VEGF/VEGFR pathway inhibitors as anti-angiogenic agents: present and future

Angiogenesis, the formation of new blood vessels from pre-existing ones, plays a central role in the process of tumor growth and metastasis. The proliferation of endothelium and formation of new blood vessels further the size of solid tumors. It is expected that blocking angiogenesis will be an efficient therapeutic approach against many tumor types. The key signaling system that regulates proliferation and migration of endothelial cells are vascular endothelium growth factor (VEGF) and their receptors (VEGFR-1, -2 and -3). VEGFR-2, a receptor with higher affinity and greater kinase activity, is more important in the direct regulation of angiogenesis, mitogenic signaling, and permeability-enhancing effects. VEGFRs are expressed at high levels in many types of human solid tumors, including glioma, lung, breast, renal, ovarian and gastrointestinal tract carcinomas. Inhibition of VEGFR has emerged as a potential therapy method for cancers and it has been clinically validated with FDA-approvals of bevacizumab, sorafenib, and suntinib. Consequently, a number of small molecules with VEGFR inhibitory properties have been developed. Many of these have been evaluated as potent inhibitors and some are currently in clinical-trials for various angiogenic related disorders including inflammatory diseases, retinopathies and age related macular degeneration. This review reports various VEGF/VEGFR pathway inhibitors such as small molecules and monoclonal antibodies, along with their reported activities.

A six-to-ten weeks' follow-up study on the effects of olanzapine on abdominal fat and other metabolic parameters in patients with psychoses--an imaging-based study with controls

OBJECTIVES

To measure the changes in subcutaneous and intra-abdominal fat and other metabolic parameters in patients with psychotic disorders, who were newly started on olanzapine treatment and in drug-free controls. The correlation between changes in visceral fat and other metabolic parameters were also studied.

METHODS

Using a longitudinal open-label design, the 2 studied groups included patients with psychoses (n = 23) [diagnosed as per the 10th edition of the International Classification of Diseases criteria] and drug-free controls (n = 11). Fasting sugar, lipid profile and glycosylated haemoglobin levels were collected at baseline and follow-up. Computed tomographic scans were used to determine changes in the various abdominal fat parameters.

RESULTS

The patients were significantly younger than the controls, and the former had higher mean subcutaneous fat at baseline. There were statistically significant increases in the subcutaneous fat, intraabdominal fat, weight, waist circumference, hip circumference and body mass index in patients but not in controls. The mean dose of olanzapine (mg/day) correlated significantly with change of intraabdominal fat at follow-up. The change in intra-abdominal fat did not correlate significantly with any of the metabolic parameters studied.

CONCLUSIONS

Olanzapine produced significant increase in weight and fat parameters. This increase correlated with the dose of olanzapine.

The efficacy of catheters coated with minocycline and rifampin in the prevention of catheter-related bacteremia in cancer patients receiving high-dose interleukin-2

High-dose interleukin-2 (HDIL-2) has proven to be an effective treatment for metastatic renal cell carcinoma and melanoma. Previous studies have shown an increase in catheter-related bacteremia (CRB) in patients on HDIL-2. The primary objective of this study was to evaluate the effectiveness of minocycline and rifampin-coated catheters (M/R-C) in reducing CRB in cancer patients on HDIL-2. This was a retrospective study where non-coated catheters (NC-C) and M/R-C were used for the administration of HDIL-2 before and after December 2004, respectively. Data collected included demographics, cancer type, catheter type, antibiotic prophylaxis, and infection rates. A total of 107 episodes of catheter use for HDIL-2 were evaluated in 78 patients (30 episodes in patients with M/R-C vs. 77 with NC-C). A total of nine episodes of CRB were identified, all in patients with NC-C (M/R-C 0% vs. NC-C 12%; p=0.06). The median time to bacteremia was 11 days (range 1-315 days). A log-rank test showed a trend that the M/R-C group had lower probability of getting CRB than the NC-C group (p=0.06). The use of M/R-C in patients on HDIL-2 therapy for advanced melanoma and renal cell carcinoma may have reduced the risk of CRB to nil. CRB still occurred despite antibiotic prophylaxis in patients with NC-C.

