Patent Application: US-95356201-A

Abstract:
there is provided a method of testing squamous epithelial cells and a method of screening therapeutic agents for squamous cell carcinoma . that the base guanine at position 2128 of the fgfr3 gene is mutated to thymine in the cells of squamous cell carcinoma , or that the cells of squamous cell carcinoma produce an fgfr3 protein in which the amino acid glycine at position 697 is mutated to cysteine is utilized to facilitate the diagnosis and treatment of squamous cell carcinoma .

Description:
the present inventor has clarified that in oral squamous cell carcinoma the substitution of the amino acid glycine at position 697 of the fgfr3 protein with cysteine ( gly697cys ) based on the mutation of the base guanine at position 2128 of the fgfr3 gene to thymine ( ggc → tgc , hereinafter this mutation will also be referred to as g2128t mutation ) occurs at a high frequency ( about 62 %). since cysteine is an amino acid that has a — sh group and thereby forms a disulfide bond , that is deeply involved in protein confirmation , and that is important for the maintenance of the biological activity of proteins , the substitution of glycine with cysteine is believed to cause a ligand - independent dimerization of fgfr molecules , which results in the functional changes of the receptor including an increased amount of expressed fgfr3 and enhanced self - phosphorylation activity of fgfr3 . it is reported that squamous cell carcinoma has mutations in oncogenes and tumor suppressor genes such as p53 , h - ras , mts1 ( p16 ), ing1 ( p33 ) and the like . according to certain reports , the frequency of these gene mutations is about 10 % in the oncogene h - ras 49 )- 51 ) , about 20 % in the tumor suppressor gene mts1 52 ), 53 ) , about 10 % in ing1 54 ), 55 ) , and about 55 % in p53 49 ) . that c2128t mutation of fgfr3 in oral squamous cell carcinoma was observed at a high frequency of 44 of 71 cases , or about 62 %, suggests a high possibility that the mutation could be used as a molecular target marker useful for the gene diagnosis of oral squamous cell carcinoma . in an statistical analysis that was made for 71 cases studied herein on the relationship of the presence of mutation , the size of tumor ( t ), the presence of regional lymph node metastasis ( n ), the presence of late metastasis , the presence of bone resorption images in roentogenogram , etc . with clinical findings , no statistically significant differences were noted though cases with metastasis have shown a trend of high t values . this is believed to be due to the presence of mutations of fgfr3 at a high frequency of 62 %. in the normal tissue of oral mucosa squamous epithelia , the expression of fgfr3 protein is observed in the cytoplasm of prickle cells , whereas in the tissue of oral squamous cell carcinoma having no mutation the expression was observed in the cytoplasm and the nucleus . on the other hand , in cases that have a fgfr3 g2128t mutation , fgfr3 protein was strongly expressed on the cell membrane . johnston et . al 56 ) reported that fgfr1 , fgfr2 and fgfr4 were expressed in the cytoplasm of the cos cells and fgfr3 was expressed in the nucleus as measured by the immunofluorescent staining method using specific antibody , whereas when the cells were allowed to excessively express wild type fgfr3 , the expression of fgfr3 was observed on the membrane . it is believed that in oral squamous cell carcinoma having a g2128t mutation of fgfr3 , fgfr3 protein is excessively expressed on the cell membrane due to the mutation . although fgfr is synthesized in the cytoplasm , it is thought that receptor proteins observed in the cytoplasm have no activity and the receptor proteins expressed on the membrane are activated to function . therefore , fgfr3 protein that is