Immunohistochemical properties of motoneurons supplying the porcine trapezius muscle

The trapezius muscle (TRAP) belongs to the scapulothoracic group of muscles, which play a crucial role in the integrity and strength of the upper limb, trunk, head, and neck movements and, thus, in maintaining balance. Combined retrograde tracing (using fluorescent tracer Fast Blue, FB) and double-labelling immunohistochemistry were applied to investigate the chemical coding of motoneurons projecting to the porcine TRAP. FB-positive (FB+) motoneurons supplying the cervical (c-TRAP) and thoracic part (th-TRAP) of the right (injected with the tracer) TRAP were located within the IX-th Rexed lamina in the ipsilateral ventral horn of the grey matter of the spinal medulla. Immunohistochemistry revealed that nearly all the neurons were cholinergic in nature [choline acetyltransferase (CHAT)- or vesicular acetylcholine transporter (VACHT)-positive]. Many retrogradelly labelled neurons displayed also immunoreactivity to calcitonin gene-related peptide (CGRP; approximately 68% of FB+ neurons). The smaller number of nerve cells (5%, 3%, 2% or 1%, respectively) stained for nitric oxide synthase (n-NOS), vasoactive intestinal polypeptide (VIP), neuropeptide Y (NPY) and substance P (SP). The retrogradely labelled neurons were closely apposed by nerve fibres expressing immunoreactivity to CHAT, VACHT, CGRP, SP, DβH, VIP, n-NOS, NPY, GAL, Leu-Enk and Met-Enk. Taking into account the clinical relevance of TRAP, the present results may be useful in designing further research aimed at the management of various dysfunctions of the muscle.

Pattern of Bone Marrow Hypometabolism on 18 F-FDG PET CT in Systemic Lupus Erythematous-Associated Aplastic Anemia

ABSTRACT

We present the case of a 23-year-old woman with juvenile onset systemic lupus erythematous on a background of thrombotic thrombocytopenic purpura, who was referred for 18 F-FDG PET CT scan due to pyrexia of unknown origin with raised inflammatory markers, severe thrombocytopenia, and anemia. An interesting pattern of predominantly photopenic hypometabolic bone marrow activity was demonstrated on 18 F-FDG PET CT.

AB0198 EFFICACY AND SAFETY AFTER TRANSITION FROM REFERENCE ADALIMUMAB TO CT-P17 (ADALIMUMAB BIOSIMILAR: 100 MG/ML) IN COMPARISON WITH THE MAINTAINED TREATMENT (CT-P17 OR REFERENCE ADALIMUMAB) IN PATIENTS WITH MODERATE-TO-SEVERE ACTIVE RHEUMATOID ARTHRITIS: 1-YEAR RESULT

Background:

Therapeutic equivalence of CT-P17 to reference adalimumab (ref-adalimumab) has been shown in patients with moderate-to-severe active rheumatoid arthritis (RA) through primary 24-week results [1]. Here, efficacy, pharmacokinetics (PK), safety and immunogenicity results up to 52-week, including transition data from ref-adalimumab to CT-P17 are presented.

Objectives:

To evaluate efficacy, PK, safety and immunogenicity when switched from ref-adalimumab to CT-P17 compared to maintaining CT-P17 or ref-adalimumab.

Methods:

In this study, 648 moderate-to-severe active RA patients despite methotrexate treatment were randomized (1:1) to either CT-P17 or ref-adalimumab and treated with doses of 40 mg every 2 weeks up to Week 24. Prior to dosing at Week 26, 608 patients were randomized again to either maintaining their treatments or being switched from ref-adalimumab to CT-P17. Efficacy, PK, safety, and immunogenicity were assessed up to Week 52.

Results:

After the second randomization, 303 patients continued with CT-P17, 153 patients continued with ref-adalimumab and 151 patients switched from ref-adalimumab to CT-P17 treatments, up to Week 48. Demographics and baseline characteristics were similar among the 3 groups. Sustained and comparable efficacy in terms of ACR20/50/70 response rates was achieved not only in the maintenance groups (CT-P17 or ref-adalimumab) but also in the switched from ref-adalimumab to CT-P17 group up to Week 52 (Figure 1).

Figure 1.

ACR 20/50/70 Response Rates up to 1 YearAbbreviation: ref-adalimumab, reference adalimumab.Note. There were patients who could not visit the study site due to COVID-19 pandemic and were counted as nonresponder for ACR response at Week 52.

In terms of PK, mean trough serum concentration (Ctrough) were maintained after Week 24 in all 3 groups. The observed mean Ctrough were within the reported therapeutic ranges of ref-adalimumab trough levels in RA patients (5-8 μg/mL).

