A Phase II Trial of Capecitabine and Docetaxel Followed by 5-FU/Epirubicin/Cyclophosphamide (FEC) as Preoperative Treatment in Women with Stage II/III Breast Cancer

Backgound: capecitabine (X) and docetaxel (T) have demonstrated synergistic effect in preclinical models and survival benefit in metastatic breast cancer. The sequential combination of anthracycline and taxane is a standard of care as preoperative setting, as well as adjuvant setting. This study's purpose was to determine the efficacy of X and T followed by 5-FU/epirubicin/cyclophosphamide (FEC) in the preoperative setting.Patients and Methods: Patients with stage II/III breast cancer received 4 cycles of XT (capecitabine 1650 mg/m2 on days 1-14 and docetaxel 60 mg/m2 on day 8 every 3 weeks), followed by 4 cycles of FEC (fluorouracil 500 mg/m2, epirubicin 90 mg/m2, cyclophosphamide 500 mg/m2 on day 1 every 3 weeks). Primary endpoints were the pathological complete response (pCR) rate and adverse drug reactions. pCR was defined as no microscopic evidence of residual viable tumor cells, invasive or noninvasive, in all resected specimens of the breast. Secondary endpoints were the clinical response rate, the breast conservation rate, and predictors for pCR.Results: From February 2005 to October 2008, 72 patients were enrolled and 71 patients were assessable for clinical and pathologic responses. The median age was 51 years (range, 27-69 years). The median tumor size was 3.5 cm (range, 2-8.3 cm). Forty-six (64.8%) patients were clinically node-positive. Overall, 50 (50.1%) patients had hormonal receptor (HR)-positive tumors, and 21 (29.6%) had HR-negative tumors. The overall response rate was 91.5%, including a complete response in 29 patients and a partial response in 36 patients. No patients showed clinical progression of disease. The pCR rate was 14.1% (10/71). Fifty-six patients (78.9%) underwent breast-conserving surgery. The breast-conserving rate in patients whose tumor size was 3 cm or smaller was 92.6%, and 69.0% of patients whose tumor size was larger than 3 cm underwent breast-conserving surgery. Grade 3/4 neutropenia was observed in 32.4% of patients, and febrile neutropenia was observed in 5.6% of patients. The most common grade 3/4 non-hematologic adverse event was hand-foot syndrome, observed in 11.3% of patients. The median relative dose intensities of FEC, T, and X were 0.982, 0.968, and 0.933, respectively. HR status and Ki67 expression were significantly correlated with pCR.Conclusions: These data indicate that the sequential combination of XT followed by FEC is a well-tolerated, effective preoperative treatment for stage II/III breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1101.

HOXB9 Promotes the Acquisition of Tumorigenic Phenotypes in Mammary Epithelial Cells

Background:The class I HOX gene family consists of 39 members with a shared highly conserved 61-amino acid homeodomain motif. HOX genes are important regulators of developmental processes, and their role in neoplastic transformation and tumor progression is increasingly recognized (Abate-Shen et al., Nat Rev Cancer, 2002; Cantile et al., Eur J Cancer, 2003). However, the molecular mechanisms by which HOX proteins promote tumorigenesis is not well understood. We recently, observed that HOXB9, a 9th HOX gene paralogue involved in mouse mammay gland development, is deregulated in breast cancer and enhanced expression correlated with high tumor grade. A role for elevated HoxB9 expression in breast tumor progression is demontrated by its ability to activate the ErbB and TGF-B pathways which influence tumor-associated phenotypes in cells.Methods and results:Overexpression of HOXB9 was found in 43% of primary breast cancer by RT-PCR and in situ hybridization (Figure 1A) and correlated with high tumor grade. Ectopic expression of HOXB9 in MCF10A mammary epithelial cells induced EMT, cell migration, invasion (Figure 1B, and 1C). It also increased the expression of angiogenic factors, which enhance the formation of new vessels in mouse dorsal air sac model. Conversely, genetic ablation of endogenous HOXB9 in MDA-MB-231 breast cancer cells suppresses their motility and angiogenic potential. Further, we confirmed that HOXB9-induced tumor phenotypes arise through the activation of both ErbB-AKT and TGFß signaling pathways. Finally, in mouse xenograft model, we observed that HOXB9 cooperates with activated H-Ras to transform mammary epithelial cells leading to large, vascularized and invasive tumors (Figure 2).Discussion:Our findings imply that overexpression of HOXB9 in human breast cancer contributes to tumor progression through activation of signaling pathways that alter both tumor-specific cell fates and tumor-stromal microenvironment, leading to increased invasion and metastasis. It is suggested that combined suppression of ErbB and TGFß signaling pathways to target breast cancers overexpressing HOXB9 may be effective in tumor inhibition.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6145.

