Abstract 4230: Transcriptomic evaluation of exercise-induced suppression of prostate cancer aggressiveness

Previous studies from our laboratory have showed that aerobic exercise significantly reduced the number of aggressive poorly differentiated tumors in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. Despite these encouraging data the underlying mechanism of how exercise reduces tumor aggressiveness remains undefined. We aimed to fill this scientific gap by utilizing a transcriptomics approach to identify potential mechanisms by which aerobic exercise suppresses prostate tumor aggressiveness.

Methods: Twelve TRAMP mice, 8-10 weeks of age, were equally randomized to exercise or control group. Mice in the exercise group were singularly housed in cages with running wheels for 12 weeks. Mice in the control group maintained normal group housing and activity conditions for 12 weeks. At euthanasia, prostate tumors were excised, weighed and processed for immunohistochemistry and transcriptome analysis. Two independent pathologists, blinded to the interventions, performed histological analysis of the genitourinary mass. Outputs of sequencing data were assessed for quality and accuracy. Counts for all known mRNA, differential expression, and heatmap were prepared. Differential expression was filtered to identify genes that had a ≥2-fold change with an adjusted p<0.05. Gene ontology and pathway analyses was performed to reveal selective pathways activated.

Results: No significant difference in genitourinary mass, body mass or tumor free body mass was found between groups. Pathology revealed majority of the tissue from the control group exhibited moderate to poorly differentiated tumors (3/6). On the other hand, none of the animals in the exercise intervention group showed such pathology. Four out of five showed well differentiated tumors including prostatic intraepithelial neoplasia (PIN) lesions in one animal. Transcriptomic analysis coupled with gene set enrichment identified pathways associated with triglyceride catabolic process, lipid homeostasis, lipid metabolic process, triglyceride metabolic process to be most impacted. Differentially expressed genes of interest include haptoglobin (HP) and hormone sensitive lipoprotein lipase (Lipe) were significantly lower in the exercise group.

Conclusion: Our preliminary findings provide novel evidence suggesting that exercise suppresses prostate tumor aggressiveness, in part, through transcriptomic modulation and altered cellular pathways associated with intratumoral energy metabolism. This project was supported by the National Center Institute designated Mays Cancer Center at UT Health San Antonio.

Citation Format: Darpan I. Patel, Paul Rivas, Yidong Chen, Zhao Lai, Robert L. Reddick, Yuji Ikeno, Rita Ghosh, A. Pratap Kumar. Transcriptomic evaluation of exercise-induced suppression of prostate cancer aggressiveness. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4230.

Abstract 4: Intercepting ribosomal protein S6KB1 signaling: Prevention of prostate cancer recurrence

There is an urgent need for innovative strategies such as the discovery of adjuvants that can prevent relapse and improve quality of life for patients treated with radiotherapy. Previously we demonstrated the utility of Nexrutine (Nex) as a neo-adjuvant with radiation. Nex was safe and well tolerated in PCa patients and potentiated radiation response in part through downregulation of ribosomal protein S6K (encoded byRPS6KB1). We now show that RPS6KB1 depleted prostate cancer cells with higher basal levels of γ-H2AX, a marker for DNA double strand breaks (i) are more sensitive to radiation and (ii) form smaller tumors with reduced levels of prostate specific antigen (PSA). Depletion of RPS6KB1 hindered DNA double-strand break repair predominantly through the alternate end-joining pathway, induction of G2/M checkpoint and NFκB pathway activation. Collectively these events led to improved radiation sensitivity. We further identified Berberine (Ber), one of the active constituents of Nex as a potential pharmacological inhibitor of RPS6KB1. In an orthotopic implantation model of C4-2B, treatment with Ber alone or Ber plus radiation decreased PSA levels that was sustained during the course of the experiment. On the other hand animals treated with radiation alone developed recurrent cancer as evidenced by a resurgence of PSA. Animals administered Ber followed by XRT intervention had increased levels of RANTES while there was no change in animals that received XRT followed by Ber. The observed reversal of the Bereffect with the sequence of intervention is statistically significant (p=0.0298). Among animals not subject to XRT, the mean PSA increased in those that did not receive Ber relative to those that did; mean difference=-1.93, 95% CI -3.75 to -0.105, p=0.04 with no significant changes in body weight. Notably,RPS6KB1 mRNA levels increased in tumor samples in patients experiencing biochemical recurrence(BCR). Given that rising PSA following conventional therapeutic approaches such as radiation remain a major clinical challenge, targeting RPS6KB1 signaling with radiation therapy is an attractive strategy to prevent BCR. Supported in part by CPRIT RP190012 (APK).

Citation Format: Addanki Pratap Kumar, Alison Clark, Michelle Villarreal, Sridharan Jayamohan, Shih-Bo Huang, Suleman S. Hussain, Xiaoyu Yang, Paul Rivas, Darpan Patel, Bethany L. Pierce, Shreya Tripathy, Pawel Osmulski, Maria Gaczynska, Lai Zhao, Li-Ju Wang, Yidong Chen, Caroline Xavier Paul Ezhilan, Mohan Natarajan, Joel E. Michalek, Robert L. Reddick, Rita Ghosh. Intercepting ribosomal protein S6KB1 signaling: Prevention of prostate cancer recurrence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4.

SIRT1 inhibition-induced senescence as a strategy to prevent prostate cancer progression

Emerging evidence suggests an important role for SIRT1, a nicotinamide adenine dinucleotide (NAD)-dependent deacetylase in cancer development, progression and therapeutic resistance; making it a viable therapeutic target. Here, we examined the impact of resveratrol-mediated pharmacological activation of SIRT1 on the progression of HGPIN lesions (using the Pten^-/- mouse model) and on prostate tumor development (using an orthotopic model of prostate cancer cells stably silenced for SIRT1). We show that precise SIRT1 modulation could benefit both cancer prevention and treatment. Positive effect of SIRT1 activation can prevent Pten deletion-driven development of HGPIN lesions in mice if resveratrol is administered early (pre-cancer stage) with little to no benefit after the establishment of HGPIN lesions or tumor cell implantation. Mechanistically, our results show that under androgen deprivation conditions, SIRT1 inhibition induces senescence as evidenced by decreased gene signature associated with negative regulators of senescence and increased senescence-associated β-galactosidase activity. Furthermore, pharmacological inhibition of SIRT1 potentiated growth inhibitory effects of clinical androgen receptor blockade agents and radiation. Taken together, our findings provide an explanation for the discrepancy regarding the role of SIRT1 in prostate tumorigenesis. Our results reveal that the bifurcated roles for SIRT1 may occur in stage and context-dependent fashion by functioning in an antitumor role in prevention of early-stage prostate lesion development while promoting tumor development and disease progression post-lesion development. Clinically, these data highlight the importance of precise SIRT1 modulation to provide benefits for cancer prevention and treatment including sensitization to conventional therapeutic approaches.

