Abraham Borkowski

Human Chorionic Gonadotropin in the Plasma of Normal, Nonpregnant Subjects

Abstract To determine whether ectopic secretion of a protein hormone can occur normally, we studied plasma from normal, nonpregnant subjects for the presence of a placental hormone, human chorionic gonadotropin. We extracted and purified this hormone from other plasma proteins. We identified the hormone in the final residue on the basis of its dose-response curves in a specific radioimmunoassay and calculated the plasma concentration after correction for losses. Because this assay is sensitive to concentrations as low as 2 pg per milliliter, human chorionic gonadotropin could be detected in the plasma of 12 of 16 blood donors; the median concentration was 19 pg per milliliter (range, <2 to 361). This immunologic human chorionic gonadotropin was further characterized from a pool of normal plasma by gel filtration on Sephadex G-100 and was found to be identical to the standard form of the hormone. The concentration in this pool from 13 normal men was 18 pg per milliliter. The source of this ectopic hormone ...

Blood Cholesterol and Hydrocortisone Production in Man: Quantitative Aspects of the Utilization of Circulating Cholesterol by the Adrenals at Rest and under Adrenocorticotropin Stimulation*

A kinetic study of the conversion of blood cholesterol into hydrocortisone was carried out in two patients through prolonged infusions of cholesterol-4-(14)C. The following points appear to be established by our observations:1) The infused tracer behaved metabolically like endogenous cholesterol; it could therefore serve as a means of labeling plasma cholesterol for investigating its utilization by the adrenal cortex.2) At rest, about 80% of hydrocortisone derived from plasma cholesterol, the other 20% thus being synthesized in situ from acetate and other unlabeled precursors.3) Under ACTH stimulation the participation of plasma cholesterol in the synthesis of hydrocortisone was the same as at rest; the conversion of plasma cholesterol into hydrocortisone was thus proportional to the production of glucocorticosteroids by the adrenal glands.4) The specific activities of hydrocortisone allowed us to trace its adrenal precursors including adrenal cholesterol. The kinetics of the replacement of adrenal cholesterol by plasma cholesterol underlined the functional heterogeneity of the former. The experimental data were compatible with the following model: A fraction of plasma cholesterol entering the adrenal cell is immediately available for metabolism and conversion into steroid hormones, and another fraction turns over slowly, representing some form of storage.

Treatment of malignancy-associated hypercalcemia with intravenous aminohydroxypropylidene diphosphonate.

Treatment of malignancy-associated hypercalcemia remains unsatisfactory. We have prospectively treated 26 consecutive hypercalcemic cancer patients with intravenous (IV) aminohydroxypropylidene diphosphonate (APD). The drug was administered daily as a 15-mg two-hour IV infusion until both serum and urinary calcium had been normalized for 48 hours. Twenty-four patients were fully evaluable (eight head and neck tumors, seven breast cancers, three epidermoid tumors of the lung, and six miscellaneous neoplasms). Whereas rehydration had only inconsistent effects, APD normalized serum calcium in all patients after a mean of three daily doses: serum calcium decreased from 13.3 +/- 0.4 mg/dL (mean +/- SEM) before APD to 8.0 +/- 0.1 mg/dL at the end of treatment. Ionized calcium declined in parallel to total calcium. APD was as effective in hypercalcemia due to bone metastases as in paraneoplastic hypercalcemia. The drug was tolerated without toxicity and had a prolonged effect: serum calcium remained normal during 3+ weeks (1 + to 8 +) in 17 patients who did not receive or did not respond to antitumoral treatment. APD normalized serum calcium by inhibiting bone resorption, as evidenced by the dramatic decrease in urinary excretion of calcium and hydroxyproline. Inhibition of bone resorption was probably also responsible for the decrease in serum phosphorus from 2.9 +/- 0.2 to 2.0 +/- 0.1 mg/dL. In summary, IV APD constitutes a major advance in the treatment of malignancy-associated hypercalcemia: it is very effective, well tolerated, and has a prolonged efficacy.