Galectin-1 suppresses alpha2(I) collagen through Smad3 in renal epithelial cells

Transforming growth factor (TGF-beta1) promotes renal fibrogenesis through activation of Smads. Galectin-1 is reported to prevent experimental glomerulonephritis. Here we investigated the fact that transfected galectin-1 significantly suppressed the transcription of alpha2(I) collagen (COL1A2) in TGF-beta1- activated human renal epithelial cells. Conversely, galectin-1 silencing RNA reduced secretion of type I collagen by HKC cells. Galectin-1 significantly decreased activation of a TGF-beta1-responsive reporter construct and of a minimal reporter construct that contains four repeats of the Smad binding element (SBE). Galectin-1 had no effect on phosphorylation of Smad3 at the linker region and C-terminus, whereas it decreased affinity of Smad3 to the SBE. Additionally, the inhibitory effect of galectin-1 disappeared using a mutated reporter construct, 376 m-LUC, in which a potential Smad recognition site within the promoter is mutated. Taken together, the results suggest that galectin-1 decreases Smad3-complex from binding to the SBE, down-regulating transcription of COL1A2 in TGF-beta1-stimulated renal epithelial cells.

Diagnostic utility of waveform analysis of compound muscle action potentials for carpal tunnel syndrome

PURPOSE

To determine the diagnostic utility of waveform analysis of compound muscle action potentials (CMAP) for carpal tunnel syndrome (CTS).

METHODS

A total of 131 hands in 71 patients diagnosed with CTS (grouped according to severity) and 80 hands in 44 normal subjects were evaluated using nerve conduction test through the carpal tunnel combined with waveform analysis of CMAP.

RESULTS

Compared to normal subjects, the sensory nerve conduction velocity and mean frequency of the CMAP waveform were significantly reduced in patients with CTS. Compared with distal motor latency and sensory nerve conduction velocity, the mean frequency of the CMAP decreased significantly with increasing clinical severity.

CONCLUSION

This study suggests that waveform analysis of CMAP is of diagnostic value in CTS, and is also of value in objective evaluation of postoperative recovery of carpal median nerve dysfunction.

Spinal reconstruction for symptomatic thoracic haemangioma using a titanium cage

Most vertebral haemangiomas are asymptomatic. A case of spinal reconstruction for symptomatic extraosseous thoracic haemangioma using a titanium cage is reported. Radiographs of the T11 vertebra demonstrated characteristic vertical striations. Magnetic resonance imaging and computed tomography showed spinal cord compression by extraosseous tumour extension. Several tumour feeding vessels were shown by angiography. Through a transpedicular biopsy, a histological diagnosis of cavernous haemangioma was made. Embolisation of feeding vessels was performed using coils before surgery. Laminectomy and subtotal vertebrectomy were performed by a single posterior approach. Rigid stabilisation of the spine was achieved with pedicle screw systems and a cage filled with an autogenous bone graft. Five months postoperatively, stabilisation of the spine was established without loosening of the cage or pedicle screws. Clinical symptoms were improved.

Role for central ghrelin in food intake and secretion profile of stomach ghrelin in rats

