Phase II trial of mapatumumab, a fully human agonistic monoclonal antibody that targets and activates the tumour necrosis factor apoptosis-inducing ligand receptor-1 (TRAIL-R1), in patients with refractory colorectal cancer

Background:

Recombinant tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) induces tumour-selective apoptosis in various pre-clinical models by binding its specific receptors expressed on cancer cells. Mapatumumab is a fully human monoclonal antibody that is agonistic to the TRAIL Receptor 1 (TRAIL-R1).

Methods:

This phase II multicentre study was designed to evaluate the efficacy and safety of mapatumumab in patients with colorectal cancer (CRC) who had failed to respond to, were intolerant to, or not candidates for fluoropyrimidine, oxaliplatin, and irinotecan-based regimens. All patients received two loading doses of mapatumumab (20 mg kg⁻¹ every 14 days), followed by maintenance therapy with 10 mg kg⁻¹ infused every 14 days.

Results:

A total of 38 patients, who had progressive disease after a median of three earlier chemotherapy lines, were enrolled. No response according to the Response Evaluation Criteria in Solid Tumors was observed. A total of 12 patients (32%) achieved stable disease for a median of 2.6 months. The median progression-free survival was 1.2 months. The most common adverse events reported, regardless of relationship, were fatigue, nausea, anorexia, and abdominal pain. Plasma mapatumumab concentrations were within the range of exposures predicted by the results of phase I studies of mapatumumab.

Conclusion:

No clinical activity of single-agent mapatumumab was observed in patients with advanced refractory CRC. However, on the basis of its favourable safety profile and pre-clinical evidence of potential synergy in combination with agents commonly used in the treatment of colorectal cancer, further evaluation of mapatumumab in combination with chemotherapy is warranted.

Expression of the reporter genes lacZ and EGFP in human glioblastoma cells using Listeria monocytogenes as vector for gene transfer

OBJECTIVE

Glioblastoma has become a model target for viral gene therapy approaches. To circumvent some of the inherent problems of viral vectors, we examined the feasibility of Listeria monocytogenes for foreign gene expression in glioblastoma cells.

METHODS

The internalin-dependent uptake of L. monocytogenes into human glioma cell lines and into 22 cell cultures obtained during neurosurgery was studied by in vitro infection assays. Internalization rates of wild-type L. monocytogenes were compared with a deletion mutant and to four strains with plasmid-based recomplementation of the internalin A/B operon. For gene transfer experiments, plasmids encoding lacZ or EGFP under control of the cytomegalovirus promotor were transfected into Listeriae. Incubation times in cell culture were studied regarding infection of cells, intracellular listerial replication and reporter gene translation. Gene transfer efficiency was determined by beta-galactosidase activity and by fluorescence microscopy.

RESULTS

The internalin-defective strain (DeltainlAB2) showed less uptake compared with the wild type. An increased invasion rate was observed in strain DeltainlAB2 + inlB(PinlA) overexpressing internalin B; complementation of the entire operon (DeltainlAB2 + inlAB(PinlA)) revealed a synergistic effect. For gene transfer experiments into glioblastoma cells, the pathogenic strain 4bL312 was employed, and efficiencies up to 5% were achieved.

DISCUSSION

Internalins A and B are major determinants for listerial uptake into neuroepithelial tumors. The L. monocytogenes vector system enables foreign gene expression in glioblastoma cells. Ongoing research deals with optimization of transfection efficiencies, with the use of less pathogenic substrains and the cloning of suicide gene vectors.

Development of a two-line OH-laser-induced fluorescence thermometry diagnostics strategy for gas-phase temperature measurements in engines

This study aims at optimizing two-line OH thermometry strategies for in-cylinder measurement in internal combustion engines. Various aspects are investigated experimentally, such as the selection of suitable OH lines and the possibility of using a single calibration coefficient for variable mixture composition, temperature, and pressure conditions. Two kinds of experimental systems have been investigated. First, a laminar methane-air burner flame at atmospheric pressure, whose stability allowed the determination of OH-laser-induced fluorescence (LIF) intensity ratios from nonsimultaneous imaging. The temperature distribution in the flame is presented for OH-transition pairs with various temperature sensitivities. The burner flame was studied for equivalence ratios from phi=0.93 to 1.30 in order to check for the stability of calibration over various flame conditions. Additionally, OH LIF images were acquired in an optical engine for the chosen OH transitions yielding data about the effect of pressure on OH LIF signals under realistic experimental conditions.