Abstract PO-085: Therapeutic targeting of RPS6KB1/SQSTM1 axis to prevent biochemical recurrence

Radiation therapy (RT) is a standard treatment for organ confined prostate cancer (PCa). Given that both intrinsic and acquired resistance to radiation causes progression to advanced metastatic PCa, there is an unmet need for adjuvant therapies that synergize with radiation to improve therapeutic efficacy. Previously, we demonstrated strong synergistic tumor growth inhibitory activities for Phellodendron amurense bark extract in combination with radiation in part through downregulation of ribosomal protein S6K (encoded by RPS6KB1). Subsequently we identified berberine (Ber), one of the active constituents of Nexrutine as a potential pharmacological inhibitor of RPS6KB1. Given these findings, we hypothesized that targeting RPS6KB1 could be an approach to enhance sensitivity to radiation. We tested the efficacy of Ber alone and in combination with radiation using an orthotopic implantation model and the mechanism associated with radio-sensitization using prostate cancer cells stably silenced and deleted for RPS6KB1. We observed that (i) RPS6KB1 deletion in androgen responsive early stage LNCaP cells and (ii) stable silencing in castrate resistant C4-2B cells increased sensitization to radiation relative to respective parental or non-targeted cells. Furthermore, pharmacological inhibition of RPS6KB1 with Ber sensitized cells to radiation. Mechanistically, RPS6KB1 silencing increased autophagic activity as revealed by changes in proteins identified through reverse phase protein array (RPPA) and decreased expression and levels of SQSTM1 via downregulation of NFkB. Pretreatment with chloroquine (CQ) rescued the observed radio-sensitization effects. Treatment with Ber alone or Ber plus radiation decreased levels of PSA that was sustained during the course of the experiment in mice orthotopically implanted with C4-2B cells. On the other hand animals treated with radiation alone developed recurrent cancer as evidenced by a resurgence of PSA. Notably, RPS6KB1 mRNA levels increased in tumor samples in patients experiencing biochemical recurrence (BCR). Taken together, these findings demonstrate that RPS6KB1 is a clinically relevant target and that Ber sensitizes prostate cancer cells to radiation in vitro and in vivo. Therefore, targeting RPS6KB1 signaling is an attractive strategy to prevent progression to BCR; given that rising PSA following conventional therapeutic approaches such as radiation remain a major clinical challenge. This work is supported in part by CPRIT RP190012 (APK).

Citation Format: Addanki P. Kumar, Alison Clark, Michelle R. Villarreal, Shih-Bo Huang, Suleman S. Hussain, Xiaoyu Yang, Roble G. Bedolla, Paul Rivas, Sridharan Jayamohan, Li-Ju Wang, Yidong Chen, Caroline Xavier Paul Ezhilan, Mohan Natarajan, Joel E. Michalek, Robert Reddick, Hiroshi Miyamoto, Rita Ghosh. Therapeutic targeting of RPS6KB1/SQSTM1 axis to prevent biochemical recurrence [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-085.

Androgen deprivation-induced elevated nuclear SIRT1 promotes prostate tumor cell survival by reactivation of AR signaling

The NAD⁺-dependent deacetylase, Sirtuin 1 (SIRT1) is involved in prostate cancer pathogenesis. However, the actual contribution is unclear as some reports propose a protective role while others suggest it is harmful. We provide evidence for a contextual role for SIRT1 in prostate cancer. Our data show that (i) mice orthotopically implanted with SIRT1-silenced LNCaP cells produced smaller tumors; (ii) SIRT1 suppression mimicked AR inhibitory effects in hormone responsive LNCaP cells; and (iii) caused significant reduction in gene signatures associated with E2F and MYC targets in AR-null PC-3 and E2F and mTORC1 signaling in castrate-resistant ARv7 positive 22Rv1 cells. Our findings further show increased nuclear SIRT1 (nSIRT1) protein under androgen-depleted relative to androgen-replete conditions in prostate cancer cell lines. Silencing SIRT1 resulted in decreased recruitment of AR to PSA enhancer selectively under androgen-deprivation conditions. Prostate cancer outcome data show that patients with higher levels of nSIRT1 progress to advanced disease relative to patients with low nSIRT1 levels. Collectively, we demonstrate that lowering SIRT1 levels potentially provides new avenues to effectively prevent prostate cancer recurrence.

Evidence for 2-Methoxyestradiol-Mediated Inhibition of Receptor Tyrosine Kinase RON in the Management of Prostate Cancer

2-Methoxyestradiol (2-ME₂) possesses anti-tumorigenic activities in multiple tumor models with acceptable tolerability profile in humans. Incomplete understanding of the mechanism has hindered its development as an anti-tumorigenic compound. We have identified for the first-time macrophage stimulatory protein 1 receptor (MST1R) as a potential target of 2-ME₂ in prostate cancer cells. Human tissue validation studies show that MST1R (a.k.a RON) protein levels are significantly elevated in prostate cancer tissues compared to adjacent normal/benign glands. Serum levels of macrophage stimulatory protein (MSP), a ligand for RON, is not only associated with the risk of disease recurrence, but also significantly elevated in samples from African American patients. 2-ME₂ treatment inhibited mechanical properties such as adhesion and elasticity that are associated with epithelial mesenchymal transition by downregulating mRNA expression and protein levels of MST1R in prostate cancer cell lines. Intervention with 2-ME₂ significantly reduced tumor burden in mice. Notably, global metabolomic profiling studies identified significantly higher circulating levels of bile acids in castrated animals that were decreased with 2-ME₂ intervention. In summary, findings presented in this manuscript identified MSP as a potential marker for predicting biochemical recurrence and suggest repurposing 2-ME₂ to target RON signaling may be a potential therapeutic modality for prostate cancer.

Exercise preserves muscle mass and force in a prostate cancer mouse model

The purpose of this study was to examine the effects of exercise in modulating biomarkers of sarcopenia in a treatment naïve transgenic adenocardinoma of the mouse prostate (TRAMP) model. Thirty TRAMP mice were randomized to either exercise (voluntary wheel running) or no-treatment control group for a period of 20 weeks. During necropsy, gastrocnemius muscles and prostate tumors were harvested and weighed. Gastrocnemius concentrations of myostatin, insulin-like growth factor (IGF)-1 and tumor necrosis factor (TNF)-α were quantified. Exercise mice had greater muscle mass than controls (p=0.04). Myostatin was significantly lower in the exercise group compared to controls (p=0.01). Exercise mice maintained forelimb grip force while control mice had a significaint decrease (p=0.01). No significant difference was observed in pre-post all limb grip strength. Further, forelimb and all limb grip strength was negatively associated with tumor mass (p<0.01).