Ghrelin, a 28-amino-acid peptide, has recently been isolated from the rat stomach as an endogenous ligand for the GH secretagogue receptor. We have reported previously that central or peripheral administration of ghrelin stimulates food intake, and the secretion of GH and gastric acid in rats. In the present study, we investigated how much endogenous centrally released ghrelin is involved in the control of food intake and body weight gain. We also examined the profile of ghrelin secretion from the stomach by RIA using two kinds of anti-ghrelin antiserum, one raised against the N-terminal ([Cys(12)]-ghrelin[1-11]) region and one raised against the C-terminal ([Cys(0)]-ghrelin [13-28]) region of the peptide. The former antibody recognizes specifically ghrelin with n- octanoylated Ser 3 (acyl ghrelin), and does not recognize des-acyl ghrelin. The latter also recognizes des-acyl ghrelin (i.e. total ghrelin). Intracerebroventricular treatment with the anti-ghrelin antiserum against the N-terminal region twice a day for 5 days decreased significantly both daily food intake and body weight. Des-acyl ghrelin levels were significantly higher in the gastric vein than in the trunk. Either fasting for 12 h, administration of gastrin or cholecystokinin resulted in increase of both acyl and des-acyl ghrelin levels. The ghrelin levels exhibited a diurnal pattern, with the bimodal peaks occurring before dark and light periods. These two peaks were consistent with maximum and minimum volumes of gastric content respectively. These results suggest that (1) endogenous centrally released ghrelin participates in the regulation of food intake and body weight, (2) acyl ghrelin is secreted from the stomach, (3) intestinal hormones stimulate ghrelin release from the stomach, and (4) regulation of the diurnal rhythm of ghrelin is complex, since ghrelin secretion is augmented under conditions of both gastric emptying and filling.

Ghrelin in neonatal rats: distribution in stomach and its possible role

Ghrelin, a 28 amino acid peptide, has recently been isolated from the rat stomach as an endogenous ligand for the GH secretagogue receptor. The fact that administration of ghrelin, centrally or peripherally, stimulates both food intake and GH secretion suggests that stomach ghrelin has an important role in the growth of rats. We used immunohistochemistry and radioimmunoassay to determine the age at which ghrelin-immunostained cells begin to appear in the rat stomach. Ghrelin-immunoreactive cells were found to be expressed in the fetal stomach from pregnancy day 18. The number of ghrelin-immunoreactive cells in the fetal stomach increased as the stomach grew. The amount of ghrelin in the glandular part of the rat stomach also increased, in an age-dependent manner, from the neonatal stage to adult. Eight hours of milk restriction significantly decreased the ghrelin concentration in the stomachs of 1-week-old rats, and increased the ghrelin concentration in their plasma. Administration of ghrelin to 1- and 3-week-old rats increased plasma GH concentrations. The daily subcutaneous administration of ghrelin to pregnant rats from day 15 to day 21 of pregnancy caused an increase in body weight of newborn rats. In addition, daily subcutaneous administration of ghrelin to neonatal rats from birth advanced the day of vaginal opening from day 30.7+/-0.94 to day 27.9+/-0.05. These results suggest that ghrelin may be involved in neonatal development.

Stable isotope-labeling studies on the oxidative coupling of caffeic acid via o-quinone

The formation of ortho-quinone from ortho-diphenol is a key step in its dimerization. An NMR analysis of the oxidation of 3,4-dihydroxycinnamic acid (caffeic acid) by NaIO4 revealed the formation of 3-(3',4'-dioxo-1',5'-cyclohexadienyl) propenoic acid (o-quinone) prior to the formation of furofuran-type lignan 4,8-exo-bis (3,4-dihydroxyphenyl)-3,7-dioxabicyclo[3.3.0]octane-2,6-dione. Both electrolytic and enzymatic oxidation of caffeic acid also generated o-quinone. The yields of o-quinone from caffeic acid were quantified by NMR and HPLC analyses. A stable isotope-labeling study of the formation of lignans directly proved the random radical coupling of semiquinone radicals formed from a set of caffeic acid and o-quinone.

Salt-loading elevates blood pressure and aggravates insulin resistance in Wistar fatty rats: a possible role for enhanced Na+ -H+ exchanger activity

OBJECTIVE

Increased Na+-H+ exchanger activity (NHE) has been reported as an intermediate phenotype in hypertensive subjects, particularly those with insulin resistance. To investigate whether NHE abnormality plays a role in hypertension, Wistar fatty rat (WFR) with overt obesity, hyperglycemia and marked hyperinsulinemia was examined.

METHODS

WFR and Wistar lean rats (WLR) as a control (n = 12, each) were fed either with normal (0.38%) or high sodium (4% NaCl) diet for 12 weeks and then sacrificed to examine platelets NHE activity.