Muramyldipeptide modulates CXCL-8 release of BEAS-2B cells via NOD2

Chronic inflammation and acute exacerbations are pathophysiological features of chronic obstructive pulmonary disease (COPD). An impaired immune response to bacterial pathogens can contribute to both of them. Nucleotide oligomerization domain 2 (NOD2) is an intracellular receptor of innate immunity for muramyldipeptide (MDP). Mutations of the NOD2 gene followed by decreased recognition of MDP are associated with chronic intestinal inflammation and pulmonary complications of patients with allogenic stem cell transplant and sepsis. Our study provides evidence that NOD2, toll-like receptor 4 (TLR4) and the adapter protein receptor-interacting protein 2 (RIP2) are induced by tumor-necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the bronchial epithelial cell line BEAS-2B. We also demonstrate that lipopolysaccharide (LPS) can further increase NOD2 transcription in a TNF-alpha and IFN-gamma-induced activation state. In addition, we show that, while MDP fails to enhance CXCL-8 release from otherwise unstimulated BEAS-2B cells, a 12 h prestimulation period with TNF-alpha and IFN-gamma primes the cells for an additional increase of CXCL-8 secretion via induction of NOD2 and RIP2. LPS itself significantly augments CXCL-8 production and co-administration of MDP further increases cytokine secretion. Finally, overexpression of an SNP13 mutant decreased MDP-induced chemokine production in BEAS-2B cells compared with NOD2 wild type overexpression. Taken together, our work indicates that MDP and NOD2 play an important role for CXCL-8 release of BEAS-2B cells following LPS-challenge via synergistic interactions between MDP and LPS.

NKG2D-dependent effector function of bronchial epithelium-activated alloreactive T-cells

Allogeneic haematopoietic stem cell transplantation (SCT) has emerged as a curative therapeutic option. However, the role of graft-versus-host disease in lung injury after SCT has yet to be determined. In the present study, primary bronchial epithelial cells and the bronchial epithelial cell line BEAS-2B were used to investigate immune responses of allogeneic CD8+ T-cells directed against respiratory epithelial cells. Following stimulation with irradiated bronchial epithelial cells, CD8+ T-cells produced significant amounts of interferon-gamma, upregulated alloantigen activation markers and proliferated highly compared with T-cells stimulated with interleukin-2 alone. Furthermore, cytotoxicity assays demonstrated that bronchial epithelial cell-specific and granzyme B-mediated cytolytic activity was induced in CD8+ T-cells. Generation of natural killer (NK) T-cells, NK-like T-cells, cytokine-induced killer cells or lymphokine-activated killer cells could be excluded by phenotyping, culture conditions and neglectable lytic activity following stimulation with interleukin-2 alone. Inhibition experiments showed that lysis of bronchial epithelial cells was not major histocompatibility complex-I restricted, but depended on NK group 2 member D signalling; a stimulatory receptor initially shown to be expressed on NK cells. The present data imply that the respiratory epithelium has an antigen presenting function and directly alloactivates cytotoxic CD8+ T-cells that show nonclassical effector function.

Neuronal nitric oxide synthase gene inactivation reduces the expression of vasopressin in the hypothalamic paraventricular nucleus and of catecholamine biosynthetic enzymes in the adrenal gland of the mouse

The impact of a lifelong absence of the neuronal nitric oxide synthase (nNOS) in the neuroendocrine stress response was investigated in nNOS knockout (KO) and wild type (WT) mice under basal conditions and in response to forced swimming. In the hypothalamic paraventricular nucleus oxytocin and corticotropin-releasing-hormone mRNA levels did not differ between these genotypes under resting conditions, whereas vasopressin mRNA levels were significantly lower in nNOS KO than in WT animals. Also, in the adrenal glands basal levels of tyrosine hydroxylase protein, the rate-limiting enzyme for catecholamine biosynthesis, and of phenylethanolamine N-methyltransferase, which converts norepinephrine to epinephrine, were significantly reduced in nNOS KO mice. Plasma adrenocorticotropin, corticosterone, norepinephrine and epinephrine levels were similar in the KO and WT genotypes under resting conditions. In response to forced swimming, a similar increase in plasma adrenocorticotropin and corticosterone was observed in KO and WT animals. Stressor exposure triggered also an increased epinephrine release in WT animals, but did not significantly alter plasma epinephrine levels in KO mice. These data suggest that the chronic absence of nNOS reduces the capacity of epinephrine synthesising enzymes in the adrenal gland to respond to acute stressor exposure with an adequate epinephrine release.