Dose/response study of aminohydroxypropylidene bisphosphonate in tumor-associated hypercalcemia

Bisphosphonates (or diphosphonates) constitute a major advance in the treatment of tumor-associated hypercalcemia and also have the potential to prevent or reverse osteolysis in normocalcemic patients. Available information on adequate therapeutic doses and potential toxicity is, however, very fragmentary. This report describes a phase I study of one of the most promising bisphosphonates currently available, aminohydroxypropylidene bisphosphonate (AHPrBP or APD), in tumor-associated hypercalcemia. Only patients remaining hypercalcemic after 48 hours of rehydration were evaluated, and antineoplastic therapy was delayed at least until a normal serum calcium level was reached. AHPrBP was given as two-hour daily infusions for three days, and three different patients were treated at each of the six following dosage levels: 0.01, 0.05, 0.25, 0.75, 1.5, and 3.0 mg/kg per day. The two lowest dosages levels were insufficient to normalize serum and urinary calcium levels, but the efficacy of the four other dosages was very similar. Plasma immunoreactive parathyroid hormone levels increased as a function of calcium levels, whereas urinary hydroxyproline levels did not prove to be a very useful measure of AHPrBPs effects on bone resorption. The drug was generally very well tolerated: only six patients had transient fever and/or decreases in lymphocyte count that were not clearly related to AHPrBP dosage. The only real problem was observed at the highest dosage of 3.0 mg/kg per day in an obese woman in whom high fever and hypotension developed. Efficacy and tolerance in dehydrated patients were verified by treating seven other patients, not previously rehydrated, at 1.0 mg/kg per day for three days. In summary, the therapeutic range of AHPrBP, given for three days as a two-hour infusion daily, lies between 0.25 and 1.5 mg/kg per day. Fasting urinary calcium levels are probably the most reliable and easily measured parameter to monitor AHPrBPs inhibition of bone resorption in normocalcemic patients.

Prospective study of the α and β subunits of human chorionic gonadotrophin in the blood of patients with various benign and malignant conditions

Abstract A prospective study of HCG-β (the human chorionic gonadotrophin and its free β subunit) and of H-α (the free α subunit) was carried out in the plasma of 414 patients with malignant tumours and 99 patients with benign diseases (chiefly benign tumours and benign conditions associated with tissue hyperplasia). HCG-β and excessive free α subunit concentrations were found with a similar frequency (in 16–21 % of the patients); both were found as frequently in the benign and in the malignant conditions; furthermore there was no clearcut predisposition according to the pathology except for choriocarcinomas. However the benign and the malignant conditions differed from each other in that the concentrations of HCG-β were significantly higher in the latter whereas the very high plasma concentrations (> 50 ng/ml) of HCG-β or of H-α were specific for malignant conditions. The patients with HCG-β were not the same as those with excessive H-α concentrations: 75% of the latter had no detectable HCG-β, indicating that the production of the α subunit can be regulated independently from that of HCG-β. Unlike in the patients with excessive H-α, in the patients with HCG-β there was a very significant correlation between the HCG-β and the corresponding free α subunit concentrations: this indicates that the production of HCG-β was linked to that of the free α subunit whereas the reverse was not necessarily true. The concentrations of HCG-β in plasma were qualified according to the elution profiles on Sephadex chromatography and the relative affinity of our antibody to HCG and the free β subunit. The presence of the free β subunit and of abnormal chorionic gonadotrophin was demonstrated.

Adrenal secretion of estrogens, glucocorticosteroids and mineralocorticosteroids in the dog

Abstract The secretion rates of cortisol, corticosterone, aldosterone, estradiol and estrone by isolated adrenal glands perfused in situ were compared to each other. The following conclusions are drawn: 1. 1. The canine adrenal gland is capable of secreting estrogens bu the secretion is extremely low even under intense ACTH stimulation. By extrapolation, this suggests that most of the estrogens produced by castrate or postmenopausal women might derive from a peripheral conversion of the adrenal androgens. 2. 2. In nephrectomized dogs the adrenal cortex behaves as a single functional unit with respect to cortisol, corticosterone and aldosterone secretion in response to various degrees of ACTH stimulation. This observation stresses the non-specific dependence of aldosterone on ACTH.

Short-term effects of carbetimer on calcium and bone metabolism in man

Carbetimer is a new antineoplastic agent whose limiting toxicity consists of dose- and treatment duration-dependent hypercalcemia. We examined the short-term effects of Carbetimer on calcium metabolism on days, 1, 3 and 5 during 11 5-day courses (6.5-8.2 g/m2/day given over daily 2-h infusions, q 3-4 weeks). Blood parameters were measured before and after Carbetimer, whereas urinary parameters were studied in three consecutive 2-h collections before, during and after Carbetimer infusions. Carbetimer effects were similar regardless of the infusion day. We found a consistent decrease of plasma ionized Ca (Ca2+) levels from 4.56 +/- 0.05 mg/dl before infusion to 4.28 +/- 0.06 mg/dl after infusion (P less than 0.001) whereas total serum Ca (corrected for protein levels) did not change. The fall of Ca2+ stimulated parathyroid function, as suggested by the increased plasma PTH levels, the decreased serum phosphorus and TmP/GFR index, or the increased urinary phosphate and cyclic AMP excretion. Carbetimer infusions also induced a marked increase in urinary Ca excretion (expressed as mg Ca/mg creatinine) from 0.093 +/- 0.011 before to 0.359 +/- 0.042 during and 0.177 +/- 0.031 after infusion (P less than 0.011). These changes were best explained by Carbetimer-induced Ca chelation that we confirmed in vitro by incubating Carbetimer at various concentrations in whole blood for 2 h at 37 degrees C, e.g. 2 mg of Carbetimer/ml lowered Ca2+ from 4.82 to 3.20 mg/dl without changing total Ca levels. On the other hand, a direct effect of Carbetimer on bone cannot be excluded since we observed an increase of serum osteocalcin levels from 2.0 +/- 0.3 to 2.5 +/- 0.4 ng/ml after infusion (P less than 0.001). In summary, the short-term effects of Carbetimer on calcium metabolism markedly differ from the long-term effects. They mainly consist of a dose-related calcium chelation leading to a decrease in Ca2+ levels, an increase in urinary Ca excretion and a stimulation of parathyroid function.

