P5-13-23: Individualized Treatment Strategies for HER2−Negative Breast Cancer Subtypes

Background Human epidermal growth factor receptor (HER2)-negative breast cancers are more heterogeneous than HER2−positive cancers, and tailored treatment is therefore required for luminal A and triple-negative breast cancer subtypes (LABC and TNBC). We therefore examined predictive factors for the efficacy of standard chemotherapy in LABC and TNBC subtypes.

Methods A total of 109 LABC and 61 TNBC patients were treated with standard neoadjuvant chemotherapy (NAC) consisting of an anthracycline and/or taxane. The pathological treatment response and prognosis were examined for each subtype. Expression levels of the following factors were examined in association with quasi-pathological complete response (QpCR): estrogen- and progesterone-receptor (ER and PgR) status, HER2, nuclear grade, MIB-1, p53, topoisomerase IIα (topoIIα), cytokeratin (CK) 5/6 and epidermal growth factor (EGFR).

Results QpCR rates in LABC and TNBC were 9.1% (10/109) and 54.1% (33/61), respectively. In LABC, the expression of PgR tended to be inversely associated with pathological response (p=0.087), while in TNBC, increased expression of topoIIa (p=0.006) and MIB-1 (p=0.018) were identified as predictors of QpCR. TopoIIα expression was also significantly associated with pathological response in multivariate analysis (p=0.014). The QpCR rate was higher in TNBC lacking CK5/6 and/or EGFR expression, defined as non-basal subtype (p=0.053).

Conclusions Low expression of PgR may be a possible predictor of the efficacy of chemotherapy in LABC, while a high level of proliferative activity, indicated by topoIIa and MIB-1, is associated with chemosensitivity in TNBC. Further subclassification into basaland non basal-subtypes may also be helpful for the development of individualized treatments.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-23.

Second-order autocorrelation of XUV FEL pulses via time resolved two-photon single ionization of He

Second-order autocorrelation spectra of XUV free-electron laser pulses from the Spring-8 Compact SASE Source (SCSS) have been recorded by time and momentum resolved detection of two-photon single ionization of He at 20.45 eV using a split-mirror delay-stage in combination with high-resolution recoil-ion momentum spectroscopy (COLTRIMS). From the autocorrelation trace we extract a coherence time of 8 ± 2 fs and a mean pulse duration of 28 ± 5 fs, much shorter than estimations based on electron bunch-length measurements. Simulations within the partial coherence model [Opt. Lett. 35, 3441 (2010)] are in agreement with experiment if a pulse-front tilt across the FEL beam diameter is taken into account that leads to a temporal shift of about 6 fs between both pulse replicas.

Seroprevalence of tularemia in wild bears and hares in Japan

Tularemia is a zoonotic disease caused by Francisella tularensis. The distribution of the pathogen in Japan has not been studied well. In this study, seroprevalence of tularemia among wild black bears and hares in Japan was determined. Blood samples collected from 431 Japanese black bears (Ursus thibetanus japonicus) and 293 Japanese hares (Lepus brachurus) between 1998 and 2009 were examined for antibodies against F. tularensis by micro-agglutination test (MA) or enzyme-linked immunosorbent assay. By subsequent confirmatory tests using western blot (WB) and indirect immunofluorescence assay (IFA), eight sera from Japanese black bears were definitely shown to be seropositive. All of these eight bears were residents of the northeastern part of main-island of Japan, where human tularemia had been reported. On the other hand, no seropositive Japanese hares were found. These results suggest that Japanese black bears can serve as sentinel for tularemia surveillance and may help understand the distribution of F. tularensis throughout the country. This is the first report on detection of antibody to F. tularensis in black bears of Japan.

Improvement of film Quality of A-Si:H Deposited by Photo-CVD using SiH2Cl2

Hydrogenated Amorphous silicon films (a-Si:H) were prepared by mercury sensitized photo-CVD using SiH4 and SiH2Cl2 gas mixture. The effects of chlorine (Cl) on the electrical, optical and structural properties of the a-Si:H films were investigated. It was found that a small addition of SiH2Cl2 to the deposition system increases the photo-sensitivity, decreases the defect density, and reduces the light induced degradation of a-Si:H films. At a large addition of SiH2Cl2, however, the CI incorporation into the films was observed, resulting in the deterioration of the film properties. The electrical and optical properties were successfully improved by the H2 dilution when the films were deposited with a large addition of SiH2Cl2.