Nexrutine® preserves muscle mass similar to exercise in prostate cancer mouse model

Muscle loss is a debilitating side effect to prostate cancer (PCa) experienced by nearly 60% of men. The purpose of this study was to test the hypothesis that Nexrutine® , a bark extract from the Phellodendrum amurense, can protect against prostate cancer induced muscle loss in a similar manner as exercise, using the transgenic adenocarcinoma of mouse prostate (TRAMP) model. Forty-five, 8- to 10-week old TRAMP mice were randomized to either control, Nexrutine® (600 mg/kg pelleted in chow) or exercise (voluntary wheel running). Mice were serially sacrificed at weeks 4, 8, 12, and 20, at which time either the left or right gastrocnemius muscle was harvested, weighted, and frozen. Proteolysis inducing factor (PIF), ubiquitin, and NF-κB concentrations were quantified using ELISA kits. Nexrutine® and exercise were equally able to protect TRAMP mice against PCa-induced muscle loss (P = 0.04). Both interventions decreased intramuscular PIF concentrations at 20 weeks compared to control (P < 0.05). A treatment effect was also observed when all time points were combined with exercise significantly lowering PIF concentrations (P < 0.01). Exercise significantly lowered intramuscular ubiquitin concentrations in weeks 4, 8, and 20 compared to control mice (P < 0.001). A treatment effect was also observed with exercise significantly lowering ubiquitin compared to control mice (P < 0.001). No significant changes were observed for NF-κB. The results of this investigation demonstrate that PCa-induced muscle loss can be attenuated with the herbal supplement Nexrutine® . This investigation provides preliminary evidence to support continued research into Nexrutine® as a potential exercise analog in protecting against muscle loss.

Abstract 5082: SIRT1 functions as a double-edged sword in prostate cancer

SIRT1 is a NAD+ dependent deacetylase known to regulate a plethora of biological processes through posttranslational regulation of proteins including those that function as tumor promoters and suppressors. In order to define the role of SIRT1 in prostate pathogenesis, we used 2 mouse models: (i) PTEN knockout (PTENKO) mouse model by pharmacological activation of SIRT1 with resveratrol (RES) a known activator of SIRT1, & (ii) orthotopic implantation model with genetic silencing of SIRT1 (SIRT1 shRNA). We also used genetic and pharmacologic inhibition of SIRT1 in cell culture models to understand the mechanism. We tested whether SIRT1 modulation is beneficial when targeted early (before the establishment of prostatic lesions) or late (after the establishment of prostatic lesions) in the PTENKO model. RES intervention was initiated in 4-5-week (early intervention) and 10-15-week-old (late intervention) PTENKO mice. Analyses of samples collected longitudinally during progression revealed that early intervention with RES reduced incidence of high-grade prostate intraepithelial neoplastic lesions (HGPIN) when given for 14 weeks with no significant difference at 7 or at 11 weeks. On the other hand, late intervention after the establishment of HGPIN lesions with RES had no beneficial effect. Importantly, longer treatment duration (28 weeks) resulted in significantly increased incidence of invasive prostate carcinoma. Furthermore, RES had no significant effect on the development of orthotopic prostate tumors following implantation of LNCaP cells in nude mice. In contrast, orthotopic implantation of SIRT1 stably silenced LNCaP cells showed significant impairment in tumor development. Immunohistochemical evaluation showed nuclear localization of SIRT1 in human prostate tumors and was associated with increased risk of biochemical recurrence. Mechanistic investigations revealed (i) suppression of AR signaling in hormone-sensitive LNCaP but not in castration-resistant 22Rv1 cells; (ii) RNAseq coupled with gene ontology enrichment analysis using SIRT1 silenced cells under conditions of androgen stimulation and inhibition identified genes involved in cell cycle checkpoint and senescence as top pathways affected by SIRT1 loss of function. In silicoanalysis shows that the identified SIRT1-regulated targets are associated with disease aggressiveness and poor disease-free survival. Taken together these data demonstrate that (i) SIRT1 plays a contextual role during prostate pathogenesis by functioning as tumor suppressor during early stage and as a tumor promoter during late stage; (ii) SIRT1 inhibition suppresses tumor development and (iii) RES is a better preventive than therapeutic agent. Therefore, our findings offer promising avenues to develop SIRT1-regulated pathways as novel therapeutic targets to inhibit prostate cancer recurrence. Supported by CPRIT Training Grant RP 170345 (SH) and CPRIT RP 150166 (APK)

Citation Format: Shih-Bo Huang, Dinesh Thapa, Roble G. Bedolla, Amanda R. Muñoz, Xiaoyu Yang, Paul Rivas, Robert L. Reddick, Hiroshi Miyamoto, Rita Ghosh, Addanki Pratap Kumar. SIRT1 functions as a double-edged sword in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5082.

Suppression of ribosomal protein RPS6KB1 by Nexrutine increases sensitivity of prostate tumors to radiation

Radiation therapy (XRT) is a standard treatment for prostate cancer (PCa). Although dose escalation increases local control, toxicity hampers further escalation. Broader improvement will be possible by the addition of adjuvant therapies, which can synergize with radiation and thus improve efficacy. We have identified a natural compound (Nexrutine, Nx) that inhibits the survival and growth of PCa cells in combination with radiation. Combination studies demonstrated strong interaction between Nx and radiation both in vitro in multiple PCa cell lines and in the Transgenic adenocarcinoma of mouse prostate (TRAMP) model. Nx potentiated growth inhibitory effects of IR by down regulating ribosomal protein S6K (RPS6KB1), CyclinD1, Chk1 and HIF-1 α and prolonging G2/M checkpoint block. RPS6KB1 is upregulated in prostate cancers and its expression is correlated with tumor grade. Knockdown of RPS6KB1 in PCa cells increased their sensitivity toward radiation-induced survival inhibition. Overall, we provide scientific evidence (i) in support of Nx as an adjuvant in PCa patients receiving XRT (ii) suggesting that RPS6KB1 is an important player in Nx-mediated combinatorial benefits and emphasizes that RPS6KB1 is a novel target for PCa treatment. These data underscore the need to test the agent in additional preclinical models to validate these observations.

