Phase I, pharmacokinetic (PK), pharmacodynamic study of paricalcitol [19-nor-1 alpha, 25-(OH)2 D2] in combination with gemcitabine [2’,2’ difluorodeoxycytidine] in patients with advanced malignancies

12010

Background: Calcitriol+ gemcitabine (gem) combination results in synergistic anti-tumor effect in preclinical models. Cytidine deaminase (CDD) inactivates gem into 2’,2’-difluorodeoxyuridine (dFdU) and its overexpression may lead to gem resistance. Calcitriol decreases CDD activity in peripheral blood mononuclear cells (PBM). Paricalcitol is cytotoxic in vitro and synergistic with several chemotherapeutic agents, including gem. We are conducting a phase I study of paricalcitol + fixed-dose gem. Objectives: The primary aim is to determine maximum tolerated dose (MTD) of the combination in patients (pts) with advanced cancer. Secondary aims are to evaluate toxicity, the effect of paricalcitol on gem PK, CDD activity in PBM and clinical outcome. Methods: Each cycle is 4 weeks: Gem 800 mg/m2 (over 80 min) weekly × 3, starting day 1; paricalcitol weekly, 24 h prior to gem, starting day 7. Standard 3+3 dose-escalation schema is used. Planned paricalcitol doses are 0.24, 0.72, 1.20, 1.8, 2.4 μg/kg, and 25% increments till MTD. Gem PK and CDD activity (PBM) are studied on days 1 and 8. Paricalcitol PK studies are obtained on day 7. Results: Fourteen pts with the following cancers: pancreatic (n=3), colon (n=3), lung (n=5), esophageal (n=1), bladder (n=1) and unknown primary (n=1) have been enrolled. No dose limiting toxicities have occurred. Median of 2 cycles were delivered (range 1–9). Grade 3 toxicities: anemia (n=3 pts), neutropenia (n=5), thrombocytopenia (n=3), thrombosis (n=2), anorexia (n=1), hypophosphatemia (n=1), dehydration (n=1), syncope (n=1), pneumonia (n=1) and chills (n=1). Grade 4 toxicities: anemia (n=1) and neutropenia (n=1). Hypercalcemia (> grade 1) did not occur. Stable disease occurred in 2 and progressive disease in 3. Conclusions: MTD was not reached at 1.8 μg/kg of paricalcitol with gem 800 mg/m2/week. Dose escalation is ongoing. PK data will be presented at meeting. Supported by NIH grants CA67267 and CA85142.

[Table: see text]

Vascular endothelial growth factor (VEGF) polymorphism is associated with prognosis of patients with gastric cancer

4019

Background: Recent studies demonstrated that the expression of vascular endothelial growth factor (VEGF) family had a prognostic significance in patients with gastric cancer. The present study analyzed VEGF polymorphism and its impact on prognosis in patients with gastric cancer. Methods: Five hundred three consecutive patients with surgically resected gastric adenocarcinoma at a single institution between January 2000 and December 2001 were enrolled into the study. Genomic DNA was extracted from paraffin-embedded tumor tissue and four VEGF (-460T > C, +405C > G, 936C> T, and -1154G > A) genotypes were determined using a PCR-RFLP assay. Results: The median age of patients was 60.0 years (range, 25–83 years), and 337 (67.0%) patients were male. Pathologic stages after resection were as follows: stage 0 (n=6, 1.2%), stage I (n=277, 55.1%), stage II (n=105, 20.9%), stage III (n=74, 14.7%), and stage IV (n=41, 8.2%). The estimated 5-year disease-free survival (DFS) rates according to stage were significantly different (p < 0.0001). Three VEGF polymorphisms (+405C > G, 936C, and -1154G > A > T) were not associated with survival of patients, while -460T > C polymorphism had a prognostic significance. In patients with early stage gastric cancer (stage 0 or 1, n=283), the estimated 5-year DFS and carcinoma-specific survival (CSS) for patients with homozygous genotype (CC or TT) of -460T > C were superior to those for heterozygous genotype (CT) (98.1% versus 90.3%, p=0.0047; 98.1% versus 92.5%, p=0.0284). In Cox multivariate regression, stage and VEGF -460T > C genotype were an independent prognostic factors for both DFS (p=0.007; p=0.010) and CSS (p=0.013; p=0.038). Conclusions: VEGF -460T > C polymorphism was found to be an independent prognostic marker for patients with curatively resected early stage gastric adenocarcinoma. Accordingly, VEGF -460T > C polymorphism can help to identify patients with unfavorable clinical outcome and thereby may be useful to refine therapeutic decisions in early stage gastric cancer.