Bandgap Engineering of ZnO Transparent Conducting Films

Low resistivity and transparent Al doped ZnMgO films were deposited on glass substrates by a pulsed laser deposition system. For up to 32 atm% of Mg content, segregation of a MgO phase was not observed. The bandgap of these films could be widened to about 4 eV with increasing Mg content. The relation between bandgap and resistivity was found to be a trade-off; i.e. the larger the bandgap, the higher the resistivity. The maximum bandgap among films with an electrical resistivity of less than 10-3 Ω cm was 3.94 eV. The average optical transmittance of these films was more than 90 % for wavelengths λ between 400 and 1100 nm. The transmittance around λ = 330 nm was still 50 %.

Structural design of a newly developed pediatric circulatory assist device for Fontan circulation by using shape memory alloy fiber

Total cavopulmonary connection (TCPC) is commonly applied for the surgical treatment of congenital heart disease such as single ventricle in pediatric patients. Patients with no ventricle in pulmonary circulation are treated along with Fontan algorithm, in which the systemic venous return is diverted directly to the pulmonary artery without passing through subpulmonary ventricle. In order to promote the pulmonary circulation after Fontan procedure, we developed a newly designed pulmonary circulatory assist device by using shape memory alloy fibers. We developed a pulmonary circulatory assist device as a non-blood contacting mechanical support system in pediatric patients with TCPC. The device has been designed to be installed like a cuff around the ePTFE TCPC conduit, which can contract from outside. We employed a covalent type functional anisotropic shape memory alloy fiber (Biometal, Toki Corporation, Tokyo Japan) as a servo actuator of the pulmonary circulatory assist device. The diameter of this fiber was 100 microns, and its contractile frequency was 2-3 Hz. Heat generation with electric current contracts these fibers and the conduit. The maximum contraction ratio of this fiber is about 7% in length. In order to extend its contractile ratio, we fabricated and installed mechanical structural units to control the length of fibers. In this study, we examined basic contractile functions of the device in the mock system. As a result, the internal pressure of the conduit increased to 63 mmHg by the mechanical contraction under the condition of 400 msec-current supply in the mock examination with the overflow tank of 10 mmHg loading.

Abstract P1-01-16: Evaluation of Sentinel Node Biopsy Using a Combined Dye and Fluorescence Method for Breast Cancer

Background: Sentinel lymph node (SLN) dissection is now widely accepted for staging the axilla in patients with breast cancer. At present, several methods are used to detect SLN. A combination of blue dye and radioactive colloid has been described previously as a superior method for detecting SLN in breast cancer patients. However, use of radioactive colloids is not generally available for various reasons in Japan. SLN detection guided by indocyanine green (ICG) fluorescence could emerge as a new method for SLN biopsy. The aim of this study was to evaluate sentinel node biopsy using a combined dye and fluorescence method for breast cancer.

Methods: Fifty-eight patients with clinically node-negative breast cancer were examined between April 2008 and March 2009 at Yokohama City University Hospital. Intradermal injections of 20 mg/5 ml of indigo carmine and 0.5 mg/0.1 ml of ICG were made into the upper-lateral region of the periareolar area. Subcutaneus lymphatic channels draining from the areola to the axilla were visible under fluorescence within a few minutes. SLNs were then dissected under direct vision supported by fluorescence navigation. Palpable lymph nodes were also dissected. All SLNs were histologically evaluated by 2-mm serial section and staining with hematoxylin and eosin. Patients with positive SLNs underwent axillary lymph node dissection (ALND), while patients with negative SLN did not.

Results: SLNs were identified in 58 patients (100%). ICG fluorescence imaging was compared with indigo carmine dye, and SLNs were identified in 57 and 52 patients, respectively (detection rate: ICG, 98.3%; dye, 89.7%). The mean number of excised SLNs was 2.72. Mean numbers of lymph nodes showing fluorescence and blue stain from injected dye were 2.31 and 1.41, respectively. Eight of 58 patients (13.8%) had metastases detected in the SLN, so ALND were subsequently performed. Five of these cases were without metastases at non-SLN that were dissected. One patient showed metastasis in a SLN that was positive for fluorescence, but negative for blue dye. Among all cases, 1 patient (1.7%) showed an SLN without fluorescence or blue staining, and this case was detected by palpation only.

Conclusion: Combined use of dye and fluorescence method identified SLNs effectively.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-16.

