Chloroquine Treatment Suppresses Mucosal Inflammation in a Mouse Model of Eosinophilic Chronic Rhinosinusitis

PURPOSE

The Toll-like receptor 9 (TLR9) signaling pathway is involved in the pathogenesis of chronic rhinosinusitis (CRS) with nasal polyposis. The aim of this study was to assess the therapeutic potential of the TLR9 pathway inhibitor chloroquine in CRS mice.

METHODS

The expression of type I interferons (IFNs) in human CRS tissues was evaluated using quantitative polymerase chain reaction (qPCR), western blotting, and immunofluorescence. Mice were divided into 4 treatment groups: the control, nasal polyp (NP), chloroquine treatment (NP + Chlq), and dexamethasone treatment (NP + Dexa) groups. The effects of chloroquine on polyp formation and mucosal inflammation were examined by hematoxylin and eosin staining. The expression levels of type I IFN, B-cell activating factor (BAFF), TLR9, high mobility group box 1 (HMGB1), and proinflammatory cytokine expression levels were assessed using qPCR, western blot, or enzyme-linked immunosorbent assay.

RESULTS

IFN-α and IFN-β mRNA levels were significantly higher in patients with eosinophilic NPs (EPs) than in healthy individuals or non-EP patients. The polyp score, epithelial thickness, mucosal thickness, and the number of eosinophils in nasal mucosa were significantly higher in the NP group compared with the control, NP + Chlq, and NP + Dexa groups. NP + Chlq or NP + Dexa significantly suppressed the induction of type I IFN and BAFF expression in the NP group; these treatments also significantly suppressed the induction of TLR9, HMGB1, interferon regulatory factors, interleukin (IL)-6, IL-1β, tumor necrosis factor-α, and Th cytokine expression in the NP group. The secreted levels of anti-dsDNA Immunoglobulin G (IgG) were significantly higher in the NP group than in the control, NP + Chlq, and NP + Dexa groups. There were significant positive correlations between BAFF and mRNA levels of IFN-α/β/the protein levels of anti-dsDNA IgG.

CONCLUSIONS

Chloroquine may be used for the treatment of patients with eosinophilic CRS.

Altered Mitochondrial Functions and Morphologies in Epithelial Cells Are Associated With Pathogenesis of Chronic Rhinosinusitis With Nasal Polyps

Purpose

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory disease of the nasal and paranasal sinus mucosa. The disease is associated with mitochondrial dysfunction, structural changes in the mitochondria, and reactive oxygen species (ROS) generation. This study investigated whether there are functional and morphological changes in the mitochondria in the epithelial cells of nasal polyps (NPs) and Staphylococcus aureus enterotoxin B (SEB)-stimulated nasal epithelial cells.

Methods

In all, 30 patients with CRSwNP and 15 healthy subjects were enrolled. Mitochondrial ROS (mtROS) and changes in mitochondrial functions and structures were investigated in the uncinate tissue (UT) of healthy controls, the UT or NPs of CRSwNP patients, and human nasal epithelial cells with or without SEB stimulation.

Results

Oxidative phosphorylation complexes showed various responses following SEB stimulation in the nasal epithelial cells, and their expressions were significantly higher in the NPs of patients with CRSwNP than in the UT of controls. Generation of mtROS was increased following SEB exposure in nasal epithelial cells and was reduced by pretreatment with MitoTEMPO, which is used as an mtROS scavenger. In the tissues, mtROS was significantly increased in the NPs of CRSwNP patients compared to the UT of controls or CRSwNP patients. The expressions of fusion- and fission-related molecules were also significantly higher in SEB-exposed nasal epithelial cells than in non-exposed cells. In tissues, the expression of fission (fission mediator protein 1)- and fusion (membrane and mitofusin-1, and optic atrophy protein 1)-related molecules was significantly higher in the NPs of CRSwNP patients than in UT of controls or CRSwNP patients. Transmission electron microscopy revealed elongated mitochondria in SEB-exposed nasal epithelial cells and epithelial cells of NPs.

Conclusions

Production of mtROS, disrupted mitochondrial function, and structural changes in nasal epithelial cells might be involved in the pathogenesis of CRSwNP.

Abstract P3-09-02: CRISPR-Cas9 mediated BRCA1 mutation in primary cells: Mutation efficiency and effects

Background: Germline mutations in Breast Cancer Associated (BRCA) 1 or 2 genes confer an increased risk of the development of breast and ovarian cancer. Germline mutation is followed by somatic loss of heterozygosity (LOH) resulting in biallelic inactivation. BRCA1 is involved in multiple homeostatic functions including control of chromatin organization, gene transcription, protein stability and cell division. Recent studies have demonstrated heterogeneity in LOH within and between premalignant and malignant breast tissues of BRCA1 mutation carriers. We hypothesize that LOH does not have a unitary effect on phenotype but differs by the function that is abrogated.

Methods: To test our hypothesis, we adopted CRISPR-Cas9 gene editing technology. The guide RNAs for targeting the exon sequence in the RING finger, nuclear export signal (NES), nuclear localization signal (NLS) and BRCA1 C Terminus (BRCT) domain/motif of BRCA1 were designed and synthesized. MCF10A cells were transfected with a complex of guide RNA and Cas9 protein (RNP) to cause in/del mutation. The mutation was analyzed by both T7E1 assay, and an innovative and more precise method developed in our lab that utilizes linked nucleic acids (LNA) and qPCR. Proliferation and apoptosis assays were performed using the transfected cells. Organoids prepared from BRCA1 mutation carriers also were transfected with RNPs and the mutation burden determined.

Results: Since single cell clones of the transfected MCF10A cells could not be selected and expanded, a pool of transfected cells was used for the analyses. T7E1 assay and qPCR analysis using LNAs demonstrated the presence of the mutations. A standard curve was created to enable the calculation of the mutation burden. IncuCyte analysis revealed increased proliferation and apoptosis, induced by irradiation, in cells with the mutation in Exon 10, where the extent of increase varied from 11% to 48% depending on the degree of mutation. In contrast, cells with the mutation in Exon 5 displayed diminished proliferation with no change in apoptosis. That mutations in exon10 and 5 have distinct biological effects when compared to the mutations in other exons is intriguing, and modification of binding proteins will be investigated. Organoids generated from BRCA1 mutation carriers (primary and nonmalignant cells) were able to be successfully transfected using the NEON electroporation system. Mutations were introduced by the CRISPR-Cas9 system and their extent quantified by our LNA-mediated qPCR method.

