Collision in the colon: concurrent adenocarcinoma and diffuse large B-cell lymphoma in the same tumour

Double malignancies in the gastrointestinal tract are unusual. Concurrent lymphoma and adenocarcinoma is a rare clinical condition. We herein report a collision tumour which first presented with a diffuse large B-cell lymphoma in the skull base and ileocecal junction area. After rituximab and chemotherapy the skull base tumour disappeared, but the ileocecal lesion remained. A biopsy revealed the presence of adenocarcinoma in the same lesion. The tumour was surgically removed. Further microscopic examination of the tumour showed it was an adenocarcinoma but residual lymphoma cell infiltration could still be observed. Serum Epstein-Barr virus (EBV) was detected at diagnosis of lymphoma and the concentration further elevated at diagnosis of adenocarcinoma. Therefore, both lymphoma and carcinoma may be EBV related. Our experience illustrated that such collision tumours are rare and difficult in diagnosis. Clinicians and pathologists should be aware of such an association in order to make a correct diagnosis and initiate proper treatment.

Pyrrolidine dithiocarbamate attenuates nuclear factor-ĸB activation, cyclooxygenase-2 expression and prostaglandin E2 production in human endometriotic epithelial cells

BACKGROUND

The nuclear factor-κB (NF-κB) pathway activates many of the target genes that are critical to the initiation and establishment of endometriosis. We sought to examine the potential application of pyrrolidine dithiocarbamate (PDTC), a potent NF-κB inhibitor, in the treatment of endometriosis.

METHODS

The phosphorylation of IκB, expression of nuclear p65 protein and NF-κB DNA binding in endometriotic epithelial cells (EECs), endometriotic eutopic epithelial cells (EuECs) and normal epithelial cells (NECs) were detected by Western blot analysis and electrophoretic mobility shift assay. Cyclooxgenase-2 (COX-2) gene and protein expressions in EECs were measured by RT-PCR and Western blot analysis. Prostaglandin E(2) (PGE(2)) production of EECs was measured by ELISA.

RESULTS

PDTC in the absence or presence of tumor necrosing factor-α (TNF-α) showed stronger inhibitory effects on IκB phosphorylation, expression of nuclear p65 protein and NF-κB DNA-binding activity in EECs than in EuECs or NECs. Pretreatment of EECs with PDTC resulted in a dose-dependent reduction in the TNF-α-induced expressions of COX-2 at gene and protein levels, as well as a reduction of PGE(2) synthesis.

CONCLUSION

PDTC may represent a novel therapeutic strategy for treatment of endometriosis.

Aryl hydrocarbon receptor in association with RelA modulates IL-6 expression in non-smoking lung cancer

Aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that is activated by cigarette smoke. Previously, we demonstrated that AhR is overexpressed in lung adenocarcinomas (ADs). In this study we observed that AhR expression is significantly correlated with nuclear RelA (a nuclear factor-κB (NFκB) subunit) and cytosolic interleukin-6 (IL-6) in 200 non-small cell lung cancer patients, especially among never smokers. Overexpression of AhR increased IL-6 expression in H1355 cells and immortalized human bronchial epithelial cells BEAS-2B. As NFκB inhibitor and knockdown RelA expression greatly reduced constitutive AhR-induced IL-6 expression, we hypothesized that AhR expression, in the absence of exogenous ligand, is able to modulate NFκB activity and subsequently upregulate IL-6 expression, thus promoting the development of lung AD. Specifically, AhR overexpression significantly increased NFκB activity, whereas interference with AhR expression significantly reduced NFκB activity and IL-6 expression in H1355 cells. We demonstrated that AhR associates with RelA in the cytosol and nucleus of human lung cells. Furthermore, AhR overexpression enhanced nuclear localization of AhR and RelA, and increased the association of AhR-RelA with the NFκB response element of the IL-6 promoter. However, p50 was not involved. Our results indicate that AhR, without exposure to a ligand, associates with RelA, which then positively modulates NFκB activity and then upregulates IL-6 expression in human lung cells. Thus we have identified a new mechanism for lung tumorigenesis in non-smokers.

Suppressing miRNA-15a/-16 expression by interleukin-6 enhances drug-resistance in myeloma cells

The bone marrow microenvironment facilitates the survival, differentiation, and proliferation of myeloma (MM) cells. This study identified that microRNA-15a and -16 expressions tightly correlated with proliferation and drug sensitivity of MM cells. miRNA-15a/-16 expression in MM cells was significantly increased after treatment with cytotoxic agents. The interaction of bone marrow stromal cells (BMSC) with MM cells resulted in decreased miRNA-15a/-16 expression and promoted the survival of the MM cells. Interleukin-6 (IL-6) produced by BMSCs suppressed the expression of miRNA-15a and 16 in a time- and dose- dependent pattern, with the suppression on miRNA-15a being more significant than on miRNA-16. miRNA-15a-transfected MM cells were found to be arrested in G1/S checkpoint, and the transfected MM cells had decreased growth and survival. In conclusion, our data suggest that via suppressing miRNA-15a and -16 expressions, IL-6 secreted by BMSCs promotes drug-resistance in myeloma cells.