Abstract P1-12-01: Preoperative Endocrine Therapy with Tamoxifen and Goserelin Acetate for Hormone Receptor-Positive Premenopausal Patients

Background: Clinical trials have consistently shown that the response rates of hormone receptor-positive breast cancer patients to neoadjuvant chemotherapy are low. Preoperative endocrine therapy has therefore become a logical alternative for such patients. Several researchers have reported favorable response rates in postmenopausal women. However, the effectiveness of preoperative endocrine therapy for premenopausal women remains unknown. The aim of this study was to evaluate the potential benefits of preoperative endocrine therapy for premenopausal women.

Materials and methods: Forty premenopausal patients with operable estrogen receptor (ER)-positive breast cancer were consecutively treated with neoadjuvant therapy with tamoxifen and Goserelin acetate for 3 months. The patients eligible for this study included clinically node-negative patients with tumors that were less than 2 cm in diameter and negative for human epidermal growth factor receptor 2 (HER2). All the patients were clinically evaluated using ultrasonograpy before and after the endocrine therapy. Further, core-needle biopsy specimens obtained before administration of the endocrine therapy and surgical specimens were pathologically evaluated for ER, progesterone receptor (PgR), HER2, p53, and Ki67 expressions. This study was approved by our institutional IRB.

Results: The patients included in this study were 30-52 years old (median age, 43 years). The size of the tumor was 0.9-2.0 cm (median, 1.5 cm).

The clinical response rate was 20% (8/40) and disease progression was not observed. In the case of 39 of the 40 patients, grade 0 or grade 1 pathological response was observed. Clinical responses were not correlated with pathological responses. The ER expression level before the endocrine therapy differed from that after the therapy in the case of 8% (2/40) of the patients (increased in 4% and decreased in 4%). Further, PgR expression was altered in the case of 50% (20/40) of the patients (increased in 8% and decreased in 42%). Moreover, Ki67 expression was decreased in 90% (36/40) of the patients after the endocrine therapy.

Conclusions: This is the first report on neoadjuvant endocrine therapy for premenopausal patients. Disease progression 3 months after the endocrine therapy was not observed. Because the expressions of Ki67 and PgR decreased, these molecules might be candidate markers of endocrine responsiveness in premenopausal patients. To confirm this assumption, further evaluations involving tumors of a larger size, longer observational period, and more number of eligible patients are planned to be conducted.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-12-01.

Histological contribution of collagen architecture to beef toughness

The relationship between shear-force value and collagen architecture of connective tissue of the longissimus thoracis (LT) muscle of Japanese Black (n = 10) and Brown (Kumamoto) (n = 5) steers (body weight: 688.4 +/- 8.6 kg as average and standard error) was investigated. There were negative correlations between the shear-force value and lipid content (n = 15, R(2)= 0.3709, P < 0.01) and protein content and lipid content (n = 15, R(2)= 0.6748, P < 0.01). Shear-force value and collagen content (n = 15, R(2)= 0.4344, P < 0.01) were positively correlated. In scanning electron microscopic photographs of the macerated preparation, the perimysium of the high-lipid LT muscle was broken down compared with the low-lipid LT muscle. The endomysium in all LT muscle fibers showed similar architecture. The fine surface cover of reticular collagen fibers around an adipocyte was observed in the high-lipid LT muscle perimysium. These results suggested that the shear-force value of the LT muscle was related to change in collagen architecture and of the perimysium in particular.

Evaluation of the 24-hour profiles of physiological insulin, glucose, and C-peptide in healthy Japanese volunteers

BACKGROUND

Some studies have demonstrated the benefit of blood glucose control as close as possible to physiological conditions. Not enough reports have investigated in detail the 24-h plasma profiles of insulin/glucose/C-peptide. Here we investigated the 24-h plasma profiles of physiological insulin/glucose/C-peptide in healthy Japanese adults.

METHODS

In order to evaluate the 24-h profiles of physiological insulin/glucose/C-peptide profiles, 42 blood samples were taken from each subject in our group of healthy Japanese volunteers to measure the 24-h profile with three standardized meals.

RESULTS

Plasma glucose and insulin increased rapidly followed by a rapid decrease after each meal with little variation at night. The average peak values of insulin after each meal were as follows: 426.20 pmol/L (breakfast), 373.75 pmol/L (lunch), and 410.28 pmol/L (dinner). The average times to peak insulin were 0.651 h (breakfast), 0.677 h (lunch), and 0.689 h (dinner). The corresponding average maximum postprandial plasma glucose levels were 8.39 mmol/L (breakfast), 8.77 mmol/L (lunch), and 8.74 mmol/L (dinner). The average times to peak glucose were 0.738 h (breakfast), 0.650 h (lunch), and 0.625 h (dinner). The average maximum postprandial C-peptide levels were 2.64 nmol/L (breakfast), 2.55 nmol/L (lunch), and 2.67 nmol/L (dinner). No major differences were found in these parameters between the Caucasian and Japanese populations.