Abstract 5823: Palmatine as a potential pancreatic cancer therapeutic agent

Over the last 30 years, little improvement has been made to the 5 year survival rate of pancreatic cancer (PanCA) patients. While survival has increase by 2% over the last several years, the current rate is still less than 8%. This depressing fact demonstrates the importance of developing or improving therapies to more effectively manage this disease. Along these lines, published studies from our laboratory demonstrated the anti-tumorigenic potential of the cork tree bark extract, Nexrutine® (Nx). Nx suppressed growth of pancreatic cancer cells through downregulation of STAT3/NF-κB activation. Subsequent biochemical and molecular investigations revealed palmatine (PMT) (i) as an active constituent of Nx able to suppress the growth of pancreatic cancer cells; (ii) synergizes with gemcitabine (GEM); and (iii) downregulates GLI1, COL1A1 and Survivin. Despite such promising in vitro observations however, the in vivo relevance of PMT is undefined. Furthermore, it is unclear if PMT can recapitulate the biological activities of Nx in vivo. In this investigation, we tested the hypothesis that PMT recapitulates the biological activities of Nx and enhances GEM activity. This hypothesis was tested by comparing the efficacy of Nx and PMT using (i) athymic mice implanted with Capan-2 cells; (ii) a syngenic mouse model using C57BL/6 mice implanted with KPC-GFP-Luc cells; and (iii) a short term ex vivo model utilizing cells isolated from primary pancreatic tumors following surgical resection. Additionally, in vitro experiments were also done to assess the underlying molecular mechanism. Analysis of these data show that both Nx and PMT are well tolerated in vivo and a significant reduction in the levels of serum inflammatory cytokines including IL-6, granulocyte-colony stimulating factor (G-CSF), and CXCL1. Interestingly, animals receiving PMT, but not Nx, showed a trend towards decreased pancreatic tumor weight that was associated with histopathological changes. Investigation into the potential mechanism revealed that Nx and PMT mediated inhibition of STAT3, EP4, Src, TrkA, and RPS6 activities may contribute to the observed growth inhibitory and anti-inflammatory effects. Incredibly, our ex vivo analysis of patient derived PanCA cells demonstrated that both Nx and PMT could inhibit the growth of these cells. Collectively, our data demonstrates PMT recapitulates biological activities of Nx and that there is potential for developing PMT as an agent for clinical management of PanCA. Supported by NCCIH (R01 AT007448; APK) and VA-MERIT Award (I01 BX 000766; APK).

Citation Format: Amanda R. Muñoz, Roble Bedolla, Shih-Bo Huang, Xiaou Yang, Paul Rivas, Robert Reddick, Martha Hanes, Glenn Halff, Rita Ghosh, Addanki P. Kumar. Palmatine as a potential pancreatic cancer therapeutic agent [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5823.

Abstract 5268: Nexrutine and palmatine mediated effects on the STAT3/EP4/IL-6 axis in pancreatic cancer

With a 5 year survival of less than 8%, the poor prognosis of pancreatic cancer (PanCA) underlines the importance of improving therapies for effective management of this disease. In previous studies, we identified the tumor cell growth inhibitory activities for Nexrutine® (Nx, a bark extract from Phellodendron amurense) and palmatine (PMT) which is a constituent of Nx. These studies revealed an important role for downregulation of KRAS downstream effectors including GLI, STAT3 and NF-κB in mediating growth inhibitory effects. Remarkably, both Nx and PMT exerted synergistic growth inhibitory effects in combination with the conventional chemotherapeutic agent, Gemcitabine (GEM). Despite such promising in vitro observations, the in vivo efficacy of Nx or PMT had not been established. In this investigation, we evaluated the ability of Nx and PMT to (i) prevent the development of pancreatic tumors; and (ii) inhibit the growth of patient derived pancreatic cancer tissue in short term ex vivo cultures. Studies were also conducted to investigate the underlying molecular mechanism using cell culture models. Our results show that both Nx and PMT are well tolerated in vivo as evidenced by a lack of significant changes in the body weights of athymic mice implanted with Capan-2 cells. Interestingly, both Nx and PMT showed a significant decrease in the circulating levels of inflammatory molecules including IL-6 and CXCL1. In this first proof-of-concept study, PMT treated animals demonstrated a trend towards decreased pancreatic tumor weight with associated histopathogical changes. Remarkably, both Nx and PMT inhibited the growth of patient derived pancreatic cancer cells. Mechanistic investigations identified downregulation of STAT3, TrkA, Src, and RPS6 activities as potential contributors to Nx or PMT-induced synergistic growth inhibitory effects with GEM. Further investigation of STAT3 signaling revealed the involvement of the prostaglandin receptor, EP4, in a potential feedback loop with STAT3 and in asserting STAT3-mediated inhibition of autophagy. Taken together these data support potential utility for Nx and/or PMT in the management of PanCA and suggest that these agents use multiple mechanisms to affect growth of pancreatic tumors. Supported by NCCIH (R01 AT007448; APK) and VA-MERIT Award (I01 BX 000766; APK).

Citation Format: Amanda R. Munoz, Roble G. Bedolla, Paul Rivas, Divya Chakravarthy, Robert L. Reddick, Martha A. Hanes, Glenn A. Halff, Rita Ghosh, Addanki P. Kumar. Nexrutine and palmatine mediated effects on the STAT3/EP4/IL-6 axis in pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5268. doi:10.1158/1538-7445.AM2017-5268

Abstract 1797: Downregulation of ribosomal protein S6 overcomes radioresistance in prostate cancer

Radiation Therapy (RT) is a definitive treatment for early-localized prostate cancer (PCA), but is associated with side effects which impair quality of life in addition to development of radioresistance. PI3K/Akt/mTOR signaling is one of the contributors to therapeutic resistance, including radioresistance. Ribosomal protein S6 (rpS6), a downstream effector of PI3K/Akt/mTOR signaling, mediates radioresistance by increasing protein synthesis, cell survival and epithelial mesenchymal transition. Also, increased activation of rpS6 is correlated with poor survival in PCA. Therefore, downregulation of rpS6 could decrease RT induced toxic side effects by sensitizing tumor cells. Based on published evidence demonstrating tumor growth inhibitory activities, we tested if Nexrutine® (Nx), an inexpensive OTC herbal supplement from Phellodendron amurense bark extract, could potentiate RT by inhibiting rpS6 activation. Using clonogenic assays, low dose RT in combination with Nx was found to have similar inhibition of surviving fraction compared to high dose RT in androgen independent PC-3 cells. Isobologram analysis of these data depicted strong synergism. In addition, increased activation of Akt/NFKB signaling molecules was observed in PC-3 cells exposed to radiation. The observed radiation-induced increase in these signaling molecules was either abolished (p-rpS6, p-NFKB and p-p70S6K) or decreased (p-Akt) in cells pretreated with Nx (8 hours) prior to RT. Additionally, Nx pretreatment prolonged the G2/M arrest caused by RT in PC-3 cells. Strikingly, knockdown of rpS6 in PC-3 cells reversed the observed effects of Nx, indicating the importance of rpS6 in mediating these changes. Furthermore, administration of Nx in combination with RT inhibited prostate tumor progression in transgenic adenocarcinoma of the mouse prostate (TRAMP) mice with no prominent toxicity. Notably, immunohistochemical analysis revealed decreased levels of p-mTOR, p70S6K, NFKB, Ki67 and Cyclin D1 in the prostate in combination group of animals compared to monotherapy. Taken together, our data suggest that Nx sensitizes PCA cells by down regulating rpS6 and delays progression to lethal disease. Remarkably, in a recent phase 0/1 study patients (81%) receiving Nx showed decreased PSA levels with no signs of grade 3 toxicity. Thus, Nx shows immense potential for use as an adjuvant in combination with conventional therapy for effective clinical management of PCA.