The safety profile after transition was comparable among the 3 groups (Table 1). The most common treatment-emergent adverse events (TEAEs) was neutropenia. Similar proportions of patients in all 3 groups experienced at least 1 TEAE: injection site reactions, hypersensitivity/allergic reactions and infections. One malignancy (basal cell carcinoma; unrelated) was reported in the ref-adalimumab maintenance group. Safety data accumulated over 1 year also showed comparable results among the 3 groups. Anti-drug antibody (ADA) and neutralizing antibody (NAb) results were similar among the 3 groups. At Week 52, the proportions of patients who had ADA/NAbs were 28.4%/24.8% patients in CT-P17 maintenance, 27.0%/24.3% patients in ref-adalimumab maintenance and 28.3%/26.3% patients in switched to CT-P17 groups.

Conclusion:

Single transition from ref-adalimumab to CT-P17 was efficacious and safe without increase in immunogenicity. Also, efficacy, PK, safety and immunogenicity profiles were comparable between CT-P17 and ref-adalimumab up to Week 52.

References:

[1]J Kay et al, 2020. Poster Presented at ACR Convergence 2020.

Table 1.

Overview of TEAEs from Weeks 26 to 52 (Safety Population – second random subset)

Patients, n (%)Second RandomizationCT-P17 Maintenance(N=303)Ref-ada Maintenance(N=152)Switched to CT-P17 (N=152)≥1 TEAE121 (39.9)69 (45.4)73 (48.0)≥1 TESAE6 (2.0)3 (2.0)5 (3.3)≥1 TEAE leading to study drug discontinuation3 (1.0)2 (1.3)5 (3.3)≥1 TEAE classified as hypersensitivity/allergic reactions2 (0.7)1 (0.7)0 (0)≥1 TEAE classified as injection site reactions1 (0.3)4 (2.6)1 (0.7)≥1 TEAE classified as infection54 (17.8)41 (27.0)28 (18.4)≥1 TEAE classified as malignancy0 (0)1 (0.7)0 (0)

Abbreviations: Ref-ada, reference adalimumab; TEAE, treatment-emergent adverse event; TESAE, treatment-emergent serious adverse event.

Disclosure of Interests:

Daniel Furst Speakers bureau: CME, Consultant of: Amgen, Corbus, Galapagos, Horizon, Kadmon, Pfizer, Talaris, Grant/research support from: Corbus, CSL Behring, Galapagos, Gilead, GSK, Horizon, Kadmon, Novartis, Pfizer, Roche/Genetech, Talaris, Edward Keystone Speakers bureau: Amgen, AbbVie, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Novartis, Pfizer Pharmaceuticals, Sanofi Genzyme, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion Inc., Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc., Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepis, Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, PuraPharm, Jonathan Kay Consultant of: AbbVie, Inc., Boehringer Ingelheim GmbH, Celltrion Healthcare Co. Ltd., Jubilant Radiopharma, Merck & Co., Inc., Pfizer Inc., Samsung Bioepis, Sandoz Inc., Scipher Medicine, UCB, Inc., Grant/research support from: Paid to the University of Massachusetts Medical School: Gilead Sciences Inc., Novartis Pharmaceuticals Corp., Pfizer Inc., Janusz Jaworski: None declared, Rafal Wojciechowski: None declared, Piotr Wiland Speakers bureau: Eli Lilly, Sanofi Aventis, Novartis, Sandoz, Consultant of: Eli Lilly, Novartis, Sandoz, Anna Dudek: None declared, Marek Krogulec: None declared, Sławomir Jeka Speakers bureau: Novartis, Pfizer, Roche, Lilly, Teva, MSD, Abbvie, Sandoz, Egis, Medac, Consultant of: Novartis, Pfizer, Roche, Lilly, Teva, MSD, Abbvie, Sandoz, Egis, Medac, Agnieszka Zielinska: None declared, Jakub Trefler: None declared, Katarzyna Bartnicka-Masłowska: None declared, Magdalena Krajewska-Wlodarczyk Speakers bureau: Abbvie, Eli Lilly, Novartis, Roche, Piotr Klimiuk: None declared, Sang Joon Lee Employee of: Celltrion, Inc., Sung Hyun Kim Employee of: Celltrion, Inc., YunJu Bae Employee of: Celltrion, Inc., GoEun Yang Employee of: Celltrion, Inc., JaeKyoung Yoo Employee of: Celltrion, Inc., TaeKyung Kim Employee of: Celltrion, Inc.

Whole body MRI in multiple myeloma: Optimising image acquisition and read times

OBJECTIVE

To identify the whole-body MRI (WB-MRI) image type(s) with the highest value for assessment of multiple myeloma, in order to optimise acquisition protocols and read times.

METHODS

Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced Dixon images [fat-only (FO) and water-only (WO)], post contrast Dixon [fat-only plus contrast (FOC) and water-only plus contrast (WOC)] and diffusion weighted images (DWI) of the pelvis from all 30 patients were randomised and read by three experienced readers. For each image type, each reader identified and labelled all visible myeloma lesions. Each identified lesion was compared with a composite reference standard achieved by review of a complete imaging dataset by a further experienced consultant radiologist to determine truly positive lesions. Lesion count, true positives, sensitivity, and positive predictive value were determined. Time to read each scan set was recorded. Confidence for a diagnosis of myeloma was scored using a Likert scale. Conspicuity of focal lesions was assessed in terms of percent contrast and contrast to noise ratio (CNR).