Revised reference value for pentachlorophenol in morning urine

Reference values are continuously derived by the Human Biomonitoring Commission of the German Federal Environment Agency to give help in assessing the exposure of individuals or population groups in comparison to the background exposure. As environmental conditions may change reference values should be checked periodically and they have to be updated, if new data become available. The results of the German Environmental Survey 1998 (GerES III) showed the decreasing pentachlorophenol (PCP) exposure of the German adult population. Therefore, the reference value for PCP in morning urine was lowered: from 8 to 5 microg/l for adults (aged 18-69 years) living in homes where wood preservatives had not been used.

[Changes in the concentration of noradrenaline and adrenaline before and after castration of piglets with and without isoflurane anesthesia]

Since the amendment of the animal welfare law in Germany in April 2006, castration of piglets without anesthesia is only allowed in the first seven days of life. However, neonates are capable of feeling pain and react more sensitive to pain than adults. Accordingly we expect that castration without anesthesia will be unaccepted in Germany in the future as castration without anesthesia will be forbidden in Switzerland from 2009 on. Denmark and The Netherlands strive for an embargo of the castration without anesthesia and Norway is already asking for an elimination of pain during castration. In Switzerland castration under isoflurane-anesthesia is considered to be a good alternative for the castration without anesthesia. Whether isoflurane-anesthesia is able to reduce stress caused by castration adequately or anesthesia, especially anesthetization that often provokes defensive reaction, is stress for the animal itself was tested in the following investigation. To get an objective statement about the stress of the animals, concentrations of epinephrine and norepinephrine were detected before and immediately after castration/fixation with or without anesthesia. Five day old, healthy animals were divided into four groups. Animals of group A (n = 10) were only fixed without anesthesia, animals of group B (n = 10) were fixed and castrated without anesthesia. In group C (n = 10) the animals were only fixed under anesthesia and the animals of group D (n = 11) were fixed and castrated under anesthesia. Norepinephrine-concentrations and epinephrine-concentrations did rise significantly in all piglets handled without anesthesia (group A and B) independently if castrated or only handled. The values of these animals were significantly higher than the values of the anesthetized animals after fixation/castration (group C and D). In contrast the norepinephrine-concentrations and the epinephrine-concentrations of all anesthetized animals (group C and D) were significantly lower after castration than the concentrations before castration. The catecholamine peak did not differ significantly between the groups of anesthetized animals. The significant increase of the catecholamines of the non-anesthetized animals can be explained by the stress caused by fixation and/or castration without anesthesia. Because of the anesthesia the catecholamine-concentration was reduced considerably during the fixation and/or castration. The results show that fixation and/or castration under anesthesia causes no stress for the piglets.

Endocardial cushion defect in a patient with Crouzon syndrome carrying a mutation in the fibroblast growth factor receptor (FGFR)-2 gene

Crouzon syndrome is an autosomal dominant disorder caused by mutation in the fibroblast growth factor receptor (FGFR)-2 gene. Recent findings from animal studies imply a critical role for FGFs in the regulation of cardiac development including cardiac cushion proliferation and valvulogenesis. We report on a 36-year-old woman, who required surgical closure for an atrial septal defect, a clinical feature that has not been previously reported in other patients with Crouzon syndrome. The findings suggest that cardiac investigations are warranted in patients with a diagnosis of Crouzon syndrome.

Image-guided neurosurgery for secondary operative removal of projectiles after missile injury of the brain

BACKGROUND

The primary treatment of penetrating missile injuries of the brain includes debridement of the scalp, fractured skull, and necrotic brain parenchyma. It is acceptable to remove all bony and metallic fragments that are accessible without additional trauma to nondamaged brain regions. Therefore, bone chips and bullets are often initially retained in the brain and are supposedly responsible for delayed cerebral infections and posttraumatic seizures.

METHODS

We successfully operated on 3 patients electively to remove bony and metallic fragments secondarily after penetrating brain trauma. We used an electromagnetic neuronavigation system for preoperative planning and chose a less invasive approach for the exact intraoperative localization of the fragments.

RESULTS

All fragments were extracted without any problems. No patients had any additional neurologic deficits, and no signs of cerebral infections or seizures occurred between 4 and 8 weeks after the operative revision.

