Creutzfeldt-Jakob disease with mixed transcortical aphasia: insights into echolalia

Aphasia is a common manifestation of Creutzfeldt-Jakob disease (CJD), and investigation of the linguistic disorders of CJD patients may provide insights into the neurobiological mechanisms of language and aphasia. We report an autopsy-confirmed case of CJD in which the presenting symptom was change in language abilities. The patient ultimately evidenced mixed transcortical aphasia (MTA) with echolalia. Disruption of frontal-subcortical circuits with environmental dependency accounts for the symptoms in MTA, including intact repetition and echolalia. Observation in this patient and a review of the literature suggest that frontal-subcortical circuit dysfunction may contribute to the syndrome of echolalia. This hypothesis offers an alternative explanation to "isolation" of the speech area as the cause of MTA.

Mitochondrial sirtuins as therapeutic targets for age-related disorders

Sirtuins are a class of histone deacetylases that have a wide range of regulatory roles in the cell. Three sirtuins, SIRT3 to SIRT5, localize to and function within the mitochondria. Mitochondrial dysfunction is thought to be the underlying mechanism of several age-related diseases, such as metabolic syndrome, cancer, and neurodegeneration. This review examines current evidence that mitochondrial sirtuins are involved in regulating mitochondrial function and pathogenesis.

Distinct long-term neurocognitive outcomes after equipotent sevoflurane or isoflurane anaesthesia in immature rats

BACKGROUND

Many anaesthetics when given to young animals cause cell death and learning deficits that persist until much later in life. Recent attempts to compare the relative safety or toxicity between different agents have not adequately controlled for the relative dose of anaesthetic given, thereby making direct comparisons difficult.

METHODS

Isoflurane or sevoflurane were given at 1 minimum alveolar concentration (MAC) for 4 h to postnatal day 7 (P7) rat pups. Beginning at P75 these animals underwent fear conditioning and at P83 Morris water maze testing to assess working memory, short-term memory and early long-term memory using delays of 1 min, 1 h, and 4 h.

RESULTS

No difference between groups was seen in fear conditioning experiments. Morris water maze learning was equivalent between groups, and no difference was seen in working memory. Sevoflurane-treated animals had a deficit in early long-term memory, and isoflurane-treated animals had a deficit in both short-term and early long-term memory.

CONCLUSIONS

Both isoflurane and sevoflurane delivered at 1 MAC for 4 h to immature rats caused a deficit in long-term memory. Isoflurane also caused a deficit in short-term memory. Isoflurane might be more detrimental than sevoflurane in very young animals.

SU-E-T-19: Fitting a Multiple Source Photon Model for Monte Carlo Treatment Plan Verification

PURPOSE

To assess and reduce the difficulty of fitting a multiple source photon model for monte carlo treatment plan verification.

METHODS

The EGS4 user code MCSIM, from Fox Chase Cancer Center, was chosen for its support of a multiple source photon model, of which the point and secondary (extrafocal) photon sources were utilized. A described method of fitting the secondary source to in-air output factors was implemented. Additionally, a method to fit the point source to a single large field dose distribution was explored. The point source fitter utilizes a database of pre-simulated mono-energetic fanlines to build distributions from arbitrary spectra. Perturbations are made to fanline spectra to reduce the errors along them. In this study the energy spectrum for each fanline has been limited to the log-normal distribution, which reduces the number of parameters for each to two.

RESULTS

It was found that one spectral parameter could be set to a constant for all fanlines and the other restricted to linearity with respect to off-axis position. The model matched the outputs and distributions in non-superficial areas to within 2% for 6MV and 15MV Varian iX field sizes between 4 and 40 cm. Various types of treatment plans were then successfully verified, including 3D, VMAT, IMRT, and an iPlan Monte Carlo stereotactic lung to within 3% (tumor dose).

CONCLUSION

With such tools it is practical for a non-research physicist to fit a two source photon model for the purpose of monte carlo treatment plan verification. The only commissioning data needed are in-air output factors, a single large field dose distribution, and the usual machine parameters provided by LINAC vendors for clinical second check programs. Even when only photons are simulated and spectra are greatly simplified it is possible to achieve acceptable results for non-superficial tumors. Furthermore, this is achieved without proprietary machine specifications.

Delayed environmental enrichment reverses sevoflurane-induced memory impairment in rats

BACKGROUND

Anesthesia given to immature rodents causes cognitive decline, raising the possibility that the same might be true for millions of children undergoing surgical procedures under general anesthesia each year. We tested the hypothesis that anesthesia-induced cognitive decline in rats is treatable. We also tested if anesthesia-induced cognitive decline is aggravated by tissue injury.

METHODS

Seven-day old rats underwent sevoflurane anesthesia (1 minimum alveolar concentration, 4 h) with or without tail clamping. At 4 weeks, rats were randomized to environmental enrichment or normal housing. At 8 weeks rats underwent neurocognitive testing, which consisted of fear conditioning, spatial reference memory, and water maze-based memory consolidation tests, and interrogated working memory, short-term memory, and early long-term memory.

RESULTS

Sevoflurane-treated rats had a greater escape latency when the delay between memory acquisition and memory retrieval was increased from 1 min to 1 h, indicating that short-term memory was impaired. Delayed environmental enrichment reversed the effects of sevoflurane on short-term memory and generally improved many tested aspects of cognitive function, both in sevoflurane-treated and control animals. The performance of tail-clamped rats did not differ from those rats receiving anesthesia alone.

CONCLUSION

Sevoflurane-induced cognitive decline in rats is treatable. Delayed environmental enrichment rescued the sevoflurane-induced impairment in short-term memory. Tissue injury did not worsen the anesthesia-induced memory impairment. These findings may have relevance to neonatal and pediatric anesthesia.

Development and implementation of a perfusion-based high cell density cell banking process

A perfusion-based high cell density (HD) cell banking process has been developed that offers substantial advantages in time savings and simplification of upstream unit operations. HD cell banking provides the means to reduce the time required for culture inoculum expansion and scale-up by eliminating the need for multiple small to intermediate scale shake flask-based operations saving up to 9 days of operation during large-scale inoculum expansion. HD perfusion cultures were developed and optimized in a disposable Wave bioreactor system. Through optimization of perfusion rate, rocking speed and aeration rate, the perfusion system supported peak cell densities of >20 × 10(6) cells/mL while maintaining high cell viability (≥ 90%). The cells were frozen at HD (90-100 × 10(6) viable cells/mL) in 5-mL CryoTube vials. HD cell banks were demonstrated to enable direct inoculation of culture into a Wave bioreactor in the inoculum expansion train thus eliminating the need for intermediate shake flask expansion unit operations. The simplicity of the disposable perfusion system and high quality of the cell banks resulted in the successful implementation in a 2000 L scale manufacturing facility.