RESULTS

Lesion count, true positives, sensitivity and confidence scores were significantly higher when compared to other image types for DWI (P<0.0001 to 0.003), followed by WOC (significant for sensitivity (P<0.0001 to 0.004), true positives (P = 0.003 to 0.049) and positive predictive value (P< 0.0001 to 0.006)). There was no statistically significant difference in these metrics between FO and FOC. Percent contrast was highest for WOC (P = 0.001 to 0.005) and contrast to noise ratio (CNR) was highest for DWI (P = 0.03 to 0.05). Reading times were fastest for DWI across all observers (P< 0.0001 to 0.014).

DISCUSSION

Observers detected more myeloma lesions on DWI images and WOC images when compared to other image types. We suggest that these image types should be read preferentially by radiologists to improve diagnostic accuracy and reporting efficiency.

Haptoglobin as a treatment monitoring factor in feline plasmacytic gingivostomatitis

INTRODUCTION

feline plasmacytic gingivostomatitis is an important and fairly common chronic disease. Its complex aetiology - which involves infectious agents, immunological disorders, and even genetic factors adds to the considerable difficulty of its treatment.

MATERIALS AND METHODS

the study was performed on 33 cats, 26 animals diagnosed with plasmacytic gingivostomatitis (study group) and 7 clinically healthy cats (control group). The study extended over four examination periods during which clinical and X-ray examinations, morphological and biochemical blood tests, as well as haptoglobin essays were performed.

RESULTS

the biochemical and haematological parameters were within normal limits. Blood serum haptoglobin measured on the first day of the treatment was above physiological levels, however its serum concentration decreased as the treatment progressed.

CONCLUSIONS

in the present study, despite the bacterial inflammatory condition of periodontal pockets, after the treatment was concluded and symptoms alleviated, neither clinical examinations nor haptoglobin essays revealed deviations from values commonly accepted as normal. Fluctuations in blood serum haptoglobin levels proved to be a useful prognostic in determining the duration of necessary treatment.

Immunohistochemical characterization of the jugular (superior vagal) ganglion in the pig

The study was carried out on three 4-month old female pigs. All the animals were deeply anesthetized and transcardially perfused with 4% buffered paraformaldehyde (pH 7.4). Left and right superior vagal ganglia (SVG) were collected and processed for immunofluorescence labeling method. The preparations were examined under a Zeiss LSM 710 confocal microscope equipped with adequate filter block. Neurons forming SVG were round or oval in shape with a round nucleus in the center. The majority of them (52%) were medium (M) (31-50 μm in diameter) while 7% and 41% were small (S) (up to 30μm in diameter) or large (L) (above 50 μm in diameter) in size, respectively. Double-labeling immunofluorescence revealed that SVG neurons stained for CGRP (approx. 57%; among them 37%, 9% and 54% were M, S and L in size, respectively), SP (14.5%; 72.4% M, 3.4% S, 24.2% L), VACHT (26%; 63% M, 24% S and 13% L), GAL (14%; 57% M, 29% S, 14% L), NPY (12%; 53% M, 12% S, 35% L), Met-Enk (5%; 40% M, 6% S and 54% L), PACAP (15%; 52% M, 24% S and 24% L), VIP (6.3%; 67% M, 8% S and 25% L), and NOS-positive (6%; 31% M and 69% L). The most abundant populations of intraganglionic nerve fibers were those which stained for CGRP or GAL, whereas only single SP-, PACAP- or Met-ENK-positive nerve terminals were observed.

The influence of resiniferatoxin on the chemical coding of caudal mesenteric ganglion neurons supplying the urinary bladder in the pig

Resiniferatoxin (RTX) is used as experimental drug therapy for a range of neurogenic urinary bladder disorders. The present study investigated the chemical coding of caudal mesenteric ganglion (CaMG) neurons supplying the porcine urinary bladder after intravesical RTX instillation. The CaMG neurons were visualized with retrograde tracer Fast Blue (FB) and their chemical profile was disclosed with double-labelling immunohistochemistry using antibodies against tyrosine hydroxylase (TH), neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), somatostatin (SOM), calbindin (CB), galanin (GAL) and neuronal nitric oxide synthase (nNOS). It was found that in both the control (n = 6) and RTX-treated pigs (n = 6), the vast majority (92.3 ± 2.7% and 93.1 ± 1.3%, respectively) of FB-positive (FB⁺) nerve cells were TH⁺. Intravesical instillation of RTX caused a decrease in the number of FB⁺ / TH ⁺ neurons immunopositive to NPY (91.0 ± 2.2% in control animals vs. 58.8 ± 5.0% in RTX-treated pigs) or VIP (1.7 ± 0.5% vs. 0%) and an increase in the number of FB⁺ / TH⁺ neurons immunoreactive to SOM (3.4 ± 1.5% vs. 20.6 ± 4.3%), CB (1.8 ±0.7% vs. 13.4 ± 2.3%), GAL (1.5 ± 0.6% vs. 7.5 ± 1.0%) or nNOS (0% vs. 10.9 ± 3.4%). The present results suggest that therapeutic effects of RTX on the mammalian urinary bladder can be partly mediated by CaMG neurons.