excessively expressed on the cell membrane observed in mutation cases is believed to be functioning . in the normal cells also , it is thought , fgfr expression on the membrane is not entirely absent , but no positive findings were observed due to its small amount expressed , but fgfr is significantly expressed on the membrane in mutation cases . thus , the difference in localization of protein expression is considered to indicate not only the difference in the amount expressed but , in the case of receptor proteins , the difference in their functions , thus , the function of fgfr3 was investigated . fgfr is considered to be a molecule that binds fgf and thereby is involved in signal transduction of cell growth , differentiation , and the like . among others , fgfr3 is thought to control the growth and differentiation of normal cells as described below . su et al . 57 ) have conducted gene transfer to 293t calls of a mutant fgfr3 having lys650glu observed in tdii and demonstrated that the mutated fgfr3 exhibits a permanent tyrosine kinase activity . deng et al . 58 ) have demonstrated the promotion of bone growth in fgfr3 - deficient mice , and colvin et al . 59 ) have constructed the fgfr3 knock - out mice and demonstrated that the mice exhibit a severe hearing loss derived from increased bone growth and differentiation hypoplasia of auris interna . based on these results , they believe that fgfr3 signals work as signals involved in regulated growth in the bone . on the other hand , onose et al . 60 ) have analyzed the function of fgfr3 by excessively expressing fgfr3 in the thyroid cancer cells . they found that the cells in which fgfr3 was excessively expressed had no difference in growth rate compared to the control , whereas the cells excessively expressing fgfr3 continued to grow even after the control group stopped the cell growth , suggesting the possibility that fgfr3 is involved in the control of contact growth inhibition . in order to investigate the functional significance of gly697cys mutation of fgfr3 in oral squamous cell carcinoma , the present inventor has conducted the expression of a wild type protein and a gly697cys mutated protein in the intracellular region of fgfr3 in the baculovirus expression system , and compared their tyrosine kinase phosphorylation activity , with a result that the mutant showed an increased activity of self - phosphorylation . the result suggests that the mutation causes a ligand - independent permanent self - phosphorylation of fgfr3 and promotes signaling of fgfr3 , rendering normal cell differentiation uncontrollable and , at the same time , negating growth inhibition by cell - to - cell contact , which results in the canceration of oral squamous cells . the findings related to the present invention may be summarized as follows : in about 62 % ( 44 out of 71 cases ) of oral squamous cell carcinoma , the mutation ( g2128t ) of the base guanine at position 2128 of fgfr3 to thymine was observed . this mutation results in the substitution ( gly697cys ) of the amino acid glycine at position 697 of the fgfr3 protein with cysteine . as a result of immunohistological examination of the expression of fgfr3 protein in normal oral mucosal squamous epithelia and oral squamous cell carcinoma , the expression of fgfr3 protein was found in the cytoplasm of prickle cells of the normal epithelia and the over - expression of fgfr3 protein on the cell membrane was noted in mutated case , whereas fgfr3 was localized in the cytoplasm and the nucleus in mutation - free cases . the wild type and the mutant fgfr3 tyrosine kinase proteins were allowed to be expressed by recombinant gene technology using the baculovirus system in order to compare phosphorylation activity , and it was shown that the tyrosine kinase phosphorylation activity was