CONCLUSIONS

This is the first investigation to measure the 24-h profiles of insulin/glucose/C-peptide in healthy Japanese volunteers with standardized meals. It is hoped this information will provide useful reference for future research and clinical management.

Pegylated interferon alpha-2b (Peg-IFN alpha-2b) affects early virologic response dose-dependently in patients with chronic hepatitis C genotype 1 during treatment with Peg-IFN alpha-2b plus ribavirin

Chronic hepatitis C (CH-C) genotype 1 patients who achieved early virologic response have a high probability of sustained virologic response (SVR) following pegylated interferon (Peg-IFN) plus ribavirin therapy. This study was conducted to evaluate how reducing drug doses affects complete early virologic response (c-EVR) defined as hepatitis C virus (HCV) RNA negativity at week 12. Nine hundred eighty-four patients with CH-C genotype 1 were enrolled. Drug doses were evaluated independently on a body weight base from doses actually taken. From multivariate analysis, the mean dose of Peg-IFN alpha-2b during the first 12 weeks was the independent factor for c-EVR (P = 0.02), not ribavirin. The c-EVR rate was 55% in patients receiving > or = 1.2 microg/kg/week of Peg-IFN, and declined to 38% at 0.9-1.2 microg/kg/week, and 22% in patients given <0.9 microg/kg/week (P < 0.0001). Even with stratified analysis according to ribavirin dose, the dose-dependent effect of Peg-IFN on c-EVR was observed, and similar c-EVR rates were obtained if the dose categories of Peg-IFN were the same. Furthermore, the mean dose of Peg-IFN during the first 12 weeks affected HCV RNA negativity at week 24 (P < 0.0001) and SVR (P < 0.0001) in a dose-dependent manner. Our results suggest that Peg-IFN was dose-dependently correlated with c-EVR, independently of ribavirin dose. Thus, maintaining the Peg-IFN dose as high as possible during the first 12 weeks can yield HCV RNA negativity and higher c-EVR rates, leading to better SVR rates in patients with CH-C genotype 1.

A randomized trial of personalized peptide vaccine (PPV) plus low-dose estramustine (EMP) versus full-dose EMP in patients with hormone-refractory prostate cancer

3007

Background: Personalized selection of the right peptides for each patient could be a novel peptide-based immunotherapy for boosting anti-cancer immunity in many patients (pts). This randomized study evaluated the anti-tumor effect and safety of PPV plus a low-dose EMP compared with full dose EMP for patients with hormone-refractory prostate cancer (HRPC). Methods: This was a randomized (1:1), open labeled, cross-over study in pts with HRPC. Pts were randomized to arm A; PPV plus low-dose EMP (280 mg/day) or arm B; full dose EMP (560 mg/day) according to age and PSA levels. In arm A, prevaccination plasma were measured for their IgG levels for each of the 14 or 12 candidate peptides which can induce HLA-A2 or A24-restricted CTL activity against cancer cells followed by biweekly subcutaneous administration of the top four peptides (3mg each) showing the strongest IgG responses. Disease progression (PD) was defined as three consecutive and 125% increase from baseline PSA levels at least two weeks apart or objective PD by RECIST criteria. After PD, pts were treated with the opposite regime. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival and toxicity. The planned sample size was 80. Results: A total of 54 pts from 4 institutions were enrolled between June 2006 and December 2008. The accural into arms A and B was 27 and 27 pts, respectively. The main pts characteristics are (arm A/B): median age 71/69 years, EOCG performance status 0/1 96%/4% and 100%/0%, HLA A2/A24/A2A24 40%/32%/28% and 54%/27%/19%, median PSA 27/25 ng/ml, and metastatic HRPC 96%/85%. All pts were evaluable for their response at the time of interim analysis. The personalized peptide vaccination was well tolerated with no major adverse effects. Increased levels of IgG responses to the vaccinated peptides were observed in 20 of 23 (87%) patients tested. The median PFS time was 246 days in the arm A group and 85 days in the arm B, respectively. The PFS time in the arm A was statistically longer than that in the arm B (log-rank test: p = 0.0007, hazard ratio: 0.27, 95%CI: 0.12 to 0.615). Conclusions: PPV plus low-dose EMP was associated with improvement in PSA-based PFS compared to full-dose EMP alone.