No significant financial relationships to disclose.

Antitumor activities of the four sesquiterpene lactones from Elephantopus scaber L

AIM

To evaluate antitumor activity of sesquiterpene lactones (scabertopin (ES-2), isoscabertopin (ES-3), deoxyelephantopin (ES-4), isodeoxyelephantopin (ES-5)) isolated from Elephantopus scaber L. in vitro and in vivo.

METHODS

SMMC-7721, Caco-2 and HeLa cell lines were treated with ES-2,3,4,5. Cell viability was determined by MTT assay. Agarose gel electrophoresis was used to detect DNA fragmentation. To evaluate in vivo antitumor activity of ES-4, experimental murine tumor model was used.

RESULTS

It was shown that ES-2, ES-4, ES-5 exhibited significant antitumor effect in vitro in a concentration-dependent manner. However, the effect of ES-3 on the growth of tested cell lines was relatively weak. In HeLa cells exposed to ES-4 for 48 h, morphological changes and DNA ladder pattern evidencing on apoptosis were detected. ES-4 revealed in vivo antitumor activity.

CONCLUSION

Antitumor activity of studied sesquiterpene lactones may be due, at least in part, to induction of apoptosis in vitro. ES-4 possesses also antitumor activity in vivo.

Crystal structure of 2-nitrobenzene-1,4-dioxyacetic acid dihydrate, C6H3(NO2)(OCH2COOH)2 · 2H2O

C10H13NO10, monoclinic, P121/n1 (no. 14), a = 7.351(2) Å, b = 22.077(5) Å, c = 8.129(2) Å, β = 99.907(4)°, V = 1299.5 Å3, Z = 4, Rgt(F) = 0.041, wRref(F2) = 0.106, T = 294 K.

Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer

BACKGROUND

Preservation or removal of the spleen during total gastrectomy for proximal gastric cancer is a matter of debate.

METHODS

A randomized clinical trial included patients with gastric adenocarcinoma who underwent total gastrectomy either with (104 patients) or without (103) splenectomy. Postoperative outcome in the two groups was compared, including morbidity, mortality and survival.

RESULTS

Gastrectomy combined with splenectomy tended to be associated with slightly higher morbidity and mortality rates, a slightly greater incidence of lymph node metastasis at the splenic hilum and along the splenic artery, and marginally better survival, but there were no statistically significant differences between the groups. Splenectomy had no impact on survival in patients with metastatic lymph nodes at the hilum of the spleen or in those with metastatic lymph nodes along the splenic artery.

CONCLUSION

These results do not support the use of prophylactic splenectomy to remove macroscopically negative lymph nodes near the spleen in patients undergoing total gastrectomy for proximal gastric cancer.

Serological discrimination by indirect enzyme immunoassay between the antibody response to Brucella sp. and Yersinia enterocolitica O:9 in cattle and pigs

A rapid, inexpensive and rugged serological test that distinguishes cattle and swine infected with Brucella sp. or Yersinia enterocolitica O:9 is described. The test protocol, which is an indirect enzyme immunoassay uses a high concentration of divalent cation chelating agents to minimize binding of Y. enterocolitica O:9 antibody to rough lipopolysaccharide antigen derived from B. abortus RB51. No false positive reactions were observed when testing 100 Canadian cattle and swine without any evidence of brucellosis. The assay detected 91.6% of cattle (n=155) and 93.5% (n=31) of swine infected with Brucella sp. Sera from 58 cattle and 38 swine exposed to Y. enterocolitica O:9 were negative while only 20 sera from 121 'false positive' reactors of unspecified origin gave low level positive reactions, eliminating 84% of the false positive reactions.

Control of filamentation induced by femtosecond laser pulses propagating in air

Filamentation formed by self-focusing of intense laser pulses propagating in air is investigated. It is found that the position of filamentation can be controlled continuously by changing the laser power and divergence angle of the laser beam. An analytical model for the process is given.

