Cancers take their Toll--the function and regulation of Toll-like receptors in cancer cells

Cancer could be deemed as an abnormal and uncontrolled tissue repair process. Therefore, it would not be surprising that factors that function in the tissue repair process, such as cytokines, chemokines, growth factors and Toll-like receptor (TLR) ligands, as well as growth signals for compensatory proliferation, would also be key factors in regulating and enhancing cancer progression. The TLR pathways, which play a critical role in tissue repair, are also key regulators in cancer progression as well as chemoresistance. TLRs serve as cell surface sensors that can initiate pathways leading to proliferation and chemoresistance; as well as mediators that are able to regulate the infiltrating immune cells to provide further support for cancer progression.

Optimized plan of centralized and decentralized wastewater reuse systems for housing development in the urban area of Xi'an, China

In an arid and water deficient urban area, such as Xi'an in the northwest region of China, gardening and forestation often use large amounts of tap water. Therefore, there is a need for treated wastewater reuse for such purpose to mitigate urban water shortage, especially in the newly developed housing area, where a high green coverage is often required for both commercial value and living condition improvement. Supply of the treated wastewater through a centralized system which has been planned and partially constructed is one measure to meet such need, but it may require an extension of the distribution system for a full coverage of the whole city area. A supplementary measure is to construct decentralized wastewater treatment and reuse (DESAR) systems in areas that are distant from the planned centralized system. In order to optimize the plan of wastewater reuse for housing development in the urban area, the authors analyzed the existing plan of centralized wastewater reuse and the envisaged plan of housing development in Xi'an urban area. A method was proposed for selection of a feasible way of reclaimed water reuse from two options, namely centralized and decentralized ones, by introducing a critical distance L0 which depends on the relationship between the cost for DESAR system installation and that for water delivery pipeline construction. If the distance from the project site to the nearest access point of the centralized system L is shorter than L0 then using reclaim water from the centralized system becomes more feasible, and otherwise DESAR system installation becomes more feasible. A distribution map was thus obtained to show an optimized plan of centralized and decentralized wastewater reuse systems for housing development in Xi'an city. An example was also given to show the advantage of a DESAR system installed.

The angiogenic potential of three-dimensional open porous synthetic matrix materials

Angiogenesis is a complex multistage process involving multiple factors and numerous cells. The use of the Chorioallantoic Membrane (CAM) assay is well documented as a method to investigate angiogenesis. This technique is ideal for screening samples, but requires an objective analysis technique. The angiogenic response of vascular endothelial growth factor (VEGF) was used to confirm that computer-based image analysis was able to quantify angiogenesis. Image analysis was used on samples of increasing porosity of PLLA to determine the effect of pore size on angiogenesis. Another effect also noted was that of an inflammatory response co-incident with angiogenesis. The difference in pore size made a difference to both angiogenesis and inflammation. Real-time polymerase chain reaction (PCR) was used with primers for TNF-alpha to demonstrate and measure the presence of an inflammatory response.

Isolated diaphragmatic tremor: Is there a spectrum in "respiratory myoclonus"?

BACKGROUND

Respiratory myoclonus or diaphragmatic flutter is an unusual movement disorder with abnormal diaphragmatic activity, which may be associated with respiratory symptoms. The effects of distracting maneuvers on diaphragmatic activity have not been investigated.

METHODS

Two patients with nondisabling abdominal movements of suspected diaphragmatic origin were studied with surface and needle electromyography (EMG).

RESULTS

The abdominal movements resulted from isolated, rhythmic diaphragmatic contractions with variable EMG burst duration, suppressibility with breath-holding and distracting maneuvers, and other attributes of volitional control.

CONCLUSION

"Respiratory myoclonus" may be a heterogeneous disorder ranging from synchronous movements of the diaphragm and other respiratory muscles associated with respiratory compromise, to diaphragmatic movements under at least some volitional control with no respiratory or functional disability. The latter group could be designated phenomenologically as "isolated diaphragmatic tremor."

