Studies on the Uptake of Vitamin B12-Co60 by the Hamster Methylcholanthrene-induced Sarcoma and the Rat Walker Carcinosarcoma* A. MILLER,t G. GAULL,H. M. LEMON,ANDJ. F. RossJ (Robert Dateson Erans Memorial, Massachusetts Memorial Hospitals, and Department Boston University School of Medicine, Boston, Afa*«.) Many studies (10, 12, 15) have demonstrated the key role of vitamin Bi2 in normal growth and development. Oleson (16) found that supplemen tary vitamin B^ caused increased growth of the Rous sarcoma in chicks. This observation suggest ed that vitamin BK might be necessary for the growth of malignant neoplasms. With the use of isotopically labeled vitamin Bi2, the possible rela tionship of vitamin B^ to tumor metabolism has been investigated. the heavier organs 30 ml. of 2 N NaOH was used. The tissues were digested in alkali at room temperature for 24 hours. Then, if necessary, gentle heating for 30-60 seconds brought the gellike digest into a liquid state. Measurements of radioactivity were made on duplicate 4-rnl. aliquots of these tissue digests. The total volume of the tissue digest solution was assumed to be equal to 10 ml. when the organ weight was less than 0.75 gm., since the volume contributed by the dissolved organ was negligible. For heavier organs the total volume of the digest was measured in a 25- or 100-ml. graduated cylinder. Urine and stools.— In the rat the total urine volume was meas ured in a 50-ml. graduated cylinder. Radioactivity was deter mined on 4-ml. aliquots of urine. For hamsters the filter paper on which the urine had dried was cut into }-inch pieces and placed into If X 8¿-inchglass bottles in which radioactivity was measured. The radioactivity in 4-day stool collections was also measured in 1} X 3i-inch glass bottles. Carcasses.—Therat carcasses were placed into i\ X 6-inch glass bottles. Carcass radioactivity measurements were made in these bottles. MATERIALS AND METHODS EXPERIMENTAL PLAN Adult male hamsters weighing from 75 to 100 gm., bearing a methylcholanthrene-induced sarcoma as previously de scribed (8, 11), and adult male Sprague-Dawley rats weighing from 220 to 880 gm., bearing the Walker carcinosarcoma, were used in these studies. These animals were housed in individual cages, at constant temperature, and fed stock diet and water ad libitum. Under light ether anesthesia, they were given sub cutaneous injections of vitamin Biz-Co60(secured from Merck & Co., Rahway, N.J.), receiving 0.10-0.50 pg. of vitamin Bi2, equivalent to 0.09-0.40 /ic. of Co60,contained in a total volume of 1.0 ml. After the injection, rats were housed in metabolic cages allowing for separate urine and stool collections. The hamsters were housed in wire cages, under which were placed pans which were covered with two thicknesses of Whatman filter paper #8. All stools fell on the paper while the urine was absorbed into the paper. Animals were sacrificed 4 days follow ing the injection of vitamin Bi2-Co60except in the turnover and flushing experiments, in which the animals were killed at the times indicated in the text. PREPARATIONOFSPECIMENSFORANALYSIS Organs.—Theliver, kidneys, spleen, heart, and tumor were removed and weighed. Organs weighing less than 5.0 gm. were placed into flasks containing 10 ml. of 2 N NaOH, whereas with * This work was supported in part by grants from the Unit ed States Public Health Service and The Atomic Energy Commission. t Formerly U.S. Public Health Service Fellow. Present address: Boston Veterans Administration Hospital, Boston, Mass. ÃŽ Present address: University of California Medical Center, Los Angeles, Calif. Received for publication March 12, 1956. of Medicine, RADIOACTIVITY DETERMINATION A 1:100 dilution of the injected vitamin Bi2-Co'° was made, and varying aliquots were then used as standards for the vary ing conditions employed in the counting of organ digests, excreta, and carcasses. By the addition