Prostate-specific antigen testing in inner London general practices: are those at higher risk most likely to get tested?

OBJECTIVES

To investigate the association between factors influencing prostate-specific antigen (PSA) testing prevalence including prostate cancer risk factors (age, ethnicity, obesity) and non-risk factors (social deprivation and comorbidity).

SETTING

A cross-sectional database of 136 inner London general practices from 1 August 2009 to 31 July 2014.

PARTICIPANTS

Men aged ≥40 years without prostate cancer were included (n=150 481).

PRIMARY OUTCOME

Logistic regression analyses were used to estimate the association between PSA testing and age, ethnicity, social deprivation, body mass index (BMI) and comorbidity while adjusting for age, benign prostatic hypertrophy, prostatitis and tamsulosin or finasteride use.

RESULTS

PSA testing prevalence was 8.2% (2013-2014), and the mean age was 54 years (SD 11). PSA testing was positively associated with age (OR 70-74 years compared to 40-44 years: 7.34 (95% CI 6.82 to 7.90)), ethnicity (black) (OR compared to white: 1.78 (95% CI 1.71 to 1.85)), increasing BMI and cardiovascular comorbidity. Testing was negatively associated with Chinese ethnicity and with increasing social deprivation.

CONCLUSIONS

PSA testing among black patients was higher compared to that among white patients, which differs from lower testing rates seen in previous studies. PSA testing was positively associated with prostate cancer risk factors and non-risk factors. Association with non-risk factors may increase the risk of unnecessary invasive diagnostic procedures.

Chemical Coding of Sensory Neurons Supplying the Hip Joint Capsule in the Sheep

Immunohistochemical properties of nerve fibres supplying the joint capsule were previously described in many mammalian species, but the localization of sensory neurons supplying this structure was studied only in laboratory animals, the rat and rabbit. However, there is no comprehensive data on the chemical coding of sensory neurons projecting to the hip joint capsule (HJC). The aim of this study was to establish immunohistochemical properties of sensory neurons supplying HJC in the sheep. The study was carried out on 10 sheep, weighing about 30-40 kg. The animals were injected with a retrograde neural tracer Fast Blue (FB) into HJC. Sections of the spinal ganglia (SpG) with FB-positive (FB+) neurons were stained using antibodies against calcitonin gene-related peptide (CGRP) substance P (SP), pituitary adenylate cyclase-activating peptide (PACAP), nitric oxide synthase (n-NOS), neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), Leu-5-enkephalin (Leu-Enk), galanin (GAL) and vesicular acetylcholine transporter (VACHT). The vast majority of FB+ neurons supplying HJC was found in the ganglia from the 5th lumbar to the 2nd sacral. Immunohistochemistry revealed that most of these neurons were immunoreactive to CGRP or SP (80.7 ± 8.0% or 56.4 ± 4.8%, respectively) and many of them stained for PACAP or GAL (52.9 ± 2.9% or 50.6 ± 19.7%, respectively). Other populations of FB+ neurons were those immunoreactive to n-NOS (37.8 ± 9.7%), NPY (34.6 ± 6.7%), VIP (28.7 ± 4.8%), Leu-Enk (27.1 ± 14.6) and VACHT (16.7 ± 9.6).

Activating PI3Kδ mutations in a cohort of 669 patients with primary immunodeficiency

The gene PIK3CD codes for the catalytic subunit of phosphoinositide 3-kinase δ (PI3Kδ), and is expressed solely in leucocytes. Activating mutations of PIK3CD have been described to cause an autosomal dominant immunodeficiency that shares clinical features with common variable immunodeficiency (CVID). We screened a cohort of 669 molecularly undefined primary immunodeficiency patients for five reported mutations (four gain-of-function mutations in PIK3CD and a loss of function mutation in PIK3R1) using pyrosequencing. PIK3CD mutations were identified in three siblings diagnosed with CVID and two sporadic cases with a combined immunodeficiency (CID). The PIK3R1 mutation was not identified in the cohort. Our patients with activated PI3Kδ syndrome (APDS) showed a range of clinical and immunological findings, even within a single family, but shared a reduction in naive T cells. PIK3CD gain of function mutations are more likely to occur in patients with defective B and T cell responses and should be screened for in CVID and CID, but are less likely in patients with a pure B cell/hypogammaglobulinaemia phenotype.