CONCLUSION

We recommend the implementation of neuronavigation techniques into the surgical strategy for secondary removal of retained missile fragments.

Glioblastoma Simultaneously Present with Meningioma - Report of Three Cases

BACKGROUND

Most primary intracranial tumors occur as solitary lesions; multiple locations of one tumor, the occurrence of two different tumors or even collision tumors have been described only in a few patients. From a statistical point of view, in less than 100 glioblastoma cases will a meningioma be simultaneously present in the brain. We report three cases with this coincidence and display the results of CGH and chromosome analysis in two patients, in whom the tumors arose in very close spatial correlation to each other.

PATIENTS

We describe three case histories with simultaneous occurrence of meningioma and glioblastoma as shown by MRI on admission. After neurosurgical removal of mass lesions, specimens from two patients were cultivated in cell culture and the cells were examined for chromosomal aberrations by conventional karyotyping as well as comparative genomic hybridization (CGH).

RESULTS

Examinations disclosed characteristic genetic aberrations for one meningioma and two glioblastomas. In one patient it was possible to compare the data for the meningioma and the glioblastoma; in this case we did not find a common genetic aberration in tumor cells with a different histology.

CONCLUSION

Genetic testing of tumor cells should be performed routinely when different histological types of brain tumors are present in a close spatial relationship. We favor the hypothesis of statistical coincidence for the simultaneous occurrence of the two tumors rather than a common pathway giving rise to two tumor entities.

Oral capecitabine in gemcitabine-pretreated patients with advanced pancreatic cancer: A single-center study

15085

Background: To date, no standard regimen for salvage chemotherapy after gemcitabine (Gem)-failure is defined in patients with advanced pancreatic cancer (PC). Methods: Within this study we prospectively collected clinical data of 37 patients (pts) with advanced PC who were treated with capecitabine (Cape) at our center. Cape was offered to patients who already had received at least one previous treatment regimen containing full-dose Gem (either as single- or combination chemotherapy or sequentially within a radio- chemotherapy (RCT) protocol), who presented with a KPS = 70% and had adequate organ function. Cape was administrated orally at a daily dose of 2 x 1250 mg/m2 for 14 consecutive days followed by 7 days of rest (in pts > 65 years: 2 x 1000 mg/m2/d). Treatment cycles were repeated every 3 weeks and continued until disease progression or unacceptable toxicity. Results: A median number of 3 treatment cycles (range 1–36) was given to 37 pts (54% male, median age 63 yrs, 97% with metastatic disease); 15 pts previously underwent RCT, 20 pts had received one previous treatment regimen and 17 pts 2 or more previous regimens. After a median follow- up of 6.1 months, 10 pts are still alive including 4 pts still on Cape. Currently, 35 pts are evaluable for response: no complete or partial response was observed, but 13 pts (37%) had stable disease (SD). A CA19–9 reduction > 20% after 8 weeks of Cape was determined in 6 pts (16%), all of them had SD. Median TTP was 2.2 months, median overall survival (since start of Cape treatment) was 7.5 months. Predominant grade 2 and 3 toxicities (per patient analysis) were: hand-foot-syndrome 30%, anemia 24%, diarrhea 14%, nausea/vomiting and leukopenia 11% each. One pt had a grade 3 infection, 1 pt experienced grade 4 cerebral ischemia during treatment with Cape. Conclusion: Single-agent Cape is a safe treatment option for Gem-pretreated pts with advanced PC. The disease control rate of 37% and a median TTP of 2.2 months appear interesting in this patient population. Further evaluation of Cape in controlled clinical trails is recommended in Gem-refractory pts with advanced PC.

No significant financial relationships to disclose.

German Environmental Survey (GerES): Human biomonitoring as a tool to identify exposure pathways

The German Environmental Survey (GerES) is a representative population study and has been repeatedly carried out since the mid-1980s. The currently run survey (GerES IV) is the first one solely targeted on children. The GerES IV Pilot Study resulted in first insights into major exposure pathways relevant to children. These insights were made possible by the determination of pollutant concentrations in blood and urine and the additional consideration of their occurrence in the indoor environment and by using questionnaire data. The results of the GerES IV Pilot Study are presented according to major exposure pathways such as house dust, food and environmental tobacco smoke (ETS). An overview on relevant pilot study results is given. The results of GerES IV will permit the verification and substantiation of the pilot study results.