Genomic stratification of multiple myeloma treated with novel agents

Cytogenetic testing is now routinely performed for the prognostic work-up of multiple myeloma (MM). The abnormalities del(17p), t(4;14) and del(13q) have been established as predictors of poor outcome in patients with MM treated with conventional chemotherapy or stem cell transplant; chromosome 1q gains and 1p losses have also been identified as novel prognostic factors. In recent years, bortezomib and lenalidomide have emerged as effective treatments for both relapsed/refractory and newly diagnosed MM. However, the effect of cytogenetic abnormalities is unclear among patients with MM treated with these novel agents. Here we review recent studies that analyze the impact of specific genomic aberrations on the outcome of MM treated with bortezomib and/or lenalidomide.

Glacial-interglacial Indian summer monsoon dynamics

The modern Indian summer monsoon (ISM) is characterized by exceptionally strong interhemispheric transport, indicating the importance of both Northern and Southern Hemisphere processes driving monsoon variability. Here, we present a high-resolution continental record from southwestern China that demonstrates the importance of interhemispheric forcing in driving ISM variability at the glacial-interglacial time scale as well. Interglacial ISM maxima are dominated by an enhanced Indian low associated with global ice volume minima. In contrast, the glacial ISM reaches a minimum, and actually begins to increase, before global ice volume reaches a maximum. We attribute this early strengthening to an increased cross-equatorial pressure gradient derived from Southern Hemisphere high-latitude cooling. This mechanism explains much of the nonorbital scale variance in the Pleistocene ISM record.

Greater likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: results from the Consortium of Rheumatology Researchers of North America registry

OBJECTIVE

To examine whether disease duration is an independent predictor of achieving remission in rheumatoid arthritis (RA) patients initiating therapy.

METHODS

RA patients in the Consortium of Rheumatology Researchers of North America registry newly prescribed a nonbiologic disease-modifying antirheumatic drug (DMARD) or anti--tumor necrosis factor (anti-TNF) with at least one followup visit were identified. Achievement of remission was defined using the Clinical Disease Activity Index (CDAI; score ≤2.8) and 28-joint Disease Activity Score (DAS28; score <2.6) at any followup visit within one year; sustained remission was defined as remission during any two successive visits. Likelihood of remission was examined through logistic regression based on 5-year increments of disease duration, adjusting for baseline covariates.

RESULTS

Among the 1,646 nonbiologic DMARD initiators, CDAI remission occurred in 21.3% of those with ≤5 years of disease duration, 19.6% with 6-10 years, and 13.5% with ≥11 years (P < 0.001); sustained remission occurred in 10.2%, 8.8%, and 2.5%, respectively (P < 0.001). Results were similar among the 3,179 anti-TNF initiators (CDAI remission in 22.3%, 17.7%, and 12.8%, respectively [P < 0.001]; CDAI sustained remission in 9.7%, 9.5%, and 4.2%, respectively [P < 0.001]). DAS28 results were similar in both groups. In adjusted analyses, an increase of disease duration by 5 years was associated with a reduced likelihood of CDAI remission in nonbiologic DMARD (odds ratio [OR] 0.91, 95% confidence interval [95% CI] 0.83-0.99) and anti-TNF initiators (OR 0.88, 95% CI 0.83-0.94). A similar result was seen for sustained remission using the CDAI (nonbiologic DMARD: OR 0.61, 95% CI 0.48-0.76; anti-TNF: OR 0.85, 95% CI 0.75-0.97).

CONCLUSION

Earlier treatment was associated with a greater likelihood of remission.

Nonaxial Strehl ratio of wavefront coding systems with a cubic phase mask

An approximate expression of the peak position of the point-spread function (PSF) of wavefront coding systems with a cubic phase mask (CPM) is derived and verified by simulation results. An approach called the nonaxial Strehl ratio (NASR) is used to evaluate the performance of wavefront coding systems with defocus aberrations. The characteristics of the NASR are investigated. The relationships between the NASR and the similarity of out-of-focus modulation transfer function (MTF) and recoverability of blurred encoding images are presented, and some useful guidelines are given for the optimization of phase mask parameters according to these relationships.

