相比,每组血小板抑制率明显升高,血小板最大聚集率明显下降,差异有统计学意义(P0.05);但15d和30d相比较,差异无统计学意义。②三组比较心血管事件发生率相近,差异无统计学意义(P0.05);奥美拉唑组和泮托拉唑组比较,心血管事件发生率也无统计学差异(P0.05)。③与对照组比较,奥美拉唑组和泮托拉唑组胃肠道出血发生率均明显减少,有统计学意义(P0.05),但两服药组间比较,出血发生率无明显区别,差异无统计学意义(P0.05)。结论:氯吡格雷联合阿司匹林具有增强血小板抑制,降低血小板凝聚的作用,而不同机制质子泵抑制剂奥美拉唑与泮托拉唑对PCI术后氯吡格雷联合阿司匹林抗血小板治疗患者的血小板功能无明显影响,不降低对心血管事件的预防效果,同时明显降低患者胃肠出血事件的发生率。     

Adaptive evolution in the photosensory domain of phytochrome A in early angiosperms

Flowering plant diversity now far exceeds the combined diversity of all other plant groups. Recently identified extant remnants of the earliest-diverging lines suggest that the first angiosperms may have lived in shady, disturbed, and moist understory habitats, and that the aquatic habit also arose early. This would have required the capacity to begin life in dimly lit environments. If so, evolution in light-sensing mechanisms may have been crucial to their success. The photoreceptor phytochrome A is unique among angiosperm phytochromes in its capacity to serve a transient role under conditions where an extremely high sensitivity is required. We present evidence of altered functional constraints between phytochrome A (PHYA) and its paralog, PHYC. Tests for selection suggest that an elevation in nonsynonymous rates resulted from an episode of selection along the branch leading to all angiosperm PHYA sequences. Most nucleotide sites (95%) are selectively constrained, and the ratio of nonsynonymous to synonymous substitutions on branches within the PHYA clade does not differ from the ratio on the branches in the PHYC clade. Thus, positive selection at a handful of sites, rather than relaxation of selective constraints, apparently has played a major role in the evolution of the photosensory domain of phytochrome A. The episode of selection occurred very early in the history of flowering plants, suggesting that innovation in phyA may have given the first angiosperms some adaptive advantage.     

Parametric study of radiofrequency ablation in the clinical practice with the use of two-compartment numerical models

The objective of the current work was to simulate radiofrequency ablation (RFA) with theoretical and realistic computational models, which correspond to single-compartment models and clinical scenarios. A 3D model in a cubic region of 12 cm edge was studied representing either a homogeneous model or real clinical scenarios in three human tissues, i.e., liver, lung and kidney. An active electrode was placed at the center of the model. Various tumor sizes (1–3 cm) and source voltages (10–30 V) were investigated for the second case of a two-compartment model. In the case of a 3-cm tumor in diameter, the electrical and thermal problems (at steady state) were solved to calculate the temperature distribution within the tumor and tissue. Lesion volume was quantified using the Arrhenius equation and the isothermals of 50 and 60 °C. The physical properties of all materials were constant during the simulations, i.e., no changes with temperature were considered. It was found that tumor conductivity was low to achieve significant damage in the tumor; in all clinical scenarios, saline-enhanced RFA was necessary and led to a more efficient tumor destruction. It was also shown that highly perfused tissues, such as liver and kidney, block the energy deposition within them, in contrast to lung, and, thus, require a further saline enhancement. Finally, the effect of perfusion on lesion size was studied, and it was concluded that tumor perfusion was more significant than surrounding tissue perfusion.