No significant financial relationships to disclose.

The Tokyo subway sarin attack--lessons learned

The sarin gas attack in the Tokyo subway system is reviewed from a clinical toxicology perspective. Based on the lessons learned from this attack, the following areas should be addressed on a global scale. First, an adequate supply of protective equipment is required, including level B protective equipment with a pressure demand breathing apparatus. In addition, a system should be established that enables a possible cause to be determined based on symptoms, physical findings, general laboratory tests, and a simple qualitative analysis for poisonous substances. If an antidote is needed, the system should enable it to be administered to the victims as quickly as possible. Preparation for a large-scale chemical attack by terrorists requires the prior establishment of a detailed decontamination plan that utilizes not only mass decontamination facilities but also public facilities in the area. A system should be established for summarizing, evaluating, and disseminating information on poisonous substances. Finally, a large-scale scientific investigation of the Tokyo sarin attack should be conducted to examine its long-term and subclinical effects and the effects of exposure to asymptomatic low levels of sarin.

Pathological evidence of rhabdomyolysis-induced acute tubulointerstitial nephritis accompanying Legionella pneumophila pneumonia: Figure 1

A case of Legionella pneumophila pneumonia with rhabdomyolysis-induced acute tubulointerstitial nephritis (ATIN) and prolonged renal dysfunction is presented. The patient was a 54-year-old man, admitted with high-grade fever, ataxia and muscle dysfunction; chest roentgenogram showed multilobular infiltrations. L pneumophila was detected in his sputum and urine, by PCR and by culture, and L pneumophila pneumonia was diagnosed. Despite antimicrobial treatment, he developed renal failure and rhabdomyolysis. Renal biopsy showed the presence of myoglobin casts that occluded the distal tubuli and tubulointerstitial nephritis, leading to the diagnosis of rhabdomyolysis-induced ATIN. Renal function subsequently normalised, and he was discharged. This is believed to be the first pathological evidence of involvement of rhabdomyolysis in legionellosis-associated ATIN.

[Mitral valve plasty for infective endocarditis associated with vertebral osteomyelitis]

Infective endocarditis (IE) associated with vertebral osteomyelitis (VO) is relatively rare, but needs long and careful therapy. We report a case of the patient who was incidentally diagnosed as having IE during therapy for VO. A 77-year-old man was hospitalized with a complaint of high fever and back pain. Because magnetic resonance imaging demonstrated osteomyelitis, antibiotic therapy was started. Persistent infectious signs and congestive heart failure indicated the diagnosis of infective endocarditis. Echocardiogram demonstrated sever mitral regurgitation due to perforation of anterior mitral leaflet but no vegetation. Surgery revealed perforation of the valvular aneurysm of the anterior mitral leaflet, which was successfully repaired with deberidement and patch closure. Antibiotic therapy was continued for 4 months postoperatively. In the case of VO, it is often necessary to consider an association of IE, although it is hardly possible to determine which the preceding infection is.

Identification of Lck-derived peptides applicable to anti-cancer vaccine for patients with human leukocyte antigen-A3 supertype alleles

The identification of peptide vaccine candidates to date has been focused on human leukocyte antigen (HLA)-A2 and -A24 alleles. In this study, we attempted to identify cytotoxic T lymphocyte (CTL)-directed Lck-derived peptides applicable to HLA-A11⁺, -A31⁺, or -A33⁺ cancer patients, because these HLA-A alleles share binding motifs, designated HLA-A3 supertype alleles, and because the Lck is preferentially expressed in metastatic cancer. Twenty-one Lck-derived peptides were prepared based on the binding motif to the HLA-A3 supertype alleles. They were first screened for their recognisability by immunoglobulin G (IgG) in the plasma of prostate cancer patients, and the selected candidates were subsequently tested for their potential to induce peptide-specific CTLs from peripheral blood mononuclear cells of HLA-A3 supertype⁺ cancer patients. As a result, four Lck peptides were frequently recognised by IgGs, and three of them – Lck₉₀₋₉₉, Lck_449−458, and Lck_450−458 – efficiently induced peptide-specific and cancer-reactive CTLs. Their cytotoxicity towards cancer cells was mainly ascribed to HLA class I-restricted and peptide-specific CD8⁺ T cells. These results indicate that these three Lck peptides are applicable to HLA-A3 supertype⁺ cancer patients, especially those with metastasis. This information could facilitate the development of peptide-based anti-cancer vaccine for patients with alleles other than HLA-A2 and -A24.