of water as needed, the height of the standard in the glass bottles was always the same as that of the specimen being counted, i.e., stools, urine, or carcasses. Organ and liquid urine samples were counted in a scintillation well-type counter (thallium-activated, sodium iodide, scintillation crystal). The radioactivity count of the organ samples usually was 3-12 X background count, except for the heart and spleen, for which the counts were usually 1-3 X background. Samples were counted long enough to give a counting error of less than 2 per cent, except for the lowcount samples, for which a 5-8 per cent counting accuracy was obtained. Duplicate samples usually agreed within 1-5 per cent. The radioactivity of all samples contained in the li X 8J-inch glass bottles was determined by placing them on top of the above-mentioned sodium iodide well crystal. The diameter of these bottles was just equal to that of the diameter of the well. Under similar geometric conditions, the radioactivity of a standard was also determined. The 6-inch bottles containing the rat carcasses were marked into three equal 2-inch segments. With the bottle in the horizontal position and directly in con tact with a solid 1 X 1-inch thallium-activated, sodium iodide crystal, the radioactivity of each 2-inch segment of the bottle containing the carcass was counted. Under similar geometric conditions, the radioactivity of the bottle containing the stand ard was measured. 842 Downloaded from cancerres.aacrjournals.org on June 14, 2017. © 1956 American Association for Cancer Research. MILLERet al.—Radioactive Vitamin BU in Animal Tumors 843 ranged from 11.4 to 29.6 per cent at both dosage levels. Furthermore, the tumor was the major site of vitamin B12-Co60localization with these counts/min/ml organ digest X total volume digest X 100; implants in the back, which grow to much larger counts/min injected sizes than the cheek pouch implants. The radioactivity uptake of the rat Walker carcinototal counts/min in organ counts/min/gm organ weight of organ (gm) sarcoma.—Eight rats with Walker carcinosarcomas weighing from 5.1 to 82.7 gm. took up from RESULTS 1.5 to 16.2 per cent of the injected radiovitamin The radioactivity uptake of the hamster methyl(Table 3). In four of the eight rats, the tumor was cholanthrene-induced sarcoma.—Hamster methylthe organ with the greatest content of radioac cholanthrene-induced sarcomas, implanted in the tivity. Except for a decreased kidney uptake, the cheek pouch, weighing from 0.25 to 1.00 gm., took distribution of radioactivity in the other organs up 1.2-3.1 per cent of the injected radioactivity was similar to that found for normal rats. When the total uptake was related to organ weight, the TABLE 1 tumor uptake was approximately one-sixteenth THE TISSUEDISTRIBUTION OFRADIOACTIVITY FOLLOW that of the kidneys and approximately one-half INGTHEPARENTERAL ADMINISTRATION* OFVITAMIN that of the liver, spleen, and heart (Table 3). Bi2-CoM TOHAMSTERS BEARING THEMETHYLCHOLANCALCULATIONS The per cent radioactivity in organ = THHENE-INDUCED CHEEK POUCH SARCOMA TABLE 2 ofinjectedradioactivityin cent COMPARISON BETWEEN Two GROUPS OFHAMSTERS IN JECTEDWITHDOTERENT DOSESOFVITAMINBn-Co60 organ6.46.66.416.911.819.411.71.21.31.53.10.30.30.30.30.20.10.40.4 OrganKidneyLiverSarcomaHeartSpleenHamsterno.1S412S41234i2341234Wt.(gm.)0.4900.6400.6421.8402.1682.4842.4730.2510.3350.4291.0000.2400.2550.2600.2330.0320.0200.1100 ASTOSARCOMA UPTAKEOFRADIOACTIVITY Per cent of Group I* Mean Group Hf Animal 1 2 3 Weight of larcoma (gm.) injected radioactivity in sarcoma 16.35 7.20 31.70 26.5 12.6 29.5 1301 1178 771 18.42 33.96 21.00 5.97 22.8 25.2 22.8 11.4 1083 2513 6487 6145 Mean 20.30 19.8 * Dose = 0.09 /ic. = 0.10 /ig. of vitamin BH. t Dose = 0.36 ite. = 0.40 ¿igof vitamin B1S. Counts/rain/ gm 5048 Relationship of the size of the tumor to vitamin Bi2-Cow uptake.