Evaluation of pulsed high intensity focused ultrasound exposures on metastasis in a murine model

High intensity focused ultrasound (HIFU) may be employed in two ways: continuous exposures for thermal ablation of tissue (> 60 degrees C), and pulsed-exposures for non-ablative effects, including low temperature hyperthermia (37-45 degrees C), and non thermal effects (e.g. acoustic cavitation and radiation forces). Pulsed-HIFU effects may enhance the tissue's permeability for improved delivery of drugs and genes, for example, by opening up gaps between cells in the vasculature and parenchyma. Inducing these effects may improve local targeting of therapeutic agents, however; concerns exist that pulsed exposures could theoretically also facilitate dissemination of tumor cells and exacerbate metastases. In the present study, the influence of pulsed-HIFU exposures on increasing metastatic burden was evaluated in a murine model with metastatic breast cancer. A preliminary study was carried out to validate the model and determine optimal timing for treatment and growth of lung metastases. Next, the effect of pulsed-HIFU on the metastatic burden was evaluated using quantitative image processing of whole-lung histological sections. Compared to untreated controls (2/15), a greater number of mice treated with pulsed-HIFU were found to have lungs "overgrown" with metastases (7/15), where individual metastases grew together such that they could not accurately be counted. Furthermore, area fraction of lung metastases (area of metastases/area of lungs) was approximately 30% greater in mice treated with pulsed-HIFU; however, these differences were not statistically significant. The present study details the development of an animal model for investigating the influence of interventional techniques or exposures (such as pulsed HIFU) on metastatic burden.

Quality of life in advanced non-small cell lung cancer patients receiving first-line gefitinib monotherapy

9614

Background: Gefitinib is a potential first-line treatment option for patients with advanced non-small cell lung cancer (NSCLC), especially for patients with activating mutations in the EGFR gene. However, little is known about patient-reported health-related quality of life (HRQOL) in this patient population. The aims of this study were to explore the prognostic values of baseline HRQOL for time-to-treatment failure (TTF), as well as the predictors of repeatedly measured posttreatment HRQOL, in advanced NSCLC patients receiving first-line gefitinib. Methods: A total of 106 chemonaive patients with advanced NSCLC were enrolled in a phase II trial. Gefitinib was given at a dose of 250 mg/d. HRQOL was assessed monthly with the EuroQoL instrument (EQ-5D) and the Lung Cancer Symptom Scale (LCSS) questionnaire. Baseline HRQOL and clinical/molecular predictors of TTF were jointly examined by multiple Cox's proportional hazards model. The associations between the clinical/molecular factors and repeatedly measured posttreatment HRQOL were analyzed by fitting marginal linear regression model using the generalized estimating equations (GEE) method. Results: In this prospective study, HRQOL data were obtained from 94 patients. Baseline EQ-5D index (estimated hazard ratio = 0.286, 95% C.I.: 0.135–0.603, p = 0.001) and the presence of L858R EGFR mutation in adenocarcinoma (estimated hazard ratio = 0.520, 95% C.I.: 0.307–0.880, p = 0.015) were retained as independent prognostic factors in the final multiple Cox's proportional hazards model for TTF. According to preliminary GEE analysis of repeatedly measured posttreatment HRQOL, the patients with wild-type EGFR consistently had worse HRQOL in EQ-5D index (p < 0.0001), EQ-5D VAS score (p = 0.0002), and LCSS global score (p < 0.0001), respectively. Conclusions: In advanced NSCLC patients receiving first-line gefitinib, better baseline EQ-5D index and L858R EGFR mutation in adenocarcinoma predict longer TTF. In addition, patients with wild-type EGFR had worse posttreatment HRQOL.

No significant financial relationships to disclose.

Phase II randomized trial of erlotinib versus vinorelbine in chemotherapy-naive patients with advanced non-small-cell lung cancer (NSCLC) aged ≥70 years in Taiwan

8051

Background: Epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors, such as erlotinib, are effective against NSCLC, especially in East Asian patients. Single-agent chemotherapy, such as vinorelbine, is an appropriate treatment choice for elderly patients. Oral vinorelbine is more convenient for elderly patients than intravenous vinorelbine. The primary objective of this study was to compare the response rate of chemo-naïve, elderly patients with advanced NSCLC treated with daily erlotinib versus oral vinorelbine. Methods: Chemo-naïve Taiwanese patients aged ≥70 years with advanced NSCLC were enrolled and randomized (stratified by histology, smoking status, ECOG performance status, and gender) to receive either oral erlotinib 150mg/day or oral vinorelbine (60mg/m2 on days 1 and 8 of the first cycle and subsequently increased to 80mg/m2 every 3 weeks in the absence of grade 2 adverse events). From February 2007 to July 2008, 116 patients were enrolled. Results: By October 2008, 77 enrolled patients (n = 37 for erlotinib; n = 40 for vinorelbine) had completed 6 cycles of study treatment and were available for efficacy and safety analyses. Objective response rates were 21.6% (8/37) with erlotinib and 12.8% (5/39) with vinorelbine [95% CI -0.09–0.24 for the difference in response rate between arms]. Disease control rate was 70.3% with erlotinib and 56.4% with vinorelbine [95% CI -0.09–0.34 for the difference in disease control rate between arms; p = 0.216). Median time to disease progression was 4.4 months [95% CI 4.1–5.4] with erlotinib, compared with 3.9 months [95% CI 2.4–6.9] with vinorelbine, p = 0.6069. The most common treatment-related toxicities were skin rash and diarrhea with erlotinib, and diarrhea and nausea with vinorelbine. Conclusions: Erlotinib is effective and well tolerated compared with oral vinorelbine in elderly, chemo-naïve, Taiwanese patients with NSCLC. Updated efficacy and safety data will be presented.