enhanced in the mutant type compared to the wild type . the result shown below demonstrates that in oral squamous cell carcinoma a gly697cys substitution based on the g2128t mutation occurs at a high frequency in the fgfr3 tyrosine kinase region , indicating that fgfr3 is useful as a molecular target for gene diagnosis and therapy . it can also been seen that the gly697cys mutation , by causing permanent activation of fgf - independent fgfr3 tyrosine kinase , is deeply involved in the onset and progression of oral squamous cell carcinoma . in accordance with the present invention , therefore , by investigating the presence of mutation of the base at position 2128 of the fgfr3 gene in oral squamous epithelial cells of interest , it can be judged whether the cells are oral squamous cell carcinoma or not , and thereby said mutation can be used as a useful molecular target marker for gene diagnosis and therapy of oral squamous cell carcinoma . the present invention will now be explained in more detail with reference to examples of oral squamous cell carcinoma , but it should be noted that the present invention is not limited by these examples in any way . paraffin - embedded blocks of 71 cases that were histopathologically diagnosed as squamous cell carcinoma during four years and a year from january 1996 to june 2000 were used . the tnm classification and the stage classification were made based on the uicc ( 1987 ) classification 291 ( table 1 . a list of oral squamous cell carcinoma cases stage case tnm classi - no . age sex subsite classification fication 1 64 f tongue t2n1m0 iii 2 64 f lower mandible t4n0m0 iv 3 54 f tongue t1n0m0 i 4 80 f lower gingiva t4n0m0 iv 5 62 m maxilla t2n0m0 ii 6 74 m buccal mucosa t2n0m0 ii 7 66 m tongue t4n0m0 iv 8 63 m maxilla t4n0m0 iv 9 39 f tongue t1n0m0 i 10 54 m tongue t3n0m0 iii 11 81 f tongue t2n0m0 ii 12 79 m maxilla t4n0m0 iv 13 66 f upper gingiva t2n0m0 ii 14 68 m lower mandible t4n0m0 ii 15 67 f upper gingiva t4n0m0 iv 16 68 m lower mandible t3n2m0 iv 17 52 m tongue t2n0m0 ii 18 72 f lower mandible t3n1m0 iii 19 74 f lower mandible t1n0m0 i 20 70 f buccal mucosa t4n0m0 iv 21 61 m lower gingiva t3n0m0 iii 22 64 m soft palate t1n0m0 i 23 71 f lower mandible t4n0m0 iv 24 82 m maxilla t4n0m0 iv 25 56 m tongue t1n0m0 i 26 59 m maxilla t4n0m0 iv 27 88 f tongue t2n0m0 ii 28 65 f tongue t2n0m0 ii 29 68 f lower mandible t1n2m0 iv 30 78 m buccal mucosa t1n0m0 i 31 75 m floor of mouth t2n0m0 ii 32 75 m maxilla t4n0m0 iv 33 81 f buccal mucosa t2n1m0 iii 34 51 m tongue t4n0m0 iv 35 68 m tongue + floor of mouth t4n2cm0 iv 36 79 f lower mandible t2n0m0 ii 37 38 m tongue t2n0m0 ii 38 61 m maxilla t3n0m0 iii 39 49 f tongue t3n0m0 iii 40 71 m tongue + lower mandible t1n0m0 i 41 69 m lower gingiva t2n0m0 ii 42 74 m floor of mouth t4n2bm0 iv 43 57 m maxilla t4n0m0 iv 44 89 f floor of mouth t4n2bm0 iv 45 72 m lower mandible t4n2bm0 iv 46 51 f tongue t2n2bm0 iv 47 66 m lower mandible t2n0m0 ii 48 56 m tongue t1n0m0 i 49 64 f upper gingiva t4n0m0 iv 50 74 m lower mandible t4n0m0 iv 51 88 f buccal mucosa t1n0m0 i 52 67 f lower mandible t2n2bm0 iv 53 65 f tongue t1n0m0 i 54 75 f maxilla + lower t4n0m0 iv mandible 55 67 m floor of mouth t2n0m0 ii 56 47 m lower mandible t2n0m0 ii 57 67 f lower mandible t2n0m0 ii 58 59 f tongue t3n2bm0 iv 59 67 f tongue t1n0m0 i 60 58 m tongue + floor of mouth t4n2bm0 iv 61 56 m tongue t1n0m0 i 62 69 m lower gingiva t2n2bm0 iv 63 77 f floor of mouth t2n0m0 ii 64 68 m lower mandible t4n0m0 iv 65 66 f upper gingiva t2n0m0 ii 66 68 m floor of mouth t2n0m0 ii 67 56 m upper gingiva t4n0m0 iv 68 73 m lower mandible t4n0m0 iv 69 56 f hard palate t1n0m0 i 70 64 f tongue t4n0m0 iv 71 73 m upper gingiva t3n0m0 iii the extraction of dna from the paraffin - embedded pathological specimens was performed using the dna extraction kit dexpat ( takara ). dna after extraction was precipitated in 1 / 10 volume of 3m sodium acetate and 2 . 