Association of HLA genes with ankylosing spondylitis in Han population of eastern China

Ankylosing spondylitis (AS) is a chronic inflammatory disorder with a multifactorial genetic basis. HLA-B27 was reported with the greatest susceptibility to AS but did not act alone. The aim of this study was to search for other gene(s) associated with AS independently of HLA-B27 using 13 microsatellite markers spanning 1.5 Mb from locus TAP1 to HLA-Cw and a single-nucleotide polymorphism marker within NFkappaBIL1 gene promoter. Genotyping for microsatellites was performed in 175 AS patients of eastern Chinese and 219 ethnically matched healthy controls using polymerase chain reaction with fluorescence-labelled primers, whereas the SNP marker was genotyped by direct DNA sequencing. Allele as well as haplotype frequencies were compared between cases and controls, and a linkage disequilibrium analysis was performed to estimate the LD relationship between the candidate regions. The frequencies of alleles D6S2811*128, STR_MICA*A5.1 and D6S2672*109, as well as haplotypes D6S2811*128-D6S2927*213-D6S2810*340, D6S2927* 221-D6S2810*350-MICA*A5.1, and D6S2810*350-MICA*A5.1-D6S2800* 136 were significantly increased in B27-positive AS patients when compared with B27-positive controls. The results indicated that there may be other gene(s) within the HLA region, especially around locus HLA-B or HLA-Cw, with susceptibility to AS independently of HLA-B27.

Regulation of two key nuclear enzymatic activities by the 7SK small nuclear RNA

7SK is a highly conserved small nuclear RNA (snRNA) in vertebrates. Since its discovery in 1968, little had been known about its function until recently, when 7SK was found to associate with the general transcription elongation factor P-TEFb. Together with the HEXIM1 protein, 7SK sequesters P-TEFb into a kinase-inactive complex, where it mediates HEXIM1's inhibition of P-TEFb. This helps maintain P-TEFb in a functional equilibrium to control transcription, cell growth, and differentiation. Although highly abundant, only a small fraction of 7SK is P-TEFb-bound. Using affinity purification, we have identified APOBEC3C as another 7SK-associated protein. As a member of the APOBEC family that functions in diverse processes through deaminating cytosine in DNA, it is unclear how APOBEC3C's activity is controlled to prevent its mutations of genomic DNA. We show that most of APOBEC3C interact with about half of nuclear 7SK, which suppresses APOBEC3C's deaminase activity and sequesters APOBEC3C in the nucleolus where it could be at a safe distance from most genomic sequences. Because the DNA substrate-binding site in APOBEC3C differs from the region for 7SK binding, 7SK does not act as a substrate competitor in inhibiting APOBEC3C. The demonstration of 7SK's suppression of yet another enzyme besides P-TEFb suggests a general role for this RNA in regulating key nuclear functions.

Pemetrexed (P) in relapsed small cell lung cancer (SCLC): Preliminary results of a phase II trial

7716

Background: Pts with relapsed SCLC have a poor prognosis and few effective treatment options. P is a novel multitargeted antifolate that is active and well-tolerated as a single agent in lung cancer. We undertook a trial to assess the efficacy and safety of single- agent P in both chemosensitive (S) and chemorefractory (R) relapsed SCLC pts. Methods: Eligible pts had limited or extensive- stage SCLC, PS 0 to 2, and only 1 prior chemo regimen. S pts were defined as having had a prior response with disease progression >2 mos from end of 1st-line chemo. R pts were those who progressed while on 1st-line therapy, or had any response but progression <2 mos from end of 1st-line chemo. The initial P dose tested was 500 mg/m2 q 21 d. Planned sample sizes were 36 S pts in a 2-stage sequential fashion with potential early stopping for lack of efficacy or unacceptable toxicity, and 25 R pts in a single-stage design with no stopping rule. The stopping rule was invoked when <3 of 14 qualified S pts responded. The protocol was then amended to evaluate P at 900 mg/m2 in additional cohorts of 40 S and 40 R pts. Pts were to receive folic acid and Vitamin B12 prior to treatment with P. The primary outcome measure was response rate. Results: From 7/04 to 3/06, 121 pts were enrolled, with 116 pts treated. S and R pts were analyzed separately at both dose levels. S pts (n=56): M/F, 29/27; median age 65 (range 43–82); PS 0/1/2, 25/23/8. R pts (n=65): M/F, 31/34; median age 64 (range, 35–85); PS 0/1/2, 16/37/12. *3 S pts treated with P 900 mg/m2 remain with disease control after a minimum of 11 mos of follow-up. Conclusions: Preliminary clinical benefit rates (CR+PR+SD) of 20% and 17.4% achieved respectively in S and R pts treated with P 500 mg/m2 suggest modest activity of single-agent P in relapsed SCLC. P can be given at a dose of 900 mg/m2 without a significant increase in Grades 3–4 toxicities, although this does not appear to increase efficacy.