[Table: see text]

A phase II study of BIBW 2992, a novel irreversible dual EGFR and HER2 tyrosine kinase inhibitor (TKI), in patients with adenocarcinoma of the lung and activating EGFR mutations after failure of one line of chemotherapy (LUX-Lung 2)

8013

Background: EGFR mutations are associated with exquisite sensitivity to EGFR TKIs in NSCLC. A phase II trial evaluating the efficacy of BIBW 2992 (Tovok), a novel, potent, irreversible, dual EGFR and HER2 TKI with preclinical activity in cell lines harboring activating (H3255, IC50=0.7 nM) and resistant (H1975, IC50=99 nM) EGFR mutations, is reported. Methods: Objective response rate is the primary endpoint of this 2-stage trial. Based on 16 or more unconfirmed PRs in an interim analysis of the first 40 2nd line patients (pts) completing 1 course (28 days), accrual will continue to a total of 120 1st and 2nd line pts (expected completion of accrual by May 2009. Data on 2nd line pts only are presented). Eligible pts have stage IIIB/IV lung adenocarcinoma, EGFR mutation in exons 18–21 (tested by direct sequencing), measurable disease, ECOG PS 0–2 and adequate end organ function. Pts receive 50 mg BIBW 2992 qd until progression. Tumor assessments are performed every 4 weeks for 12 weeks, then every 8 weeks. Results: Since Oct 2007, samples from 289 pts (222 from Taiwan and 67 from the US) have been sequenced. 100 had detectable EGFR mutations including del19 (n=39), L858R (n=45) and others (n=16). 69 pts have started treatment. The trial was moved to stage 2 after 21 of the first 38 treated pts had objective response at 28 days. Of 55 evaluable 2nd line pts, 29 (53%) had PR, and 23 (42%) had SD. Median follow up is 5.1 months. Most common related AEs were diarrhea and skin-related AEs, reported in 87% and 88% of pts, respectively. 27 pts (42.9 %) had dose reduction to 40 mg and 7 pts (11%) to 30 mg but only 1 pt permanently discontinued due to AEs. Diarrhea and rash were main causes of dose reduction. Conclusions: In the 2nd line setting, BIBW 2992 shows efficacy in NSCLC harboring EGFR activating mutations. Diarrhea and skin disorders, the most frequently observed AEs, are manageable with supportive care and dose reduction. Updated response and disease control rates and preliminary progression-free survival data will be presented. An international Phase III trial program investigating BIBW 2992 in NSCLC, LUX-Lung, is now recruiting.

[Table: see text]

Patching fellow eyes during subjective night does not prevent disruption to minus lens compensation in constant light-reared chicks

PURPOSE

This study re-examined an earlier claim that monocular patching during subjective night (i.e. patched at the usual time that night would occur) in the chicks reared in continuous lighting (CL), offered unpatched eyes some protection from the ocular effects of CL. It also examined whether this monocular patching protected unpatched eyes against the disruptive effect of CL on compensation to minus lenses.

METHODS

Hatchling White-Leghorn chicks were reared in either constant or diurnal lighting conditions (n=28) for 2 weeks. Some CL chicks had their right eyes patched every night during the entire study. Lenses of either +10 or -10D power were fitted to the unpatched eyes of some patched chicks at the beginning of the second week. Retinoscopy, IR photo-keratometry and high-frequency A-scan ultrasonography were used to track refractions, corneal radius of curvature and ocular axial dimensions respectively; data were collected on experimental days 0, 7, 9 and 14.

RESULTS

The patched eyes were completely protected from the ocular growth effects of CL, i.e. accelerated posterior segment (vitreous chamber) growth and inhibited anterior segment growth. Although the unpatched eyes showed no protection from the anterior chamber effects of CL, they were completely protected from the effects of CL on vitreous chamber growth. Nonetheless, the response to the -10D lenses was disrupted in unpatched eyes, which responded in the wrong direction for compensation (+5.5+/-0.25D more hyperopic than no lens-unpatched eyes). The response to the +10D lenses was preserved (+9.25+/-0.25D more hyperopic than no lens-unpatched eyes).

CONCLUSION

These data provide further support for local control of emmetropization, as reflected in compensatory lens responses, but point to additional influences on eye growth as reflected in CL-induced ocular changes.

Boron Carbide-Silicon Carbide Laminated Ceramics for Ballistic Protection

The paper describes the development of tough boron carbide-silicon carbide ceramic laminates with enhanced ballistic performance for armor application. Laminates with strong interfaces can provide high fracture toughness and damage tolerance along with improved ballistic protection. The enhancement of the mechanical/ballistic performance of laminates is obtained through design of controlled residual stresses in separate layers. The research produced a fundamental knowledge of the interrelationships between processing, residual stresses, and mechanical behavior of boron carbide based multilayered ceramic composites with an enhanced understanding of laminate’s fracture toughness, strength, and Young’s modulus. It was expected that the newly developed laminates would have necessary mechanical properties to increase maximum critical velocity of dwell/penetration transition during impact experiments.

Vagus nerve stimulation for epilepsy: is output current correlated with acute response?

OBJECTIVES

Vagus nerve stimulation (VNS) is an effective treatment for intractable epilepsy. It is unknown whether acute response is correlated with the amplitude of output current. The purpose of this study was to determine if the output current of VNS is correlated with percent reductions in seizure frequency and response.

MATERIALS AND METHODS

Retrospective analysis of a multicenter randomized trial of three unique paradigms of VNS was carried out in patients with intractable partial onset epilepsy. Output current at 1 and 3 months was correlated with percent reduction in seizure frequency and response rates.

RESULTS

Sixty-one subjects were enrolled and completed the study. Output current, ranging from 0.25 to 1.5 mA, was not correlated with reductions in seizure frequency, or with > or = 50% reduction in seizures. Six of seven initial non-responders did experience > or = 50% reductions in seizures after current was increased.

CONCLUSIONS

The output current is not a major determinant of acute response to VNS for epilepsy. Many patients respond to low current (<1 mA). Some (20%) initial non-responders may respond to an increase in output current.

Systemic RNAi in Caenorhabditis elegans

RNA interference (RNAi) in Caenorhabditis elegans induced by ingestion or injection of double-stranded RNA (dsRNA) spreads throughout the organism and is even transmitted to the progeny. We have identified two proteins required for spreading of RNAi, SID-1 and SID-2, whose structure, subcellular localization, and expression pattern have been informative for how dsRNA can be transported into and between cells. SID-1 is a transmembrane protein that functions as a pore or channel that transports dsRNA into and out of cells. Proteins homologous to SID-1 are present in a wide range of invertebrate and vertebrate animals but are absent from plants. SID-2 is a small transmembrane protein that is expressed in the gut and localizes strongly to the luminal membrane where it appears to act as a receptor for uptake of dsRNA from the environment. Characterization of SID-2 activity in a variety of Caenorhabditis nematodes indicates that C. elegans SID-2 may have a novel activity.