Receptor tyrosine kinase inhibitors as potent weapons in war against cancers

Receptor Tyrosine Kinases class I (RTK class I, EGF receptor family) constitute a family of transmembrane proteins involved in various aspects of cell growth and survival and have been implicated in the initiation and progression of several types of human malignancies. Activation of EGFR may be because of overexpression, mutations resulting in constitutive activation, or autocrine expression of ligand. In contrast, activation of HER2 occurs mainly by overexpression, which leads to spontaneous homodimerization and activation of downstream signaling events in a ligand-independent manner. EGFR and HER2 have now been validated as a clinically relevant target, and several different types of agents inhibiting these receptors are currently in development. The EGFR inhibitors Erlotinib, Gefitinib, and Cetuximab have undergone extensive clinical testing and have established clinical activity in non small cell lung cancer (NSCLS) and other types of solid tumors. Several of the other erbB inhibitors are also undergoing advanced clinical testing, either alone or in combination with other agents. This review reports various inhibitors, natural, small molecules and monoclonal antibodies, along with their reported activities for various members of erbB family. It will highlight the potential for the development of novel anti-cancer molecules.

Inhibitors of cyclin dependent kinases: useful targets for cancer treatment

Cancer drug discovery is one of the most rapidly changing areas of pharmaceutical research. Uncontrolled proliferation is a hallmark of cancer cells. Over the past two decades, it has become increasingly clear that in many human cancers, hyperactivity of Cyclin Dependent Kinases (CDKs) is one of the mechanisms underlying the physiological hyper-proliferation. CDKs are serine/threonine protein kinases, which play an important role in cell-cycle regulation. Their sequential activation ensures, the correct timing and ordering of events required for cell cycle progression. Therefore, inhibition of CDKs, through the insertion of small molecules into its ATP binding pocket has emerged as a potential therapy method for cancers. Consequently, a number of small molecules with CDK inhibitory properties have been developed. Many of these have been evaluated as potent inhibitors and some are currently in clinical-trials for various types of cancer. This review reports various CDK inhibitors, natural as well as small molecules, along with their reported activities for various CDKs. It will highlight the potential for the development of novel anti-cancer molecules.

Protective effect of vitamin E against mercuric chloride reproductive toxicity in male mice

Mercury intoxication has been associated with male reproductive toxicity in experimental animals and mercury may have the potential to produce adverse effects on fertility in men. Vitamin E may protect against toxic effects of mercury in the liver and other tissues. To investigate the protective role of vitamin E against mercuric chloride toxicity for the testis, epididymis, and vas deferens of adult male mice, animals were treated with either mercuric chloride 1.25 mg/kg/day, vitamin E 2 mg/kg/kg, or a combination of the two treatments. Control animals were treated with water. Treatments were administered by daily gavage for 45 days. An additional group of animals treated with mercuric chloride were permitted to recover for 45 days after mercuric chloride treatments. Parameters studied included serum testosterone, epididymal sperm count, motility, and morphology, epididymal and vas deferens adenosine triphosphatase (ATPase), phosphorylase, sialic acid, glycogen and protein, testicular succinate dehydrogenase (SDH), phosphatases, cholesterol, ascorbic acid, and glutathione. Fertility was evaluated by sperm positive vaginal smears after overnight cohabitation with a female. Mercuric chloride produced a reduction in epididymal sperm count, sperm motility, and sperm viability, and there were no sperm-positive smears in this group. Biochemical tests from the male reproductive organs were also altered by mercuric chloride treatment. Coadministration of vitamin E with mercuric chloride prevented the changes in sperm and biochemical parameters and was associated with control rates of sperm positive smears after cohabitation. Animals given vitamin E with mercuric chloride also had lower concentrations of mercury in the testis, epididimyis, and vas deferens. Permitting animals to recover for 45 days after mercuric chloride treatment resulted in partial recovery of sperm and biochemical parameters. Vitamin E cotreatment has a protective role against mercury-induced male reproductive toxicity.

Post discharge dropout of alcoholics - a naturalistic study in a general hospital setting

In a naturalistic longitudinal design 133 consecutive inpatients with alcohol dependence syndrome were followed up for one year following discharge from the hospital. 59 patients (group 1) paid follow up visit at regular intervals whereas 28 subjects (group 2)never returned despite three consecutive postal intimations. Rest of the patient were irregular in follow up. The individuals in group 1 were compared with those in group 2 on various sociodemographic and clinical variables with the aim of delineating the characteristics that could define the alcoholics who dropped out following discharge. It was found that such patient were relatively younger with lower level of education, less frequently married, had earlier onset of problem drinking with poor social support and higher rates of mental problems. It was concluded that post discharge attrition of alcoholics could be a social as well as a clinical problem in any setting rendering long treatment for alcoholism.