Supported by NCCAM (R01 AT-007448) and VA-MERIT Award (I01 BX 000766; APK)

Citation Format: Suleman S. Hussain, Paul Rivas, Roble G. Bedolla, Nikos Papanikolaou, Robert L. Reddick, Brad H. Pollock, Daniel C. Chan, Rita Ghosh, Addanki P. Kumar. Downregulation of ribosomal protein S6 overcomes radioresistance in prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1797. doi:10.1158/1538-7445.AM2015-1797

Validity of criteria for hospital admission in exacerbations of COPD

AIMS

To validate a previously developed set of explicit criteria for the appropriateness of hospital admission among these patients using the RAND/UCLA Appropriateness Methodology (RAM).

METHODS

We conducted a prospective cohort study of patients experiencing symptoms of COPD exacerbation seen in the emergency departments (ED) of 16 hospitals belonging to the Spanish National Health Service. Sociodemographic and clinical variables needed to assess appropriateness were recorded. Main outcomes were mortality, severe COPD evolution, complications at follow up, and three patient-reported measures: dyspnoea level, capacity for physical activity and perceived health status.

RESULTS

Appropriately admitted patients were more likely to die (6.70% vs. 2.68%, p = 0.0102) than inappropriately admitted patients, and were more likely to develop severe evolution (27.09% vs. 6.08%, p < 0.0001) and complications (18.72% vs. 11.92%, p = 0.0244). Among discharged patients, no significant differences were observed in clinical outcomes. All patients exhibited worse dyspnoea and capacity for physical activity after exacerbation, but changes among appropriately admitted patients were less than among appropriately discharged patients.

CONCLUSION

Our appropriateness criteria identified patients in worse condition at ED arrival who were more likely to benefit from admission in terms of mortality and COPD evolution.

Combined targeting of STAT3/NF-κB/COX-2/EP4 for effective management of pancreatic cancer

PURPOSE

Near equal rates of incidence and mortality emphasize the need for novel targeted approaches for better management of patients with pancreatic cancer. Inflammatory molecules NF-κB and STAT3 are overexpressed in pancreatic tumors. Inhibition of one protein allows cancer cells to survive using the other. The goal of this study is to determine whether targeting STAT3/NF-κB crosstalk with a natural product Nexrutine can inhibit inflammatory signaling in pancreatic cancer.

EXPERIMENTAL DESIGN

HPNE, HPNE-Ras, BxPC3, Capan-2, MIA PaCa-2, and AsPC-1 cells were tested for growth, apoptosis, cyclooxygenase-2 (COX-2), NF-κB, and STAT3 level in response to Nexrutine treatment. Transient expression, gel shift, chromatin immunoprecipitation assay was used to examine transcriptional regulation of COX-2. STAT3 knockdown was used to decipher STAT3/NF-κB crosstalk. Histopathologic and immunoblotting evaluation was performed on BK5-COX-2 transgenic mice treated with Nexrutine. In vivo expression of prostaglandin receptor E-prostanoid 4 (EP4) was analyzed in a retrospective cohort of pancreatic tumors using a tissue microarray.

RESULTS

Nexrutine treatment inhibited growth of pancreatic cancer cells through induction of apoptosis. Reduced levels and activity of STAT3, NF-κB, and their crosstalk led to transcriptional suppression of COX-2 and subsequent decreased levels of prostaglandin E2 (PGE2) and PGF2. STAT3 knockdown studies suggest STAT3 as negative regulator of NF-κB activation. Nexrutine intervention reduced the levels of NF-κB, STAT3, and fibrosis in vivo. Expression of prostaglandin receptor EP4 that is known to play a role in fibrosis was significantly elevated in human pancreatic tumors.

CONCLUSIONS

Dual inhibition of STAT3-NF-κB by Nexrutine may overcome problems associated with inhibition of either pathway.

Forensic paleoradiology: identification of a public figure murdered in 1837

Two unidentified graves were found during construction of a new crypt at the Metropolitan Cathedral in Santiago, Chile. One of the bodies was sent to the Teaching Hospital of the University of Chile for forensic identification. The fully mummified corpse was suspected to be that of Diego Portales, a prominent Chilean politician who was assassinated in 1837. The condition of the corpse determined that the best way to establish a positive identification was by means of a multislice CT scan, since the body had been autopsied and embalmed using unknown substances. This paper presents the results of the virtual autopsy of the remains and compares these results with the original autopsy report of 1837. The embalming method is also discussed, based on chemical analysis using inductively coupled mass spectroscopy (ICP-MS) and cold vapour atomic absorption spectrometry (HG-CVAAS).

Abstract 3673: AMPK-SIRT1 axis: a potential therapeutic target for prostate cancer management

Recently we have shown that resveratrol (RES) intervention prevents development of high-grade prostatic intraepithelial neoplastic (HGPIN) lesions in prostate-specific PTEN knockout mouse model targeting SIRT1/mTORC1 axis. It is known that insufficient nutrient supply combined with high proliferation keeps solid tumors including prostate under hypoxic and metabolic stress. Tumor cells adapt to survive under such conditions through activation of AMP-activated kinase (AMPK). AMPK has been reported to be activated in prostate tumors. Therefore targeting AMPK and associated signaling pathways will be a promising approach for prostate cancer management. Accordingly we investigated the role of AMPK in RES-induced growth inhibitory effects using multiple human prostate cancer cell lines and preclinical animal model. These data show that RES treatment (50 μM, 24 h) results in activation of SIRT1, significant inhibition of AMPK phosphorylation and cell survival in human prostate cancer cells (RWPE-1, LNCaP, C42B and DU145). The observed molecular changes were associated with induction of apoptosis and autophagy following treatment with RES. Further dietary administration of RES (0.1 and 2%) to 4-5 week old prostate-specific PTEN knockout mice for 11 and 14 weeks showed prevention of HGPIN development. Interestingly intervention for 7 weeks showed prevention of HGPIN development at lower dose but not at high dose. On the other hand, 28-week intervention had no significant effect on the development of HGPIN lesions. Immunohistochemical evaluation showed modulation of AMPK, pS6K and SIRT1 in the prostate. Overall these data provide novel insights into RES-induced prevention of HGPIN development via AMPK/SIRT1/mTORC1 axis. Supported in part by NIH (CA 137518 and 135451 APK).