Gemcitabine plus conventional-dose epirubicin versus gemcitabine plus cisplatin as first-line chemotherapy for stage IIIB/IV non-small cell lung carcinoma: A randomized phase II trial

18072

Background: Epirubicin is active for treatment of non-small cell lung carcinoma (NSCLC) but its optimal dose was undetermined. This study was designed to evaluate the efficacy and safety of gemcitabine plus conventional-dose epirubicin for stage IIIB/IV NSCLC. Methods: Patients with histological or cytological diagnosis of stage IIIB/IV NSCLC who had not received prior chemotherapy were eligible. Patients were randomized to GE (gemcitabine, 1,000 mg/m2 on days 1, 8, and 15 and epirubicin, 70 mg/m2 on day 15) or GC (gemcitabine, 1,000 mg/m2 on days 1, 8, and 15 and cisplatin, 80 mg/m2 on day 15). Treatment cycles were repeated every 4 weeks. Objective tumor response and toxicity were evaluated by using the World Health Organization criteria. Results: No significant difference in baseline characteristics between patients randomized to GC (n=41) and GE (n=39) arms were found. The objective response rate was 31.0% (95% C.I. 16.4% to 45.5) for GC and 37.2.0% (95% C.I. 22.2% to 52.3%) for GE. The median time-to-treatment-failure and overall survival were 6.1 months (95% C.I. 4.9 to 7.4 months) and 13.2 months (95% C.I. 8.9 to 17.5 months) for GC and 6.2 months (95% C.I. 5.2 to 7.2 months) and 21.2 months (95% C.I. 14.6 to 27.8 months) for GE, respectively. More grade 3/4 neutropenia (71.8%) was noted in GE than in GC (43.9%). Febrile neutropenia was also more common in GE (4 patients) than in GC (1 patient). However, delay of protocol treatment due to leukopenia was similar between the 2 arms. Data on the expresssion of the excission repair cross-complimentation 1 (ERCC1), evaluated by immunohistochemical study for patients with available tumor tissue, will be presented. Conclusions: Gemcitabine plus conventional-dose epirubicin is an effective and well-tolerated regimen for patients with stage IIIB/IV NSCLC.

No significant financial relationships to disclose.

An increase of cytochrome C oxidase mediated disruption of gemcitabine incorporation into DNA in a resistant KB clone

Mechanistic aberrations leading to Gemcitabine (2',2'-dFdCyd,2,2-difluorodeoxycytidine, Gem) resistance may include alteration in its transport, metabolism and incorporation into DNA. To explore the mechanism of Gem resistance, the restriction fragment differential display PCR (RFDD-PCR) was employed to compare the mRNA expression patterns of KBGem (Gem resistant), KBHURs (hydroxyurea resistant) and KBwt (parental KB cell). Nine gene fragments were overexpressed specifically in the KBGem clone. Sequencing and BLAST results showed that three fragments represent cytochrome C oxidase (CCOX, respiration complex IV) subunit III (CCOX3). The cDNA microarray confirmed that the mRNAs of CCOX and ATP synthase subunits were upregulated in KBGem as compared to KBwt and KBHURs. The increase in CCOX1 protein and activity led to the increase of free ATP concentration, which is consistent with the gene expression profile of KBGem. Furthermore, the sensitivity to Gem could be reversed by sodium azide, a CCOX inhibitor. Following the treatment of sodium azide, the cellular accumulation of [3H]-Gem increased in a dose (of azide)-dependent manner, which is associated with increase of [3H]-Gem incorporation into DNA in KBGem. In summary, an increase of CCOX activity and free ATP level may reduce the transport, metabolism and DNA incorporation of Gem, resulting in Gem resistance.

Constant light rearing disrupts compensation to imposed- but not induced-hyperopia and facilitates compensation to imposed myopia in chicks

PURPOSE

While rearing chicks in constant light (CL) inhibits anterior segment growth, these conditions also induce excessive enlargement of the vitreous chamber. The mechanisms underlying these effects are poorly understood although it has been speculated that the enlarged vitreous chambers are a product of emmetropization, a compensatory response to the altered anterior segments. We examined the ability of eyes to compensate to defocusing lenses in CL as a direct test of their ability to emmetropize. We also studied recovery responses, i.e. from lens-induced changes in CL as well as CL-induced changes alone or combined with lens-induced changes in eyes returned to normal diurnal lighting (NL).

METHODS

Hatchling White-Leghorn chicks were reared in either CL or NL (control) lighting conditions (n=36) for 2 weeks, with lenses of either +10 or -10D power fitted to one eye of all chicks at the beginning of the second week. The lenses were removed at the end of the same week, at which time some CL chicks (n=14) were shifted to NL, the rest of the chicks remaining in their respective original lighting conditions. Retinoscopy, IR photo-keratometry and high-frequency A-scan ultrasonography were used to track refractions, corneal radii of curvature and ocular axial dimensions, respectively; data were collected on experimental days 0, 7, 9, 14 and 21.

RESULTS

Under CL, eyes showed near normal, albeit slightly exaggerated responses to +10D lenses while the response to -10D lenses was disrupted. With +10D lenses, lens-wearing eyes became more hyperopic (RE), and had shorter vitreous chambers (VC) and optical axial lengths (OL) relative to their fellows by the end of the lens period [RE: +10.5+/-1.5D, CL, +8.25+/-2.5D, NL; VC: -0.363+/-0.129mm, CL; -0.306+/-0.110mm, NL; OL: -0.493+/-0.115mm, CL, -0.379+/-0.106mm, NL (mean interocular difference+/-SD)]. With -10D lenses, the NL group showed a myopic shift in RE and increased elongation of both VC depth and OL (RE: -10.75+/-2.0D; VC depth: 0.554+/-0.097mm; OL: 0.746+/-0.166mm), while the CL group showed a small hyperopic shift in RE (+4.0+/-6.0D). Nonetheless, CL eyes were able to recover from lens-induced hyperopia, whether they were left in CL or returned to NL. One week of exposure to NL was sufficient to reverse the effects of 2 weeks of CL on anterior and vitreous chamber dimensions.

CONCLUSION

CL impairs emmetropization. Specifically, it disrupts compensation to lens-imposed hyperopia but not imposed myopia. However, CL eyes are able to recover from lens-induced hyperopia, suggesting that the mechanisms underlying the compensatory responses to defocusing lenses are different from those involved in recovery responses. The ocular growth effects of CL on young eyes are reversible under NL.

