Immunochemical analysis of cathepsin B in lung tumours: an independent prognostic factor for squamous cell carcinoma patients

In order to evaluate the possible role of the proteolytic enzyme cathepsin B (cath B) in human non-small cell lung cancer (NSCLC) we examined cath B concentrations (cath Bc) and activities (cath BA) in homogenates of 127 pairs of lung tumour tissues and corresponding non-tumourous lung parenchyma. Total cath B activity (cath BAT) and enzymatic activity of the fraction of cath B, which is stable and active at pH 7.5 (cath BA7.5) were determined by a fluorogenic assay using synthetic substrate Z-Arg-Arg-AMC. The immunostaining pattern of cath B was determined in 239 lung tumour tissue sections, showing the presence of the enzyme in tumour cells (cath BT-I) and in tumour-associated histiocytes (cath BH-I). The median levels of cath BAT, cath BA7.5 and cath BC were 5.6-, 3.2- and 9.1-fold higher (P < 0.001), respectively, in tumour tissue than in non-tumourous lung parenchyma. Out of 131 tissue sections from patients with squamous cell carcinoma (SCC), 59.5% immunostained positively for cath B, while among the 108 adenocarcinoma (AC) patients 48.2% of tumours showed a positive reaction. There was a strong relationship between the levels of cath BAT, cath BA7.5, cath BC and cath BT-I in the primary tumours and the presence of lymph node metastases. Significant correlation with overall survival was observed for cath BT-I and cath BA7.5 (P < 0.01 and P < 0.05, respectively) in patients suffering from SCC. In these patients positive cath B in tumour cells (cath BT-I) and negative cath B in histiocytes (cath BH-I) indicated significantly shorter survival rate compared with patients with negative cath BT-I and positive cath BH-I (P < 0.0001). In contrast, in AC patients, both, positive cath BT-I and positive cath BH-I, indicated poor survival probability (P < 0.014). From these results we conclude that the proteolytic enzyme cath B is an independent prognostic factor for overall survival of patients suffering from SCC of the lung. © 1999 Cancer Research Campaig

Treatment with Oral Drugs

Till the turn of the century, treatment of hyperglycemia in Type 2 diabetes was limited to two main classes of oral agents: sulfonylureas and biguanides. In the meantime, better understanding of the pathophysiology of hyperglycemia in Type 2 diabetes has been gained and the identification of several pathogenitic mechanisms has enabled moving from serendipitous discovery – as for sulfonylureas and metformin – to the development of agents with more targeted modes of action. Current guidelines concur in recommending metformin at diagnosis of diabetes. Selection of the second drug therapy should be made on the basis of an educated process tacking into consideration efficacy, risk of hypoglycemia, effect on body weight, costs of different drugs, as well as patient’s characteristics. With more clinical data generated, other features of the available oral agents should be taken into account such as durability, predominant effect on fasting vs. postprandial glucose, as well effects beyond their glucose lowering capacity