Caudal mesenteric ganglion in the sheep - macroanatomical and immunohistochemical study

The caudal mesenteric ganglion (CaMG) is a prevetrebral ganglion which provides innervation to a number of organs in the abdominal and pelvic cavity. The morphology of CaMG and the chemical coding of neurones in this ganglion have been described in humans and many animal species, but data on this topic in the sheep are entirely lacking. This prompted us to undertake a study to determine the localization and morphology of sheep CaMG as well as immunohistochemical properties of its neurons. The study was carried out on 8 adult sheep, weighing from 40 to 60 kg each. The sheep were deeply anaesthetised and transcardially perfused with 4% paraformaldehyde. CaMG-s were exposed and their location was determined. Macroanatomical observations have revealed that the ovine CaMG is located at the level of last two lumbar (L5 or L6) and the first sacral (S1) vertebrae. The ganglion represents an unpaired structure composed of several, sequentially arranged aggregates of neurons. Immunohistochemical investigations revealed that nearly all (99.5%) the neurons were DβH-IR and were richly supplied by VACHT-IR nerve terminals forming "basket-like" structures around the perikarya. VACHT-IR neurones were not determined. Many neurons (55%) contained immunoreactivity to NPY, some of them (10%) stained for Met-ENK and solitary nerve cells were GAL-positive. CGRP-IR nerve fibres were numerous and a large number of them simultaneously expressed immunoreactivity to SP. Single, weakly stained neurones were SP-IR and only very few nerve cells weakly stained for VIP.

MRI assessment of early response to certolizumab pegol in rheumatoid arthritis: a randomised, double-blind, placebo-controlled phase IIIb study applying MRI at weeks 0, 1, 2, 4, 8 and 16

OBJECTIVES

To identify the first time point of an MRI-verified response to certolizumab pegol (CZP) therapy in patients with rheumatoid arthritis (RA).

METHODS

Forty-one patients with active RA despite disease-modifying antirheumatic drug therapy were randomised 2:1 to CZP (CZP loading dose 400 mg every 2 weeks at weeks 0-4; CZP 200 mg every 2 weeks at weeks 6-16) or placebo→CZP (placebo at weeks 0-2; CZP loading dose at weeks 2-6; CZP 200 mg every 2 weeks at weeks 8-16). Contrast-enhanced MRI of one hand and wrist was acquired at baseline (week 0) and weeks 1, 2, 4, 8 and 16. All six time points were read simultaneously, blinded to time, using the Outcome Measures in Rheumatology Clinical Trials RA MRI scoring system. Primary outcome was change in synovitis score in the CZP group; secondary outcomes were change in bone oedema (osteitis) and erosion scores and clinical outcome measures.

RESULTS

Forty patients were treated (27 CZP, 13 placebo→CZP), and 36 (24 CZP, 12 placebo→CZP) completed week 16. In the CZP group, there were significant reductions from baseline synovitis (Hodges-Lehmann estimate of median change, -1.5, p=0.049) and osteitis scores (-2.5, p=0.031) at week 16. Numerical, but statistically insignificant, MRI inflammation reductions were observed at weeks 1-2 in the CZP group. No significant change was seen in bone erosion score. Improvements across all clinical outcomes were seen in the CZP group.

CONCLUSIONS

CZP reduced MRI synovitis and osteitis scores at week 16, despite small sample size and the technical challenge of reading six time points simultaneously. This study provides essential information on optimal MRI timing for subsequent trials.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT01235598.

Salivary markers in renal cell carcinoma

489

Background: Kidney cancer ranks number 8 among cancer diagnoses in the UK with around 9,600 new diagnoses made each year (Cancer Research UK. Risks and causes of kidney cancer. http://www.cancerresearchuk.org/cancer-help/type/kidney-cancer/about/risks-and-causes-of-kidney-cancer). This study aimed to identify overexpressed proteins in human saliva that could serve as markers for renal cell carcinoma. Methods: Saliva was collected from 144 participants (95 male and 28 female).; 123 RCC patients (85%) and 21 healthy controls (15%), Total salivary protein levels were determined by BCA protein assay. Then 10ug of total saliva protein were evaluated via Western blotting on 4-12% Bis-Tris SDS-PAGE gels. Blots were probed for albumin as well as for three proteins associated with RCC; profilin1, 14-3-3 zeta, and endogenous avidin binding protein (EABP). Additionally, 6 saliva samples were evaluated via quantitative proteomics in a Tandem mass tag (TMT) labelling experiment comparing 4 RCC patients vs. 2 renal cyst patients. Results: Profilin1 levels were determined visually on a scale of 0 to 3 depending on band intensities on Western blots. Cancer patients had a higher percentage of levels 2 and 3 with 62 patients (50.4%). The control group only had 2 patients at level 2 (9.5%) and none at level 3. No difference in profilin1 levels was seen between metastatic vs. non-metastatic disease. Differences were seen in gender and histology, with female and non-CC patients having higher profilin levels. There is a potential link between profilin1 levels and surgical or drug treatment. 14-3-3 zeta could not be detected in saliva with these analyses. Albumin was present across all samples. EABP was found in 40.6% of cancer patients vs. 0% of controls; however no clear trend was seen with respect to disease burden, histology, or gender. Proteomic analysis gave a total of 33 hits showing raised protein levels of up to 20x higher in cancer patients vs. controls. Profilin1 was 2x and 14-3-3 zeta 5x more prevalent. Conclusions: This study has successfully identified profilin1 as a detectable salivary marker for renal cell carcinoma. [Table: see text]