Translational regulation of the rod photoreceptor cGMP-phosphodiesterase: the role of the 5'- and 3'-untranslated regions

We have established earlier that rod photoreceptor cGMP-phosphodiesterase (PDE6) alpha and beta subunits are equally represented in the retina at the protein level and have similar turnover rates. mRNA quantification revealed five PDE6beta messages for every PDE6alpha transcript pointing at post-transcriptional regulation of PDE6alpha and PDE6beta expression. Indeed, the wild-type PDE6alpha mRNA was translated 5-fold more efficiently than that of PDE6beta. The coding regions of these subunits had a major contribution in this process. Here, we extend our study of translational regulation of PDE6 subunits and present a detailed analysis of the role of PDE6alpha and PDE6beta 5'- and 3'-UTRs (untranslated regions) in this process. We showed that both the short and long PDE6beta 5'-UTRs lead to more efficient protein synthesis than the PDE6alpha 5'-UTR. The 3'-UTRs of PDE6alpha and PDE6beta stimulated translation by approximately 2- and 3-fold, respectively. However, the positive effect of the PDE6alpha or PDE6beta 3'-UTRs was not observed when these regions were placed in constructs containing the 5'-UTR of the corresponding PDE6 subunit. Furthermore, it appears that PDE6alpha 5'- and 3'-UTRs may be involved in a base pairing interaction that reduces the efficiency of protein synthesis. Finally, using progressive deletion analysis of the PDE6alpha 5'-UTR, we have identified several regions that have significant contribution in regulation of protein synthesis. Based on these and earlier published data, it can be stated that an equimolar level of PDE6alpha and PDE6beta synthesized from different amounts of mRNA (ratio of PDE6alpha to PDE6beta mRNA in the retina is 1:5) is achieved as a result of combinatorial effects of 5'-UTRs and coding regions of PDE6alpha and PDE6beta mRNAs on translational regulation.

Metastasis-suppressing potential of ribonucleotide reductase small subunit p53R2 in human cancer cells

PURPOSE

Previous gene transfection studies have shown that the accumulation of human ribonucleotide reductase small subunit M2 (hRRM2) enhances cellular transformation, tumorigenesis, and malignancy potential. The latest identified small subunit p53R2 has 80% homology to hRRM2. Here, we investigate the role of p53R2 in cancer invasion and metastasis.

EXPERIMENTAL DESIGN

The immunohistochemistry was conducted on a tissue array including 49 primary and 59 metastatic colon adenocarcinoma samples to determine the relationship between p53R2 expression and metastasis. A Matrigel invasive chamber was used to sort the highly invasive cells and to evaluate the invasion potential of p53R2.

RESULTS

Univariate and multivariate analyses revealed that p53R2 is negatively related to the metastasis of colon adenocarcinoma samples (odds ratio, 0.23; P<0.05). The decrease of p53R2 is associated with cell invasion potential, which was observed in both p53 wild-type (KB) and mutant (PC-3 and Mia PaCa-2) cell lines. An increase in p53R2 expression by gene transfection significantly reduced the cellular invasion potential to 54% and 30% in KB and PC-3 cells, respectively, whereas inhibition of p53R2 by short interfering RNA resulted in a 3-fold increase in cell migration.

CONCLUSIONS

Opposite regulation of hRRM2 and p53R2 in invasion potential might play a critical role in determining the invasion and metastasis phenotype in cancer cells. The expression level of ribonucleotide reductase small subunits may serve as a biomarker to predict the malignancy potential of human cancers in the future.

Role of airway epithelial injury in murine orthotopic tracheal allograft rejection

BACKGROUND

Murine tracheal transplantation is a model used to study bronchiolitis obliterans syndrome, a major cause of morbidity and mortality after lung transplantation. Unlike murine heterotopic tracheal transplants, orthotopic transplantation does not cause luminal obliteration despite major histocompatibility antigen mismatch. Repopulation of the tracheal allografts with recipient-derived epithelium confers protection against luminal obliteration. The purpose of this study was to determine whether (1) orthotopic tracheal transplantation showed signs of allograft rejection, and (2) airway epithelial cell injury promoted orthotopic tracheal allograft rejection.

METHODS

Forty isogeneic (C57BL/6 to C57BL/6) and 40 allogeneic (BALB/c to C57BL/6) orthotopic tracheal transplants were performed. Damage to airway epithelial cells was induced by Sendai viral (SdV) infection and tracheal transplantation into non-reepithelializing matrix metalloproteinase-7 knockout (MMP7-KO) recipient mice. Percent fibrosis and lamina propria to cartilage ratio were calculated with computer assistance on harvested allografts.

RESULTS

Allografts showed significantly more intramural fibrosis compared with isografts at 30, 60, and 180 days after transplant without luminal occlusion. Tracheal allografts infected with SdV showed an increase in fibrosis and lamina propria to cartilage ratio compared with noninfected controls. Allografts retrieved from MMP7-KO recipients also showed a significant increase in fibrosis and lamina propria to cartilage ratio.

CONCLUSIONS

Although orthotopic tracheal transplantation does not cause luminal obliteration, it results in increased fibrosis in allografts. Damage to the respiratory epithelium by viral infection or defective reepithelialization after transplant as seen in MMP7-KO recipient mice leads to changes consistent with chronic allograft rejection, suggesting a role for epithelial injury in bronchiolitis obliterans syndrome development.

Pre-treatment PSA doubling time (PSADT) predicts biochemical response to chemotherapy in patients with androgen sensitive PSA progression after local therapy

14528

Background: As phase III studies are developed in patients with androgen sensitive (AS) PSA progression after local therapy, efforts to stratify patients based on likelihood of benefit is critical. In an effort to define a pretreatment PSADT cutoff that predicts chemotherapy response in AS patients for use in hypothesis testing in phase III studies, we assessed patients with pretreatment PSA data in two of our prior published phase II studies of docetaxel (D) or mitoxantrone (M) chemotherapy in patients with AS PSA progression without metastasis. Methods: A retrospective analysis of PSADT was performed on 36 pts with AS PSA progression following local therapy without metastasis with available pretreatment PSA values (23 pts with D and 13 pts with M). PSADT was calculated as [LN(2)]/b, where b is the slope of the regression of LN(PSA) vs time. A t-test was used to compare the PSADT of responders vs non-responders; ANOVA was used for the combined data. A logistic regression analysis with ROC curves was used to evaluate the value of PSADT in discriminating response. Results: Mean PSADT of patients with ≥50% decrease in PSA with therapy was 204 vs. 99 days (P = 0.02). For D only, mean PSADT of pts with any PSA decrease (mean 52%) vs. increase was 211 vs. 115 days (P = 0.04). The mean PSADT of pts with ≥50% PSA decrease only on D was 203 vs. 174 days (P = 0.31). Overall, logistic regression analysis showed that PSADT is a good test to discriminate which pts will have some decrease in PSA while on treatment (P = 0.03). ROC curves (AUC = 0.807) for pts with a decline in PSA on treatment showed that the best balance of sensitivity and specificity was for a PSA DT cutoff of 70 days (sens = 70.0%, spec = 71.4%). Sensitivity was highest at a DT of 50 days (85%), and specificity at 180 days (93%). Conclusions: This study suggests that pretreatment PSADT may be a useful predictor of response to therapy in patients with AS PSA progression after local therapy, but will require larger confirmatory studies. A PSADT cutoff of 70 days can be considered to stratify patients in future trials in this patient population.

