Serial assessment of lymphocytes and apoptosis in the prostate during coordinated intraprostatic dendritic cell injection and radiotherapy

Local radiotherapy plus intratumoral syngeneic dendritic cell injection can mediate apoptosis/cell death and immunological tumor eradication in murine models. A novel method of coordinated intraprostatic, autologous dendritic cell injection together with radiation therapy was prospectively evaluated in five HLA-A2(+) subjects with high-risk, localized prostate cancer, using androgen suppression, 45 Gy external beam radiation therapy in 25 fractions over 5 weeks, dendritic cell injections after fractions 5, 15 and 25 and then interstitial radioactive seed placement. Serial prostate biopsies before and during treatment showed increased apoptotic cells and parenchymal distribution of CD8(+) cells. CD8(+) T-cell responses to test peptides were assessed using an enzyme-linked immunosorbent spot IFN-γ production assay, demonstrating some prostate cancer-specific protein-derived peptides associated with increased titer. In conclusion, the technique was feasible and well-tolerated and specific immune responses were observable. Future trials could further test the utility of this approach and improve on temporal coordination of intratumoral dendritic cell introduction with particular timelines of therapy-induced apoptosis.

Prostate Cancer Chemoprevention Targeting Men with High-Grade Prostatic Intraepithelial Neoplasia (HGPIN) and Atypical Small Acinar Proliferation (ASAP): Model for Trial Design and Outcome Measures

In spite of the large number of nutrient-derived agents demonstrating promise as potential chemopreventive agents, most have failed to prove effectiveness in clinical trials. Critical requirements for moving nutrient-derived agents to recommendation for clinical use include adopting a systematic, molecular-mechanism based approach and utilizing the same ethical and rigorous methods such as are used to evaluate other pharmacological agents. Preliminary data on a mechanistic rationale for chemoprevention activity as observed from epidemiological, in vitro and preclinical studies, phase I data of safety in suitable cohorts, duration of intervention based on time to progression of preneoplastic disease to cancer and the use of a valid panel of biomarkers representing the hypothesized carcinogenesis pathway for measuring efficacy must inform the design of phase II clinical trials. The goal of this paper is to provide a model for evaluating a well characterized agent- Polyphenon E- in a phase II clinical trial of prostate cancer chemoprevention.

Challenges and potential solutions to meeting accrual goals in a Phase II chemoprevention trial for prostate cancer

OBJECTIVE

The goal of this report is to describe the on going strategies, successes, challenges and solutions for recruitment in this multi-center, phase II chemoprevention trial targeting men at high risk for prostate cancer.

METHODS

We developed and implemented a multi-center clinical trial in institutions with supportive infrastructure, lead by a recruitment team of experienced and committed physicians and clinical trial staff, implementing multi-media and community outreach strategies to meet recruitment goals. Screening logs were reviewed to identify trends as well as patient, protocol and infrastructure -related barriers impacting accrual and revisions to protocol implemented.

RESULTS

Between January 2008 and February 2011 a total of 3547 individuals were prescreened with 94% (n=3092) determined to be ineligible based on diagnosis of cancer or benign biopsy results. Of these, 216 were considered eligible for further screening with 52% (n=113) declining to participate due to patient related factors and 14% (n=29) eliminated due to protocol-related criteria for exclusion. Ninety-four (94) subjects consented to participate with 34% of these subjects (n=74) meeting all eligibility criteria to be randomized to receive study agent or placebo. Across all sites, 99% of the recruitment of subjects in this clinical trial is via physician recruitment and referral with less than 1% responding to other recruitment strategies.

CONCLUSION

A contemporary approach to subject recruitment and frequent evaluation is needed to assure responsiveness to emerging challenges to accrual and the evolving scientific literature. A focus on investing on improving systems for physician recruitment may be key to meeting recruitment target in chemoprevention trials.

Know when to say when: Serial assessment of apoptosis and lymphocyte infiltrates with combined intraprostatic autologous dendritic cell immunotherapy/radiation therapy in high-risk prostate cancer

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Background: Previous work suggested combining local radiotherapy (XRT) with intratumoral syngeneic dendritic cell (DC) injection could result in apoptosis/cell death mediated induction of cytotoxic T lymphocytes (CTL) based anti-tumor immunity. However, the presence, timing, and effectiveness of effector CTL prior, during, and following combined XRT/intratumoral autologous DC injection in humans is unknown.