—Chart 1 demonstrates the corre lation between tumor size and the per cent uptake (Table 1). The distribution of radioactivity in the of vitamin Bi2-Co80by the hamster sarcoma both liver, kidney, and other viscera was similar to that in the cheek pouch and on the back. There was a found in normal hamsters. When the total uptake good correlation between the uptake of radioac was related to organ weight, the tumor uptake was tivity and the tumor size for tumors weighing less approximately ^ that of the kidney, | that of the than 17.5 gm. With the heavier tumors the in liver, similar to that of the spleen, and 3 times that crease in vitamin Bu-Co60 uptake was not com mensurate with increases in their weight. The rat of the heart (Table 1). Effect of size of dose on the uptake of radioactivity Walker carcinosarcoma showed a similar relation in hamster methylcholanthrene-induced sarcoma.— ship between tumor radioactivity uptake and size. Two groups of hamsters with large methylcholan Thus, with Walker carcinosarcomas weighing less threne-induced sarcomas implanted in the back than 40.3 gm., a fair correlation was found be tween vitamin Bw-Co60uptake and size. However, were given injections of 0.1 and 0.4 ¿tg. of vitamin Biz-Co60.No major difference in the sarcoma con with the heavier tumors, this relationship no long tent of radioactivity (expressed as per cent of ad er obtained (Table 3). ministered dose) was found at these two dosage The turnover of radioactivity in the hamster sarco ma.—The turnover of radioactivity in the tumors levels (Table 2). The tumor uptake of radioactivity * Dose—0.45MC.Co«= 0.50 /ig. Vitamin B12. Downloaded from cancerres.aacrjournals.org on June 14, 2017. © 1956 American Association for Cancer Research. 844 Cancer Research and organs of hamsters sacrificed at varying inter vals up to 45 days was studied. The per cent radio activity in the sarcoma over a 45-day period was relatively constant, i.e., there was a negligible rate of turnover (Chart 2). The 9.7-19.5 per cent range in the sarcoma content of radioactivity found dur ing the 45 days was probably secondary to the dif ference in the weights of the tumors (3.37-99.20 gm.) and to the varying degrees of necrosis found. The per cent radioactivity in the liver, kidney, spleen, and heart also remained relatively con stant. After the first 4 days urinary excretion of radioactivity was no longer present, whereas the daily excretion of radioactivity in the stools, al though very small, continued over the whole 45day period. "Flushing" experiment in rats bearing Walker carcinosarcomas.—Two groups of rats bearing Walker carcinosarcomas were given injections of vitamin Biz-Co60. Beginning \\ days after injec- TABLE 3 THETISSUEDISTRIBUTION OFRADIOACTIVITY FOLLOWING THEPARENTERAL ADMINISTRATION* OFVITAMIN B,2-CoM TORATSBEARING THEWALKER CARCINOSARCOMA Per cent of injected activity(couDti/min/gm)6,9834,65312,4603,1393,1396,2934,5262,6906498 radioactivity Wt.(gm.)1.772.602.452.801.8»2.652.502.352.38 Liver in organ Rat no. Organ Kidney 1 2 3 4 6 6 7 8 Mean and S.E. of mean 1 2 8 4 5 6 7 8 8.6 8.4 21.9 6.1 8.7 •¿ .0 4.9 5.0 0.1314.4015.5115.2317.8119.4318.4223.4122.8318.S8±1.2034.709.405 + ±11341,0337784M6436297861,097771780 9.1±2.0 10.3 8.4 5.4 7.9 8.9 10.9 18.7 12.8 10.4 + 1 4 ±71301426427305350551258301 Mean and S.E. of mean Walker carcinosarcoma 1 2 9 4 5 6 7.3 2.8 1.5 1143 5163.4037 9.2 16 2 15 6 15.6 15.2 5382.7169.20Specific 7 8 Spleen Heart Mean and S.E. of mean 1 2 3 4 5 6 7 8 Mean and S.E. of mean 1 2 3 4 .5 6 7 8 43.20 + 9.78 78 32 70 08 86 1.46 1.52 1.48 1.7 ±0.21 1.04 1.28 1.02 1.02 Mean and S.E. of Mean 1.09 ±0.07 ' Dose = 0.25 ite. Coâ„¢= 0.30 pg. vitamin BU. 365 ±34 861 758 538 608 1,219 771 788 1,214 10.4±1.7 845 ±87 404 703 896 637 1.0±0.1 0.3 0.7 06 0.5 660 ±102 0.5±0.1 10 06 0.6 18 1.2 0.8 09 1.4 Downloaded from cancerres.aacrjournals.org on June 14, 2017. © 1956 American Association for Cancer Research. MILLERet al.