RESULTS

Mean arterial pressure (MAP) was higher in WFR than in WLR (113 +/- 4 versus 96 +/- 7 mmHg, P < 0.05) under a normal chow. Vmax values of NHE activity were significantly higher in WFR than in WLR. WFR fed with a high sodium diet showed higher MAP than those with a normal chow (128 +/- 3 versus 113 +/- 4 mmHg, P < 0.05). Though Km values were not different between WFR and WLR under a normal chow, both maximal transport rate (Vmax) and half maximal transport (Km) values were significantly higher in WFR with a high salt diet than those with a control diet. Vmax showed significant correlation with MAP, whereas Km values correlated with immunoreactive insulin (IRI) levels. Significant interaction between dietary sodium intake and the strain differences was observed both on blood pressure and on IRI levels by two-way analysis of variance (ANOVA).

CONCLUSION

WFR presented salt-sensitive blood pressure elevation. NHE activity was enhanced in WFR in correlation with the blood pressure. These results suggest that augmented NHE activity contributes to the development of salt-sensitive blood pressure elevation in WFR.

Electrophysiological course of uraemic neuropathy in haemodialysis patients

The objective of this study was to confirm electrophysiologically both the presence and course of uraemic neuropathy in haemodialysis patients. Nerve conduction studies of the lower extremities were done in 70 haemodialysis patients and 20 normal volunteers. Compared with that in normal volunteers, the distal motor latency in the tibial nerve of patients was prolonged significantly (p<0.05), and the minimal F wave latency in the tibial nerve was also prolonged significantly (p<0.05). Motor conduction velocity in the tibial nerve was reduced significantly (p<0.05), and sensory nerve conduction velocity in the medial plantar nerve also was reduced significantly (p<0.05). These results suggest the presence of uraemic neuropathy in haemodialysis patients. Twenty patients were investigated by a follow up study five years later. Parameters from F wave conduction studies, which were thought to be the most useful in the evaluation of neuropathy, showed no significant differences between the initial and follow up trials. These observations suggest that uraemic neuropathy does not progress during haemodialysis. These results also suggest that most haemodialysis patients showed electrophysiological evidence of uraemic neuropathy, but no remarkable electrophysiological change in uraemic neuropathy during haemodialysis was recognised.

Ghrelin in domestic animals: distribution in stomach and its possible role

Ghrelin, a novel growth-hormone-releasing acylated peptide, was recently isolated from rat and human stomachs. In rat, peripheral or central administration of ghrelin stimulates the secretion of growth hormone (GH) from the pituitary gland. Recent work suggests that ghrelin plays an important role in energy homeostasis, body weight, and food intake. We examined the distribution of cells immunoreactive to ghrelin in the stomachs of domestic animals and rats, using a polyclonal antibody for the N-terminal fragment of rat ghrelin [1-11]. We measured the plasma levels of ghrelin before and after feeding in cows, and GH levels after central administration of ghrelin in Shiba goats, to elucidate the possible role of ghrelin. Immunostained cells were widely distributed from the neck to the base of the oxyntic gland in all animals. The plasma ghrelin concentration in cows decreased significantly 1 h after feeding, and then recovered to pre-feeding levels. Administration of ghrelin into the third ventricle in Shiba goats dramatically increased the plasma GH concentration dose-dependently. These results suggest that ghrelin plays an important role in GH secretion and feeding regulation in domestic animals.

Estimation of cervical cord dysfunction by somatosensory evoked potentials

The purpose of this study was to examine the relationship of abnormal short-latency somatosensory evoked potentials (SSEPs) recorded by a noncephalic reference montage with clinical variables in cervical myelopathy patients and to reexamine the diagnostic utility of SSEPs in such patients. We studied cervical SSEPs elicited by stimulating the median and ulnar nerves in 87 patients. Our grade classification of spinal N13, which is based on the normal limits of latencies or amplitudes, corresponded well with the clinical variables and is of value when trying to localize the cervical lesion segmentally. The N9-P14 interpeak latency in response to ulnar nerve stimulation correlated well with lower extremity function (r = -0.440, P <0.0001). We suggest a combined assessment of N13 amplitude, and N9-N13 and N9-P14 interpeak latencies to estimate dorsal column and dorsal horn function separately in patients with cervical myelopathy.

Morphometric study of nucleus ambiguus in multiple system atrophy presenting with vocal cord abductor paralysis

AIM

To identify lesions responsible for vocal cord abductor paralysis (VCAP) in multiple system atrophy (MSA), we performed a morphometric study of the nucleus ambiguus which innervates the intrinsic laryngeal muscles.