Citation Format: Guiming Li, Paul Rivas, Roble Bedolla, Robert L. Reddick, Rita Ghosh, Addanki P. Kumar. AMPK-SIRT1 axis: a potential therapeutic target for prostate cancer management. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3673. doi:10.1158/1538-7445.AM2013-3673

Abstract 5392: Metabolic profiling of castrate-resistant prostate cancer reveals novel role for bile acids in driving castration resistance

The 5-year survival for metastatic castrate-resistant prostate cancer patients is less than 30% despite significant progress in the understanding of prostate cancer biology and development of novel therapeutic agents. A major contributing factor for the observed low survival rate of patients with castrate resistant disease is the lack of knowledge regarding metabolic alterations and their underlying contributions during development of castrate-resistant phenotype. Studies conducted in our laboratory and others identified a potential role for 2-methoxyestradiol (2-ME2) to prevent prostate cancer development and progression through inhibition of the anti-apoptotic protein FLIP. The goal of the current study was to identify biochemical changes in response to castration and treatment with 2-ME2 in serum from transgenic adenocarcinoma of mouse prostate (TRAMP) mice using mass spectrometry based global profiling. We identified a total of 54 biochemicals of which 16 increased and 38 decreased in castrated animals compared to sham-castration. Treatment of sham-castrated animals with low and high doses of 2-ME2 altered 91 and 145 biochemicals respectively. On the other hand treatment of castrated animals modulated 89 and 106 biochemicals. Cumulative analysis of these data also identified alteration of 60 biochemicals associated with castration effect, 149 with treatment and 70 interactions between castration and treatment effects. Castration affected metabolites involved in variety of metabolic pathways including lipid, oxidative stress, energetics and bile acid. Given the data showing enhanced expression of FLIP in castrate-resistant prostate tumors and upregulation of bile acids in patients undergoing androgen deprivation therapy, we examined the activation of FLIP in prostate cancer cells in response to deoxycholic acid (DCA). Our data suggests that transcriptional activity of FLIP was higher in PC-3 cells treated with DCA. To the best of our knowledge, this is the first report demonstrating global metabolomic profiling of serum in response to castration and provide a framework for therapeutic targeting of bile acid metabolism. Supported by NIH CA 135451 (APK).

Citation Format: Divya Chakravarthy, Paul Rivas, Brian Keppler, Jianhua Ruan, Rita Ghosh, Addanki Pratap Kumar. Metabolic profiling of castrate-resistant prostate cancer reveals novel role for bile acids in driving castration resistance. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5392. doi:10.1158/1538-7445.AM2013-5392

Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.

A direct comparison of efficacy between desloratadine and rupatadine in seasonal allergic rhinoconjunctivitis: a randomized, double-blind, placebo-controlled study

Background

H1-antihistamines are recommended as the first-line symptomatic treatment of allergic rhinitis. The objective of this study was to evaluate the effects of rupatadine (RUP) versus desloratadine (DES) in subjects with seasonal allergic rhinitis (SAR).

Method

To assess the efficacy and safety of RUP in SAR in comparison with placebo (PL) and DES. A randomized, double-blind, multicenter, international, and PL-controlled study was carried out. The main selection criteria included SAR patients over 12 years old with a positive prick test to a relevant seasonal allergen for the geographic area. Symptomatic patients at screening with a nasal symptom sum score of ≥6 points (nasal discharge, nasal obstruction, sneezing, and nasal pruritus), a non-nasal score of ≥3 points (ocular pruritus, ocular redness, and tearing eyes), and a rhinorrhea score of ≥2 points with laboratory test results and electrocardiography within acceptable limits were included in the study. Change from baseline in the total symptom-score (T7SS) over the 4-week treatment period (reflective evaluation) was considered the primary efficacy variable. Secondary efficacy measures included total nasal symptom score (T4NSS) and conjunctival symptom score (T3NNSS), both of which are reflective and instantaneous evaluations. Furthermore questions related to quality of life (eg, sleep disturbances or impairment of daily activities) have also been evaluated. Safety was assessed according to adverse events reported, as well as laboratory and electrocardiography controls.

Results

A total of 379 patients were randomized, of which 356 were included and allocated to PL (n = 122), RUP (n = 117), or DES (n = 117). Mean change of T7SS over the 4-week treatment period was significantly reduced in the RUP (–46.1%, P = 0.03) and DES (–48.9%, P = 0.01) groups, compared with PL. Similarly, RUP and DES were comparable and significantly superior to PL for all secondary endpoints, including nasal and conjunctival symptoms and patients’ and investigator’s overall clinical opinions. Symptom score evaluation (both reflective and instantaneous evaluations) throughout the treatment period showed a progressive and maintained significant improvement with both treatments at day 7 (P = 0.01), day 14 (P = 0.007), and day 21 (P = 0.01) in comparison with PL. Adverse events were scarce and were similar in both treatment groups. Electrocardiography (QTc) and lab test results did not show any relevant findings

Conclusion

RUP is a very good choice for SAR due to its contribution to the improvement of nasal (including obstruction) and non-nasal symptoms to a similar degree as DES.

Dietary resveratrol prevents development of high-grade prostatic intraepithelial neoplastic lesions: involvement of SIRT1/S6K axis

SIRT1 (mammalian ortholog of the yeast silent information regulator 2) is a NAD-dependent histone deacetylase belonging to the multigene family of sirtuins. Anecdotal and epidemiologic observations provide evidence for beneficial effects of the calorie restriction mimetic resveratrol (RES), a SIRT1 activator in preventing cardiovascular diseases and cancer. Although SIRT1 possesses both tumorigenic and antitumorigenic potential, the molecular mechanisms underlying SIRT1-mediated tumor progression or inhibition are poorly understood. In this study, we investigated the role of SIRT1 in multiple human prostate cancer cell lines and prostate-specific PTEN knockout mouse model using resveratrol. Androgen-independent prostate cancer cell lines (C42B, PC3, and DU145) express higher levels of SIRT1 than androgen-responsive (LNCaP) and nontumorigenic prostate cells (RWPE-1). Resveratrol enhanced this expression without any significant effect on SIRT1 enzymatic activity. Inhibition of SIRT1 expression using shRNA enhanced cell proliferation and inhibited autophagy by repressing phosphorylation of S6K and 4E-BP1. These biologic correlates were reversed in the presence of resveratrol. Analysis of prostates from dietary intervention with resveratrol showed a significant reduction in prostate weight and reduction in the incidence of high-grade prostatic intraepithelial neoplastic (HGPIN) lesions by approximately 54% with no significant change in body weight. Consistent with the in vitro findings, resveratrol intervention in the PTEN knockout mouse model was associated with reduction in the prostatic levels of mTOR complex 1 (mTORC1) activity and increased expression of SIRT1. These data suggest that SIRT1/S6K-mediated inhibition of autophagy drives prostate tumorigenesis. Therefore, modulation of SIRT1/S6K signaling represents an effective strategy for prostate cancer prevention.