Sources of sensory innervation of the hip joint capsule in the rabbit - a retrograde tracing study

The aim of the study was to investigate the sensory innervation of the hip joint capsule in the rabbit. Individual animals were injected with retrograde fluorescent tracer Fast Blue (FB) into the lateral aspect of the left hip joint capsule (group LAT, n = 5) or into the medial aspect of the hip joint capsule (group MED, n = 5), respectively. FB-positive (FB+) neurons were found within ipsilateral lumbar (L) and sacral (S) dorsal root ganglia (DRG) from L7 to S2 (group LAT) and from L6 to S4 (group MED). They were round or oval in shape with a diameter of 20-90 μm. The neurons were evenly distributed throughout the ganglia. The average number of FB+ neurons was 16 ± 2.8 and 27.6 ± 3.5 in rabbits from LAT and MED, respectively. The largest average number of FB+ neurons in animals of group LAT was found within the S1 DRG (8 ± 1.7), while S2 ganglion contained the smallest number of the neurons (3.6 ± 1). In the L7 DRG, the average number of FB+ neurons was 6.2 ± 1.6. In rabbits of MED group, the largest number of FB+ neurons was found within the S1 DRG (13.4 ± 4), while the smallest one was found within the S3 ganglion (1.4 ± 0.4). In L6, L7, S2 and S4 ganglia, the number of retrogradely labelled neurons amounted to 1.6 ± 0.5, 4 ± 1.5, 4.4 ± 1.5 and 2.8 ± 1.7, respectively. The data obtained can be very useful for further investigations regarding the efficacy of denervation in the therapy of hip joint disorders in rabbits.

A phase II trial of dasatinib in advanced melanoma

9010

Background: Direct or indirect inhibition of Src kinases (non-receptor tyrosine kinase signaling intermediates) reduces melanoma cell proliferation in vitro. Dasatinib is a well tolerated, small molecule inhibitor of src kinase family members c-Src, c-Yes, Lck, and also inhibits c-KIT, PDGFβR and EPHA2. We initiated a CTEP-sponsored phase 2 trial of dasatinib in melanoma to assess response rate, PFS and toxicity. The secondary objective is to evaluate the association between clinical response and expression of dasatinib targets in tumors obtained pre-treatment. Methods: Adults with stage III/IV unresectable melanoma with a PS of 0- 1, who have not received prior chemotherapy are eligible. Dasatinib was administered at 100mg PO BID continuously to the first 18 patients. Subsequently, the starting dose was decreased to 70mg BID. Cycles are 4 weeks, tumor assessments occur q2 cycles. Results: Thirty patients have been accrued, five are too early to evaluate. Five, four and three patients had acral-lentiginous, ocular or mucosal primaries, respectively. Median age was 62, M:F 18:12, six received prior non-cytotoxic therapy. Three patients had confirmed partial responses lasting 16, 6, and 5 months, and one had a non-confirmed partial response, progressing after 4 cycles. One patient had a minor response and remains on study after 24 cycles. A patient with an exon 13 mutation in c-KIT responded to therapy, while another with a c-KIT exon 11 deletion mutation did not. Common toxicities are grade II fatigue, grade II-III dyspnea and pleural effusions. Chronic toxicities required reduction of the starting dose, and have been observed in all patients on dasatinib for over two months, all of whom required two dose reductions. Conclusions: Daily dasatinib has modest activity in melanoma. Accrual is almost complete. Toxicities are frequent, alternate schedules providing breaks in dosing might be better tolerated and should be evaluated. Combination studies may be warranted based on preclinical evaluation in molecularly defined subsets of patients.

[Table: see text]

Morphological examination of the proximal ganglion of the vagus nerve in the pig

This is the first report dealing with the localisation and morphology of the proximal (jugular) ganglion in the pig. Six 3-months-old pigs of both sexes were used in this study. Tissues were stained with three histological methods: Klüver-Barer counterstained with Cresyl violet, Haematoxylin-eosin and Mayer's haematoxylin. The localisation and morphological features of the ganglion and ganglionic neurones were described and discussed.

Phase I study of bortezomib plus cetuximab in patients with tumors expressing epidermal growth factor receptor (EGFR)