Towards single screening tests for brucellosis

This paper describes an indirect enzyme-linked immunosorbent assay (I-ELISA) and a fluorescence polarisation assay (FPA), each capable of detecting antibody in several species of hosts to smooth and rough members of the genus Brucella. The I-ELISA uses a mixture of smooth lipopolysaccharide (SLPS) and rough lipopolysaccharide (RLPS) as the antigen, and a recombinant protein A/G conjugated with horseradish peroxidase as the detection reagent. When using individually determined cutoff values, the SLPS/RLPS combined-antigen I-ELISA detected antibody in slightly more animals exposed to SLPS or to RLPS than did I-ELISA procedures using each individual antigen separately. Similarly, the assay using combined antigens detected antibody in slightly fewer animals not exposed to Brucella sp. When a universal cutoff of 10% positivity was used (relative to strongly positive control sera of each species), the overall performance index (percentage sensitivity plus percentage specificity) value decreased by 1.0 (from 199.4 to 198.4). In the FPA, it was not possible to use a universal cutoff without significant loss of performance. The overall sensitivity value for the FPA using the combined FPA antigen was 1.0% lower than using the O-polysaccharide (OPS) from SLPS and 9.1% higher than using the core antigen (CORE) from RLPS. When the combined antigen was used, the FPA specificity was slightly higher (1.2%) than from only the OPS, and considerably higher (12.6%) than the CORE. Overall, both the I-ELISA and the FPA with combined antigens were suitable as screening tests for all species of Brucella in the animal species tested.

Synthesis of functional protein in liposome

The liposome consisting of eggPC, cholesterol, and DSPE-PEG5000 with a molar ratio of 1.5:1:0.08 was used to entrap cell-free protein synthesis reaction mixture. The synthesis of a mutant green fluorescent protein in the liposome was confirmed by the fluorescence emitted from the liposome on flow cytometry analysis and fluorescence microscopy. The protein synthesized in the liposome is hence functional.

Coexistence of superconductivity and antiferromagnetism probed by simultaneous nuclear magnetic resonance and electrical transport in (TMTSF)2PF6 system

We report simultaneous NMR and electrical transport experiments in the pressure range near the boundary of the antiferromagnetic spin density wave (SDW) insulator and the metallic/superconducting (SC) phase in (TMTSF)2PF6. Measurements indicate a tricritical point separating a line of second-order SDW/metal transitions from a line of first-order SDW/metal(SC) transitions with coexistence of macroscopic regions of SDW and metal(SC) order, with little mutual interaction but strong hysteretic effects. NMR results quantify the fraction of each phase.

An effective thermal conductivity model of nanofluids with a cubical arrangement of spherical particles

The theoretical investigation of the effective thermal conductivities of nanofluids, a new class of solid-liquid suspensions, is important in both predicting and designing nanofluids with effective thermal conductivities. We have developed a new thermal conductivity model for nanofluids that is based on the assumption that monosized spherical particles are uniformly dispersed in the liquid and are located at the vertexes of a simple cubic lattice, with each particle surrounded by a liquid layer having a thermal conductivity that differs from that of the bulk liquid. This model nanofluid with a cubical arrangement of nanoparticles gives a more practical upper limit of thermal conduction than a model nanofluid with a parallel arrangement of nanoparticles. The new model unexpectedly shows a nonlinear relationship of thermal conductivity with particle concentration, whereas the conductivity-concentration curve changes from convex upward to concave upward with increasing volume concentration. The effects of particle and layer parameters on the effective thermal conductivities are also analyzed. A comparison of predicted thermal conductivity values and experimental data shows that the predicted values are much higher than the experimental data, a finding that indicates that there is a potential to further improve the effective thermal conductivities of nanofluids with more uniformly dispersed particles.

Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis

Eighteen patients underwent stenting for symptomatic basilar artery stenosis. There were three major periprocedural complications (16.7%) without fatality. At a mean 26.7 +/- 12.1-month follow-up, 15 patients (83.3%) had an excellent long-term outcome. Only one patient (5.6%) had moderate disability from recurrent stroke, and two patients died of medical illness at 30 and 36 months after stenting. In this uncontrolled study, stenting appeared to be effective in reducing stroke risk and death and worthy of further scrupulous trial.