Abstract 2585: Resveratrol induces autophagy in prostate cancer cells and intervention suppresses the progression of PIN in animals

Resveratrol (3,4′-trihydroxystilbene), a natural product is present in significant concentrations in red wine, peanuts, walnuts etc. Emerging evidence indicates that resveratrol exerts antitumorigenic activity in various tumor models including prostate. Although multiple biological effects on proliferation, apoptosis and activation of SIRT1 have been demonstrated to be associated with resveratrol-induced activities, the precise mechanism associated with resveratrol-induced SIRT1 activation and cancer cell growth inhibition remains unclear. In addition, whether resveratrol intervention suppresses the development and progression of PIN (Prostatic Intraepithelial Neoplasia) is unknown. In this study, we examined the role of SIRT1 and the underlying mechanism involved in resveratrol-mediated biological effects. Our results show that although resveratrol significantly inhibited proliferation of multiple prostate cell lines including RWPE-1, C42B, PC3 and DU145 at higher concentrations (&gt; 50 µM); however, at lower concentrations (&lt; 25 µM), resveratrol prompted cell proliferation. Interestingly androgen responsive LNCaP cells exhibited resistance to resveratrol-mediated inhibition of cell proliferation. Under these experimental conditions, we also observed significant increase in autophagy without remarkable increase in apoptosis. Given the role of Akt/mTOR signaling pathway as a negative regulator of autophagy, we investigated whether resveratrol induce autophagy via modulation of Akt/mTOR signaling. Our data indicate that resveratrol-induced autophagy was associated with decreased levels of mTORC1 activity and increased SIRT1 expression. Knockdown of SIRT1 enhanced prostate cell proliferation and attenuated resveratrol-induced autophagy. Using prostate specific PTEN−/− mice, we found that dietary administration of resveratrol reduced the incidence of high-grade PIN lesions significantly. These findings implicated an important role for mTORC1/SIRT1 signaling axis in mediating resveratrol-induced upregulation of autophagy and inhibition of apoptosis. [Supported by NIH CA137578 (APK)]

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2585. doi:1538-7445.AM2012-2585

Abstract 851: Interactions among transcription factors as a potential mechanism for inhibiting castrate-resistant prostate cancer (CRPCa) in transgenic adenocarcinoma of mouse prostate (TRAMP) through regulation of FLIP

Androgens are critical regulators of prostate differentiation and function as well as prostate cancer growth and survival. Prostate tumors initially regress in response to androgen-ablation therapy. However, most cancers eventually relapse with an androgen-depletion-independent phenotype that is often more aggressive than the original androgen-dependent tumor. Studies from our laboratory demonstrated that intervention with 2-ME2[2-methoxyestradiol] prevents early stage prostate cancer development and causes regression of established prostate tumors in the transgenic adenocarcinoma of mouse prostate model. Although 2-ME2 was found to be safe, well tolerated, reduce or stabilize PSA levels when given to hormone refractory prostate cancer patients who had failed other treatments including hormone therapy, it was found to be less bioavailable. Accordingly second generation 2-ME2 was developed using nanocrystal colloidal dispersion technology and has increased its bioavailability by 5-10 fold (EntreMed, Inc, Rockville, MD). In the current study we tested the ability of this newly formulated 2-ME2 on the development and progression of castrate-resistant prostate cancer in TRAMP mice. 10-12 week old TRAMP mice were castrated and fed water containing different amounts of 2-ME2 for 6 weeks. Efficacy was evaluated by magnetic resonance imaging, determining the prostate seminal vesicle complex volume and histological analysis of prostate tumor or tissue. Our results also show that 2-ME2 inhibited development of CRPCa in these mice. Further molecular analysis using cell lines demonstrated 2-ME2 treatment significantly inhibited DHT-stimulated cell proliferation in androgen-responsive LNCaP cells (p&lt;0.001). Further DHT-induced FLIP, PSA and AR transcriptional activity (as measured by promoter activities) were also reduced by 2-ME2 (p&lt;0.001). Transient expression assays coupled with gel-shift and ChIP assays show binding of multiple transcription factors including Sp1, Sp3, NFκB and AR to the FLIP promoter. 2-ME2 treatment reduced such binding to the FLIP promoter as evidenced by ChIP. 2-ME2 treatment also modulated the interactions among these transcription factors as evidenced by Re-ChIP assays. Interestingly transcription factor CREB but not Sp1 seems to play a predominant role in androgen regulation of FLIP expression. Our findings suggest that 2-ME2 affects androgen induced survival of prostate cancer cells through regulation of FLIP involving potential interactions between multiple transcription factors. Supported by ACS RSG-04-169 and NIH CA 135451 (APK).

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 851. doi:10.1158/1538-7445.AM2011-851

Pore Water Chemistry of the Febex Bentonite

The knowledge of pore water chemistry in the clay barrier is essential for performance assessment purposes in a nuclear waste repository, since the pore water composition controls the processes involved in the release and transport of the radionuclides. The methodology followed to define the representative composition of the FEBEX bentonite pore water is presented in this paper.

A series of bentonite-water interaction tests have been performed with the aim of providing a database on the main chemical parameters of the bentonite. These tests were carried out both with high solid to liquid (s:l) ratios (squeezing tests) and low s:l ratios (aqueous extracts tests). The exchangeable cations have also been analyzed to determine the selectivity coefficient of the exchange reactions. To complete the data set, a physical and mineralogical characterization of the bentonite was made.

The most significant bentonite-water interaction processes controlling the chemistry of the system was identified. The ion concentrations basically depend on the s:l ratio of the system, and the pore water composition is controlled by the dissolution of chlorides, dissolution/precipitation of carbonates and sulphates and the cation exchange reactions in the smectite.

The bentonite/water system was modelled with the PHREEQC2 program to obtain the best possible estimation of the pore water composition for initial conditions of water content (≍14%), after checking the conceptual model with the experimental results. The model predictions fitted satisfactorily with the experimental data at low s:l ratios. At high s:l ratios, the modelled results agree adequately, except for the sulphate content, which could be affected by the effective porosity, anion exclusion or stagnant zones not taken into account in the model. According to the model, the FEBEX bentonite pore water at 14% moisture is a sodium-chloride type, with an ionic strength of 0.25 M and pH of 7.78.

Phellodendron amurense bark extract prevents progression of prostate tumors in transgenic adenocarcinoma of mouse prostate: potential for prostate cancer management

Prostate cancer is the second leading cause of cancer-related deaths in men in Western society. Epidemiological studies suggest that a reduced risk of cancer is associated with the consumption of a phytochemical-rich diet that includes fruits and vegetables. Strategies to delay clinically significant prostate cancer will have a tremendous impact in reducing the overall incidence of prostate cancer as well as improving quality of life for elderly men. Furthermore, the long latency involved in the development of clinically significant prostate cancer provides a plethora of opportunities for its management, especially using prevention approaches. Previous studies from our laboratory show that Nexrutine (bark extract from Phellodendron amurense) prevents prostate tumor development when given prior to the development of high-grade prostatic intraepithelial neoplasia in the transgenic adenocarcinoma of mouse prostate (TRAMP) model. In this study, we investigated the effect on the progression of established tumors in the TRAMP model by administering Nexrutine to 28-week-old TRAMP mice. Efficacy of Nexrutine was determined by histopathological evaluation of the prostate. Our data indicate that Nexrutine inhibited progression of prostate tumors that was correlated with tissue levels of transcription factors nuclear factor kappa B, cyclic-AMP response element-binding protein and phosphorylated CREB. Moreover, Nexrutine intervention resulted in a significant increase in the bone mineral density of the left femur diaphysis (p=0.009) and prevented the development of metastatic lesions. Nexrutine treatment also significantly (p=0.005) inhibited invasion of androgen-independent prostate cancer cells.