—Radioactive Vitamin Bn in Animal Tumors tion, one group of rats was given five daily "flush ing" doses of nonradioactive vitamin BU. A marked decrease in radioactivity was found in the liver, carcass, and Walker carcinosarcoma of the flushed animals as compared with the control group (Chart 3). Slight differences in tumor size between the two groups were present, but these 845 nary excretion of radioactivity rose to a mean of 11.0 per cent in the flushed group as compared with a mean of 1.8 per cent in the nonflushed group (Chart 3). DISCUSSION The hamster sarcoma and the Walker carcino sarcoma concentrated appreciable amounts of the injected vitamin Bi2-Co60.The uptake correlated fairly well with the weight of the tumor. This rela tionship was true for all but the heaviest tumors, in which increases in tumor weight were associated with only minimal increases in the uptake of vita min Bi2-Co60. The necrosis found in the larger tumors probably explains this finding. 10 - . •¿ RADIOACTIVITY e5 IO 15 20 25 30 35 40 WEIGHT OF SARCOMA (CM.) CHART1.—Correlation between the size of the inethylcholanthrerie-induccd sarcoma and the tumor uptake of vita min Bi2-CoM. »CAM *AOlO*Crmrr —¿ >nKIDNEY cttlmnvat— 12912.9 mURINE ;02t44 .nCARCASS itiLIVER m TUMOR 16.UZ.5 11.4:1.2 160112 CHART3.—Changes in the tissue distribution and excretion of a parenteral dose of vitamin Bij-CoMfollowing large flushing doses of nonradioactive vitamin BU in rats bearing the Walker carcinosarcoma. * Refers to number of animals in each group. ** Flushed group received five daily SO-ftg. injections of vitamin Hi- beginning I Õdays after the injection of 0.3 p%.of vitamin B|2-Co60. 5 IO DAYS AFTER 15 20 25 S.C. INJECTION 30 OF Co" 35 40 45 Vitamin 3g CHART2.—Theturnover of tumor and organ radioactivity after the parenteral administration of vitamin Bu-Co80 to hamsters bearing the methylcholanthrene-induced sarcoma. At each indicated time, the tumor and organ radioactivity (per cent of injected dose) of two hamsters are given, except at 45 days, when only one hamster was used. The tumor and organ turnover curves shown above were drawn through the mean of each of the two given values. The weights of the ham ster sarcomas at each indicated time are also shown. differences were probably not large enough to ac count for the results noted. In contrast, the kid neys of the flushed animals contained only about one-half the radioactivity of the kidneys of the control animals. Urinary excretion during the first 1| days (be fore flushing) was identical for both groups (an average of 5.7 per cent). Following flushing, uri- In this study it would have been desirable to administer a dose of vitamin Bj2 that did not ap preciably alter the blood concentration of vitamin BIZ, i.e., a "tracer" dose. The smallest doses of vitamin Bu-Co60 compatible with accurate count ing were thus employed. However, these doses still exceeded the total blood vitamin Bw of the rat (3) by about 10-11 times. The organ and tumor uptake of the radiovitamin at such pharmacologi cal dosage levels may not represent their uptake of endogenous vitamin B^. Because of the size of dose and the necrosis in the larger tumors, com parison of the organ and tumor uptake of vitamin Bi2-Co«° is difficult. In some of the larger hamster and rat neo plasms, the tumor uptake of B^-Co60 was greater than that of any other organ. It is possible that depletion of vitamin Bi2 stores, with or without evidence of tissue depletion of this vitamin, may Downloaded from cancerres.aacrjournals.org on June 14, 2017. © 1956 American Association for Cancer Research. 