[Table: see text] [Table: see text]

Portal vein and systemic thromboses in hepatocellular carcinoma

15048

Background: Hemostatic activation may be important for tumor growth and metastasis. Hepatocellular carcinoma (HCC) is commonly associated with portal vein thrombosis (PVT). Very little is known about factors predictive for PVT in patients with HCC or its correlation with systemic venous thromboembolism (VTE). Methods: We conducted a retrospective chart review of 194 patients diagnosed with HCC at the University of Rochester between 1998 and 2004. The primary endpoints of this study were presence of PVT and any systemic VTE. The secondary endpoint was overall survival calculated from time of diagnosis. Univariate and multivariate logistic regression analyses were conducted to assess the association of PVT with a set of clinical covariates, and the survival curve was estimated using the method of Kaplan-Meier. Results: The mean age of the total population was 60.4 ± 11.9, and one-third of the patients underwent liver transplant. The incidence of PVT in the total population was 31% (60/194) with a higher incidence in the non-transplant group compared to transplanted patients (34% vs. 24%; p= 0.08). In univariate analysis, advanced stage, major vessel involvement, higher MELD score, higher Child-Turcotte-Pugh (CTP) classification, lower serum albumin, elevated serum bilirubin, elevated serum alpha-fetoprotein (AFP) level, and elevated INR were associated with development of PVT (p <0.05 for each). In multivariate analysis CTP class, stage, major vessel involvement, serum albumin, and serum AFP were independently and significantly associated with PVT (p <0.05 for each). The presence of PVT was associated with reduced survival (median survival 4.61 months for those with PVT versus 17.55 months for those without PVT, HR 2.01, p <0.001). The incidence of systemic VTE in the total population was 6.7%, and patients with PVT had a higher rate of systemic VTE compared to patients without PVT (11.5% vs. 4.4%; p 0.044). Conclusions: PVT is common in patients with HCC and is associated with worse outcomes. The correlation between PVT and systemic VTE suggests a common mechanism of hemostatic activation. Advanced stage, higher CTP class, major vessel involvement, and serum albumin and AFP levels are predictive of PVT. Identifying patients at high-risk for PVT and instituting prophylaxis may affect HCC outcomes.

No significant financial relationships to disclose.

Clinical validation of a self-organizing map (SOM)-based quantitative prediction algorithm to determine the site of origin of cancers of unknown primary (CUP)

21064

Background: As many as 100,000 new cases of CUP are diagnosed each year in the United States. Identifying the site of origin of the CUP is critical for effective cancer management, and several genomic assays have been developed to facilitate this process. The genomic profile generated does not always fit into a discrete classification, however, and communicating results in a simple, easily understood format is important to clinical practice. Methods: We created a novel algorithm that combines SOMs for qualitative visualization with a quantitative clustering algorithm to predict the site of origin of metastatic cancers. We trained the algorithm on a dataset of 231 tumor-bank samples from 9 primary sites. After fixing all thresholds and algorithm settings, we evaluated the algorithm's performance in making a correct first or second prediction on a second blinded and independent dataset of 63 samples. Results: The algorithm correctly predicted the primary site in 82% of cases with the first prediction, and 89% with either the first or second prediction. The map visualization component helped to reduce the biological and mathematical complexity of the test into an easy to understand format for practicing physicians. The map- based approach allowed a fuzzy prediction that complements a class-based prediction and provides substantial additional information on the relationship between an unknown specimen and other related specimens of known provenance. Conclusion: CUP is a formidable clinical problem; correctly identifying the primary site and rendering specific treatment translates into improved patient outcomes. The use of an SOM to depict the genomic profile of the tumor specimen makes it easier for the clinician or pathologist to understand what tumor type the CUP most closely resembles and facilitates further diagnostic or therapeutic decisions.