Evolutionary trend of phylogenetic diversity of nitrogen fixation genes in the gut community of wood-feeding termites

Nitrogen fixation by gut microorganisms is one of the crucial aspects of symbiosis in wood-feeding termites since these termites thrive on a nitrogen-poor diet. In order to understand the evolution of this symbiosis, we analysed the nitrogenase structural gene nifH in the gut microbial communities. In conjunction with the published sequences, we compared approximately 320 putatively functional NifH protein sequences obtained from a total of 19 termite samples that represent all the major branches of their currently proposed phylogeny, and from one species of the cockroach Cryptocercus that shares a common ancestor with termites. Using multivariate techniques for clustering and ordination, a phylogeny of NifH protein sequences was created and plotted variously with host termite families, genera, and species. Close concordance was observed between NifH communities and the host termites at genus level, but family level relationships were not always congruent with accepted termite clade structure. Host groups examined included basal families (Mastotermitidae, Termopsidae, Kalotermitidae, as well as Cryptocercus), the most derived lower termite family Rhinotermitidae, and subfamilies representing the advanced and highly diverse apical family Termitidae (Macrotermitinae, Termitinae, and Nasutitermitinae). This selection encompassed the major nesting and feeding styles recognized in termites, and it was evident that NifH phylogenetic divergence, as well as the occurrence of alternative nitrogenase-type NifH, was to some extent dependent on host lifestyle as well as phylogenetic position.

A multicenter study of leukocytapheresis in rheumatoid arthritis

OBJECTIVE

To evaluate the efficacy and safety of leukocytapheresis (LCAP) in patients with rheumatoid arthritis (RA) that is refractory to disease modifying antirheumatic drugs (DMARDs), we conducted a prospective, multicenter, open-label clinical trial.

METHODS

We enrolled 38 active RA patients, including 32 patients who showed an inadequate response to > or = 2 DMARDs and 6 patients with rapidly progressive RA. All patients continued drug therapy and were treated with 5 LCAP sessions conducted at 1-week intervals. The clinical response was evaluated at baseline before starting LCAP and at 4 weeks after the completion of all the LCAP sessions using the American College of Rheumatology (ACR) criteria and the 28-joint disease activity score (DAS28) of the European League Against Rheumatism (EULAR).

RESULTS

Of the 35 patients who fulfilled the study's eligibility criteria, 24 (69%), 10 (29%), and 23 (66%) patients achieved 20% (ACR20), 50% (ACR50), and DAS28-C-reactive protein (CRP) EULAR improvement, respectively. The mean DAS28-CRP score of the 35 patients decreased significantly from 5.99 +/- 0.92 at baseline to 4.54 +/- 1.39 after treatment. Comparison analysis of the ACR20 responders and non-responders to LCAP revealed that 22 of 24 responders (92%) concomitantly received methotrexate, whereas significantly fewer, that is, 6 of 11 non-responders (55%) received methotrexate. Less frequent and transient mild-to-moderate adverse events, including nausea and headache, were seen in 12 of 189 LCAP sessions (6.3%).

CONCLUSION

These results demonstrate the usefulness of LCAP in combination with DMARDs, particularly methotrexate, as an effective and safe treatment for refractory RA.

Expression of APOBEC3G in kidney cells

The apolipoprotein B mRNA-editing enzyme, catalytic polypeptide-like 3G (APOBEC3G), a member of the APOBEC family possessing DNA mutator activity through cytosine deamination, is reported to play an important role in host defense against infections such as those of hepatitis B virus and human immunodeficiency virus. Here, we examined the expression of APOBEC3G in human kidney cells to better understand its biological role against infection. APOBEC3G was immunohistochemically detectable in kidney mesangial cells and also to some extent in kidney epithelial tubular cells. In addition, overexpression of APOBEC3G was shown in renal carcinoma tissues and cell lines. APOBEC3G expression was upregulated by inflammatory cytokines, such as interferon, interleukin-6, and tumor necrosis factor. These results may provide new insight into the role of APOBEC3G in host defense against viral infection and cancer.