77Se NMR probe of magnetic excitations of the magic angle effect in (TMTSF)2PF6

We report 77Se spin-lattice relaxation rates for (TMTSF)2PF6, carried out in the regime where a set of spectacular transport anomalies known as the "magic angle effects" are observed. In situ resistance measurements (R(zz)) were used to verify the experimental conditions and give precise sample alignment information. We found that the 77Se T-11 exhibits no significant changes as the magnetic-field orientation is rotated through the magic angles, and conclude that there is no evidence for either a single-particle gap or a spin gap. The clearly observed field-induced spin-density wave transition temperature is also, unexpectedly, not enhanced at the magic angles.

Using GIS in government: an overview of the VHA's Healthcare Atlas, FY-2000

The amount of VA data available for analysis can be overwhelming to individuals who need to translate these data into usable information. The Atlas, using current GIS technology, was funded to provide data in a comprehensive guide. Patients were identified using a disease classification scheme based on Kaiser Permanente methodology and the Clinical Classifications Software (AHRQ). Utilization data were extracted from the Medical SAS Datasets. Cost data were obtained from the HERC. GIS tools were used to create the Atlas. The Atlas overviews the location of VA hospitals; profiles veteran, VA enrollee and patient populations; examines overall utilization; depicts patterns in healthcare use by specific disease cohorts; and examines geographic variations in costs. This product will enhance knowledge of VA's enrolled patient population and their healthcare needs, and provide background information that will improve the formulation of specific research questions to address those needs.

Hereditary neuropathy with liability to pressure palsy: fulminant development with axonal loss during military training

Hereditary neuropathy with liability to pressure palsy (HNPP) is characterised by recurrent mononeuropathies following minor trauma. We describe a case of fulminant HNPP beginning on the first day of military physical training. Protracted weakness, muscle atrophy, hand contractures, and multifocal sensory loss developed during a further three weeks of basic training. Nerve conduction changes were typical of HNPP, but without segmental slowing. Electromyographically, there was prominent acute denervation in muscles of the hands and right shoulder. Sural nerve biopsy demonstrated tomaculae and remyelination. Genetic testing revealed PMP-22 gene deletion. This case report demonstrates that HNPP can present with rapidly progressive peripheral nerve dysfunction and electrophysiological evidence of focal axonal loss.

A sterically stabilized immunolipoplex for systemic administration of a therapeutic gene

A sterically stabilized immunolipoplex (TsPLP), containing an antitransferrin receptor single-chain antibody fragment (TfRscFv)-PEG molecule, has been developed to specifically and efficiently deliver a therapeutic gene to tumor cells. A postcoating preparation strategy was employed in which a DNA/lipid complex (lipoplex) was formed first and then sequentially conjugated with PEG and TfRscFv. The complex prepared by this method was shown to be superior in ability to deliver genes to tumor cells than when prepared by a common precoating strategy, in which DNA is mixed with TfRscFv-PEG conjugated liposome. Using prostate cancer cell line DU145, a comparison was made between the in vitro and in vivo gene delivery efficiencies of four complexes, Lipoplex (LP), PEG-Lipoplex (PLP), TfRscFv-PEG-Lipoplex (TsPLP) and our standard TfRscFv-Lipoplex (TsLP). In vitro, the order of transfection efficiency was TsLP>LP approximately TsPLP>PLP. However, in vivo the order of transfection efficiency, after systemic administration via the tail vein, was TsPLP>TsLP>LP or PLP with TsPLP-mediated exogenous gene expression in tumor being two-fold higher than when mediated by TsLP. This suggests that the in vitro transfection efficiency of TsPLP was not indicative of its in vivo efficiency. In addition, it was found that the level of exogenous gene expression in the tumor mediated by TsPLP was higher than that mediated by TsLP and did not decrease over the time. More importantly, high exogenous gene expression in tumor, but low expression in liver, was observed after an i.v. delivery of TsPLP carrying either the GFP reporter gene or the p53 gene, indicating that tumor preferential targeting was maintained by this complex in the presence of PEG. These findings show that incorporation of PEG into our targeted lipoplex results in a more efficient delivery of the complex to the tumor cells, possibly by inhibiting the first pass clearance observed with non-PEG containing liposomes. Therefore, these data demonstrate that TsPLP is a improvement over our previously established tumor targeted gene delivery complex for systemic gene therapy of cancer.