5 volumes of 100 % ethanol , and after purification , it was determined using a spectrophotometer ( manufactured by beckman - coulter ). pcr 301 was performed according to the method of kawasaki et al . 311 . primer pairs that amplify each of exons 10 to 19 that correspond to the entire exons of the intracellular region of the fgfr3 gene were designed in the intron portions as follows 131 : pcr was performed using geneamp pcr core kit ( perkin - elmer cetus instrument co . ltd . ), and dna was amplified using the dna thermal cycler ( perkin - elmer cetus instrument co . ltd .). to the dna extracted ( 0 . 02 μg ), the pcr solution ( 10 mm tris - hcl , ph 8 . 3 , 50 mm kcl , 1 . 5 mm mgcl 2 , 0 . 2 mm dntp , 25 pm upstream primer , 25 pm downstream primer , 2 . 5 u amplitaq dna polymerase ) was added to make the total volume of 25 μl , which was subjected to 35 cycles of a program with one cycle comprising a denaturation reaction at 95 ° c . for 30 seconds , an annealing reaction at 55 ° c . ( exon 17 ), 58 ° c . ( exon 10 , 15 ), 60 ° c . ( exon 11 , 16 ), 64 ° c . ( exon 18 ), 66 ° c . ( exon 13 ), and 68 ° c . ( exon 19 ) for 30 seconds each , and an elongation reaction at 72 ° c . for one minute to obtain pcr products . after the pcr products were electrophoresed on 1 . 2 % agarose gel , they were visualized with etidium bromide . the presence of mutation was investigated by pcr - sscp for each exon . to 3 . 5 μl of the pcr product obtained in the above ( 3 ), an equal amount of the denaturation solution ( 95 % formamide , 0 . 05 % xylene cyanol , 0 . 04 % bromophenol blue ) was added , and treated at 95 ° c . for 5 minutes . after the denaturation of dna , it was immediately cooled and made single stranded . electrophoresis was conducted using the gene phor ( amersham pharmacia biotech ) under the condition of 600 v , 25 ma , and 15 ° c . as the sscp gel , genegel excel 12 . 5 / 24 kit ( amersham pharmacia biotech ) was used . after the electrophoresis , the gel was stained with the plusone dna silver staining kit ( amersham pharmacia biotech ) to detect dna bands . for exons for which the presence of mutation was predicted by pcr - sscp , the base sequence was determined by the direct sequencing method to identify the mutation sites . to 1 . 5 μl of the pcr products obtained in the above ( 3 ), 3 μl of the pre - mix ( dna sequencing kit ; perkin - elmer cetus instrument co . ltd .) and 10 pm of the upstream primer were added to make the total volume of 20 μl , which was then subjected to 25 cycles of a program with one cycle comprising a denaturation reaction at 96 ° c . for 20 seconds , an annealing reaction at 50 ° c . for 15 seconds , and an elongation reaction at 60 ° c . for 4 minutes , and then cooled at 4 ° c . the samples after the reaction were purified with four volumes of 100 % ethanol and then 70 % ethanol . the pellet obtained was dissolved in 13 μl of template suppression reagent ( perkin - elmer cetus instrument co . ltd .) and denatured at 95 ° c . for 5 minutes . then the base sequence was determined using the abi prism 310 genetic analyzer ( pekin - elmer cetus instrument co . ltd .) by the terminator labeled method ( dye terminator method ). by investigating the presence of mutation from exon 10 to exon 19 of the fgfr3 intracellular region in the oscc - derived dna by pcr - sscp , the presence of mutation was suggested in exon 17 of the fgfr3 gene ( fig3 ). no results were obtained that suggest the presence of mutation in the other exons . thus , the base sequence on exon 17 was investigated using the direct sequencing method , and the point mutation ( g2128t ) in that the base guanine at position 2128 of fgfr3 was mutated to thymine was