Nitric oxide in pulp cell growth, differentiation, and mineralization

Dental preparation sometimes causes transient congestion, edema, and necrosis of the pulp. We hypothesized that nitric oxide (NO) is involved in the pathophysiological changes in pulp after preparation. The mRNA and protein expression of the inducible isoform of NO synthase (iNOS) was examined in murine pulp after dental preparation. The effects of NO on the proliferation, mineralization, and apoptosis of pulp cells were also studied in vitro. We found that not only iNOS, but also mRNAs for alkaline phosphatase and plasma membrane glycoprotein-1, were expressed in the pulp after preparation. NOC-18, an NO donor, suppressed the proliferation of pulp cells without inducing cell death, whereas it promoted the mineralization of cells cultured in the presence of beta-glycerophosphate, ascorbic acid, dexamethasone, and KH(2)PO(4). Under these conditions, NOC-18 induced the apoptosis of pulp cells. These results suggest that NO regulates the growth, apoptosis, and mineralization of pulp cells.

Manipulation of cell-sized phospholipid-coated microdroplets and their use as biochemical microreactors

Cell-sized water droplets coated by a phospholipid layer mimicking the inner surface of living cells were manipulated by laser tweezers and used as biochemical microreactors. The cell-sized phospholipid-coated microdroplets (CPMDs) consisted of a water droplet in mineral oil with a diameter of 1-100 microm and coated by 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine. We monitored the time development of biochemical reactions in a single CPMD obtained after the controlled fusion of two CPMDs containing a substrate and an enzyme, respectively. We present results on two enzymatic reactions: calcein production in the presence of esterase and green fluorescence protein expression.

Expression and localization of Cayman ataxia-related protein, Caytaxin, is regulated in a developmental- and spatial-dependent manner

Mutation of the gene encoding Caytaxin causes human Cayman ataxia by interfering with normal splicing and, in mutant rodents, by reducing normal transcription, which leads to ataxia, dystonia, and mental retardation: These observations suggest that Caytaxin may be crucial for higher brain functions such as motor learning. We generated antibodies against mouse Caytaxin. Interestingly, we found that the expression of Caytaxin is regulated during brain development while quantitative real time RT-PCR indicated that the mRNA level did not change between postnatal days 7 (P7) and P14 in the cerebellum and hippocampus, implying that the expression of Caytaxin may be controlled by a post-transcriptional mechanism. Immunostaining analyses demonstrated that Caytaxin was localized in many brain areas including the cerebellum and hippocampus. Furthermore, Caytaxin was localized to the presynaptic cytosol by the subcellular fractionation of mouse brain and an observation that was confirmed by co-localization studies with synapsin I and VGLUT1. The above data, disease phenotypes, and mutant animals suggest that Caytaxin may be essential for synaptic function. Thus, identifying the role of Caytaxin in synapse maturation may lead to the development of therapeutic interventions for cerebellar ataxia as well as mental disorders.

The effect of dexamethasone on defective nephrin transport caused by ER stress: a potential mechanism for the therapeutic action of glucocorticoids in the acquired glomerular diseases

The mechanism by which glucocorticoids govern antiproteinuric effect in nephrotic syndrome remains unknown. Present study examined the protective role of dexamethasone (DEX) in the intracellular trafficking of nephrin under endoplasmic reticulum (ER) stress. Human embryonic kidney-293 cell line expressing a full-length human nephrin was cultured in mediums containing 5.5 or 25 mM glucose with or without DEX. The result revealed that glucose starvation evoked a rapid ER stress leading to formation of underglycosylated nephrin that was remained in the ER as a complex with calreticulin/calnexin. DEX rescued this interfered trafficking through binding to its receptor and stimulating the mitochondrial transcripts and adenosine 5' triphosphate (ATP) production, leading to synthesis of fully glycosylated nephrin. These results suggest that ER-stress in podocytes may cause alteration of nephrin N-glycosylation, which may be an underlying factor in the pathomechanism of the proteinuria in nephrotic syndrome. DEX may restore this imbalance by stimulating expression of mitochondrial genes, resulted in the production of ATP that is essential factor for proper folding machinery aided by the ER chaperones.