Enzyme immunoassay for the diagnosis of brucellosis: chimeric Protein A–Protein G as a common enzyme labeled detection reagent for sera for different animal species

A recombinant protein combining the immunoglobulin binding sites of Proteins A and G, conjugated with horseradish peroxidase was used as a universal detection reagent for the assessment of antibodies against Brucella spp. The reagent was applied in an indirect enzyme immunoassay for detection of antibodies to smooth lipopolysaccharide antigen in sera from Brucella spp. exposed and non-exposed cattle, sheep, goats and pigs and to antibodies to rough lipopolysaccharide in sheep, dogs and cattle. The results were similar to those obtained when murine monoclonal antibody-enzyme conjugates were used. An added advantage was that a universal cut-off for all tests using the proteins A and G detection reagent could be established, simplifying diagnostic interpretation of the data.

Phase inhomogeneity of the itinerant ferromagnet MnSi at high pressures

The pressure induced quantum phase transition of the weakly ferromagnetic metal MnSi is studied using zero-field 29Si NMR spectroscopy and relaxation. Below P(*) approximately 1.2 GPa, the intensity of the signal and the nuclear spin-lattice relaxation are independent of pressure, even though the amplitude of the magnetization drops by 20% from the ambient-pressure amplitude. For P>P(*), the decreasing intensity within the experimentally detectable bandwidth signals the onset of an inhomogeneous phase that persists to the highest pressure measured, P>/=1.75 GPa, which is well beyond the known critical pressure P(c)=1.46 GPa. Implications for the non-Fermi liquid behavior observed for P>P(c) are discussed.

Comparative genomic hybridisation using a proximal 17p BAC/PAC array detects rearrangements responsible for four genomic disorders

BACKGROUND

Proximal chromosome 17p is a region rich in low copy repeats (LCRs) and prone to chromosomal rearrangements. Four genomic disorders map within the interval 17p11-p12: Charcot-Marie-Tooth disease type 1A, hereditary neuropathy with liability to pressure palsies, Smith-Magenis syndrome, and dup(17)(p11.2p11.2) syndrome. While 80-90% or more of the rearrangements resulting in each disorder are recurrent, several non-recurrent deletions or duplications of varying sizes within proximal 17p also have been characterised using fluorescence in situ hybridisation (FISH).

METHODS

A BAC/PAC array based comparative genomic hybridisation (array-CGH) method was tested for its ability to detect these genomic dosage differences and map breakpoints in 25 patients with recurrent and non-recurrent rearrangements.

RESULTS

Array-CGH detected the dosage imbalances resulting from either deletion or duplication in all the samples examined. The array-CGH approach, in combination with a dependent statistical inference method, mapped 45/46 (97.8%) of the analysed breakpoints to within one overlapping BAC/PAC clone, compared with determinations done independently by FISH. Several clones within the array that contained large LCRs did not have an adverse effect on the interpretation of the array-CGH data.

CONCLUSIONS

Array-CGH is an accurate and sensitive method for detecting genomic dosage differences and identifying rearrangement breakpoints, even in LCR-rich regions of the genome.

Inhomogeneous electronic structure probed by spin-echo experiments in the electron doped high-Tc superconductor Pr1.85Ce0.15CuO4-y

63Cu nuclear magnetic resonance spin-echo decay rate (T-12) measurements are reported for the normal and superconducting states of a single crystal of Pr(1.85)Ce(0.15)CuO(4-y) in a magnetic field B(0)=9 T over the temperature range 2<T<200 K. The spin-echo decay rate is temperature dependent for T<55 K and has a substantial dependence on the radio frequency (rf) pulse parameters below T approximately 25 K. This dependence indicates that T-12 is strongly effected by a local magnetic field distribution that can be modified by the rf pulses, including ones that are not at the nuclear Larmor frequency. The low-temperature results are consistent with the formation of a static inhomogeneous electronic structure that couples to the rf fields of the pulses.