observed in all cases for that mutation was suggested by pcr - sscp ( fig4 ). this was found in about 62 %, or 44 out of 71 cases . this mutation indicated the substitution ( gly697cys ) of the amino acid glycine at position 697 of the fgfr3 gene with cysteine . expression of fgfr3 protein in the tissues of oral squamous cell carcinoma and the normal epithelium ( 1 ) the expression of fgfr3 protein was investigated using the vectastatin abc kit ( vector laboratories , inc .) by the immunoperoxidase staining method based on avidin - biotin - peroxidase complex method ( abc method ). sections of 4 μm in thickness were prepared on poly - l - lysine coated slides . after incubating at 37 ° c . for 4 days , they were hydrated with the xylene and ethanol series , and the endogenous peroxidase was removed by meoh / 0 . 3 % h 2 o 2 at room temperature for 30 minutes followed by treatment with 0 . 1 % triton x - 100 / pbs on ice for 10 minutes , and then 0 . 05 % protenass - k / pbs at room temperature for 5 minutes . in order to prevent nonspecific reactions , blocking was performed by 10 % goat serum / pbs at 37 ° c . for 1 hour . anti - fgfr3 rabbit polyclonal antibody ( santa cruz biotechnology , inc .) as the primary antibody was allowed to react overnight at 4 ° c . then biotin - labeled goat anti - rabbit igg + iga + igm was allowed to react at 37 ° c . for 1 hour , and the avidin - biotin - peroxidase complex was reacted at room temperature for 30 minutes , and finally color was developed using the dab solution ( 0 . 25 mg / ml 3 , 3 - diaminobendizine , 0 . 01 % h 2 o 2 , 50 mm trio - hcl buffer , ph 7 . 6 ). the nucleus was stained with hematoxylin . as the control , anti - rabbit igg was used . in the normal epithelial tissue , the expression of fgfr3 protein was observed in the cytoplasm of the prickle cells ( fig5 ). in the tissue of oral squamous cell carcinoma having no mutation in fgfr3 , the expression of fgfr3 protein was observed in the cytoplasm and the nucleus of the cancer cells ( fig6 ). on the other hand , in the tissue of oral squamous cell carcinoma having the g2128t mutation , the strong expression of fgfr3 protein was observed in the cell membrane of the cancer cells ( fig7 ). study on the tyrosine kinase phosphorylation activity of the wild type and the g2128t mutant fgfr3 ( 1 ) extraction of rna derived from the epithelial cells of normal human oral mucosa rna extraction from cultured epithelial cells of normal human oral mucosa was performed according to the method of chomozynski at al . 32 ) . after the cultured normal epithelial cells were harvested from the denaturation solution ( 4 m guanidinothiocyanate , 25 mm sodium citrate , ph 7 . 0 , 0 . 1 m 2 - mercaptoethanol , 0 . 5 % n - laurylsarcocine ), they were homogenized with a 20g injection needle . after adding 1 / 10 volume of 2 m sodium acetate , ph 4 . 0 , total rna was isolated using phenol / chloroform in which an equilibrated acidic phenol ( phenol / te ) and phenol and chloroform were mixed in equal amounts . then , one volume of isopropanol was added to precipitate rna . the rna was dissolved again in the denaturation solution to which one volume of isopropanol was added to precipitate rna and to obtain total rna . specific primers that amplify from the atp - biding site to the c - terminal of the tyrosine kinase region of fgfr3 were designed as follows : then using normal human epithelium - derived rna , rt - pcr was performed . rt - pcr used geneamp rna pcr core kit ( perkin - elmer cetus instrument co . ltd . ), and dna was amplified using the dna thermal cycler ( perkin - elmer cetus instrument co . ltd .). first , to the rt solution ( 10 mm tris - hcl ph 8 . 3 , 50 mm kcl , 5 mm mgcl 2 , 1 mm dntp , 1 u ribonuclease inhibitor , 2 . 5 mm random hexamer , 2 . 