Conclusions: CRISPR-Cas9-mediated gene editing of BRCA1 in MCF10A resulted in a change in the proliferation rate and the extent of apoptosis that is dependent on the location of the de novo mutation within the gene. The development of a novel method, LNA-mediated qPCR, provides quantitative information regarding the mutations that may be used to correlate mutation burden with biological functional change. Successful establishment of this BRCA1 tumorigenesis model has provided us with a method to test other putative tumor suppressors.

Citation Format: Choi MR, Yadav S, Shidfar A, Khan SA, Clare SE. CRISPR-Cas9 mediated BRCA1 mutation in primary cells: Mutation efficiency and effects [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-09-02.

Adverse effects of tempol on hidrosaline balance in rats with acute sodium overload

We studied the effects of tempol, an oxygen radical scavenger, on hydrosaline balance in rats with acute sodium overload. Male rats with free access to water were injected with isotonic (control group) or hypertonic saline solution (0.80 mol/l NaCl) either alone (Na group) or with tempol (Na-T group). Hydrosaline balance was determined during a 90 min experimental period. Protein expressions of aquaporin 1 (AQP1), aquaporin 2 (AQP2), angiotensin II (Ang II) and endothelial nitric oxide synthase (eNOS) were measured in renal tissue. Water intake, creatinine clearance, diuresis and natriuresis increased in the Na group. Under conditions of sodium overload, tempol increased plasma sodium and protein levels and increased diuresis, natriuresis and sodium excretion. Tempol also decreased water intake without affecting creatinine clearance. AQP1 and eNOS were increased and Ang II decreased in the renal cortex of the Na group, whereas AQP2 was increased in the renal medulla. Nonglycosylated AQP1 and eNOS were increased further in the renal cortex of the Na-T group, whereas AQP2 was decreased in the renal medulla and was localized mainly in the cell membrane. Moreover, p47-phox immunostaining was increased in the hypothalamus of Na group, and this increase was prevented by tempol. Our findings suggest that tempol causes hypernatremia after acute sodium overload by inhibiting the thirst mechanism and facilitating diuresis, despite increasing renal eNOS expression and natriuresis.

Abstract OT1-02-10: A phase 2 study of poziotinib in patients with HER2-positive metastatic breast cancer (MBC) who have received prior HER2 regimens for MBC

Background: Poziotinib is a novel, oral, quinazoline-based pan-HER inhibitor that irreversibly blocks signaling through the epidermal growth factor receptor (EGFR) family of tyrosine-kinase receptors, including EGFR (HER1/ErbB1/EGFR), HER2 (ErbB2), and HER4 (ErbB4), as well as HER receptor mutations. This, in turn, leads to inhibition of the proliferation of tumor cells that overexpress these receptors. It is well established that breast cancers are associated with a mutation in, or overexpression of, members of the EGFR receptor family. The primary objective of this Phase 2 study is to evaluate the Objective Response Rate (ORR) of poziotinib in patients with human epidermal growth factor receptor 2 (HER2)-positive MBC. The secondary efficacy variables are Progression-Free Survival (PFS), Disease Control Rate (DCR), Overall Survival (OS), and Time to Progression (TTP).

Trial Design: This is a Phase 2, open-label, multicenter study to evaluate the efficacy, safety and tolerability of poziotinib in patients with HER2-positive MBC who have received at least 2 prior HER2- directed treatment regimens. Each treatment cycle is 21 days in duration. During each cycle, eligible patients receive 24 mg of poziotinib orally (as three 8-mg tablets) once daily for 14 days, followed by a 7 day treatment-free period.

Eligibility Criteria: Eligible patients are at least 18 years of age, have confirmed HER2 overexpression, adequate hematologic, renal and hepatic function, and have received at least 2 prior HER2-directed therapy regimens, including trastuzumab and trastuzumab emtansine (TDM-1). Patients are excluded if they have prior exposure to poziotinib, a history of congestive heart failure, left ventricular ejection fraction <50%, unable to take oral medications, or have conditions that cause malabsorption. A 30 day wash out period from previous chemotherapeutic or radiation therapies is required.

Statistical Methods: The purpose of this study is to evaluate the efficacy of poziotinib compared to the efficacy of other standard HER2-positive breast cancer treatments as reported in the literature. The ORR will be analyzed descriptively along with the 95% CI. The secondary efficacy variables will be analyzed descriptively.

Target Accrual: Approximately 70 patients. Enrollment began February 2016.

Contact Information: For more information or to refer a patient,

email: spi-poz-201@sppirx.com or fax: 1-949-398-9711.

Citation Format: Lathrop K, Lucas J, Vacirca JL, Bhat G, Choi MR, Naughton M. A phase 2 study of poziotinib in patients with HER2-positive metastatic breast cancer (MBC) who have received prior HER2 regimens for MBC [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-02-10.

Abstract P5-11-09: Sustained efficacy of eflapegrastim in breast cancer patients in a phase 2, open-label, dose-ranging study

Background: Eflapegrastim is a distinct biologic that uses the innovative proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™) and consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker. A Phase 2 study of 3 doses of eflapegrastim vs pegfilgrastim was conducted in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy.

Methods: This was an open-label, global, multicenter, dose-ranging study designed to compare the safety and efficacy of eflapegrastim relative to a fixed dose of pegfilgrastim as a concurrent active control. The study included 4 treatment arms: 3 dose levels of eflapegrastim (45 μg/kg, 135 μg/kg, and 270 μg/kg) vs pegfilgrastim (6 mg). The primary objective of the study was the Duration of Severe Neutropenia (DSN) during Cycle 1. The results for the primary objective, along with demographics and safety, were described in a previous presentation (SABCS 2015 P1-10-05). The secondary endpoints included DSN in Cycles 2-4, absolute neutrophil count (ANC) in Cycles 1-4, the overall incidences of febrile neutropenia (FN) and hospitalization rates.

Results: A total of 147 evaluable patients were enrolled. Patient and tumor characteristics were comparable across all 4 treatment arms. Median age was 59.0 years (range 32 to 77 years); most patients were <65 years (68%), Female (98%), and White (95%). The DSN for the 135 µg/kg and 270 µg/kg was non-inferior to pegfilgrastim during all cycles and the DSN for patients treated with 45 µg/kg was non-inferior during Cycles 2 and 3 (Table 1). The ANC was dose proportional across all 4 cycles. The incidence of FN and hospitalization rates was low in all arms and there were no significant differences between the Eflapegrastim and Pegfilgrastim Arms (Table 2).