18143

Background: Bortezomib is a proteasome inhibitor that augments EGFR inhibitor activity (Cancer Research 2007; 67:(2),1–8). Cetuximab is a chimeric mouse-human antibody against EGFR that has been found to induce tumor responses in patients with colon cancer and head and neck cancer. The purpose of this study was to establish a maximum tolerated dose (MTD) for the combination of bortezomib plus cetuximab in patients with EGFR-expressing epithelial tumors. Methods: A 21-day treatment cycle was given with a maximum of six cycles per patient. Bortezomib was administered intravenously on days 1 and 8 via dose escalation, beginning with a minimum dose of 1.3 mg/m2 and increasing in one-tenth increments to 2.0 mg/m2 for a total of eight dose levels. Cetuximab was delivered with an initial dose of 400mg/m2 on day 1 cycle 1, with subsequent doses of 250mg/ m2 on days 1, 8 and 15. Results: Twenty patients (13 male and 7 female) with an ECOG PS <2 were enrolled in this study from November 2005 to December 2006. The median age was 59.5 (range: 41- 68), and the median number of prior chemotherapy regimens was 5 (range 1–7). Primary tumor sites included lung (9), head and neck (4), kidney (3), pancreas (2), bladder (1), and ovary (1). A total of 54 cycles of chemotherapy were administered; the median number of cycles per patient was 2.5 (range 1–6). Thirteen patients discontinued therapy because of disease progression. Two patients completed all six cycles of therapy. One dose-limiting toxicity (DLT) was seen at dose level 4 (bortezomib 1.6 mg/m2), which included grade 3 nausea, vomiting and dysphagia based on evaluation using CTCAE (version 3.0). Level 4 was expanded to enroll 3 additional patients, and no further grade 3 or 4 toxicities were observed. Grade 3/4 non- hematological toxicities were observed in 14 patients after their first cycle of therapy. Nine patients had delay in treatment. Conclusions: MTD for bortezomib plus cetuximab was not achieved at dose levels 1–6. This combination therapy has shown limited clinical activity in our extensively pretreated group of patients with solid tumors. Complete results for all dose levels, including dose levels 7–8, will be reported at the 2007 meeting of the American Society of Clinical Oncology.

[Table: see text]

A phase II study of intravenous (IV) milataxel (M) for the treatment of non-small cell lung cancer (NSCLC) refractory to platinum-based therapy

7098

Background: M (TL139, MAC-321) is a novel taxane that has shown activity when administered IV or orally in both taxane-resistant and susceptible nude mouse xenograft models. The current study is an open-label study in previously treated patients (pts) with locally advanced, metastatic, or recurrent NSCLC to determine response rate. Methods: Pts with cytologically or histologically confirmed NSCLC must have received 1 or 2 prior regimens including prior platinum, and may have received prior paclitaxel or docetaxel. Good performance status (ECOG 0 or 1), and adequate hematologic, hepatic and renal function were required. Pts with clinically active brain metastases were excluded. Pts were treated with M 35 mg/m2 as a 4 hr IV infusion every 3 weeks. The primary end point was objective response rate. Results: A total of 46 pts were treated: 21 (46%) female pts and 25 (54%) male pts. Mean age was 59 (range 41–85), ECOG was PS 0 in 13 (28%) pts, PS 1 in 31 (67%) pts and unknown in 2 (4%) pts. The number of prior chemotherapy regimens was > 1 in 21 (46%) pts. Twenty-five (54%) pts had one prior taxane and 7 (15%) pts had both paclitaxel and docetaxel previously. The median number of cycles was 3 (range 1–14). Nine (20%) pts required dose reduction. Five (11%) pts discontinued treatment due to adverse events. A total of 25 (54%) pts reported drug related grade 3 or 4 adverse events. Non-hematologic grade 3 or 4 drug-related events occurring in more than 1 pt included: neuropathy 4 (9%) pts, neutropenic fever 3 (7%) pts, arthralgia 2 (4%) pts. There was no treatment related mortality. Objective responses were confirmed in 4 (9%) pts (3 PR, 1 CR). Three pts with response (including pt with CR) had received prior docetaxel. PR duration was 175, 250, and 315 days. Pt with CR received 4 cycles of M and discontinued due to the CR. Pt remained in CR at day 504. Conclusions: Milataxel 35 mg/m2 as a 4 hr IV infusion every 3 weeks provided durable responses in heavily pretreated pts including pts who had previously received taxanes.

No significant financial relationships to disclose.

Initial results of a phase II study of biweekly pemetrexed and gemcitabine in patients with advanced NSCLC