Phytochromes regulate SA and JA signaling pathways in rice and are required for developmentally controlled resistance to Magnaporthe grisea

Old leaves of wild-type rice plants (Oryza sativa L. cv. Nipponbare) are more resistant to blast fungus (Magnaporthe grisea) than new leaves. In contrast, both old and new leaves of the rice phytochrome triple mutant (phyAphyBphyC) are susceptible to blast fungus. We demonstrate that pathogenesis-related class 1 (PR1) proteins are rapidly and strongly induced during M. grisea infection and following exogenous jasmonate (JA) or salicylic acid (SA) exposure in the old leaves, but not in the new leaves of the wild-type. In contrast, the accumulation of PR1 proteins was significantly attenuated in old and new leaves of the phyAphyBphyC mutant. These results suggest that phytochromes are required for the induction of PR1 proteins in rice. Basal transcription levels of PR1a and PR1b were substantially higher in the wild-type as compared to the phyAphyBphyC mutant, suggesting that phytochromes also are required for basal expression of PR1 genes. Moreover, the transcript levels of genes known to function in SA- or JA-dependent defense pathways were regulated by leaf age and functional phytochromes. Taken together, our findings demonstrate that phytochromes are required in rice for age-related resistance to M. grisea and may indirectly increase PR1 gene expression by regulating SA- and JA-dependent defense pathways.

Phase III study of gemcitabine/oxaliplatin (GEMOX) with or without erlotinib in unresectable, metastatic biliary tract carcinoma

LBA4032

Background: Currently, there is no standard regimen for palliative chemotherapy in metastatic, unresectable biliary tract cancer (BTC). A phase II trial of erlotinib monotherapy showed a promising anti-tumor activity in BTC with tolerable toxicity. Additionally, gemcitabine + erlotinib demonstrated superior efficacy when compared to gemcitabine alone in pancreatic cancer. Hence, we conducted a phase III trial to compare between GEMOX vs GEMOX+erlotinib (Tarceva [T]) (GEMOX/T) as first-line chemotherapy in unresectable, metastatic BTC. Methods: Eligible patients were as follows: histologically confirmed adenocarcinoma of biliary tract (CCC), ampulla of vater (AOV) or gall bladder (GB); unresectable or metastatic; ECOG performance status of 0~2; adequate marrow, hepatic, renal and cardiac functions; no prior chemotherapy. The primary endpoint was progression free survival (PFS). The study regimen was gemcitabine 1,000mg/m2, oxaliplatin 100mg/m2, erlotinib 100mg qd daily q 2 weeks. Results: From February 2009 to August 2010, 268 pts were randomized, 133 patients to GEMOX arm and 135 patients to GEMOX/T arm. Patient characteristics: median age 61 yrs (range 30-82); male (63.4%); CCC (n=180, 67.2%), GB (n=82, 30.6%), and AOV (n=6, 2.2%). With a median follow-up of 13.9 months (range, 6.7 – 25.0), median PFS was 5.8 months (95% CI, 4.6 - 7.0) in GEMOX/T arm and 4.2 months (95% CI, 2.7 - 5.7) in GEMOX arm (P=0.080). In subgroup analysis (CCC, n=180), however, median PFS was significantly longer in GEMOX/T arm (5.9 months) when compared with GEMOX arm (3.0 months, P=0.049). The overall response rate was significantly higher in the GEMOX/T arm when compared with GEMOX arm. There was no significant difference in overall survival between the two arms (GEMOX/T: 9.5 months, 95% CI, 7.6 – 11.4; GEMOX: 9.5 months, 95% CI, 7.5 – 11.5; P=0.611). The EGFR mutation testing results in correlation to responsiveness to erlotinib will be presented at the meeting. Conclusions: This phase III represents the first multicenter, randomized trial to compare GEMOX vs GEMOX/T in unresectable, metastatic BTC. Although PFS was not prolonged in GEMOX/T, there was a significant benefit in terms of PFS in GEMOX/T arm for CCC patients.

Genomic aberrations and survival of patients with light-chain-only multiple myeloma undergoing autologous stem cell transplantation

The majority of patients with multiple myeloma (MM) have intact immunoglobulin, but in a subset of patients (∼15%), their tumors produce monoclonal light chains only (LCO). Although specific genomic aberrations have emerged as a major prognostic factor in MM, their incidence and prognostic impact on LCO myeloma patients are not clear. We therefore investigated a cohort of 86 LCO MM cases diagnosed and treated with autologous stem cell transplantation at our institution. Overall, genomic risk factors del(13q), del(17p), t(4;14), 1p loss, and 1q21 gain were detected by cytoplasmic fluorescence in situ hybridization (cIg-FISH) in 40.6%, 18.5%, 11.9%, 18.8%, and 25% of the cases, respectively. Patients with del(13q) and 1q gains had a significantly shorter overall survival (OS) (median 80.4 vs 56.2 months, P = .021; median 77.9 vs 26.9 months, P = .006, respectively) and shorter progression-free survival (PFS) (median 33.4 vs 15.8 months, P = .002; median 33.4 vs 19.1 months, P = .011, respectively) than those without the genetic abnormalities. In addition, 1p loss was significantly associated with shorter PFS (median 37.9 vs 18.2 months, P = .001). There was no significant difference in PFS or OS in patients with or without t(4;14) or del(17p). On multivariate analysis, del(13q) was an independent prognostic factor for PFS and OS.