846 Cancer Research occur in such animals. In the human, widespread carcinomatosis has not been associated with the usual evidence of vitamin BIZ deficiency. The peripheral neuropathy reported with some cases of bronchogenic carcinoma (6, 9, 18) does not ap pear to be due to a deficiency of vitamin Bi2. The flushing experiment was conducted to de termine to what extent the radiovitamin was bound or altered 36 hours after injection. Since large injections of vitamin Bi2 are largely excreted in the urine (2, 14, 19), the appearance of radio activity in the urine following such an injection indicates exchange between the previously admin istered radiovitamin and the nonradioactive parenteral dose. The increase in kidney concentra tion of radioactivity found in the "flushed" ani mals is undoubtedly a reflection of this excretion, further evidenced by the increase in urinary radio activity. This increase in urinary radioactivity was accompanied by a reduction in the radioactivity in the liver, Walker carcinosarcoma, and carcass of the "flushed" animals to about hah' that of the control animals. This would indicate that at least hah" of the administered radiovitamin was not firmly bound or materially altered 36 hours after injection, since exchange between the parenterally administered vitamin and some radioactive inter mediate seems unlikely. Approximately one-half of the radioactivity in the carcass, liver, and Walk er carcinosarcoma was not exchangeable, indicat ing either firm "binding" or chemical alteration of this portion of the injected radiovitamin. It is of interest that the radiovitamin taken up by the Walker carcinosarcoma was exchangeable, which observation suggested that this tumor is not an absolute metabolic "trap" for vitamin Bi2 analo gous to that suggested for amino acids and pro teins (4, 13). The results of this "flushing" experi ment differ from those of Harte et al. (5) in a simi lar study on normal rats. Radioactivity as measured in this study merely determines the presence of the Co60moiety of the vitamin B^ molecule. Thus, the radioactivity may be due to vitamin B^ and/or to an intermediate degradation product of the vitamin. Barbee and Johnson found the radioactivity in the rat kidney to be due to vitamin B12 (1). Furthermore, after parenteral administration of vitamin BIJ, intact vi tamin Bi2 is excreted in the urine (7, 17). Thus, it appears likely that the radioactivity found in the kidneys in this study is due to vitamin B12.How ever, insofar as the tumor and the other organs are concerned this question cannot be answered. The turnover of radioactivity in the hamster sarcoma, liver, kidney, and spleen was negligible over a 45-day period. A slow rate of turnover of radioactivity in normal rat liver, kidney, and spleen has also been described by Harte (5). As tissue radioactivity measurements do not neces sarily measure the intact radiovitamin molecule, these findings do not necessarily reflect the true metabolic turnover of vitamin Bi2-Co60in these tissues. The uptake of Bi2-Co60by tumor tissue suggests that this vitamin may be important for the growth of malignant tumors as well as for normal tissues. Further studies should help in clarifying the role of vitamin Bw in the metabolism of malignant tumors. SUMMARY AND CONCLUSIONS 1. The uptake of parenterally administered vitamin B^-Co60 by the hamster methylcholanthrene-induced sarcoma and the rat Walker car cinosarcoma was studied. 2. Vitamin Bu-Co60 was taken up by both the hamster sarcoma and the Walker carcinosarcoma. The uptake of vitamin Bi2-Co60correlated well with tumor weight except for the heavier tumors. 3. Large tumors were the major sites of vita min Bis-Co60localization in some animals. 4. The turnover of radioactivity in the methylcholanthrene-induced sarcoma of the hamster, as well as in the kidneys, liver, and spleen, was neg ligible. 5. Large doses of nonradioactive vitamin BU administered If days after the injection of vitamin Biz-Co80were associated with: (a) a decrease in liver, carcass, and Walker carcinosarcoma radio activity; (6) an increase in kidney radioactivity; and (c) an increase in urinary excretion of radio activity. ACKNOWLEDGMENTS The authors wish to acknowledge the valuable technical assistance of Mrs. Mary Lou Turner. REFERENCES 1. BARBEE,K. W., and JOHNSON,B. C. Metabolism of Radio active Vitamin B]2 by the Rat. Proc. Soc. Exper. Biol. & Med., 76:720-21, 1951. 