Table 1. Duration of Severe Neutropenia in Cycles 2 to 4 of TC Chemotherapy by Treatment ArmDSN (Days)Eflapegrastim 45 μg/kg (N=39)Eflapegrastim 135 μg/kg (N=36)Eflapegrastim 270 μg/kg (N=36)Pegfilgrastim 6 mg (N=36)Cycle 2Difference with pegfilgrastim0.380.04-0.05NANon-Inferiority p-value0.001<0.001<0.001NACycle 3Difference with pegfilgrastim0.310.020.01NANon-Inferiority p-value0.002<0.001<0.001NACycle 4Difference with pegfilgrastim0.940.07-0.02NANon-Inferiority p-value0.781<0.001<0.001NADSN = Duration of Severe Neutropenia; NA = Not Applicable

Table 2. Incidence of Febrile Neutropenia and Hospitalizations Eflapegrastim 45 μg/kg (N=39)Eflapegrastim 135 μg/kg (N=36)Eflapegrastim 270 μg/kg (N=36)Pegfilgrastim 6 mg (N=36)Febrile NeutropeniaIncidence (%)3 (7.7%)1 (2.8%)1 (2.8%)2 (5.6%)Difference with Pegfilgrastim2.1 %-2.8%-2.8%NAp-value1.0001.0001.000NAHospitalizationsIncidence (%)3 (7.7%)3 (8.3%)1 (2.8%)5 (13.9%)Difference with Pegfilgrastim-6.2%-5.6%-11.1%NAp-value0.4690.7100.199NA

Conclusions: In breast cancer patients treated with TC, the non-inferiority of DSN of 135 µg/kg and 270 µg/kg eflapegrastim, compared to pegfilgrastim in Cycle 1, was sustained through Cycles 2-4 and the ANC profiles were comparable in Cycles 1-4. In addition, the overall incidence of FN and hospitalizations was comparable between the eflapegrastim arms and the pegfilgrastim arm.

Citation Format: Vacirca JL, Agajanian R, Papai Z, Horvath Z, Makharadze R, Ibrahim EN, Choi MR, Song T, Tedesco KL, McGregor K, Schwartzberg LS. Sustained efficacy of eflapegrastim in breast cancer patients in a phase 2, open-label, dose-ranging study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-09.

Abstract OT1-01-11: Randomized phase 3 study of a novel, long-acting G-CSF (eflapegrastim) versus pegfilgrastim in the management of chemotherapy-induced neutropenia in early-stage breast cancer patients receiving docetaxel and cyclophosphamide (TC) (ADVANCE study)

Background: Eflapegrastim is a distinct biologic that uses an innovative, proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™). Eflapegrastim consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker to produce a new, longer-acting G-CSF with a potentially unique distribution to areas rich in Fc receptors including its site of action in the bone marrow. A successful dose-finding Phase 2 trial including a pegfilgrastim control arm established the dose for a Phase 3 non-inferiority trial.

Trial Design: This is a randomized, open-label, active-controlled, multinational, multicenter, Phase 3 study comparing the efficacy and safety of eflapegrastim to pegfilgrastim. Patients (n=580) will be randomized in a 1:1 ratio to receive either eflapegrastim (equivalent to 3.6 mg G-CSF) or pegfilgrastim (equivalent to 6.0 mg G-CSF) once per chemotherapy cycle (up to 4 cycles), approximately 24 hours after chemotherapy. The primary endpoint is to compare the efficacy of a single dose of eflapegrastim with pegfilgrastim in patients with ESBC receiving TC, as measured by the Duration of Severe Neutropenia (DSN) in Cycle 1. Key secondary objectives include Time to Absolute Neutrophil Count (ANC) Recovery in Cycle 1; Depth of ANC Nadir in Cycle 1; incidence of Febrile Neutropenia. Safety and pharmacokinetics will also be assessed.

Eligibility Criteria: This study is enrolling histologically confirmed ESBC patients who are: eligible to receive adjuvant or neoadjuvant TC chemotherapy; at least 18 years of age, with adequate hematologic, renal and hepatic function. Patients will be excluded if they have: active concurrent malignancy or life-threatening disease; a known sensitivity or previous reaction to E. coli derived products or any of the products to be administered during study participation; concurrent adjuvant cancer therapy; locally recurrent/metastatic or contralateral breast cancer; previous exposure to filgrastim, pegfilgrastim, or other G-CSF products in clinical development prior to the administration of study drug; bone marrow or hematopoietic stem cell transplant or radiation therapy prior to enrollment, or are pregnant or breast-feeding.

Statistical Methods: The goal of this study is to demonstrate non-inferiority. For the Primary Efficacy Analysis, the mean DSN in Cycle 1 will be compared between the eflapegrastim and pegfilgrastim treatment arms. A 2-sided 95% confidence interval (CI) of the difference between the mean DSN of the eflapegrastim arm and the mean DSN of the pegfilgrastim arm will be calculated using bootstrap resampling with treatment as the only stratification factor. For the Secondary Efficacy Analyses, the results will each be summarized by treatment arm and cycle. The two-sided 95% CI for the difference between the treatment arms will be calculated.

Target Accrual: Approximately 580 patients. Enrollment began January 2016.

Contact Information: Spectrum Pharmaceuticals. advance@sppirx.com.

Citation Format: Schwartzberg LS, Bharadwaj J, Peguero JA, Vacirca JL, Ibrahim EN, Bhat G, Choi MR, McGregor K, Agajanian R. Randomized phase 3 study of a novel, long-acting G-CSF (eflapegrastim) versus pegfilgrastim in the management of chemotherapy-induced neutropenia in early-stage breast cancer patients receiving docetaxel and cyclophosphamide (TC) (ADVANCE study) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-01-11.

Abstract OT3-02-13: Randomized phase 3 study of a novel, long-acting G-CSF (SPI-2012) versus pegfilgrastim in the management of chemotherapy-induced neutropenia in early-stage breast cancer patients receiving docetaxel and cyclophosphamide (TC) (ADVANCE study)

Background: SPI-2012 is a distinct biologic that uses the innovative, proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™) to enhance the activity of G-CSF. SPI-2012 consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker to produce a new, more potent, longer-acting G-CSF with a potentially unique distribution to areas rich in Fc receptors. The primary endpoint of this Phase 3 study is to compare the efficacy of a single dose of SPI-2012 with pegfilgrastim in patients with early-stage breast cancer (ESBC) receiving TC chemotherapy, as measured by the Duration of Severe Neutropenia (DSN) in Cycle 1. Key secondary objectives include the comparison of SPI-2012 with pegfilgrastim during Cycle 1 in: Time to Absolute Neutrophil Count (ANC) Recovery; Depth of ANC Nadir and Incidence of Febrile Neutropenia. Safety and pharmacokinetics will also be assessed.