No significant financial relationships to disclose.

Phase III study of immediate versus delayed docetaxel after induction therapy with gemcitabine plus carboplatin in advanced non-small cell lung cancer: Updated report with survival

LBA7516

Background: Gemcitabine (G) plus carboplatin (C) therapy is active in patients with advanced non-small-cell lung cancer (NSCLC). For nonprogressing patients, optimal timing of second-line therapy with a non-cross-resistant agent is unclear. This Phase III, randomized trial assessed the efficacy and safety of docetaxel (D) administered either immediately after GC induction therapy or upon disease progression (PD). Methods: Patients having either Stage IIIB with pleural effusion or Stage IV NSCLC were enrolled. Prior chemotherapy for NSCLC was not permitted. For GC induction, G 1000 mg/m2 was administered on Days 1, 8 followed by C AUC 5 on Day 1. After four 21-day cycles, nonprogressors were randomized to either the immediate D group (D 75 mg/m2 administered on Day 1 every 21 days, for a maximum of 6 cycles) or the delayed D group (patients given best supportive care after randomization and the same D regimen after first evidence of PD) treatment arms. Primary endpoint was overall survival (OS). Additional analyses included response rates, toxicity and progression-free survival (PFS). Results: Results are summarized in the table below. OS was not statistically different (p=0.071) between the two D arms. However, 31 patients (20.1%) in the delayed D arm and 38 patients (24.8%) in the immediate D arm were censored for OS analysis. PFS analysis (from randomization to first evidence of PD or death) showed a statistically significant (p=<0.0001) improvement in the immediate D arm. D given to NSCLS patients immediately after GC induction did not increase toxicity. Conclusions: Comparison of PFS for each D arm suggests a possible clinical benefit for immediate D therapy. However, even though OS trended in favor of immediate D therapy, the OS result did not reach statistical significance. The implications of these results will be discussed.

[Table: see text] [Table: see text]

The impact of shortened vitamin supplementation lead-in time before pemetrexed (P) in patients with relapsed small cell lung cancer (SCLC)

7726

Background: Clinical studies of P have shown less overall toxicity and reductions in Grades 3–4 hematologic and nonhematologic toxicities when pts are pretreated with folic acid and vitamin B12. Current recommendations are to give folic acid 350 μg - 1,000 μg by mouth for at least 5 of 7 days prior to the 1st dose of P, and 1 injection of vitamin B12 1000 μg during the week preceding the 1st P dose. Treatment delay to allow this supplementation may be clinically undesirable, particularly in pts with aggressive malignancies. A trial evaluating single-agent P for the treatment of relapsed SCLC gave us opportunity to observe the effects of a shortened lead-in time for vitamin supplementation. Methods: We reviewed data from a U.S. trial designed to assess the safety and efficacy of single-agent P in chemosensitive and chemorefractory relapsed SCLC pts. Eligible pts had limited or extensive-stage SCLC, PS 0 to 2, and 1 prior chemo regimen. Pts received P doses of 500 mg/m2 or 900 mg/m2 q 21 d. The protocol required the administration of folic acid for at least 5 of 7 days prior to the 1st P dose, and vitamin B12 administration on Day 1, Cycle 1, or up to 14 days prior to the 1st P dose. Included in the analysis were pts who received at least 1 dose of folic acid prior to 1st P dose. We then analyzed preliminary toxicity results for pts receiving vitamin B12 for 0–3, 4–6 and =7 days prior to 1st P dose. Results: From 7/2004 to 3/2006, 116 pts were treated with P. At baseline M/F 57%/59%; median age 64.5 years (range 35–85); PS 0/1/2 was 39%/57%/20%. Cycle 1 vitamin administration timing data is available for 109 pts. Data for all 116 pts will be reported at time of meeting. Because toxicities observed between the 2 P doses were not significantly different, the combined toxicities for both dosing groups are reported here. Conclusions: Based on this data, Vitamin B12 given less than 7 days prior to P does not appear to be associated with increased serious toxicities.

No significant financial relationships to disclose.