2. CONLEY,C. L.; KREVANS,J. R.; CHOW,B. F.; BARROWS, C.; and LANG, C. A. Observations on the Absorption, Utilization and Excretion of Vitamin B«.J. Lab. & Clin. Med., 38:84-94, 1951. 3. COUCH,J. R.; OLCESE,O.; WITTEN,P. W.; and COLBY, R. W. Vitamin Bi2 Content of Blood from Various Species. Am. J. Physiol., 163:77-80, 1950. 4. FENNINOER,L. D., and MIDER,G. B. Energy and Nitrogen Metabolism in Cancer. Adv. Cancer Research, 2:229-53, 1954. 5. HARTE,R. A.; CHOW,B. F.; and BARROWS, L. Storage and Elimination of Vitamin Bu in the Rat. J. Nutrition, 49: 669-78, 1953. Downloaded from cancerres.aacrjournals.org on June 14, 2017. © 1956 American Association for Cancer Research. MILLERet al.—Radioactive Vitamin BÃŒ2 in Animal Tumors 6. HENSON,R. A.; RÜSSEL, D. S.; and WILKINSON,M. Carcinomatous Neuropathy and Myopathy. A Clinical and Pathological Study. Brain, 77:82-121, 1954. 7. LANG,C.; HARTE,R. A.; CONLEY,C. L.; and CHOW,B. F. Retention of Crystalline Vitamin Bi2 by Healthy Male Individuals Following Intramuscular Injection. J. Nutri tion, 46:215-21, 1952. 8. LEMON,H. M., and SMAKULA, E. Factors Affecting Ham ster Sarcoma Growth in the Cheek Pouch. Cancer Re search, 16:273-79, 1955. 9. LENNOX,B., and PBICHARD,S. The Association of Bron chial Carcinoma and Peripheral Neuritis. Quart. J. Med., 19:97-109, 1950. 10. LUECKE,R. W.; McMiLLEN, W. M.; THORP,F., JR.; and BONIECE,J. R. The Effects of Vitamin Bu Concentrate on the Growth of Weanling Pigs Fed Corn Soy-Bean Diets. Science, 110:139-40, 1949. 11. LUTZ,B. R.; FULTON,G. P.; PATT,D. I.; HANDLER,A. H.; and STEVENS,D. F. The Cheek Pouch of the Hamster as a Site for the Transplantation of a Methylcholanthreneinduced Sarcoma. Cancer Research, 11:64-66, 1951. 12. McCoLLUM, E. B., and CHOW,B. F. Sex Differences in Weight-Stimulating Effects of Bis in Rats on Diets of Varying Composition. Proc. Soc. Exper. Biol. & Med., 76:20-28, 1950. 847 13. MIDER, G. B.; TESLTTK, H.; and MORTON,J. J. Effects of Walker Carcinoma 256 on Food Intake, Body Weight and Nitrogen Metabolism of Growing Rats. Acta Union Inter nat. Contre Cancer, 6:409-20, 1948. 14. MOLLIN,D. L., and Ross, G. I. M. Vitamin Bi2Concentra tions of Serum and Urine in the First 72 Hours after Intra muscular Injections of the Vitamin. J. Clin. Path., 6:54— 61, 1953. 15. NICHOL,C. A; DIETRICH,L. S.; CRAVENS,W. W.; and ELVEHJEM,C. A. Activity of Vitamin Bi2 in the Growth of Chicks. Proc. Soc. Exper. Biol. & Med., 70:40-42, 1949. 16. OLESON,J. J., and LITTLE,P. A. The Effect of Pteroylglutamic Acid and Vitamin Bi2 on Growth of Rous Sarcoma Implants. Proc. Soc. Exper. Biol. & Med., 71:226-27, 1949. 17. ROSENBLUM, C.; CHOW,B. F.; CONDON,G. P.; and YAMAMOTO, R. Oral Versus Parenteral Administration of CoM-Labeled Vitamin B«to Rats. J. Biol. Chem., 198:91528, 1952. 18. SMITH, T. W., and WHITFIELD,A. G. W. Malignant Sensory Neuropathy. Lancet, 2:282-85, 1955. 19. YAMAMOTO, R.; BARROWS, C. H.; LANG,C. A.; and CHOW, B. F. Further Studies on the Absorption of Vitamin BU Following Oral and Parenteral Administration. J. Nutri tion, 45:507-19, 1951. Downloaded from cancerres.aacrjournals.org on June 14, 2017. © 1956 American Association for Cancer Research. Studies on the Uptake of Vitamin B12-Co60 by the Hamster Methylcholanthrene-induced Sarcoma and the Rat Walker Carcinosarcoma A. Miller, G. Gaull, H. M. Lemon, et al. Cancer Res 1956;16:842-847. Updated version E-mail alerts Reprints and Subscriptions Permissions Access the most recent version of this article at: http://cancerres.aacrjournals.org/content/16/9/842 Sign up to receive free email-alerts related to this article or journal. 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