Trial Design: This is a randomized, open-label, active-controlled, multicenter study comparing the efficacy and safety of SPI-2012 to pegfilgrastim. Patients (n=506) will be randomized in a 1:1 ratio to receive either SPI-2012 (equivalent to 3.6 mg G-CSF) or pegfilgrastim (equivalent to 6.0 mg G-CSF) once per chemotherapy cycle (up to 4 cycles), approximately 24 hrs after chemotherapy.

Eligibility Criteria: This study will enroll histologically confirmed ESBC patients who are eligible to receive adjuvant or neoadjuvant TC chemotherapy and at least 18 years of age, with adequate hematologic, renal and hepatic function. Patients will be excluded if they have active concurrent malignancy or life-threatening disease; a known sensitivity or previous reaction to E. coli derived products or any of the products to be administered during study participation; concurrent adjuvant cancer therapy; locally recurrent/metastatic or contralateral breast cancer; previous exposure to filgrastim, pegfilgrastim, or other G-CSF products in clinical development prior to the administration of study drug; bone marrow or hematopoietic stem cell transplant or radiation therapy prior to enrollment or are pregnant or breast-feeding.

Statistical Methods: The goal of the study is to demonstrate non-inferiority of SPI-2012 to pegfilgrastim. For the Primary Efficacy Analysis, the mean DSN in Cycle 1 will be compared between the SPI-2012 and pegfilgrastim treatment arms. A 2-sided 95% confidence interval (CI) of the difference between the mean DSN of the SPI-2012 arm and the mean DSN of the pegfilgrastim arm will be calculated using bootstrap resampling with treatment as the only stratification factor. For the Secondary Efficacy Analyses, the results will each be summarized by treatment arm and Cycle. The two-sided 95% CI for the difference between the treatment arms will be calculated.

Target Accrual: Approximately 506 pts.

Citation Format: Schwartzberg L, Vacirca JL, Hager SJ, Adoo CS, Ibrahim EN, Bhat G, Choi MR, Allen LF, Tedesco KL, Agajanian R. Randomized phase 3 study of a novel, long-acting G-CSF (SPI-2012) versus pegfilgrastim in the management of chemotherapy-induced neutropenia in early-stage breast cancer patients receiving docetaxel and cyclophosphamide (TC) (ADVANCE study). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-13.

Abstract P1-10-05: Randomized phase 2, open-label, dose-ranging study of a novel, long-acting G-CSF (SPI-2012) or pegfilgrastim for the management of neutropenia in patients with breast cancer (BC) treated with (Neo) adjuvant chemotherapy with docetaxel + cyclophosphamide (TC)

Background: SPI-2012 is a distinct biologic that uses the innovative proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™) to enhance the activity of G-CSF. SPI-2012 consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker to produce a new, more potent, longer-acting G-CSF with a potentially unique distribution to areas rich in Fc receptors. To assess the effect of SPI-2012 in supporting patients with breast cancer receiving myelosuppressive chemotherapy with TC, we conducted a randomized Phase 2 study of 3 SPI-2012 doses versus pegfilgrastim.

Methods: This was an open-label, global, multicenter, dose-ranging study designed to compare the safety and efficacy of SPI-2012 relative to a fixed, standard dose of pegfilgrastim as a concurrent active control. The study included 4 treatment arms: 3 dose levels of SPI-2012 (45 μg/kg, 135 μg/kg, and 270 μg/kg) vs pegfilgrastim (6 mg,). The primary objective of the study was the Duration of Severe Neutropenia (DSN) during Cycle 1 in patients with BC who received adjuvant or neoadjuvant TC chemotherapy.

Results: A total of 147 evaluable patients were enrolled. Patient and tumor characteristics were comparable across all 4 treatment arms. Mean age was 58.2 years (range 32 to 77 years); most patients were <65 years (68%), female (98%) and white (95%). The study met its primary endpoint with DSN in patients treated in the 135 µg/kg and 270 µg/kg SPI-2012 treatment arms in Cycle 1 showing non-inferiority to the DSN in patients treated with pegfilgrastim (p=0.002 and p<0.001, respectively). In addition, superiority was demonstrated in patients treated with 270 µg/kg SPI-2012 compared to pegfilgrastim (p=0.023). Non-inferiority in DSN was also observed in Cycles 2 to 4 in both the 135 µg/kg and 270 µg/kg SPI-2012 treatment arms compared to pegfilgrastim.

Duration of Severe Neutropenia in Cycle 1 of TC chemotherapy by Treatment Arm  45 μg/kg SPI-2012 (N=39) 135 μg/kg SPI-2012 (N=36) 270 μg/kg SPI-2012 (N=36)Pegfilgrastim (N=36)DSN Mean (SD)(days)1.03 (1.5)0.44 (1.3)0.03 (0.2)0.31 (0.8)Difference with pegfilgrastim0.720.14-0.28NANon-inferiority p-value0.2960.002<0.001NASuperiority p-value0.0060.5280.023NASD=Standard Deviation; NA=Not Applicable

The common treatment-emergent adverse events observed in ≥20% of patients were similar across all 4 study arms with similar or lower incidence in the SPI-2012 treatment arms, and included fatigue, nausea, alopecia, diarrhea, and bone pain.

Conclusions: All doses of SPI-2012 administered in this Phase 2 study were well tolerated, and no new or significant dose-related toxicities were observed. Most reported adverse events were mild and similar to those previously reported in clinical trials with filgrastim and pegfilgrastim in patients receiving myelosuppressive chemotherapy. In Cycle 1, the 135 µg/kg dose of SPI-2012 was non-inferior compared to pegfilgrastim, and the 270 µg/kg dose was superior in terms of DSN. Additional efficacy and safety data for SPI-2012 will be collected in planned Phase 3 clinical trials.

Citation Format: Vacirca JL, Chan A, Mezei K, Adoo CS, Papai Z, McGregor K, Okera M, Horvath Z, Landherr L, Hanslik J, Hager SJ, Ibrahim EN, Ghazal H, Rostom M, Bhat G, Choi MR, Allen LF, Tedesco KL, Agajanian R, Lang I. Randomized phase 2, open-label, dose-ranging study of a novel, long-acting G-CSF (SPI-2012) or pegfilgrastim for the management of neutropenia in patients with breast cancer (BC) treated with (Neo) adjuvant chemotherapy with docetaxel + cyclophosphamide (TC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-05.