No significant financial relationships to disclose.

Structurally dependent redox property of ribonucleotide reductase subunit p53R2

p53R2 is a newly identified small subunit of ribonucleotide reductase (RR) and plays a key role in supplying precursors for DNA repair in a p53-dependent manner. Currently, we are studying the redox property, structure, and function of p53R2. In cell-free systems, p53R2 did not oxidize a reactive oxygen species (ROS) indicator carboxy-H2DCFDA, but another class I RR small subunit, hRRM2, did. Further studies showed that purified recombinant p53R2 protein has catalase activity, which breaks down H2O2. Overexpression of p53R2 reduced intracellular ROS and protected the mitochondrial membrane potential against oxidative stress, whereas overexpression of hRRM2 did not and resulted in a collapse of mitochondrial membrane potential. In a site-directed mutagenesis study, antioxidant activity was abrogated in p53R2 mutants Y331F, Y285F, Y49F, and Y241H, but not Y164F or Y164C. The fluorescence intensity in mutants oxidizing carboxy-H2DCFDA, in order from highest to lowest, was Y331F > Y285F > Y49F > Y241H > wild-type p53R2. This indicates that Y331, Y285, Y49, and Y241 in p53R2 are critical residues involved in scavenging ROS. Of interest, the ability to oxidize carboxy-H2DCFDA indicated by fluorescence intensity was negatively correlated with RR activity from wild-type p53R2, mutants Y331F, Y285F, and Y49F. Our findings suggest that p53R2 may play a key role in defending oxidative stress by scavenging ROS, and this antioxidant property is also important for its fundamental enzymatic activity.

A Ferrous-triapine complex mediates formation of reactive oxygen species that inactivate human ribonucleotide reductase

Ribonucleotide reductase plays a central role in cell proliferation by supplying deoxyribonucleotide precursors for DNA synthesis and repair. The holoenzyme is a protein tetramer that features two large (hRRM1) and two small (hRRM2 or p53R2) subunits. The small subunit contains a di-iron cluster/tyrosyl radical cofactor that is essential for enzyme activity. Triapine (3-aminopyridine-2-carboxaldehyde thiosemicarbazone, 3-AP) is a new, potent ribonucleotide reductase inhibitor currently in phase II clinical trials for cancer chemotherapy. Ferric chloride readily reacts with Triapine to form an Fe(III)-(3-AP) complex, which is reduced to Fe(II)-(3-AP) by DTT. Spin-trapping experiments with 5,5-dimethyl-1-pyrroline-N-oxide prove that Fe(II)-(3-AP) reduces O2 to give oxygen reactive species (ROS). In vitro activity assays show that Fe(II)-(3-AP) is a much more potent inhibitor of hRRM2/hRRM1 and p53R2/hRRM1 than Triapine. Electron paramagnetic resonance measurements on frozen solutions of hRRM2 and p53R2 show that their tyrosyl radicals are completely quenched by incubation with Fe(II)-(3-AP). However, the enzyme activity is maintained in protein samples supplemented with catalase alone or in combination with superoxide dismutase. Furthermore, catalase alone or in combination with superoxide dismutase markedly decreases the antiproliferative effect of Triapine in cytotoxicity assays. These results indicate that Triapine-induced inhibition of ribonucleotide reductase is caused by ROS. We suggest that ROS may ultimately be responsible for the pharmacologic effects of Triapine in vivo.

A dityrosyl-diiron radical cofactor center is essential for human ribonucleotide reductases

Ribonucleotide reductase catalyzes the reduction of ribonucleotides to deoxyribonucleotides for DNA biosynthesis. A tyrosine residue in the small subunit of class I ribonucleotide reductase harbors a stable radical, which plays a central role in the catalysis process. We have discovered that an additional tyrosine residue, conserved in human small subunits hRRM2 and p53R2, is required for the radical formation and enzyme activity. Mutations of this newly identified tyrosine residue obliterated the stable radical and the enzymatic activity of human ribonucleotide reductases shown by electron paramagnetic resonance spectroscopy and enzyme activity assays. Three-dimensional structural analysis reveals for the first time that these two tyrosines are located at opposite sides of the diiron cluster. We conclude that both tyrosines are necessary in maintaining the diiron cluster of the enzymes, suggesting that the assembly of a dityrosyl-diiron radical cofactor center in human ribonucleotide reductases is essential for enzyme catalytic activity. These results should provide insights to design better ribonucleotide reductase inhibitors for cancer therapy.

Vagus nerve stimulation for epilepsy: randomized comparison of three stimulation paradigms

Vagus nerve stimulation (VNS) is an effective adjunctive treatment for intractable epilepsy. However, the optimal range of device duty-cycles [on/(on + off times)] is poorly understood. The authors performed a multicenter, randomized trial of three unique modes of VNS, which varied primarily by duty-cycle. The results indicate that the three duty-cycles were equally effective. The data support the use of standard duty-cycles as initial therapy.

The ribonucleotide reductase subunit M2B subcellular localization and functional importance for DNA replication in physiological growth of KB cells

Ribonucleoside diphosphate reductase (EC 1.17.4.1) (RR) is a potential target for antineoplastic agents due to its crucial role in DNA replication and repair. The expression and activity of RR subunits are highly regulated to maintain an optimal dNTP pool, which is required to maintain genetic fidelity. The human RR small subunit M2B (p53R2) is thought to contribute to DNA repair in response to DNA damage. However, it is not clear whether M2B is involved in providing dNTPs for DNA replication under physiological growth conditions. Serum starvation synchronized studies showed that a rapid increase of M2B was associated with cyclin E, which is responsible for regulation of G(1)/S-phase transition. A living cell sorting study that used KB cells in normal growth, further confirmed that M2B increased to maximum levels at the G(1)/S-phase transition, and decreased with DNA synthesis. Confocal studies revealed that M2B redistributed from the cytoplasm to the nucleus earlier than hRRM2 in response to DNA replication. Nuclear accumulation of M2B is associated with dynamic changes in dNTP at early periods of serum addition. By using M2B-shRNA expression vectors, inhibition of M2B may result in growth retardation in KB cells. We conclude that M2B may translocate from the cytoplasm into the nucleus and allow dNTPs to initiate DNA synthesis in KB cells under physiological conditions. Thus, our findings suggested that M2B might play an important role for initiating DNA replication of KB cells in normal growth.

Over-expression of fibroblast growth factor receptor 3 in human hepatocellular carcinoma

AIM: To describe the significant over-expression of fibroblast growth factor receptor 3 (FGFR3), which is a signal transduction and cell proliferation related gene in hepatocellular carcinoma (HCC).