Evolution of bone mineral density in AIDS patients on treatment with zidovudine/lamivudine plus abacavir or lopinavir/ritonavir

OBJECTIVES

The aim of the study was to determine the factors that may contribute to decreases in bone mineral density (BMD) in patients with AIDS.

METHODS

This was a prospective, non-randomized study. Dual X-ray absorptiometry (DXA) was used to determine the BMD of the lumbar spine, femoral neck and distal radius in treatment-naïve HIV-infected male patients with AIDS before and after 1 year of treatment with zidovudine (ZDV)/lamivudine (3TC) plus abacavir (ABC) or lopinavir/ritonavir (LPV/r).

RESULTS

Basal DXA was performed in 50 patients with CD4 counts <200 cells/microL and/or any AIDS-defining condition. Thirty-two patients completed 1 year with full adherence (17 on ABC and 15 on LPV/r) and a second DXA was then performed. At baseline, 19% had osteopenia at the lumbar spine and 19% at the femoral neck. Low body weight was related to low BMD. After 48 weeks, BMD loss was significant at the three locations. The percentage of BMD loss at the femoral neck tended to be greater in the lopinavir group (5.3 vs. 3.2%, P=0.058). The differences became significant at the lumbar spine (5.7 vs. 2.7%, P=0.044). In the multivariate analysis, the treatment with LPV/r remained associated with bone loss at the lumbar spine.

CONCLUSIONS

Osteopenia is frequent in treatment-naïve HIV-infected men with AIDS. Bone loss is higher with LPV/r-based regimens compared with triple nucleoside reverse transcriptase inhibitors.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire

OBJECTIVES

To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations.

METHODS

An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).

RESULTS

The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score.

CONCLUSIONS

This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.

Psychosocial profile in favor of organ donation

INTRODUCTION

The lack of organ donation continues to be a major limiting factor in transplantation. Our aims are: (1) to define the psychosocial profile against organ donation, and (2) to determine the impact of a law on the procurement and transplantation of organs based on "presumed consent" in the population.

MATERIALS AND METHODS

The population in this study (n = 2000) was randomly selected and stratified according to sex, age, and geographic localization. The attitude toward organ donation and transplantation was evaluated according to a questionnaire that probed psychosocial aspects of donation. Statistical comparisons were performed using the chi2 and logistic regression tests.

RESULTS

The population attitude toward organ donation was favorable in 63% of subjects, unfavorable in 31%, and 6% did not respond. With regard to the law based on "presumed consent," only 24% of the population agreed with the law; 53% thought it was an abuse of authority. The population subgroup with a negative attitude to the law was characterized by: age over 40 years, low educational level, no previous experience with organ donation or transplant, no experience in prosocial activities, a refusal to accept cadaver manipulation or mutilation, and lack of knowledge of the brain-death concept.

CONCLUSIONS

The psychosocial profile against donation is a person above 40 years with a low level of education who has never performed prosocial activities, did not have previous experience with organ donation or transplantation, displays no knowledge of the brain-death concept, and rejects cadaver manipulation. For these people a law based on "presumed consent" is considered an abuse of authority.

[Laryngeal chondro-radionecrosis]

Laryngeal chondroradionecrosis is a complication following radiotherapy for laryngeal tumours that may appear many years after the treatment. We present the case of a 78 year old man, that come to the Accident and Emergency department with a prelaryngeal mass and hemoptysis. He had been treated 17 years before with radiotherapy for a vocal cond carcinoma. Posteriorly the lesion did a cutaneous fistula with complete laryngeal exposition and torpid evolution. Post-radiotherapy necrosis in the larynx is a serious complication though not a common one. A tumour recurrence needs to be excluded and even in this case a total laryngectomy is mandatory as it will end in total loss of laryngeal function.

[The truthfulness of the answers of children, adolescents and young people to surveys on tobacco consumption conducted in schools]

BACKGROUND

The prevalence of tobacco consumption in scholars has been determined by self-governed inquiries, methodology that presents limitations of reliability and validity. This obstacle has been endeavoured to overcome through methodological inspections such as the test-retest valuation. On the contrary, the available analytical methods (i.e., determination of cotinine in urine or determination of carbon monoxide [CO] in exhaled air) have not been used up to now in this type of studies. Their use together with the inquiries could complement the results of the questionnaires and verify their reliability.

POPULATION AND METHODS

814 scholars took part in the survey, being valid the results of 809, 385 male students and 424 female students, 13 to 24 years old (mean 15.90, SD 1.73) from an urban high school and another in the rural area. The survey included a survey and the measurement of CO levels in exhaled air in the same scholar centre.

RESULTS

257 scholars stated that they had never tried tobacco and in 15 of them (5.8%) levels of CO were equal or higher than 10 ppm (14.26, SD 4.35 ppm). 589 students stated that were not regular smokers; in 46 of them (7.8%) levels of CO were superior to 10 ppm (13.87, SD 4.68). The morning when the survey was held 629 students assured that they had not smoked: in 52 of them (8.3%) levels of CO higher than 10 ppm were observed. The mean level of CO observed in these students was 13.5 (SD 4.4) ppm. In our survey, the measurement of CO in exhaled air allowed us to show percentage between 5.8 and 8.3% of students whose answers to the different questions were not reliable.

CONCLUSIONS

The reliability of the results, observed through the carrying out of surveys, can be determined with the use of analytical methods that, owe to their simplicity, can be used massively. We have not found any relation between the shortage of reliability and the variants studied (age, sex or habitat), which reaffirms the difficulty in identifying variants that can determine those "deceives" and demands for its identification the need of practicing analytical determinations.

Effects of some beta-carboline alkaloids on intact Trypanosoma cruzi epimastigotes

Several beta-carboline (9H-pyrido-[3,4-b]-indole) alkaloids were evaluated for in vitro trypanosomicidal activity against Trypanosoma cruzi epimastigotes belonging to two different strains (Tulahuén and LQ) showing different sensitivity to nifurtimox. Important differences were observed in the susceptibility of the parasites to these natural substances, with the relatively nifurtimox-resistant LQ strain showing greater sensitivity to the beta-carbolines. Respiratory chain inhibition appears to be a possible determinant of the trypanosomicidal activity of these compounds.