PCDHB14- and GABRB1-like nervous system developmental genes are altered during early neuronal differentiation of NCCIT cells treated with ethanol

Ethanol (EtOH) exposure during embryonic development causes dysfunction of the central nervous system (CNS). Here, we examined the effects of chronic EtOH on gene expression during early stages of neuronal differentiation. Human embryonic carcinoma (NCCIT) cells were differentiated into neuronal precursors/lineages in the presence or absence of EtOH and folic acid. Gene expression profiling and pathway analysis demonstrated that EtOH deregulates many genes and pathways that are involved in early brain development. EtOH exposure downregulated several important genes, such as PCDHB14, GABRB1, CTNND2, NAV3, RALDH1, and OPN5, which are involved in CNS development, synapse assembly, synaptic transmission, and neurotransmitter receptor activity. GeneGo pathway analysis revealed that the deregulated genes mapped to disease pathways that were relevant to fetal alcohol spectrum disorders (FASD, such as neurotic disorders, epilepsy, and alcohol-related disorders). In conclusion, these findings suggest that the impairment of the neurological system or suboptimal synapse formation resulting from EtOH exposure could underlie the neurodevelopmental disorders in individuals with FASD.

Diagnostic value of CA125 as a predictor of recurrence in advanced ovarian cancer

PURPOSE

The aim of this study was to establish the guidelines for detecting early recurrences of advanced epithelial ovarian cancer by use of the CA-125 level.

MATERIALS AND METHODS

Eighty-five of the patients who met the inclusion criteria were enrolled in this study. The authors examined 25 incremental changes of CA125 from one to 25 IU/ml, and compared the CA-125 value with other prognostic factors. Increases in the CA-125 level from the nadir level were expressed as CA-125- increments.

RESULTS

Among the 25 increments, a CA-125-8 (eight IU/ml) was selected as the predictor that was the most efficient and time-effective. CA-125-8 had a sensitivity of 91.5%, a specificity of 84.6%, a positive predictive value of 93.1%, a negative predictive value of 81.5%, an efficiency of 89.4%. and a median lead-time of 68.5 days (p <0.0001).

CONCLUSION

The authors suggest the incremented CA-125-8 as a predictor of recurrent advanced ovarian cancer.

Abstract P1-15-01: Patterns of granulocyte colony stimulating factor (G-CSF) use in elderly breast cancer (BC) patients receiving myelosuppressive chemotherapy

Background: Febrile neutropenia (FN) is a common and potentially serious complication of myelosuppressive chemotherapy treatment in cancer patients. Oncology guidelines recommend primary G-CSF prophylaxis (PPG) in patients with a high risk of developing FN, which is risk &gt;20% based on myelotoxicity of the regimen itself or from a combination of the therapy, older age, comorbidities and disease characteristics (Lyman Cancer 2011). Current patterns of G-CSF use and FN occurrence among elderly patients receiving myelosuppressive chemotherapy for BC have not been previously reported. To determine this, we performed a retrospective analysis using a subset of the Medicare 5% database.

Methods: The Medicare 5% claims data set (includes a representative 5% systematic sample of Medicare beneficiaries) was used to identify BC patients age 65+ initiating chemotherapy between 7/1/2003 and 6/30/2009. Chemotherapy courses were identified for each patient; only the first course was used for this analysis. Using the National Comprehensive Cancer Network guidelines on Myeloid Growth Factors (NCCN V1.2012), chemotherapy course regimens were classified as high risk (HR) or intermediate risk (IR) for FN. Duration of first cycle was from date of first chemotherapy claim to the chemotherapy claim at day 21 or later, which defined the first day of the second cycle, etc., to a maximum of 9 cycles. First administration of G-CSF [filgrastim (NEUPOGEN®) or pegfilgrastim (Neulasta®)] was classified as either PPG (within first 5 days of first cycle), secondary prophylaxis (within first 5 days of second or subsequent cycles), or reactive (day 6 or later of first or subsequent cycles). FN assessed during the chemotherapy course was defined as hospitalization with a code for neutropenia in any position.

Results: 885 courses with high FN risk and 1046 with IR FN risk were identified. The HR cohort was younger (71.4 vs 74.5 yrs) and had fewer comorbidities than the IR cohort. Selected aspects of G-CSF use patterns are summarized in the table. Among HR courses, 11.8% had ≥1 FN hospitalization and 2.1% had 2+; among IR courses 5.6% had ≥1 and 0.4% had 2+.

Conclusion: NCCN recommends PPG be used with HR regimens and older age (notably &gt;65 yr), an important risk factor for developing severe neutropenic complications. Despite this, PPG was used for elderly breast cancer patients in only 52% of chemotherapy courses with high risk of FN and in 10% of IR courses. More than 10% of patients with a HR regimen had an FN hospitalization. Careful attention to FN risk factors, including regimen and patient age, is needed when planning treatment strategy.

P5-20-07: Estimation of Febrile Neutropenia in Women Receiving Docetaxel Plus Cyclophosphamide as Adjuvant Therapy for Early Stage Breast Cancer: A Retrospective Analysis

Background: US Oncology Trial 9735 (Jones S, et al. JCO. 2006;24:5381–5387) established the docetaxel plus cyclophosphamide (TC) regimen as an effective adjuvant therapy for early stage breast cancer (ESBC). This trial did not specifically evaluate the incidence of febrile neutropenia (FN) as a study endpoint, but rates of 4%-8% were reported. Prophylactic granulocyte colony-stimulating factor (G-CSF) support was not allowed; reactive G-CSF support overall was not reported. Subsequent reports in the community setting have indicated FN rates of 25%-50% without G-CSF support and 0%-6.3% with G-CSF support (Table 1). To better determine the incidence of FN among ESBC patients treated with TC, we performed a retrospective clinical data review from the electronic medical record (EMR) database of Georgia Cancer Specialists, a large community oncology practice.

Methods: EMR data were captured between January 2006 and March 2010. Eligibility included women ≥ 18 years old with ESBC (stage I-IIIA) who completed ≥ 1 cycle of TC. The study time period was from the first dose of chemotherapy (CTX) to 6 weeks after the last dose of CTX, death, or loss to follow-up. The primary endpoint was the incidence of FN. Other endpoints included the incidence of severe (grade 3/4) neutropenia, neutropenia-related hospitalizations, G-CSF use, relative dose intensity (RDI), and dose delays and reductions. Results: Data from 662 patients were included in the analysis. Median age was 55 (range: 25–81) years. 40% of patients were white. The median number of CTX cycles received was 4 (range: 1–6). Most patients (91%) received G-CSF support; 73% as primary prophylaxis. See Table 2 for additional results.