METHODS: Following DNA microarray, Northern blot and quantitative real-time PCR were employed to confirm FGFR3 expression difference in HCC tissues and surrounding non-neoplastic liver tissue. FGFR3 expression levels were further determined by immunohistochemical study in 43 cases of HCC.

RESULTS: Northern blot results showed the significant over-expression of FGFR3 in HCC tissues, which was consistent with that from DNA microarray. Quantitative real-time PCR demonstrated that the mean ratio of FGFR3 mRNA to glyceraldehyde-3-phosphate dehydrogenase (GADPH) mRNA in HCC tissue was 0.250, whereas the ratio in non-neoplastic liver tissue was 0.014. Statistical analyses of 43 cases of HCC revealed that HCC scored higher than the matched non-neoplastic liver tissues. Examination of clinicopathological features revealed a strong correlation of over-expression of FGFR3 with poor tumor differentiation and high nuclear grade.

CONCLUSION: Over-expression of FGFR3 may play an important role in liver carcinogenesis. FGFR3 may be an ideal candidate as a molecular marker in the diagnosis of HCC and a potential therapeutic target.

Determination of the potency and subunit-selectivity of ribonucleotide reductase inhibitors with a recombinant-holoenzyme-based in vitro assay

Ribonucleotide reductase (RR) is an important therapeutic target for anticancer drugs. The structure of human RR features a 1:1 complex of two homodimeric subunits, hRRM1 and hRRM2. p53R2 is a newly identified homologue of hRRM2. We have devised a holoenzyme-based in vitro assay for the determination of the potency and subunit-selectivity of small-molecule inhibitors of RR. The assay was implemented using two forms of recombinant RR (hRRM2/hRRM1 and p53R2/hRRM1) and based on their [(3)H]CDP reduction activity. Hydroxyurea was used to standardize the assay. We found that the activities of hRRM2/hRRM1 and p53R2/hRRM1 were decreased by hydroxyurea in a dose-dependent manner. The -NH-OH segment of hydroxyurea was shown to be essential for inhibition. In the presence of Fe(III) and reductants, less inhibition of enzymatic activity by hydroxyurea was observed, especially for p53R2/hRRM1. The potency of four hydroxyurea analogues (Schiff bases of hydroxysemicarbazide, SB-HSC) decreased in the order SB-HSC 21 > SB-HSC 24 > SB-HSC 2 > hydroxyurea (HU) > SB-HSC 29. SB-HSC 2 and SB-HSC 24 inhibited p53R2/hRRM1 significantly more than hRRM2/hRRM1, whereas SB-HSC 21 and SB-HSC 29 showed low subunit-selectivity. Electron paramagnetic resonance (EPR) measurements showed that inhibition of RR was accompanied by reduction of its tyrosyl radical. The method was validated by comparison with data obtained using cell-based assays. We suggest that this novel recombinant-holoenzyme-based in vitro assay is a useful tool for the discovery of more potent and subunit-selective inhibitors of RR.

Hypermethylation of growth arrest DNA damage-inducible gene 45 beta promoter in human hepatocellular carcinoma

Growth arrest DNA damage-inducible gene 45 beta (GADD45beta) has been known to regulate cell growth, apoptotic cell death, and cellular response to DNA damage. Down-regulation of GADD45beta has been verified to be specific in hepatocellular cancer (HCC) and consistent with the p53 mutant, and degree of malignancy of HCC. This observation was further confirmed by eight HCC cell lines and paired human normal and HCC tumor tissues by Northern blot and immunohistochemistry. To better understand the transcription regulation, we cloned and characterized the active promoter region of GADD45beta in luciferase-expressing vector. Using the luciferase assay, three nuclear factor-kappaB binding sites, one E2F-1 binding site, and one putative inhibition region were identified in the proximal promoter of GADD45beta from -865/+6. Of interest, no marked putative binding sites could be identified in the inhibition region between -520/-470, which corresponds to CpG-rich region. The demethylating agent 5-Aza-dC was used and demonstrated restoration of the GADD45beta expression in HepG2 in a dose-dependent manner. The methylation status in the promoter was further examined in one normal liver cell, eight HCC cell lines, eight HCC tissues, and five corresponding nonneoplastic liver tissues. Methylation-specific polymerase chain reaction and sequencing of the sodium bisulfite-treated DNA from HCC cell lines and HCC samples revealed a high percentage of hypermethylation of the CpG islands. Comparatively, the five nonneoplastic correspondent liver tissues demonstrated very low levels of methylation. To further understand the functional role of GADD45beta under-expression in HCC the GADD45beta cDNA constructed plasmid was transfected into HepG2 (p53 WT) and Hep3B (p53 null) cells. The transforming growth factor-beta was assayed by enzyme-linked immunosorbent assay, which revealed a decrease to 40% in transfectant of HepG2, but no significant change in Hep3B transfectant. Whereas, Hep3B co-transfected with p53 and GADD45beta demonstrated significantly reduced transforming growth factor-beta. The colony formation was further examined and revealed a decrease in HepG2-GADD45beta transfectant and Hep3B-p53/GADD45beta co-transfectant. These findings suggested that methylation might play a crucial role in the epigenetic regulation of GADD45beta in hepatocyte transformation that may be directed by p53 status. Thus, our results provided a deeper understanding of the molecular mechanism of GADD45beta down-regulation in HCC.

Nuclear factor Y regulation and promoter transactivation of human ribonucleotide reductase subunit M2 gene in a Gemcitabine resistant KB clone

Overexpression of human ribonucleotide reductase subunit M2 (hRRM2) has been shown as a potential factor causing Gemcitabine (Gem) resistance. We hypothesized the nuclear factor Y (NF-Y) would transcriptionally regulate hRRM2 and contribute to overexpression of hRRM2 in a Gem resistant clone. A luciferase and gel shift assay, and a Southwestern blot were employed to analyze the promoter activity of hRRM2. The data exhibited the hRRM2 promoter was upregulated almost 5-fold in the Gem resistant KB clone (KBGem) via three sequential CCAAT boxes located in the proximal promoter region. Nuclear extracts from KB and KBGem could interact with the CCAAT motif of the hRRM2 proximal promoter region, and could form DNA-protein complexes with different binding patterns. The complexes could be further recognized with antibodies against NF-Y subunits A and B. Histone deacetylases (HDAC) involvement in NF-Y transcription repression in the KBGem clone was examined. A HDAC activity assay revealed a 3-fold decrease of HDAC activity in the KBGem clone compared to KB cells. Parental cells were treated with trichostatin A (TSA), a HDAC inhibitor. NF-Y transactivation was induced, resulting in an increase of hRRM2 expression. This led to an expanded dCTP pool and an abrogated [3H]Gemcitabine incorporation. In addition, microarray analysis results showed most of the proliferation-related genes were upregulated in KBGem. This finding was consistent with enhanced NF-Y transactivation in KBGem. In summary, upregulation of NF-Y transactivation increased hRRM2 transcription, which played a pivotal role in the Gem resistant KB clone.