Septicemias in cancer patients during parenteral nutrition: Contributing factors and detection by weekly blood cultures

Infections constitute the main complication of parenteral nutrition, particularly in cancer patients, but prediction of catheter-related septicemias (CRS) has been little investigated. We have evaluated, in 200 consecutive episodes of parenteral nutrition (PN) in cancer patients, the factors contributing to infectious complications, and the predictive value of weekly blood cultures performed through the nutrition catheter. The median duration of PN was 22 days with a total of 5816 patient-days of PN, neutropenia (neutrophils < 1,000/microl) being present in 872 (15%). Catheters were placed either in a jugular vein (71% single-lumen silicone catheters, 18.5% double-lumen Hickman-Broviac catheters) or in a femoral vein (10.5%). We observed 62 episodes of septicemia of which 22 were CRS (11% incidence for the 200 cycles) and 40 were non-CRS (20% incidence); CRS were mostly due to Staphylococcus epidermidis (14/22). Neutropenic patients as a group did not suffer more CRS than non-neutropenic patients, but the risk of CRS was slightly increased when expressed per day of neutropenia (8 CRS/872 days vs 14 CRS/4942 days without neutropenia, P < 0.05). On the other hand, a femoral insertion site was associated with a much higher incidence of CRS (9 CRS/21 femoral catheters vs 13 CRS/179 jugular catheters, P < 0.0001). It was possible to evaluate 20 episodes of CRS for their predictability by weekly blood cultures: the sensitivity for detecting CRS due to Staphylococcus epidermidis was 67%, the specificity 92%, the negative predictive value 98% and the positive predictive value 36%. The simple and widely available procedure of routine surveillance blood cultures performed through the PN catheter should be further investigated, because it could help the clinician to determine the origin of recent fever, particularly to exclude CRS and avoid unnecessary removal of PN catheters.

Human Chorionic Gonadotropin in the Plasma of Normal Nonpregnant Subjects

To determine whether ectopic secretion of a protein hormone can occur normally, we studied plasma from normal, nonpregnant subjects for the presence of a placental hormone, human chorionic gonadotropin. We extracted and purified this hormone from other plasma proteins. We identified the hormone in the final residue on the basis of its dose-response curves in a specific radioimmunoassay and calculated the plasma concentration after correction for losses. Because this assay is sensitive to concentrations as low as 2 pg per milliliter, human chorionic gonadotropin could be detected in the plasma of 12 of 16 blood donors; the median concentration was 19 pg per milliliter (range, less than 2 to 361). This immunologic human chorionic gonadotropin was further characterized from a pool of normal plasma by gel filtration on Sephadex G-100 and was found to be identical to the standard form of the hormone. The concentration in this pool from 13 normal men was 18 pg per milliliter. The source of this ectopic hormone production is unknown, but may be normal, rapidly proliferating nonmalignant cells.

Study of growth hormone secretion in lung carcinoma

Abstract We investigated the possibility of ectopic growth hormone (HGH) secretion in 26 patients with lung carcinoma by measuring plasma HGH during an oral glucose tolerance test (GTT). Only 4 patients had raised basal HGH concentrations; however, these concentrations were only slightly above normal, remained well below the range of our acromegalics and did not result from an autonomous secretion since they were modified by the GTT. Five patients had a paradoxical response to glucose. In the other 18 patients, basal HGH was normal and remained within normal limits after glucose administration. Consequently, we did not find any evidence for a significant ectopic HGH secretion. Nevertheless, a slight ectopic secretion without increased plasma HGH concentrations cannot be excluded since during the GTT some plasma HGH remained constantly measurable in most of our 26 patients. There was no correlation between plasma HGH and any other clinical or biological parameter, particularly clubbing.