Methods: Herein, we report on timing concerns of intraprostatic DC injection in vivo, in human; five HLA-A2+, high risk localized prostate cancer patients were treated on protocol using androgen suppression therapy (AS), external beam radiation therapy (EBRT, 45 Gy) followed by brachytherapy permanent interstitial implant with addition of autologous intraprostatic DC injections during EBRT, after fractions 5, 15, and 25 of 25. Multiple serial prostate biopsies were collected before initiation of treatment, during EBRT and at 3, 12, 24 and 36 months after completion of treatment. Biopsies were stained for CD3, CD4, CD8, and cleaved caspase 3, and evaluated in a blinded manner. Specific anti-tumor immunity was assessed via ELISpot IFN-gamma production by CTL stimulated by HLA-A2 peptides derived from sequences of proteins associated with prostate cancer.

Results: Apheresis, DC injections, and biopsies were well tolerated. The pattern of distribution of CD8+ cells was consistent with prostate cancer antigen targeting, rather than non-specific organ infiltration. There was not immediate obvious intraprostratic infiltrate by CTL after DC injection in vivo, in humans. Measurable, induced increases in ELISpot titers in peripheral blood CTL were observed for some subjects and for some antigens, but non-specific immunity fluctuated.

Conclusions: This initial translational experience demonstrates safety and timing of DC injection coordinated with combined AS and XRT. Design of future trials employing combination XRT and DC will consider timing concerns to match therapy-induced apoptosis/cell death.

No significant financial relationships to disclose.

Robotic-assisted partial cystectomy with en bloc excision of the urachus and the umbilicus for urachal adenocarcinoma

We report two cases of urachal adenocarcinoma managed with robotic-assisted partial cystectomy. A detailed description of the robotic technique including methods used to resect the tumor, urachus, and umbilicus en bloc is described. A review of the management of urachal adenocarcinoma is presented. The robotic approach is technically feasible and safe, and is an attractive alternative to traditional open or laparoscopic-assisted partial cystectomy for this uncommon genitourinary malignancy.

Identification of hTLR10: a novel human Toll-like receptor preferentially expressed in immune cells

Herein we describe the isolation of a cDNA encoding a novel human Toll-like receptor (hTLR) that we term hTLR10. Human TLR10 contains 811 amino acid residues. Deduced amino acid sequence analysis reveals that like the other known hTLRs (hTLR1-9) it is characterized by a signal peptide followed by multiple leucine-rich repeats (LRRs), a cysteine-rich domain, a transmembrane sequence and a cytoplasmic domain homologous to that of the human interleukin-1 receptor. Phylogenetic analysis indicates that among all the hTLRs, hTLR10 is most closely related to hTLR1 and hTLR6; the overall amino acid identity is 50% and 49%, respectively. hTLR10 mRNA is most highly expressed in lymphoid tissues such as spleen, lymph node, thymus, and tonsil. Expression analysis of cell lines indicates a predominance in a variety of immune cell types. Thus, hTLR10 is preferentially expressed in tissues and cells involved in immune responses.

Masoprocol (nordihydroguaiaretic acid): a new antihyperglycemic agent isolated from the creosote bush (Larrea tridentata)

An ethnomedically-driven approach was used to evaluate the ability of a pure compound isolated from the creosote bush (Larrea tridentata) to lower plasma glucose concentration in two mouse models of type 2 diabetes. The results indicated that plasma glucose concentration fell approximately 8 mmol/l in male C57BL/ks-db/db or C57BL/6J-ob/ob mice following the oral administration of masoprocol (nordihydroguaiaretic acid), a well known lipoxygenase inhibitor. The decline in plasma glucose concentration following masoprocol treatment in the mice was achieved without any change in plasma insulin concentration. In addition, oral glucose tolerance improved and the ability of insulin to lower plasma glucose concentrations was accentuated in masoprocol-treated db/db mice. These data raise the possibility that masoprocol, or other lipoxygenase inhibitors, represents a new approach to the pharmacological treatment of Type 2 diabetes.

Expression of bomapin, a novel human serpin, in normal/malignant hematopoiesis and in the monocytic cell lines THP-1 and AML-193