The human ribonucleotide reductase subunit hRRM2 complements p53R2 in response to UV-induced DNA repair in cells with mutant p53

Ribonucleotide reductase (RR) is responsible for the de novo conversion of the ribonucleoside diphosphates to deoxyribonucleoside diphosphates, which are essential for DNA synthesis and repair. RR consists of two subunits, hRRM1 and hRRM2. p53R2 is a new RR family member. Because the majority of human tumors possess mutant p53, it is important to know the molecular mechanism by which mutant p53 regulates RR and to what extent. In this study, we investigated the expression and function of p53R2 and hRRM2 after UV treatment in human prostate cancer PC3 cells, which possess mutant p53 with a truncated COOH-terminal, and in human oropharyngeal cancer KB cells, which possess wild-type p53. p53R2 (analyzed by Western blot and standardized relative to Coomassie Blue-stained band) was down-regulated in PC3 cells and up-regulated in KB cells after UV exposure. In contrast, hRRM2 was up-regulated by UV in both PC3 cells and KB cells. hRRM2 and p53R2 mRNA levels were assessed by Northern blot, and the results paralleled that of the Western blot. Coimmunoprecipitation assays using agarose-conjugated goat antihuman RRM1 antibody confirmed that the p53R2 binding to hRRM1 decreased in PC3 cells but increased in KB cells after UV treatment. hRRM2 binding to hRRM1 increased in both cell lines under the same conditions. These results suggest that PC3 cells are deficient in both transcription of p53R2 and binding to hRRM1 in response to UV irradiation. Confocal microscopy further confirmed that these findings were not due to translocation of hRRM2 and p53R2 from the cytoplasm to the nucleus. RR activity was measured following UV treatment and shown to increase in PC3 cells. It was unchanged in proportional of KB cells. The RR activity is consistent with the expression of hRRM2 seen in the Western blots. Thus, we hypothesize that hRRM2 complements p53R2 to form RR holoenzyme and maintain RR activity in PC3 cells after UV treatment. To further confirm this hypothesis, we examined the effect of RRM2 inhibitors on cells exposed to UV. In PC3 cells, hydroxyurea inhibited hRRM2 and resulted in increased sensitivity to UV irradiation. We also examined the effect of UV treatment on the colony-forming ability of cells transfected with hRRM2 as well as p53R2 sense or antisense expression vectors. Expression of antisense hRRM2 in PC3 cells led to decreased hRRM2 expression and resulted in greater sensitivity to UV than observed in wild-type PC3 cells. Taken together, we conclude that UV-induced activation of p53R2 transcription and binding of p53R2 to hRRM1 to form RR holoenzyme are impaired in the p53-mutant cell line PC3.

Differential expression of rod photoreceptor cGMP-phosphodiesterase alpha and beta subunits: mRNA and protein levels

The catalytic core of photoreceptor-specific cGMP-phosphodiesterase (PDE) consists of two subunits, PDEalpha and PDEbeta, that are homologous and have similar domain organization but are encoded by different genes. We have examined the PDEalpha and PDEbeta mRNA steady-state and protein levels as well as the biosynthesis rate of these proteins in developing and fully differentiated retinas. We have also determined the translational efficiency of PDE subunits and the role of their mRNA structures in regulating protein synthesis. In mature retinas, PDEalpha and PDEbeta are represented by approximately 1.5 x 108 and 7.5 x 108 copies/microg retinal mRNA, respectively. The levels of these transcripts in developing photoreceptors (P10) are approximately 75% of those at P30. Quantification of protein concentration indicated that PDEalpha and PDEbeta are equally expressed in developing and fully differentiated photoreceptors. Furthermore, the PDEalpha/PDEbeta ratios obtained throughout a 2-h pulsechase period revealed a similar turnover rate for both subunits. The observed discordance between the mRNA and protein levels of PDEalpha and PDEbeta suggested post-transcriptional regulation of their expression. We found that PDEalpha mRNA is translated more efficiently than either of the two PDEbeta transcripts expressed in retina. Therefore, the lower level of PDEalpha mRNA is compensated by its more efficient translation to achieve equimolar expression with PDEbeta. We also analyzed the effect of PDEalpha and PDEbeta mRNA 5'- and 3'-untranslated regions as well as that of their coding regions on protein synthesis. We determined that the PDE-coding regions play a critical role in the differential translation of these subunits.

A phase I trial of weekly paclitaxel, 13- cis-retinoic acid, and interferon alpha in patients with prostate cancer and other advanced malignancies

PURPOSE

Based on prior studies demonstrating the effect of 13- cis-retinoic acid and interferon alpha (CRA/IFN) in decreasing the expression of the antiapoptotic protein bcl-2, our prior clinical study of CRA/IFN with paclitaxel (TAX) administered every 3 weeks, and data demonstrating increased activity of weekly TAX against prostate cancer, we designed a phase I study of weekly TAX in combination with CRA/IFN in patients with prostate cancer and other advanced malignancies. To develop a marker of drug effect, we assessed bcl-2 downregulation in patient peripheral blood mononuclear cells (PBMC).

METHODS

Enrolled in the study were 14 patients with prostate cancer or other advanced malignancies, and 13 were treated with 1 mg/kg CRA on days 1 and 2, 6 MU/m(2) IFN subcutaneously on days 1 and 2, and TAX at increasing doses on day 2 each week for 6 weeks out of an 8-week cycle. The effect of CRA/IFN on bcl-2 expression was assessed in PBMCs by immunoblotting.

RESULTS

The combination of CRA/IFN and TAX was well tolerated. Dose-limiting toxicities (DLT) in the first cycle of therapy included one patient with fever and neutropenia, and one patient with grade 4 hypertriglyceridemia. The recommended phase II dose of TAX in this combination was 80 mg/m(2). Of 13 patients assessable by tumor markers or scans, 5 had stable disease and 2 had a biochemical partial response including a patient with a decrease in PSA of >50% while on study. The assessment of patient PBMC bcl-2 was feasible in ten patients.

CONCLUSIONS

This is the first study in which the safety and clinical activity of weekly TAX combined with CRA/IFN has been demonstrated. The assessment of PBMC bcl-2 is feasible in this weekly chemotherapy schedule