PBDEs and methoxylated analogues in sediment cores from two Michigan, USA, inland lakes

Polybrominated diphenyl ethers (PBDEs) have been widely studied in sediments from the North American Great Lakes; however, no studies have been conducted of occurrences of methoxylated (MeO-) PBDEs in abiotic compartments in this region. In the present study, 23 tri- to hepta-PBDEs and 12 MeO-PBDEs were analyzed in dated sediment cores collected from two inland lakes (White Lake and Muskegon Lake) in Michigan, USA. Concentrations of Σ(23) PBDEs ranged from 3.9 × 10(-1) to 2.4 × 10(0) and from 9.8 × 10(-1) to 3.9 × 10(0) ng/g dry weight in White Lake and Muskegon Lake, respectively. The historical trends of tri- to hepta-PBDEs in the two lakes were different, possibly because of different input and remediation histories. The tri- to hepta-PBDE profiles were similar in the two lakes, with BDE-47 as the predominant congener, followed by BDE-99 and BDE-183. A different temporal trend for BDE-183 was found compared with other PBDEs, which is consistent with debromination of high-brominated PBDEs during sedimentation and aging. Methoxylated-PBDEs were detected only in Muskegon Lake (3.6 × 10(-3) to 1.2 × 10(-1) ng/g dry wt). Methoxylated PBDEs showed different temporal trends compared with tri- to hepta-PBDEs. The differences in patterns of concentrations of MeO-PBDEs in the two lakes might be due to different aquatic communities in each lake. The occurrences of MeO-PBDEs could be the major source of hydroxylated-polybrominated diphenyl ethers (OH-PBDEs) observed in organisms collected in these freshwater systems.

Bone marrow stromal cells protect myeloma cells from bortezomib induced apoptosis by suppressing microRNA-15a expression

Despite unsurpassed anti-tumor activity of bortezomib for multiple myeloma (MM), drug resistance has emerged as a challenge, especially when MM cells adhere to the stroma. This study aimed to determine whether bone marrow stromal cells (BMSCs) have a role in the development of chemoresistance in MM. Our data demonstrate that the secretion of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), and cell-to-cell contact with microenvironment-derived stromal cells from patients with multiple myeloma (MM-BMSCs) significantly decreased the sensitivity of myeloma cells to bortezomib treatment. Mechanistically, we found that microRNA (miRNA)- 15a expression was up-regulated in U266 and NCI-H929 cells treated by bortezomib, which was inhibited by MM-BMSCs. miRNA-15a transfected myeloma cells were arrested in G1/S checkpoint and secreted less VEGF compared to control transfected cells, although no significant difference was found in VEGF mRNA levels. In conclusion, our data suggest that via suppressing miRNA-15a expression, BMSCs provide survival support and protect myeloma cells from bortezomib induced apoptosis.

Behaviors of glucocorticoids, androgens and progestogens in a municipal sewage treatment plant: comparison to estrogens

This work investigated the behaviors of seven glucocorticoids, eight androgens, and nine progestogens compared to six estrogens in a municipal sewage treatment plant (STP) in Beijing, China. Among all of the hormones considered, androgens were the dominant steroids detected in all samples (total concentrations up to 10 216±912 ng/L for influents, 171±10 ng/L for effluents, and 647±52 ng/g for dehydrated sludge samples), followed by estrogens (102±8 ng/L, 14±2 ng/L, and 14±1 ng/g), progestogens (57±6 ng/L, 8±2 ng/L, and 13±3 ng/g), and glucocorticoids (42±2 ng/L, 0.7±0.1 ng/L, and 1.2±0.3 ng/g). With the exception of 19-nor-4-androstene-3,17-diol (NAD, 67%), removal rates for androgens were relatively high (98-99%), while those for glucocorticoids, estrogens, and all progestogens except 6α-methylhydroxyprogesterone (MHPT) were 85-99%, 78-99%, and 73-96%, respectively. Glucocorticoids, androgens, and progestogens were mainly removed by degradation as with estrogens, while different behaviors were observed in the aerated grit chamber, anaerobic tank, anoxic tank, and aerobic tank units. Many of the detected glucocorticoids, androgens, and progestogens were eliminated in the anaerobic tank, but estrogens were largely degraded in the aerobic one. Significant increases in the mass of 21α-hydroxyprogesterone (21-HPT) and MHPT in the anaerobic tank and anoxic tank, respectively, were due to deconjugation.