Cardioprotective Effect of Marsdenia tenacissima and Sansevieria roxburghiana in Doxorubicin-induced Cardiotoxicity in Rats in vivo: The Role of Dresgenin and Lupeol

Objectives

The major adverse effect of doxorubicin (DOX) in cancer treatment is cardiac toxicity. Murva is a controversial plant used in the Ayurvedic system, which consist of more than 12 medicinal plant roots found in different parts of India. Marsdenia tenacissima (MT) is an acceptable source in Murva, whereas Sansevieria roxburghiana (SR) Schult & Schult.f. (S. zeylanica Roxb.) are also considered as Murva in West Bengal, India. The present study focused on the evaluation of the cardioprotective mechanism as well as the in vivo cardioprotective potential of methanol extracts of MT and SR on rats by using in silico methods.

Materials and Methods

A total of 48 rats were divided into 8 groups with 6 in each group. DOX 20 mg/kg, intraperitoneally (i.p.) was administered to all rats on the 13^th day, with the exception of group 1. Group 2 was the disease control, group 3 was the treated with the standard drug propronolol, and groups 4 to 5 were treated with two lower doses of methanol extract of MT (MEMT) and methanol extract of SR (MESR), whereas group 7 received higher dose combinations of both extracts for 14 continuous days. Blood and tissue antioxidant levels as well as cardiac enzymes were measured at the end of the study. Damage to cellular functional units was analyzed by histopathological study. Dresgenin from MT similarly lupeol from SR were taken as ligands for the target peroxisome proliferator activated receptors (PPARα) protein to find out the mechanism of action. High-performance thin layer chromatography (HPTLC) fingerprinting was performed to determine the number of phytoconstituents present in both extracts.

Results

The combination that showed the most significant (p<0.001) effect on altered cardiac enzymes and antioxidant enzyme levels in both blood and tissues also corrected the extreme damage in cellular functional units. Dresgenin and lupeol showed binding scores of -8.2 (kcal/mol) and -9 (kcal/mol), respectively, with PPARα. HPTLC reports revealed that 17 and 12 peaks were found at 254 nm for dresgenin and lupeol, respectively.

Conclusion

The study results concluded that the combination of MESR and MEMT and that of MESR and MEMT exerted cardioprotective activity via binding of dresgenin and lupeol to PPARα. The order of efficacy was the extract combination > MESR > MEMT.

Abstract P3-05-10: Impact of neoadjuvant systemic therapy on sTIL in breast cancer

Background

Multiple studies have shown a correlation between the presence of stromal tumor infiltrating lymphocytes (sTIL) and breast cancer outcomes. Higher sTIL are associated with higher rates of pCR, DFS, and OS. These findings have been primarily observed in TNBC and in HER2+ rather than in HR+, which overall has lower sTIL. Despite this growing body of prognostic evidence, there is little data comparing sTIL at diagnosis to sTIL after neoadjuvant systemic treatment. Understanding the impact of treatment on sTIL may lead to novel techniques to increase host immune response in the tumor microenvironment. The objective of this study was to correlate sTIL in paired samples before and after standard neoadjuvant systemic therapy, and then to identify the direction and magnitude of change in sTIL along with any associated features.

Methods

Institutional pathology database was queried for invasive breast carcinoma with “yp” in staging designation. From July 2013 to September 2016, there were 122 cases identified. When cases were excluded due to unavailable biopsy slides, there were 61 cases remaining. Needle biopsy and finalsurgical specimens were evaluated using International TIL Working Group 2014 guidelines and reported as a whole number percentage. In specimens with pCR, where there are no applicable guidelines, sTIL were determined by estimating the lymphoplasmacytic infiltrate in the tumor bed. Additional information gathered from the electronic medical record included patient age, clinical TNM stage, breast cancer subtype (HR+, HER2+, TNBC), neoadjuvant systemic therapy regimen (anthracycline, nonanthracycline, Trastuzumab-containing, endocrine), and response to treatment (pCR, residual invasive disease). A negative binomial generalized linear mixed model was used for analysis.

Results

Overall the sTIL declined from biopsy to surgery by about 36% (β = -0.448, S.E. = 0.223, pvalue = 0.045). However, there were 19/61 patients who had an increase in sTIL with neoadjuvant systemic therapy. For this group, the mean biopsy sTIL was 9.7% while the mean surgery sTIL was 28.7%, significantly higher than the mean biopsy (p-value &lt; 0.001). This group was not associated with age, stage, breast cancer subtype, or regimen. We examined our results in the 37/61 patients who did not achieve pCR. In all breast cancer subtypes, this group had an increase from biopsy to surgery in sTIL, with no significant difference between treatment regimens. Increasing age was significantly associated with lower sTIL in both biopsy and surgery specimens (p-value = 0.033). For every decade increase in age, sTIL decreased by about 37%.