5 u mulv reverse transcriptase ), total rna ( 1 μg / 2 μl ) was added , and a reverse transcription reaction was performed at 42 ° c . for 30 minutes and 99 ° c . for 5 minutes . then the pcr solution ( 10 mm tris - hcl , ph 8 . 3 , 50 mm kcl , 1 . 5 mm mgcl 2 , 0 . 2 mm dntp , 25 pm upstream primer , 25 pm downstream primer , 2 . 5 u amplitaq dna polymerase ) was added to make the total volume of 100 μl , which was subjected to 40 cycles with one cycle comprising a denaturation reaction at 95 ° c . for 45 seconds , an annealing reaction at 56 ° c . for 15 seconds , and an elongation reaction at 70 ° c . for two minutes and 45 seconds . after the pcr product obtained were purified with ethanol , it was treated with an the ecori restriction enzyme . on the other hand , palter - max vector ( promega ) was treated with an ecori restriction enzyme and , to prevent self - ligation , treated with calf intestine - derived alkaline phosphatase ( ciap ). to the vector an ecori - treated dna was integrated to construct a wild type fgfr3 tyrosine kinase expression vector ( fig1 ). the base sequence of the vector was confirmed by the direct sequencing method . for the construction of a mutant fgfr3 tyrosine kinase expression vector having the g2128t mutation , the altered sites ii mammal mutagenesis system ( promega madison ) was used . first , an fgfr3 mutagenic oligonucleotide containing the g2128t mutation was designed as shown below : using this oligonucleotide and the vector constructed above ( 2 ), a mutant vector was constructed with the es1301 muts competent cells ( promega madison ), the vector was amplified with the jm109 competent cells ( promega madison ). the base sequence was confirmed by the direct sequencing method . the wild type and the mutant fgfr3 tyrosine kinase expression vector integrated into the palter - max vector constructed in the above ( 2 ) and ( 3 ) were recombined into the pachlt - a vector ( pharmingen ) to which a histidine tag was added to the n - terminal ( baculovirus expression vector ) ( fig2 ). as the insect cell , sf9 cells ( pharmingen ) were used . the medium used was the grace &# 39 ; s insect medium supplemented ( gibco brl ) with 5 % calf serum ( hy clone ), and subcultured in a 25 cm 2 flask ( falcon cat . # 3081 ). culturing was performed in an incubator mir - 153 ( sanyo ) at 27 ° c . gene transfection was performed based on the baculovirus expression vector system ( pharmingen ). first , the insect cell sf9 was plated to a 6 cm culture dish at a concentration of 2 × 10 6 , cells . on the other hand , 5 μg of baculogold dna ( pharmingen ) and 5 μg of dna into which had integrated the wilt type and the mutant fgfr3 tyrosine kinase region constructed in the above ( 2 ) and ( 3 ) were mixed , allowed to stand for 5 minutes , to which was added 1 ml of the transfection buffer b ( hepes buffer ). the medium was replaced with 1 ml of the transfection buffer a ( 10 % cs grace &# 39 ; s medium ), to which was slowly added the mixed solution , to perform co - transfection . after 4 hours , it was replaced with 5 % cs - added grace &# 39 ; s insect medium . it was observed every day , and on day 5 when an infection image was observed it was subcultures . by repeating subculturing , virus titer was raised , and the culture supernatants of the wild type and the mutant were harvested . they was mixed with the ni - nta agarose ( qiagen ), and incubated at 4 ° c . for 1 hour . then agarose was recovered by centrifugation , and then the phosphorylation reaction buffer ( 50 mm tris - hcl , ph 6 . 8 , 200 mm kcl , 0 . 1 mm atp , 1 mm mgcl 2 , 2 mm dtt , 1 mm pmsf ) was added , and further reacted at 37 ° c . for 15 minutes . immediately after the completion of the reaction , they were dissolved in a 4 × sds - page loading buffer ( 200 mm trig - hcl , ph 6 . 