Twenty years of the German Environmental Survey (GerES): Human biomonitoring – Temporal and spatial (West Germany/East Germany) differences in population exposure

The German Environmental Surveys (GerESs) are nationwide population studies, which have repeatedly been carried out in Germany since the mid-1980s. The subjects were representatively selected from the regional registration offices with regard to age, gender and community size. The first survey for adults (GerES I) was carried out in 1985/1986 (West Germany) followed by GerES IIa in 1990/1991 (West Germany) and GerES IIb in 1991/1992 (East Germany). In GerES II children were also included to some extent. In 1998, the third GerES for adults was conducted in both parts of Germany (GerES III). The current survey 2003/2006 (GerES IV) is focussing exclusively on children. A 1-year pilot study was conducted in 2001-2002 to collect information on parameters influencing the response rate and to test the suitability of the different instruments intended to be used for the main study. The main goal of the surveys is to analyse and document the extent, distribution and determinants of exposure to environmental pollutants of the German general population. Three main instruments of investigation were comprised in GerES: human biomonitoring (HBM), monitoring of the domestic environment, and collecting information on exposure pathways and living conditions via questionnaires. This paper is focussed on the general design of the GerESs, the trend over time and spatial differences (West Germany and East Germany) for HBM data on arsenic, cadmium, lead, mercury, pentachlorophenol (PCP), and polycyclic aromatic hydrocarbons (PAH). These substances have been determined in blood and/or morning urine of adults and children. All GerESs have been conducted in close connection with the National Health Interview and Examination Surveys performed by the Robert Koch-Institute, Berlin.

Kinder-Umwelt-Survey (KUS) im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS)

The German Environmental Survey for Children (GerES IV) is the environment-related module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute and the fourth GerES of the Federal Environment Agency. The main objective of GerESs is to analyse and document the extent, distribution and determinants of exposure to environmental pollutants of the German general population. GerES IV was performed from 2003 to 2006. A total of 1.790 children aged 3-14 years from 150 sampling locations participated in GerES IV. Samples of blood, urine, tap water, house dust and indoor air were analysed. Hearing tests, measurements of traffic noise and interviews to get exposure-related information were conducted. First results indicate a clear decrease of the exposure to arsenic, lead and mercury. Cotinine concentrations in urine can be used to classify the exposure of children to environmental tobacco smoke. The examination of the tap water used in the subjects' households indicates that in some households the guideline values of the German Drinking Water Ordinance were not always met. This is the case for nickel, copper and lead which are used as pipe material for domestic plumbing.

Diagnostic Management of Benign and Malignant Pheochromocytoma

As rare and thus often overlooked hormone-secreting tumors, pheochromocytomas pose a particular diagnostic challenge. Difficulties involve biochemical confirmation, localizing, and detection of malignancy. Measurement of free plasma metanephrines, genetic testing and specific imaging procedures--such as MIBG and octreotide scintigraphy or fluorodopamine PET--represent a considerable progress, and the management of benign pheochromocytomas has become very effective. However, a comparable improvement in the prognosis of malignant chromaffin cell tumors, which occur in approximately 10-15% of all cases, has not yet been achieved. Here, telomerase catalytic subunit (hTERT) activity and heat shock protein 90 expression could serve both as molecular markers allowing an earlier diagnosis of malignancy and as therapeutic targets. Familial syndromes should be considered both in benign and malignant pheochromocytoma, and should be tested for prior to surgery in selected patient groups.

The German Human Biomonitoring Commission

In Germany, the Human Biomonitoring Commission of the German Federal Environment Agency was established in 1992 to develop scientifically based criteria for the application of human biomonitoring (HBM). The goal is to clarify fundamental and practical issues related to HBM. Following the assessment of pollutants in body fluids, the commission derives two different kinds of guideline values: reference values and HBM values (HBM I and HBM II values). This article gives a review of the current reference values, HBM values, and the work of the German Human Biomonitoring Commission.

19-jährige Patientin mit akuter Promyelozytenleukämie und Knieschwellung

We report on a case of a 19-year-old female patient with acute promyelocytic leukemia suffering from febrile monarthitis of the right knee during neutropenia after consolidation chemotherapy caused by Geotrichum capitatum. Apparently this infection occurred due to a hematological reactivation since the patient had already developed Geotrichum capitatum fungemia during induction therapy. Under antimycotic therapy with voriconazole, flucytosine, and caspofungin as well as after two arthroscopic synovectomies with cleansing of the right knee, the infection could be controlled and the full clinical function of the knee joint could be preserved.