7128

Background: Pemetrexed (P), a multi-targeted antifolate, is synergisitic with gemcitabine (G) in preclinical models. A phase I study examining a biweekly schedule established a recommended phase 2 dose of G 1500 mg/m2 followed by P 500mg/m2. Methods: Patients with Stage IIIB (with pleural effusion) or IV NSCLC, ECOG PS of 0 or 1, no prior systemic chemotherapy, immunotherapy, or biological therapy were enrolled. G was infused over 30 minutes, followed immediately by P given intravenously over 10 minutes once on day 1 every 14 days. Cycles were repeated until 12 treatments or progressive disease. All patients received folic acid, vitamin B12 and steroid prophylaxis. Results: Data on 53 patients (29 male, 24 female) are currently available. Median age: 64 (range: 35, 80), ECOG performance status 0:1 = 38%:60%, Stage IIIB:IV = 19%:81%. Three hundred twelve cycles of treatment were administered with 14 dose reductions (26.4%); median number of doses was 5 for both G and P, and median dose intensity was 98.05% for both G and P. Response data included 1 complete response (1.9%), 14 partial responses (26.4%), 24 stable diseases (45.3%), and 10 progressive diseases (18.9%), with a response rate of 28.3% (95% CI: 16.8–42.3%). Patient-based Grade 3/4 hematologic events included febrile neutropenia (9.4%), neutropenia (28.3%), and thrombocytopenia (1.9%). Grade 3/4 non-hematologic events included fatigue (22.6%), dyspnea (7.5%), dehydration (7.5%), diarrhea (5.7%), constipation (3.8%), and pneumonia (1.9%). Preliminary median survival was 7.8 months (95% CI: 6.0–10.8) with 43.4% patients censored and median TTPD was 4.6 months (95% CI: 2.8–6.1). Conclusion: Biweekly G and P appear to be well tolerated in advanced NSCLC. A clinical benefit rate (ORR + SD) of 73.6% indicates activity in patients with advanced NSCLC. The dose intensity for biweekly G and P is higher than a previously reported 6-cycle, 21-day regimen with median dose intensity of 83.2% for P and 82.2% for G (West, et al. Proc ASCO 2005; 7117).

[Table: see text]

A phase I clinical study of biweekly carboplatin and gemcitabine in patients with advanced solid tumors

12024

Background: Carboplatin (CBDCA) and gemcitabine (GEM) in combination is used commonly in lung cancer and is administered on a 21 day cycle. The purpose of this study was to determine the maximum tolerated dose (MTD) of CBDCA and GEM administered on a biweekly schedule and to assess safety and efficacy of this schedule. Methods: GEM was given intravenously (IV) over 30 minutes followed by CBDCA also given IV over 30 minutes. This combination was given on day 1 every 2 weeks. The dose levels examined are shown in the Table . A total of 26 patients were studied (18 male, 8 female) with median age of 56 (range 41–83 years); ECOG performance status of 24 patients were 0 (5), 1 (16), 2 (2), 3 (1); prior chemotherapy ranged from 0 to 4 regimens; median number of cycles administered per patient was 3 (range 1–9) with a total of 81 cycles. The primary tumors were lung (11), melanoma (4), head and neck (3), squamous cell penile/toe (2), bladder (2), kidney (1), gastric (1), esophageal (1) and ovary (1). Results: No DLTs were seen in any of these patients and the MTD was not reached. Delay in treatment was seen in total of 6 cycles due to myelosuppression and 1 cycle due to nausea and anorexia. Grade 3/4 hematological toxicity rates: anemia - 3/81 cycles (3.7%), neutropenia - 20/81 cycles (25%), and thrombocytopenia - 4/81 cycles (5%). Non-hematological toxicity was mild. The median time to progression was 40 days (range 4–133) and of 18 evaluable patients partial response or stable disease was seen in 7 (38.8%). Conclusions: Even at maximum tested dose of GEM at 2000 mg/m2 and CBDCA at AUC of 3.0, this schedule is well tolerated. Hematological toxicity such as neutropenia and thrombocytopenia was minimal. We plan to study this schedule of GEM and CBDCA in appropriate tumor types in combination with biologic agents.

[Table: see text]

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Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary Heart (ARCH) trial

OBJECTIVES

This study was designed to test whether intravenous (i.v.) amiodarone would prevent atrial fibrillation and decrease hospital stay after open heart surgery.

BACKGROUND

Atrial fibrillation commonly occurs after open heart procedures and is thought to be a significant determinant for prolongation of hospitalization. Oral amiodarone given preoperatively appears to reduce the incidence of atrial fibrillation. This study was designed to test whether the more rapid-acting i.v. formulation of amiodarone given postoperatively would reduce the incidence of atrial fibrillation.

METHODS

Three hundred patients undergoing standard open heart surgery were randomized in a double-blind fashion to i.v. amiodarone (1 g/day for 2 days) versus placebo immediately after open heart surgery. The primary end points of the trial were incidence of atrial fibrillation and length of hospital stay. Baseline clinical variables and mortality and morbidity data were collected.

RESULTS

Atrial fibrillation occurred in 67/142 (47%) patients on placebo versus 56/158 (35%) on amiodarone (p = 0.01). Length of hospital stay for the placebo group was 8.2 +/- 6.2 days, and 7.6 +/- 5.9 days for the amiodarone group (p = 0.34). No differences were noted in baseline variables, morbidity or mortality.

CONCLUSIONS

Low-dose i.v. amiodarone was safe and effective in reducing the incidence of atrial fibrillation after heart surgery, but did not significantly alter length of hospital stay.

[Growth hormone concentration following various factors stimulating its release]

Growth hormone concentration has been assayed in 105 children (45 girls and 60 boys) during starvation and following its stimulation with clonidine and insulin and during the sleep. A significant difference between growth hormone concentration during fasting and after stimulation has been noted. No statistically significant difference between growth hormone concentrations during the sleep and following insulin has been found. The most intensive growth hormone release has been observed during the sleep. Test with clonidine is technically simple and may be performed also in the out-patient clinics.