8 , 400 mm dtt , 8 % sds , 40 % glycerol , 0 . 04 % bromophenol blue ), and were treated at 100 ° c . for 10 minutes 331 , for each sample , protein was isolated using the sds - polyacrylamide gel electrophoresis ( sds - page ) in the presence of 5 % 2 - mercaptoethanol . for separation 10 % gel concentration and for concentration 4 % gel concentration were used , respectively at a thickness of 1 mm . according to the method of lastick et al . 341 , electrophoresis was performed using the thermostat double minislab gel electrophoresis instrument ( nippon eido ) at 100 v for 2 . 5 hours . using the trans - blot sd semi - dry transfer cell ( bio - rad laboratories ), the gel was transferred to a pvdf membrane ( millipore ) by applying 20 v for 2 hours . in order to inhibit nonspecific reactions , the pvdf membrane after the transfer was allowed to react with 5 % defatted milk / tbs ( 50 mm tris - hcl , ph 7 . 6 , 150 mm nacl )+ 0 . 1 % tween 20 at room temperature for 1 hour . thereafter , a 1000fold diluted anti - phosphotyrosine antibody ( monoclonal antibody 4g10 ) ( upstate biotechnology lake placid ) as the primary antibody was reacted at 4 ° c . overnight , and , as the second antibody , 1000 - fold diluted goat anti - mouse igg ( e + l )- ap conjugate ( bio - rad laboratories ) was reacted at room temperature for 1 . 5 hour . color was developed using the bcip / nbt membrane phosphatase substrate system ( kirkgard & amp ; perry laboratories ). the intracellular , regions of the wild type and the g2128t mutated fgfr3 protein were constructed by the baculovirus expression system , and the tyrosine phosphorylation activity was compared using anti - phosphotyrosine antibody in the western blotting method . as a result , few bands that exhibit tyrosine phosphorylation were confirmed in the wild type protein , whereas bands that exhibit apparently high tyrosine phosphorylation were detected in the mutant protein ( fig8 ), indicating that an enhanced tyrosine kinase phosphorylation activity was noted in the fgfr3 protein having a gly697cys amino acid substitution due to the g2128t mutation as compared to the wild type . disappearance of g2128t mutation by chemotherapy and radiation therapy and reversion to the wild type for patients with primary squamous cell carcinoma in the maxillary sinus , the fgfr3 gene derived from the cancer tissue before treatment was examined and the g2128t mutation was observed in exon 17 . this patient was treated with the “ selective artery injection therapy ” in which an indwelling catheter was inserted into the maxillary artery , a dominant artery of tumor . via the catheter , lymphokine - activated killer cells ( lak cells ), interleukin 2 , and 5 - fu ( anticancer agent ) were given in combination with radiation therapy . for the lak cells , the patient peripheral blood - derived lymphocytes were cultured in a serum - free medium ( rd5f ) containing interleukin 2 for 1 - 2 weeks to induce lak cells , and then a total of 8 × 10 5 cells were given again to the patient via the catheter . prior to the administration of the lak cells , 1 . 2 million units of interleukin 2 ( celeuk ) was also given simultaneously via the catheter . a total of 2375 mg of 5 - fu comprising 25 mg × 14 days and 62 . 5 mg × 10 days was given to the patient via the catheter . the radiation therapy was 2 gy / day × 26 days with a total of 55 gy . in dna derived from tumor tissue from the same patient after the treatment with lak cells , interleukin 2 , 5 - fu , and radiation therapy , the g2128t mutation disappeared and reverted to the wild type fgfr3 . the result is shown in fig9 ) gospodarowics , d ., jones , k . l ., sato , g . : purification of a growth factor for ovarian cells from bovine pituitary glands proc - 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