Conclusions: This is the largest retrospective, community-based study to evaluate the incidence of FN in ESBC patients treated with TC. The observed FN rate of 5% (with 91% of patients receiving G-CSF) is consistent with other published reports using TC (Table 1). Our results suggest that TC is a taxane regimen with clinically significant myelosuppression (similar to other commonly used regimens in ESBC, such as TAC [NCCN Guidelines v2.2011]) and that the use of G-CSF support should always be considered.

No evidence for increased skin cancer risk in Koreans with skin phototypes III-V treated with narrowband UVB phototherapy

Narrowband ultraviolet B (nbUVB) phototherapy is used around the world for the treatment of various skin diseases. However, the carcinogenic risk associated with nbUVB treatment in patients with skin phototypes III-V has not been studied. This retrospective study compared the incidence of skin cancer in Korean patients with skin phototypes III-V treated with nbUVB with that in a control Korean population. A total of 445 nbUVB-treated patients were followed for 1,274 person-years (mean follow-up period 34.4 months). No melanoma cases were detected during the follow-up period. How-ever, one patient developed basal cell carcinoma four months after the start of nbUVB phototherapy. For non-melanoma skin cancer, the expected number of cases was 0.059 and the standardized incidence ratio 17.0 (95% confidence interval 0.4-94.8). There were no statistically significant differences between the nbUVB and control groups. Thus, nbUVB phototherapy using TL-01 lamps seems to be a safe therapeutic modality for patients with skin phototypes III-V.

Abstract P3-15-02: Underreporting of Myelotoxicity with Emerging Breast Cancer Regimens

Background: Although many emerging regimens that incorporate targeted agents may produce increased myelosuppressive side-effects, clinical data guiding colony-stimulating factor (CSF) use with these regimens are not readily available. This review assessed the reporting diligence around febrile neutropenia and the related use of CSF and antibiotics in published clinical trials evaluating emerging regimens for breast cancer treatment.

Methods: We searched Medline, EMBASE, and Cochrane databases to identify randomized, controlled phase 3 breast cancer studies published between Jan 2005 and June 2009. After excluding trials of vaccines, hormonal therapy alone, and stem cell transplantation/mobilization, corresponding publications were retrieved and data extracted on the incidence of neutropenia and its complications and CSF/antibiotic use. We then calculated the percentage of these publications that reported each outcome.

Results: Of 463 trials identified from the search, only 73 met the inclusion criteria. Overall, 70% and 55% of trials reported the incidence of grade 3/4 neutropenia and febrile neutropenia, respectively (Table). Neutropenia-related hospitalizations were reported in 3% of trials. Prophylactic use of CSF and antibiotics was defined in the methods section of 59% and 23% of trials, respectively; and only reported in the results section of 22% and 5% of trials, respectively.

Conclusion: Clinically significant neutropenia and neutropenia-related events (including febrile neutropenia) were generally described in the studies evaluated; however, the reported use of CSF and/or antibiotics was infrequent and inconsistent in the published literature of emerging regimens. A standardized approach to reporting neutropenic outcomes as well as the use of supportive care measures can assist cliniciansto prospectively manage the relevant toxicities associated with these emerging regimens and thereby facilitate their safe and effective use in clinical practice.

Table: Reporting of myelotoxicity data in published phase 3 trials

CSF = colony-stimulating factor

Large nonlinear optical response of polycrystalline Bi3.25La0.75Ti3O12 ferroelectric thin films on quartz substrates

We measure the nonlinear susceptibility of Bi(3.25)La(0.75)Ti(3)O(12) (BLT) thin films grown on quartz substrates using the Z-scan technique with picosecond laser pulses at a wavelength of 532 nm. The third-order nonlinear refractive index coefficient gamma and absorption coefficient beta of the BLT thin film are 3.1 x 10(-10) cm(2)/W and 3 x 10(-5) cm/W, respectively, which are much larger than those of most ferroelectric films. The results show that the BLT thin films on quartz substrates are good candidate materials for applications in nonlinear optical devices.

Piezoelectric and electromechanical properties of relaxor ferroelectric Pb(Mg1/3Nb2/3)O3(65%)-PbTiO3(35%) thin films observed by scanning force microscopy

Relaxor ferroelectric PbMg(1/3)Nb(2/3)O(3)(65%)-PbTiO(3)(35%) (PMN-35PT) thin films were grown by a sol-gel method on Pt(111)/TiO(2)/SiO(2)/Si(100) substrates. Piezoresponse and poling behavior appear to have a relation with the relaxor behavior of the materials. Piezoelectric images were studied in a number of regions on the films with subsequent statistical analysis of the obtained data using the contact mode of scanning force microscopy. Hysteresis loops were observed with external field applied over a wide range of the vibration frequency. The piezoelectric coefficient, d(33), and the crystallographic electrostrictive constant, Q(33), were also determined as 100pm/V and 2.8x10(-3)C(-2)m(4), respectively.

Au(I)-Catalyzed Cyclization of Enynes Bearing an Olefinic Cycle

Gold(I)-catalyzed cyclization of enynes containing an olefinic cycle has been studied. The introduction of an olefinic ring instead of a terminal alkene in enynes dramatically increased the yield of the reaction. Enynes having an olefinic cycle were prepared by a rhodium-catalyzed intermolecular [4 + 2] cycloaddition of diynes with butadiene. Consecutive rhodium-catalyzed Diels-Alder/gold(I)-catalyzed cycloisomerization reactions were integrated in a one-pot reaction.

Differential effects of forskolin and phobol 12-myristate-13-acetate on the c-fos and c-jun mRNA expression in rat C6 glioma cells

The effects of forskolin (FSK) and phobol 12-myristate-13-acetate (PMA) on c-fos and c-jun mRNA expressions in rat C6 glioma cells were studied. Both FSK and PMA increased the c-fos mRNA level. The C-jun mRNA level was decreased by FSK, whereas it was increased by PMA. The elevated c-fos mRNA level, induced by FSK or PMA, was significantly inhibited by dexamethasone (DEX). In contrast, DEX did not affect the FSK- and PMA-induced response of the c-jun mRNA level. Cycloheximide (CHX) caused a superinduction of the FSK- or PMA-induced c-fos mRNA level. Furthermore, CHX also potentiated the PMA-induced c-jun mRNA level. However, CHX did not affect the FSK-induced down-regulation of the c-jun mRNA level. When C6 glioma cells were incubated with PMA and FSK, the PMA-induced c-jun mRNA level was inhibited by FSK, whereas FSK did not affect the PMA-induced c-fos mRNA level. Our results suggest that the activations of PKA and PKC pathways have different roles in the regulation of the c-jun mRNA expression in rat C6 glioma cells. PKA activation can inhibit induction of the c-jun mRNA expression by PMA. In addition, DEX appears to have a selective inhibitory action against c-fos, but not c-jun, -mRNA expression that is regulated by PKA and PKC. On-going protein synthesis inhibition is required for the superinduction of the c-fos expression that is induced by PMA, or FSK and the PMA-induced c-jun mRNA level.

