Summary:Prostate-specific antigen is found in the prostate in two forms, one with a low (30 000) and one with a high (100000) relative molecular mass. The latter has recently been found to be a complex of prostatespecific antigen with aj-antichymotrypsin.Immunoluminometric assays were designed for the prostate-specific antigen-ocj-antichymotrypsin complex äs well äs for (Xi-antichymotrypsin, the former being compared with a commercially available radioimmunoassay for prostate-specific antigen (ProsChek RIA -Yang Laboratories).The precision of the immunoluminometric assays was acceptable (intra-assay Variation < 7%; inter-assay Variation < 8.5%) in the measuring ranges 0-90 g/l for the prostate-specific antigen-a r antichymotrypsin complex and 0-12 g/l for a r antichymotrypsin.The correlation between the assays for prostate-specific antigen and prostate-specific antigen-aj-antichymotrypsin complex was acceptable, showing a correlation coefficient r = 0.83 after double logarithmic transformation, or r = 0.85 using the Spearman rank correlation on 131 data pairs.Extremely high arantichymotrypsin levels (above 2 g/l) caused interference in the prostate-specific antigena r antichymötrypsin complex assay. Such levels, although rare, are encountered in pulmonary inflammatory disease. The reference ranges for the three assays were found to be äs follows: prostate-specific antigen 0.13-4.63 g/l, prostate-specific antigeii-ai-antichymotrypsin complex 0.08 -1.78 g/l, and for ai-antichymotrypsin 0.27-0.61 g/l. These values were obtained from 82 höspitalised males fpr the first two assays and from 80 males and females free from infection fpf the latter. % Purified prostate-specific antigen (M r 30000) does not react in the prostate-specific antigen-arantichymotrypsin complex as$ay; a concentration of 200 /1 generates a signal whieh is less than that from the first Standard (0.04 g/l).In three cases of metästatic cancer of the prostate, discrepancies were found in the values from the prostatespecific antigen assay (8.56, 30.0 and 107 g/l) and the prostate-specific antigen-a r antichymotrypsin complex assay (0.78, 3.72 and 1,24 jig/1). This may indieate the production of an altered prostate-specific antigen, which was unable to complex with a r antichymotrypsin.The new assay is not suitable äs a screening assay for prostatic cancer, but it may be of interest for detecting metästatic disease.
Summary:The interaction between Bacillus Calmette-Guerin (BCG) and the host was investigated after repeated intravesicular BCG-therapy for superficial bladder cancer. Studies were performed on (a) the local reaction in the bladder, (b) the systemic reaction, and (c) short and long term interactions in both the bladder and the serum/plasma.The analytes measured included anti-BCG IgA and IgG, fibronectin, lactoferrin, elastase-oci-proteinase inhibitor, myeloperoxidase and oc 2 -proteinase inhibitor. All analytes, with the exception of oc 2 -proteinase inhibitor, were measured in both serum/plasma and urine.An additional group of 94 patients undergoing bronchoalveolar lavage was used for comparison with other diseases affecting mucous membranes. In vitro studies on human bladder in culture were also carried out to study the relationship between BCG, elastase and fibronectin.The results revealed a normal defence reaction, in which IgA and IgG antibodies specific to BCG were produced by the host. Maximal concentrations of all analytes in urine were found about 4 h after BCG instillation.Immunoglobulins, soluble fibronectin, and granulocyte markers all appeared in urine after instillation and all showed a similar time course. The in vitro study showed the synergistic effect of elastase and BCG in stimulating the host defence reaction. The relationship between BCG and fibronectin can be seen as fortuitous but not indicative of the efficacy of BCG-therapy in patients with superficial bladder cancer. Introduction(2-4), the necessity for the presence of a fibrin clot (3, 5), the saturation of BCG receptors with soluble Although post-operative intravesicular treatment of monomeric fibronectin (6), and the mediation of Tsuperficial bladder cancer with Bacillus Calmette-lymphocytes (7). Studies in these laboratories over the Guerin (BCG) has been carried out for some 15 years past four years have revealed further physiological (1) the exact mode of action of this therapy is still factors which may contribute to the action of BCG not known. Many theories have been postulated, in-in promoting an "anti-tumour" reaction in cases opeluding the interaction between BCG and fibronectin erated for superficial bladder cancer.
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