Summary The expression of the drug resistance (DR) mediators P-glycoprotein (P-gp) and the metallothioneins (MT) was assessed immunohistochemically in biopsy material from patients with high-grade malignant osteosarcoma (OS). No significant difference was found in survival rate between expressors of both P-gp and MT and non-expressors. Thus, it was concluded that lack of expression of these two drug resistance-related proteins does not appear to confer any advantage in terms of patient survival in osteosarcoma.Keywords: osteosarcoma; P-glycoprotein; metallothioneins; drug resistance; immunohistochemistry; confocal laser scanning microscopy Failure to respond to, or relapse from, drug therapy are among the most common causes of death in patients with osteosarcoma (OS). Tumour unresponsiveness to drug therapy may be related to many factors. The most frequently described model of drug resistance is the P-glycoprotein (P-gp)-specific multiple-drug resistance (MDR) gene phenotype (Juliano and Ling, 1976). Increased levels of P-gp are thought to confer MDR to tumour cells by decreasing the net intracellular accumulation of unrelated lipophilic cytotoxic agents, such as doxorubicin and vincristine (Weinstein et al, 1990), which are commonly used in treatment regimens for high-grade malignant OS. Results from earlier studies carried out on OS have been conflicting. While some have shown a correlation between Pgp expression at biopsy, and response to therapy (Chan et al, 1991; Wunder et al, 1993), other groups have shown that it is possible for OS cells to be P-gp negative, but still be drug resistant (Shnyder et al, 1994;Kandel et al, 1995).Various mechanisms for drug resistance due to the exclusion from cells of cisplatinum, which is also commonly used in therapy for OS, have also been proposed (Richon et al, 1987;Andrews and Howell, 1990). One such mechanism proposes the involvement of metallothioneins (MTs), which are intracellular cytoplasmic proteins containing high amounts of thiol groups as well as being rich in cysteine. These thiol groups are able to bind to several cytotoxic agents containing heavy metals (Thiele et al, 1986), such as cisplatinum. MTs appear to have a physiological role in the absorption, transport and metabolism of important trace metals, as well as a role in heavy metal detoxification. MTs have also been shown to affect the cellular sensitivity to cisplatinum (Bahnson et al, 1991; Kasahara et al, 1991;Chin et al, 1993;Kondo et al, 1995). No previous studies have reported on MT expression in OS.In this study, the expression of P-gp and MT was assessed immunohistochemically in biopsy material from patients with clinically diagnosed high-grade malignant OS, and the expression Received 29 May 1996 Revised 27 January 1998 Accepted 10 February 1998Correspondence to: SD Shnyder, Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand of these molecules was statistically analysed with respect to patient survival data (over 5 years) to determine whether there were any correla...