Stimulation of astrocyte-enriched culture with C2 ceramide increases proenkephalin mRNA: involvement of cAMP-response element binding protein and mitogen activated protein kinases

In rat astrocyte-enriched culture, C2 ceramide dose- and time-dependently increased proenkephalin (proENK) mRNA; the significant increase began at 6 h after 30 microM C2 ceramide treatment (about 13-fold) and at 12 h after treatment (about 21-fold). In addition, C2 ceramide also increased AP-1 proteins, such as Fra-1, c-Jun, JunB and JunD, and phosphorylation of CREB. The blocking of protein synthesis by cycloheximide (CHX) evokes a further increase of C2 ceramide-induced proENK mRNA and phospho-CREB level, while C2 ceramide-induced increases of AP-1 protein levels were reduced by CHX. The C2 ceramide-induced proENK mRNA expression was not changed significantly by the pretreatment with H89 (a PKA inhibitor), KN62 (a calcium/calmodulin-dependent protein kinase II inhibitor), and PD98059 (an ERK pathway inhibitor). However, calphostin C (a PKC inhibitor) and or SB203580 (a p38 inhibitor) partially but significantly reduced C2 ceramide-induced proENK mRNA expression as well as phospho-CREB level. These results suggest that, in the rat astrocyte-enriched culture, C2 ceramide increases proENK mRNA expression via phosphorylation of CREB rather than the increases of AP-1 protein levels. Additionally, the activations of PKC and p38, but not PKA, calcium/calmodulin-dependent protein kinase II, and ERK, by C2 ceramide play important regulatory roles in C2 ceramide-induced proENK mRNA expression via activating the CREB.

The difference in perceptions of educational need between epilepsy patients and medical personnel

PURPOSE

This study was undertaken to determine what patients with epilepsy need to know about their condition, and to discern what differences exist between patients' perceptions of this need and the medical profession's perception of what patients should know.

METHODS

Seventy-five consecutive patients with epilepsy and 56 medical personnel (residents and nurses) who were working in either Neurology or Neurosurgery Units were studied using a structured questionnaire consisting of 3 subsets with a total of 27 questions.

RESULTS

Using a Likert scale, epilepsy patients gave high priority to their need for more information about "how epilepsy is diagnosed," "the structure of the brain" (p < 0.05, p < 0.01, respectively), and "the diet that might prevent the attack" (p < 0.05) than did medical personnel. Our study also revealed that men were more concerned with questions regarding smoking and drinking than were women (p < 0.05, respectively), whereas married patients gave higher scores in the category of employment (p < 0.01) and contraception/pregnancy (p < 0.05) than did unmarried patients. The patients with one or more seizures per month rated higher scores on questions concerning the first aid at the time of attack and dosage of antiepileptic drugs (AEDs; p < 0.05, respectively) than did the patients with fewer than one seizure per month. The patients taking poly-AED treatment gave higher scores on six items related to AED therapy than did those receiving monotherapy. No significant differences were found with regard to the length of time patients had the condition, nor to educational level or current employment status.

CONCLUSIONS

An educational program for epilepsy patients should be developed on the basis of understanding that there are differences in perspectives among patients with different sociocultural contexts as well as between patients and medical personnel.

Possible roles of JNK pathway in the regulation of hippocampal proenkephalin and immediate early gene expression induced by kainic acid

Mitogen-activated protein kinases (MAPKs) may play crucial roles in the kainic acid (KA)-evoked excitotoxic effect and the regulation of transcription factors (e.g. c-Fos and c-Jun) in hippocampus, but their exact role in the regulation of KA-induced opioid peptides expression has not been well characterized in vivo. Therefore, we examined possible involvement of the phosphorylated form of JNK, as well as CREB, in the regulation of KA-induced proenkephalin and immediate early genes (IEGs) expression in the rat hippocampus. KA increased proenkephalin mRNA expression in rat hippocampus, which was decreased by pre-administration with cycloheximide (CHX, a protein synthesis inhibitor). KA alone increased c-fos as well as c-jun mRNA levels. CHX further enhanced KA-induced c-fos and c-jun mRNA levels. Additionally, KA increased the phosphorylation of JNK, especially JNK1, which was attenuated by CHX. CHX decreased KA-induced c-Fos protein expression. Interestingly, CHX itself increased the phosphorylation of CREB, which was abolished by KA administration. Our results suggest that the phosphorylation of JNK is involved in the up-regulation of the proenkephalin gene expression via c-Fos and c-Jun that is induced by KA in rat hippocampus. However, the phosphorylation of CREB is not associated with the up-regulation of the proenkephalin mRNA level induced by KA in the rat hippocampus.

Regulation of c-fos gene expression by lipopolysaccharide and cycloheximide in C6 rat glioma cells

The effect of lipopolysaccharide (LPS) on the expression of immediate early genes, such as c-fos and c-jun, was examined in C6 rat glioma cells. LPS (1 microg/ml) alone did not affect c-fos mRNA level. LPS, however, transiently increased c-jun mRNA level. Cycloheximide (CHX, 20 microM), a protein synthesis inhibitor, alone caused increases of c-fos and c-jun mRNA levels. LPS showed a potentiating effect in the regulation of c-fos mRNA level, whereas LPS showed an additive action for the regulation of CHX-induced c-jun mRNA expression. To determine if CREB and mitogen-activated protein kinases (MAPKs) are involved in the regulation of c-fos mRNA expression by LPS and CHX, Western blot was carried out using the phosphorylated form of antibodies against ERK, JNK, p38, and CREB. LPS transiently increased the phosphorylation of p38-MAPK and CREB. In addition, LPS alone elevated phosphorylation of ERK (p44/p42) MAPK in a time-dependent manner. Furthermore, LPS plus CHX enhanced phosphorylation of ERK, p38, and CREB in a synergistic manner. Our results suggest that the phosphorylation of ERK, p38, and CREB may be involved in the regulation of synergistic c-fos mRNA expression induced by LPS plus CHX in C6 rat glioma cells.