Discussion

Overall the sTIL declined from biopsy to surgery. In the group of patients with an increase in sTIL, there was no significant correlation with systemic treatment regimen. There was a nonsignificant trend towards increasing sTIL and residual disease at surgery. We hypothesize that the host immune response declined after tumor eradication in pCR and remained active when residual disease was present. Increasing age was significantly associated with lower sTIL. Further work to identify additional factors associated with sTIL is needed to guide efforts to alter the immune response for improved breast cancer outcomes.

Citation Format: Armaghani A, Asirvatham R, Mramba L, Daily K. Impact of neoadjuvant systemic therapy on sTIL in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-05-10.

In vitro antioxidant and anticancer activity studies on drosera indica L. (Droseraceae)

PURPOSE

The aim of present in vitro studies was performed to examine the antioxidant and anticancer activities of ethanol and aqueous extracts of Drosera indica L.

METHODS

Different concentrations (5 - 640mcg/ml) of the ethanol (EEDI) and aqueous (AEDI) extracts of D.indica L were used in various antioxidant assay methods such as hydroxyl radicals, DPPH, super oxide radical scavenging activity, chelating ability of ferrous ion, nitric oxide radical inhibition, ABTS and reducing power. Ascorbic acid (AA) was used as the standard antioxidant for the free radical scavenging assays. Dalton's Ascitic Lymphoma (DAL) and Ehrlich Ascitic Carcinoma (EAC) cell lines were used as the in vitro cancer models for the tryphan blue dye and LDH leakage assays, where 5 to 250mcg /ml of both EEDI and AEDI were tested.

RESULTS

EEDI showed antioxidant activities with the minimum IC50 values of 34.8±0.43 mcg/ml in scavenging of hydroxyl radical and moreover AEDI showed minimum IC50 values of 94.51±0.84 mcg/ml in Fe(2+)chelating assay. EEDI on the reducing power assay and ABTS showed higher IC50 than standard AA. IC50 values of AEDI on Fe(2+) chelating assay and super oxide radical assay was lesser than IC50 value of AA. Both extracts at 250mcg/ml dose showed remarkable increase in the percentage of dead cancer cells (90% by EEDI and 86% by AEDI in DAL model and 89% by EEDI and 80% by AEDI in EAC model).

CONCLUSION

It is concluded from this study that D.indica L exhibited excellent antioxidant activity against the different in vitro antioxidant models and anticancer activity against the two different cell lines tested.

Tuberculosis in a renal allograft recipient presenting with intussusception

Extra-pulmonary tuberculosis (TB) is more common in renal allograft recipients and may present with dissemination or an atypical features. We report a renal allograft recipient with intestinal TB presenting 3 years after transplantation with persistent fever, weight loss, diarrhea, abdominal pain and mass in the abdomen with intestinal obstruction. He was diagnosed to be having an ileocolic intussusception which on resection showed a granulomatous inflammation with presence of acid-fast bacilli (AFB) typical of Mycobacterium tuberculosis. In addition, AFB was detected in the tracheal aspirate, indicating dissemination. He received anti-TB therapy (ATT) from the fourth postoperative day. However, he developed a probable immune reconstitution inflammatory syndrome (IRIS) with multiorgan failure and died on 11(th) postoperative day. This is the first report of intestinal TB presenting as intussusception in a renal allograft recipient. The development of IRIS after starting ATT is rare in renal allograft recipients. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and the therapeutic dilemma with overwhelming infection and development of IRIS upon reduction of immunosuppression and starting ATT.

Idiopathic forefoot-adduction deformity: medial capsulotomy and abductor hallucis lengthening for resistant and severe deformities

Between February 1981 and March 1993, 18 children (29 feet) with resistant forefoot adduction underwent medial capsulotomy and abductor hallucis lengthening for correction. There were 12 feet with metatarsus adductus (two simple, 10 complex) and 17 feet with skewfoot (15 simple and two complex). The mean age at the time of operation was 3.6 years (range, 9 months-5.5 years). When seen 3.6 years (range, 1-8) after surgical correction, all of them showed an improved talofirst metatarsal angle. Two children complained of pain in the foot, and one child had persistent difficulty with shoe fitting. We conclude that medial capsulotomy and abductor hallucis lengthening is a simple procedure that is effective in improving metatarsus adductus deformity.

Hypertension after surgical release for flexion contractures of the knee

We reviewed retrospectively 94 patients who had undergone soft-tissue release to correct flexion contracture of the knee to determine the incidence of postoperative hypertension. The cause of contracture in most patients was cerebral palsy (45) or old poliomyelitis (39). Twenty patients developed persistent hypertension. Two of them were symptomatic, one developing hypertensive encephalopathy. Patients who had had poliomyelitis were at a higher risk than those with cerebral palsy; the risk increased with bilateral procedures. The amount of correction achieved had no influence on the incidence of hypertension.

Ossifying parosteal lipoma with exuberant cortical reaction. A case report

Lipomas lying close to bone are called parosteal lipomas. They usually cause some bone reaction. We are reporting a dramatic example of this rare condition and have discussed the differential diagnosis and management.