[Table: see text]

MicroRNA regulation in mantle cell lymphoma

8056

Mantle Cell Lymphoma (MCL) represents only 5–10% of all non-Hodgkins lymphomas, making it an uncommon but difficult form of lymphoma to treat. It has the worst prognosis among the B cell lymphomas with median survival of three years. The genetic hallmark of MCL is a t(11;14) q32 translocation which results in ectopic and dysregulated expression of cyclin D1. Recent comparative genomic hybridization studies have identied Syk as another gene important in the pathogenesis of MCL. Previous studies have suggested that post transcriptional regulation of Cyclin D1 and Syk may be important the pathogenesis of in MCL. MicroRNAs are a new class of abundant small RNAs that play important regulatory roles at the post transcriptional level by binding to the 3’ untranslated region (UTR) of mRNAs blocking either their translation or initiating their degradation. There have been numerous reports of misregulation of microRNAs and their targets in human cancers. We hypothesized that altered microRNA regulation of cyclin D1 and/or Syk may be present in MCL. Based on bioinformatics, we identified 8 microRNAs and their putative docking sites in either Cyclin D1 and Syk. We then examined their integrity in MCL cell lines, and identified a mutation in the 3’UTR of Syk at the docking site of 1 mir-452* and a SNP in mir-458. Using a GFP reporter construct with the mutated Syk 3’UTR we demonstrated that this mutation resulted in altered microRNA function. We also show that mimics of the microRNA leads to down regulation of Syk protein. This data suggests that microRNA regulation of important genes in MCL may be compromised and play a role in the development and progression of this disease.

No significant financial relationships to disclose.

Dual EGFR and mTOR targeting in squamous cell carcinoma models, and development of early markers of efficacy

The epidermal growth factor receptor (EGFR) is a validated target in squamous cell carcinoma (SCC) of the head and neck. Most patients, however, do not respond or develop resistance to this agent. Mammalian target of rapamycin (mTOR) is involved in the pathogenesis of SCC of the head and neck (SCCHN). This study aimed to determine if targeting mTOR in combination with EGFR is effective in SCC, and to develop early pharmacodynamic markers of efficacy. Two SCC cell lines, one resistant (HEP2) and one of intermediate susceptibility (Detroit 562) to EGFR inhibitors, were xenografted in vivo and treated with an mTOR inhibitor (temsirolimus), an EGFR inhibitor (erlotinib) or a combination of both. Temsirolimus exerted superior growth arrest in both cell lines than erlotinib. The combined treatment resulted in synergistic antitumor effects in the Detroit 562 cell line. Immunohistochemical assessment of pharmacodynamic effects in fine-needle aspiration (FNA) biopsies early after treatment using phospho MAPK, Phospho-P70 and Ki67 as end points demonstrated pathway abrogation in the Detroit 562 tumours treated with the combination, the only group where regressions were seen. In conclusion, an mTOR inhibitor showed antitumor activity in EGFR-resistant SCC cell lines. Marked antitumor effects were associated with dual pathway inhibition, which were detected by early FNA biopsies.

Subthalamic nucleus stimulation modulates afferent inhibition in Parkinson disease

BACKGROUND

Peripheral sensory stimulation at the wrist inhibits the motor cortex as measured by transcranial magnetic stimulation at interstimulus intervals of approximately 20 ms (short latency afferent inhibition [SAI]) and 200 ms (long latency afferent inhibition [LAI]). Previous studies suggested that reduced SAI in Parkinson disease (PD) reflects adverse effect of dopaminergic medications and reduced LAI may be related to nondopaminergic manifestations of PD. We hypothesize that subthalamic nucleus (STN) deep brain stimulation (DBS) may correct these deficiencies.

METHODS

We studied the effects of STN DBS on SAI and LAI in seven PD patients and age-matched controls. PD patients were studied in an off medication followed by an on medication session, with the stimulator switched on or off in random order in each session.

RESULTS

In the on medication session, SAI was reduced in the stimulator off condition and was restored by STN DBS. LAI was partially normalized by STN DBS in the medication on condition.

CONCLUSIONS

Subthalamic nucleus (STN) stimulation improves short latency afferent inhibition, suggesting that it could normalize pathways that are adversely affected by dopaminergic medications. The effect of STN stimulation on long latency afferent inhibition suggests that it may influence nondopaminergic pathways involved in sensorimotor integration.