Immunological evaluation of personalized peptide vaccination with gemcitabine for advance pancreatic cancer patients

14029

Background: A phase I clinical study was performed to determine safety and immunogenicity of personalized peptide vaccination with gemcitabine (GEM) in advanced pancreatic cancer patients (APC). Methods: Thirteen human histocompatibility leukocyte antigen (HLA)-A24+ or A2+ patients with unresectable (n=10) or recurrent (n=3) pancreatic cancer were treated with GEM plus up to four peptides that were positive for pre-vaccination measurement of peptide-specific IgG antibodies and/or cytotoxic T lymphocyte (CTL) precursors in the circulation (personalized peptide vaccine). GEM was administered at 1000mg/m2 as a 30-min intravenous infusion once a week for three week, followed by 1 week of rest. All patients were treated on outpatient basis. The cycle was repeated every 8 weeks. Results: Peptide doses of vaccination per week were planned as follows: level 1, 1mg; level 2, 2mg; and level 3, 3mg. The main grade 3 toxicities observed during the first cycle in each level were neutropenia (15%), anemia (23%) and thrombocytopenia (15%). No significant differences in the toxicities were found between each level. There was no dose limiting toxicity (DLT) observed in each level. Augmentation of peptide-specific CTL responses in the post-vaccination peripheral blood mononuclear cells was observed in each level, while increased titer of peptide-specific IgG antibodies was observed in the post-vaccination plasma in level 2 and level 3. Applicable responses were no complete response, two partial responses (15%), and 7 stable diseases (55%). Nevertheless 7 patients of them (54%) were under the second-line chemotherapy, disease control rate was 70%, the median TTP (time to progression) was 18.5 weeks and the MST (median survival time) was 7.6 months in this study. Conclusions: The combination therapy of personalized peptide vaccination with GEM for APC patients is feasible and safe. Because of positive immune responses under a full dose of GEM, the peptide vaccination of 3 mg is recommended.

No significant financial relationships to disclose.

Immunological evaluation of personalized peptide vaccination for patients with malignant glioma: The results of a clinical phase I trial

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Purpose: To investigate the safety and immunological responses of personalized peptide vaccination in patients with malignant glioma. Patients and Methods: Twenty-six patients with recurrent malignant glioma entered in the phase I clinical study of personalized peptide vaccination. Peripheral blood mononuclear cells (PBMCs) and plasma prior to vaccination were provided for cellular and humoral responses in vitro to each of 31 or 36 peptides in cases of HLA-A24+ or HLA-A2+ patients, respectively, and then only the reactive peptides (maximum: 4) were allowed to in vivo administration. Post-vaccination PBMCs and plasma, and also pre-and post-vaccination cerebrospinal fluid, were provided for their reactivity to the vaccinated peptides. Expression of class 1 molecule on glioma cell was evaluated using EMR 8–5 antibody by immunohistochemical analysis. Results: The protocol was generally well tolerated, although the majority of patients developed grade 1 or 2 local redness and swelling at the injection site. Increase in cellular and humoral responses specific to at least one of the vaccinated peptides was observed in the post vaccination (6th)-PBMCs and -plasma from 62%, 73% respectively. More importantly, peptide-specific IgG were found in the post-vaccination cerebrospinal fluid of tumor sites. Clinical responses were 4 partial response, 8 stable disease, and 8 progressive disease. The clinical response was correlated to the expression of MHC class 1 on the glioma cell. The median overall survival for patients with recurrent glioblastoma multiforme in this study was 622 days. Conclusion: Personalized peptide vaccination is well tolerated and has ability to induce immune responses to the majority of malignant glioma patients along with several cases of major tumor regression. These results would encourage the phase II clinical study of personalized peptide vaccination to patients with recurrent malignant glioma.

No significant financial relationships to disclose.

Requirement of nectin, but not cadherin, for formation of claudin-based tight junctions in annexin II-knockdown MDCK cells

Adherens junctions (AJs) and tight junctions (TJs) comprise a junctional complex which plays key roles not only in cell adhesion and polarization but also in regulation of cell movement and proliferation in epithelial cells. E-Cadherin and nectin are major cell-cell adhesion molecules (CAMs) at AJs, whereas claudin is a major CAM at TJs. We have shown that the cadherin-based cell-cell adhesion is not formed in MDCK cells in which annexin II, a Ca(2+)- and phospholipid-binding protein, is knocked down. Here, we found that TJs and the nectin-based cell-cell adhesions were formed in annexin II-knockdown cells. The formation of TJs in annexin II-knockdown MDCK cells required the nectin-based cell-cell adhesion and afadin, a nectin- and actin-filament-binding protein. In addition, it required the activation of Cdc42 and Rac small G proteins and subsequent reorganization of the IQGAP1-dependent actin cytoskeleton which were induced by the nectin-based cell-cell adhesion. These results indicate that the nectin-based cell-cell adhesion and afadin, but not the cadherin-based cell-cell adhesion, are necessary for the formation of TJs and that the signaling by nectin and the subsequent reorganization of the actin cytoskeleton are also necessary for the formation of TJs under certain conditions.