Our group recently cloned the cDNA-encoding bomapin, a member of the serine protease inhibitor (serpin) superfamily, from a human bone marrow cDNA library (J Biol Chem 270:2675, 1995). To understand its expression within the hematopoietic compartment, RNA extracted from bone marrow or peripheral blood from normal donors and patients with leukemia was reverse transcribed and analyzed by polymerase chain reaction (PCR). Bomapin PCR products were readily detected in normal bone marrow, which was designated as a medium mRNA level. In peripheral blood, bomapin expression was low or undetectable in normal donors (n = 6) and patients with chronic lymphocytic leukemia (n = 6). Blood from patients with chronic myeloid leukemia (n = 6), chronic myelomonocytic leukemia (n = 6), acute myeloid leukemia (n = 5), and acute lymphocytic leukemia (n = 5) exhibited low to medium levels of bomapin expression. Furthermore, a high level of bomapin expression was detected in one individual with acute monocytic leukemia. These data suggest that bomapin expression may be elevated in hematopoietic cells of monocytic lineage. Therefore, we analyzed the expression of bomapin within cell lines that exhibited characteristics of the monocytic lineage. Bomapin PCR products were detected in the monocytic THP-1 and AML-193 cell lines but not in CRL 7607, CRL 7541, KG-1, or K562 cells. Induction of bomapin transcripts was not detected in the latter series of cell lines following a 24-hour treatment with phorbol myristate acetate (PMA, 10(-8) mol/L) or tumor necrosis factor-alpha (TNF-alpha, 30 U/mL), whereas treatment of THP-1 or AML-193 cells with these agents reduced the intensity of the bomapin PCR products. Northern blotting confirmed these results and showed that the expression of bomapin in THP-1 cells was downregulated over a 4-day period by PMA and, to a lesser extent, TNF-alpha. Immunoblotting was used to show the presence of a 40-kD protein in THP-1 cytosol preparations. Bomapin antigen levels were correspondingly reduced after treatment with PMA. Because PMA and TNF-alpha induce monocytic differentiation in THP-1 and AML-193 cells, these data increase the possibility that bomapin may play a role in the regulation of protease activities specifically in early stages of cellular differentiation.

Multiband generation of mid infrared by use of periodically poled lithium niobate

We report the generation of simultaneous multiband mid-infrared laser output by use of periodically polled lithium niobate pumped by the 1.54-microm output from a KTP optical parametric oscillator. The multiband source is capable of producing three mid-infrared wavelengths ranging from 2.5 to 4microm . In initial experiments we obtained output powers of 542 mW near 2.5microm and 453 mW near 4microm , with power conversion efficiencies of 30% and 25%, respectively. To the best of our knowledge, this is the first demonstration of this kind in the literature.

Brca2 is required for embryonic cellular proliferation in the mouse

Mutations of the tumor suppressor gene BRCA2 are associated with predisposition to breast and other cancers. Homozygous mutant mice in which exons 10 and 11 of the Brca2 gene were deleted by gene targeting (Brca2(10-11)) die before day 9.5 of embryogenesis. Mutant phenotypes range from severely developmentally retarded embryos that do not gastrulate to embryos with reduced size that make mesoderm and survive until 8.5 days of development. Although apoptosis is normal, cellular proliferation is impaired in Brca2(10-11) mutants, both in vivo and in vitro. In addition, the expression of the cyclin-dependent kinase inhibitor p21 is increased. Thus, Brca2(10-11) mutants are similar in phenotype to Brca1(5-6) mutants but less severely affected. Expression of either of these two genes was unaffected in mutant embryos of the other. This study shows that Brca2, like Brca1, is required for cellular proliferation during embryogenesis. The similarity in phenotype between Brca1 and Brca2 mutants suggests that these genes may have cooperative roles or convergent functions during embryogenesis.

Effect of dispersion on the operation of a KTP electro-optic Q switch

The effect of dispersion on the operation of a KTP electro-optic Q switch was investigated. A KTP crystal in the normal orientation has been successfully operated as a Q switch. The experiment was performed with a laser resonator containing a Nd:YLF crystal end pumped with a cw diode-laser array. A pulse length of approximately 100 ns was obtained at a repetition rate of 1 KHz. Temperature tuning was used to eliminate static phase retardation. The effect of dispersion was found to affect Q switching. Wavelength stabilization was performed to counteract the effect of dispersion. These measures allowed us to achieve Q switching action.

Tunable diode-laser-pumped solid state LNA laser for helium spectroscopic experiments

We have designed, built, and tested a compact, integrated, single-mode solid state LNA laser pumped by a semiconductor laser array for exciting the He resonance line at lambda = 1.083 microm. The laser's three major components are mounted on a single aluminum base, and the diode laser and its beam shaping optics are mounted on a separate stage. This compact and stable structure provides good frequency stability and nearly pure TEM(00) transverse mode operation. The laser can be tuned around the metastable He resonance transition in a single longitudinal mode with linewidth congruent with 5 MHz using a solid, 60% coated intracavity 0.25-mm thick etalon. Saturated absorption signals on this transition have been used to measure the stability and tuning range. We have measured the properties for several crystals and calculated the expected performance characteristics to compare with the measured ones.