Mania in hiv infection

Mania in HIV infected individuals is an uncommon clinical presentation. It can, however, complicate any stage of the HIV infection. We herewith report a set of three case reports of patients with HIV infection who developed manic episodes. The cases highlight some aspects of the plausible relationship between HIV infection and mania. HIV infection could be revealed by manic episode, it could itself also be associated with increased cycling in bipolar patients. Mania could be secondary to HIV or zidovudine therapy (though the etiological role of the latter is as yet unclear). Mania could also occur as a reaction to awareness to having HIV infection. These relationships are important for both the physician and the psychiatrist as they have important therapeutic and prognostic implications.

Diagnosing dementia due to alzemier's disease : clinical perspective

The diagnosis of dementia in Alzheimer's disease on clinical grounds is made by exclusion of other etiologies. The differential diagnoses of other subtypes considered along with dementia of Alzheimer's disease and the clinical process involved were studied in a tertiary level health care set up. Out of 39 patients with dementia admitted over 12 years it was found that a differential diagnoses of other subtype were considered along with dementia of Alzheimer's disease in 13 cases, while 15 cases had no such association. Most frequently associated category was vascular dementia in 30.8%. The clinical difficulties in differentiating dementia in Alzheimer's disease are discussed.

A case report of carisoprodol dependence

Carisoprodol is a centrally acting skeletal muscle relaxant whose active metabolite is meprobamate. There have been few reports of carisoprodol abuse from India. This is a report of a case with carisoprodol dependence. The patient also had poly substance abuse of alcohol, nicotine, benzodiazepine and dextropropoxyphene. Although no specific withdrawal syndrome could be identified, the patient had symptoms of anxiety, insomnia, restlessness and craving. Clinicians must be aware of the dependence potential of carisoprodol and need to be cautious in its prescription, especially in view of its free availability in the Indian market.

Patients who discontinue day hospitalisation - an analysis

Treatment discontinuation has been noted as a problem with psychiatric patients. This would equally be the case when long term measures for the rehabilitation of the mentally ill are concerned. In this study of patients who discontinued psychiatric day hospitalisation, it was found that over 90 % had dropped out in the first month of treatment. Schizophrenics, Manic Depressives, Epileptics and others contributed to the largest extent to this group whereas Mental Retardates discontinued less often. The discontinued patients either had better prognostic factors and maintained well subsequently (usually Manic Depressives) or relapsed soon after (usually Schizophrenics). The implications of the findings are discussed whilst comparing the discontinuers with those continuing day hospitalisation.

Neuropsychiatric morbidity in a beggars' colony

A begger's colony where a neuropsychiatric extension clinic is being run by NIMHANS, Bangalore, was selected for this study wherein 78 neuropsychiatrically ill inmates and 85 well ones were examined and diagnosed as per I.C.D.-9 and followed up on treatment. A period prevalence of 131.09/1000 serious neuropsychiatric morbidity was found with psychoses, mental retardation and epilepsy being more frequent than in general population studies. Findings in this study, point towards a need for reaching neuropsychiatric care to this section of society, and also confirm the association of certain social factors with serious morbidity.

Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permanent successors

Twenty-five permanent premolars were evaluated for enamel defects. The primary molars that they succeeded had been successfully treated with a formocresol pulpotomy. A relationship between the enamel defects and the pulpotomy procedures has been found.

Odontodysplasia

Results of a comprehensive dental examination, including a histologic evaluation, of a patient showing unilateral odontodysplasia revealed no hint as to the origin of the abnormality. A complete medical examination also resulted in negative findings, with the excetion of congenital bilateral talipes equinovarus. The genetic history was negative, and results of chromosomal studies of the child and her mother revealed no abnormalities. Neither had an anatomic or a functional abnormality, with the exception of the odontodysplasia in the child. Results of laboratory studies including complete blood counts, urinalyses, ferric chloride tests of the urine, and electrolyte tests also were negative. The special considerations given in this case in an attempt to establish a possible causation of the abnormality were inconclusive. We think, however, that the management of the patient was successful in regard to the prosthetic appliance, and every attempt will be made to follow up the patient to ensure a good prognosis of the remaining developing dentition.