Differential effects of cholera toxin and pertussis toxin on the c-fos and c-jun mRNA expression in rat C6 glioma cells

Cholera toxin (CTX) increased c-fos mRNA level whereas it down-regulated the c-jun mRNA level in rat C6 glioma cells. In contrast to the action of CTX, pertussis toxin (PTX) did not affect either c-fos or c-jun mRNA level. The elevated c-fos mRNA level induced by CTX was significantly inhibited by the co-treatment with dexamethasone (DEX). However, DEX did not affect CTX-induced down-regulation of c-jun mRNA level. Cycloheximide (CHX) increased c-fos and c-jun mRNA levels. CHX caused a super-induction of CTX-induced c-fos mRNA level. Our results suggest that CTX-, but not PTX-, sensitive G-proteins may play an important role for c-fos mRNA up-regulation and c-jun mRNA down-regulation. In addition, DEX appears to have a selective inhibitory action against c-fos mRNA expression regulated by CTX. Ongoing protein synthesis inhibition is required for the superinduction of c-fos, but not c-jun, mRNA induced by CTX.

Differential modulatory roles of cholera toxin and pertussis toxin in the regulation of pain responses induced by excitatory amino acids administered intrathecally in mice

The present study was designed to characterize the possible roles of spinally located cholera toxin (CTX)- and pertussis toxin (PTX)-sensitive G-proteins in excitatory amino acids induced pain response. Intrathecal (i.t.) injection of glutamate (20 microg), N-methyl-D-aspartic acid (NMDA; 60 ng), alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA; 13 ng), and kainic acid (12 ng) showed pain response. Pretreatment with CTX (0.05 and 0.5 microg, i.t.) attenuated pain response induced by glutamate, NMDA, AMPA and kainic acid administered i.t. in a dose-dependent manner. On the other hand, i.t. pretreatment with PTX further increased the pain response induced by glutamate, NMDA, AMPA and kainic acid administered i.t., especially at the dose of 0.5 microg. Our results suggest that, at the spinal cord level, CTX- and PTX-sensitive G-proteins appear to play opposite roles in modulating the pain response induced by spinally administered. Furthermore, CTX- and PTX-sensitive G-proteins appear to modulate pain response induced by stimuli of both NMDA and non-NMDA glutamate receptors.

Supraspinal NMDA and non-NMDA receptors are differentially involved in the production of antinociception by morphine and beta-endorphin administered intracerebroventricularly in the formalin pain model

Our previous studies have demonstrated that supraspinal glutamate receptors are differentially involved in the antinociception induced by morphine and beta-endorphin given intracerebroventricularly (i.c.v.) in the tail-flick and hot-plate tests. The formalin pain test was used in the present study. Injection of mice with formalin solution (2%, 10 microl) into the hindpaw intraplantarly produced the first (0-5 min) and second (20-40 min) phases of formalin responses. The formalin responses in the both phases were attenuated dose-dependently by morphine (0.125-1 microg) or beta-endorphin (0.125-1 microg) administered i.c.v. 5 min before. The antinociceptive effect of morphine was slightly more potent in the second phase whereas the effect of beta-endorphin was more pronounced in the first phase. MK-801 (0.1-1 microg), a non-competitive NMDA receptor antagonist, and CNQX (0.05-0.5 microg), a non-NMDA antagonist, given i.c.v., produced antinociceptive effect in the both phases, but only in a partial manner. Both MK-801 (0.05 microg) and CNQX (0.01 microg), at the dose which had no intrinsic effect, reversed the antinociceptive effect of beta-endorphin (1 microg) observed during the second, but not the first, phase partially but significantly. However, the antinociceptive effect of morphine (1 microg) was not affected by the same dose of MK-801 or CNQX given i.c.v. Our results indicate that, at the supraspinal level, both NMDA and non-NMDA receptors are involved in the production of antinociception induced by supraspinally administered beta-endorphin, but not morphine, in the formalin pain model.

Cycloheximide increases proenkephalin and tyrosine hydroxylase gene expression in rat adrenal medulla

The effect of cycloheximide (CHX; 5 mg/kg) on proenkephalin (proENK) and tyrosine hydroxylase (TH) mRNA expression in rat central and peripheral nervous systems was studied. CHX increased proENK and TH mRNA levels in the adrenal gland, but not in hippocampus, striatum, midbrain, brainstem, pituitary, and hypothalamus. The pretreatment with actinomycin D (0.5 mg/kg) significantly decreased CHX-induced proENK and TH mRNA expression, suggesting that the CHX-dependent increase of these mRNA levels may be caused by the increase of transcriptional activity rather than RNA stabilization. To investigate the factors involved in CHX-induced proENK and TH mRNA expression, the effect of CHX on activator protein-1 (AP-1), cAMP response element (CRE) binding protein (CREB), and glucocorticoid response element (GRE) was tested. In AP-1, the basal expression of Fra-2 and c-Jun proteins and AP-1 DNA binding activity in the adrenal medulla was higher than other tissues tested, but CHX reduced these protein levels and AP-1 DNA binding activity. In CREB, CHX time dependently increased the level of phospho-CREB without altering total CRE level and CRE DNA binding activity. Furthermore, phospho-CREB actively participated in CRE DNA binding activity. In GRE, although CHX increased plasma and adrenal corticosterone level, RU486 (10 mg/kg) reduced CHX-induced proENK, but not TH, mRNA level in a partial manner. These results suggest that the basal expression of proENK and TH mRNA transcription in the adrenal gland seems to be tonically inhibited by de novo protein synthesis. In addition, CHX-dependent increase of proENK and TH mRNA expression in the adrenal medulla is well correlated with phospho-CREB level, but not AP-1. Finally, glucocorticoid seems to be involved at least partially in CHX-dependent proENK, but not TH, mRNA expression in the adrenal medulla.

Activation of adenylate cyclase results in down-regulation of c-jun mRNA expression in rat C6 glioma cells

To investigate the possible mechanisms involved in forskolin-induced c-jun mRNA decrease in rat C6 glioma cells, we examined effects of a PKA inhibitor (H-89), a L-type Ca2+ channel blocker (nimodipine), a calmodulin activation inhibitor (calmidazolium chloride) and a Ca2+/calmodulin-dependent protein kinase II inhibitor (KN-62) on forskolin-induced c-jun mRNA down-regulation. H-89 caused a reversal of forskolin-induced c-jun mRNA decrease. Furthermore, nimodipine, KN-62 and calmidazolium chloride partially blocked forskolin-induced c-jun mRNA down-regulation. Our results suggest that activation of adenylate cyclase appears to be involved in a down-regulation of c-jun mRNA expression through a PKA pathway. In addition, L-type calcium channels, calmodulin and Ca2+/calmodulin-dependent protein kinase II may be partially involved in c-jun mRNA down-regulation induced by forskolin.