Solitary infantile myofibromatosis of axis. A case report

Lytic lesions of the cervical spine are rare and may be caused by infection or tumors. The authors report a rare case of solitary infantile myofibromatosis presenting as a lytic lesion of the second cervical vertebral body (C2) and odontoid, causing atlanto-axial instability.

Supracondylar femoral extension osteotomy: its complications

Between 1979 and 1989, 105 supracondylar extension osteotomies of the femur were performed to correct knee flexion contractures. Disturbed by serious neurovascular complications, we reviewed our experience. Besides other complications, nine patients developed serious neurovascular complications; seven had permanent residua. There was no correlation between neurovascular complications and degree of preoperative contracture, patients' ages, or scarring from previous operation. We conclude that this osteotomy, although it appears to be technically simple, is potentially dangerous. We propose that the osteotomy be internally fixed and that the knee be flexed to relax the posterior neurovascular structures.

Extensor hallucis longus coaptation to tibialis anterior: a treatment for paralytic drop foot

Between June 1982 and April 1983, a procedure to coapt the extensor hallucis longus (EHL) to the tibialis anterior was performed in eight post-polio patients to correct drop foot and to enable the EHL to be a more efficient dorsiflexor of ankle. Although at early follow-up, every patient was able to actively dorsiflex the ankle against gravity, at final review, (mean follow-up 7.8 years), only two patients could still do so. Three patients developed a cock-up toe deformity or dorsiflexion deformity of great toe. We have attributed the poor final results to stretching of the coaptation. Use of splints or orthosis for a longer period postoperatively and a more carefully designed physical therapy may have yielded better results. Alternatively, if the EHL is anchored to navicular bone better results may be obtained.

Primary resection total knee arthroplasty for complicated fracture of the distal femur with an arthritic knee joint

Treatment of fractures of the distal end of the femur in an elderly patient is difficult. If the knee joint is arthritic, the problem is even greater. The reports of two patients with rheumatoid arthritis who sustained fractures of the distal end of the femur and underwent unconventional treatment with a resection total knee arthroplasty are presented.

Giant cell tumour of bone. A surgical approach to grade III tumours

Thirty-one patients with giant cell tumours of bone (BGCT) were treated at our hospital by a conservative approach between 1975 and 1988. 94% of the tumours were grade III (Campanacci) and the follow up was from 2 to 13 years. In the 20 patients who had a modified intralesional excision (curettage) with bone grafting and cement, 5 recurrences occurred. There was one soft tissue recurrence in the 11 patients who had marginal or wide excisions. All recurrences were in grade III lesions. We conclude that grade III BGCT can be treated by modified intralesional excision provided the articular surfaces and part of the metaphysis are intact.

Stabilization of the interphalangeal joint of the big toe: comparison of three methods

Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.

Ollier's disease with secondary chondrosarcoma associated with ovarian tumour. A case report

The association of an ovarian tumour with Ollier's disease or the Maffucci Syndrome is rare. We report what we believe to be the first patient with Ollier's disease associated with an ovarian tumour who later developed a secondary chondrosarcoma.

Tendoachilles tenodesis to the fibula: a retrospective study

Tendoachilles tenodesis to the fibula was performed in postpolio patients to improve their gait. The charts of 48 patients with 52 tenodeses were reviewed. The mean follow-up was 5.5 years. Gait improved in one-third. When the hindfoot was stabilized, gait improved in 40% of the patients, but when it was not stabilized, only 22% improved their gait. Excessive equinus developed in 18 patients, all of whom were less than age 12 years when operated. We conclude that it is reasonable to use this procedure to improve the gait of postpolio children with flail lower extremity, provided the hindfoot is stabilized.

Proximal tibial extension medial rotation osteotomy to correct knee flexion contracture and lateral rotation deformity of tibia after polio

A proximal tibial extension medial rotation osteotomy was performed on 17 tibias in postpoliomyelitis patients to correct knee flexion contractures simultaneously with the correction of lateral rotation deformity of the tibia through the same osteotomy. Gait improved in 10 patients. Five patients developed recurrence of knee flexion contractures; five more developed greater than 20 degrees genu recurvatum. One patient developed a common peroneal nerve palsy. Because of the high incidence of complications, we recommend that this procedure be abandoned.

Rotation osteotomy of the tibia after poliomyelitis. A review of 51 patients

After severe poliomyelitis, which is still relatively common in some developing countries, lateral rotation deformity of the tibia may occur. We have reviewed 51 patients treated by O'Donoghue's rotation osteotomy of the tibia. An average lateral rotation deformity of 57 degrees was fully corrected in all the patients, and in 38 of them the graft obtained during the osteotomy was used for a simultaneous Grice-Green subtalar arthrodesis in one or both feet. All the osteotomies united in an average of 11 weeks, some with relatively minor and unintentional posterior angulation. There was no posterior angulation when the length of the step cut osteotomy was 4.5 cm or more. O'Donoghue's osteotomy is a simple and safe operation, being particularly advantageous if a Grice-Green procedure is also required.