METHODS

Two autopsied cases of MSA presenting with VCAP and one control were examined. Both cases of MSA showed selective neurogenic atrophy of the posterior cricoarytenoid muscles among the intrinsic laryngeal muscles, while no abnormalities were seen in the control. From a block of the medulla oblongata, sections 10 microm thickness were cut serially without spacing and stained with cresyl violet. The ambiguus neurons were counted in all the sections to make a histogram.

RESULTS

In the control case, ambiguus neurons showed densely populated areas and sparsely populated areas alternately with significant difference in the mean neuronal density between two areas. In MSA, ambiguus neurons were significantly decreased in number at all levels. It indicates that the neurogenic atrophy of the posterior cricoarytenoid muscle is derived from the neuronal loss of the nucleus ambiguus.

CONCLUSION

Though it has still been controversial whether or not the ambiguus neurons are decreased in number in MSA with VCAP, we speculated possible reasons for the disagreement on the involvement of the nucleus ambiguus as follows: different mechanism of VCAP are playing role, and histometric data have been disturbed by factors such as split-cell counting error and marked variation in the distribution of the ambiguus neurons.

Multipoint imprinting analysis in sporadic colorectal cancers with and without microsatellite instability

Disrupted imprinting is implicated in certain tumorigenesis. Since aberrant methylation has been described for a majority of microsatellite instability (MSI)-positive sporadic colorectal cancers, we have investigated alteration to the imprinting in 55 sporadic colorectal cancers with or without MSI. Loss of imprinting (LOI) of IGF2 and PEG1/MEST was observed in 42% and 35% of informative cancers, respectively. H19 expression was not detected in 24% of informative cancers. SNRPN and NDN retained monoallelic expression in all the cancers examined. These findings indicate no simultaneous disruption of the imprinted genes. LOI of IGF2 and PEG1/MEST was also observed in colorectal mucosa from almost all the patients with LOI in tumor tissue. Moreover, MSI-positive colorectal cancers exhibit LOI of IGF2 with a high frequency compared to MSI-negative cancers (P=0.013). These observations, consistent with a previous report, establish an association between LOI of IGF2 and MSI in colorectal cancers and provide insight into susceptibility of tumor development.

Auditory P50 obtained with a repetitive stimulus paradigm shows suppression to high-intensity tones

We manipulated stimulus intensity and number of frequency bands in auditory stimuli in order to investigate the nature of P50 in human auditory evoked potentials. Pure-tone and mixed-tone conditions were examined. For each condition, four stimulus intensities were used: 55, 70, 85 and 100 dB sound pressure level (SPL). The P50s were obtained at Cz using a repetitive stimulus paradigm. P50 amplitudes increased as stimulus intensities increased up to 85 dB; with 100 dB stimulation amplitudes decreased. The number of frequency bands in the stimulus did not affect P50 amplitude. Considered in terms of P50 suppression under a conditioning/testing paradigm, the results suggest that the P50 wave reflects activity of the sensory gating mechanism in humans.

[Improvement of obstructive sleep apnea by uvulopalatopharyngoplasty and tonsillectomy in a case of Duchenne muscular dystrophy]

A 10-year-old boy with Duchenne muscular dystrophy (DMD) underwent uvulopalatopharyngoplasty and tonsillectomy for obstructive sleep apnea (OSA). He has snored loudly during nocturnal sleep since infancy, and OSA developed one and a half years after he was wheel chair-bound at 8 years. Magnetic resonance imaging (MRI), conventional spirometry and overnight polysomnography were performed before and after the surgery. MRI before surgery revealed moderate tonsillar hypertrophy and a long uvula which narrowed the upper airway. After the surgery, his vital capacity (VC) was not changed (% VC; from 77 to 78%), but forced expiratory volume (FEV) was improved (FEV 1.0%; from 75 to 86%). A preoperative apnea index of 32.8/hour decreased to 0.8/hour postoperatively. REM-related falls in HbSaO2 improved remarkably. The present case suggests that subjects with DMD with tonsillar hypertrophy and a redundant uvula tend to develop noctrurnal OSA earlier than DMD cases with a normal tonsil and uvula. Assessment of respiratory function, particularly FEV 1.0%, is important for determining surgical indication of OSA in patients with DMD.