Neuroendocrine cancer of the kidney: Clinical implications of expression microarray analysis

20093

Background: Conventional clinical trial strategies cannot be used to develop new therapies for rare malignancies. Neuroendocrine neoplasms of the kidney are extremely rare. Here we compare the gene expression profiles of a neuroendocrine tumor from a 32 year old male with a horseshoe kidney, a large renal primary and metastatic thyroid lesions to the profiles of other cancers. Response to systemic therapy is also reported. The ultimate objective of this project is to identify new therapeutic targets for patient-specific cancer therapy. Methods: After informed consent, tissue from the patient was analyzed by cytology and immunohistochemistry. Total RNA was isolated from formalin-fixed paraffin-embedded archival reference tissues with Arcturus Paradise Reagents. Gene expression was analyzed with Affymetrix X3P arrays of the entire expressed genome. A supervised significance analysis of microarrays (SAM) procedure, using 400 data permutations, was performed to identify gene products that were differentially expressed. Clinical outcomes were documented in the patient’s medical record on the basis of standard medical imaging. Results: Cytology, immunohistochemistry and microarray studies revealed similar patterns for the primary and metastatic lesions. Gene expression profiles of the patient’s kidney and thyroid lesions, as well as other kidney and neuroendocrine tumors, identified 11 genes overexpressed significantly in the neuroendocrine tumors. Each was associated with neuroendocrine biology. The patient had a mixed response to chemotherapy with gemcitabine and cisplatin and progressive disease after 3 monthly treatments with sandostatin. He awaits assessment of response to metaiodobenzylguanidine (MIBG). Conclusions: Gene expression profiling was effective in characterizing an unusual case of renal cancer with metastasis to thyroid, though no new therapeutic target has yet been identified. Comparing response or resistance to therapy with microarray analysis may prove to be an effective strategy for developing patient-specific cancer therapy. This work was supported, in part, by a VA Merit Review Award.

No significant financial relationships to disclose.

Comparison of carbon dioxide, argon, and nitrogen for inducing unconsciousness or euthanasia of rats

We compared CO(2), Ar, and N(2) for inducing unconsciousness and euthanasia of Sprague-Dawley rats. We determined time to unconsciousness and monitored heart rate (HR) and mean arterial blood pressure (MAP) by radiotelemetry to assess stress, recovery after exposure, and time of death. Unconsciousness (mean +/- standard error) occurred 24 +/- 3, 87 +/- 8, and 93 +/- 8 s after short-term exposure to CO(2), Ar, and N(2), respectively. During exposure, CO(2) depressed HR, whereas Ar and N(2) increased HR. Upon removal from the chamber, rats' HR rapidly normalized after CO(2) or N(2) but remained elevated for 60 min after Ar. During exposure, all agents depressed MAP, which returned to resting levels 10 to 50 min after rats' removal from the chamber. For euthanasia, CO(2) at approximately 100% induced unconsciousness in 37 +/- 3 s, increased and then depressed MAP and HR, and caused death at 188 +/- 15 s. CO(2) at approximately 30% induced unconsciousness in 150 +/- 15 s, decreased HR and MAP, and induced death at 440 +/- 9 s. Ar at approximately 100% increased MAP but decreased HR, induced unconsciousness with hyperreflexia at 54 +/- 4 s, and caused death at 197 +/- 20 s. N(2) at approximately 100% decreased MAP but not HR and produced unconsciousness with hyperreflexia at 164 +/- 17 s and death at 426 +/- 28 s. We conclude that CO(2) effectively produced unconsciousness and euthanasia, but we were unable to ascertain distress. Ar also appears effective but produced hyperreflexia and tachycardia. N(2) was ineffective.

A double-blind, multicenter, parallel-group study of paroxetine, desipramine, or placebo in breast cancer patients (stages I, II, III, and IV) with major depression

OBJECTIVE

This study compared the efficacy and safety of paroxetine and desipramine with those of placebo in the treatment of depressive disorders in adult women with breast cancer, stages I-IV.

METHOD

In a double-blind, placebo-controlled study, 35 female outpatients with breast cancer and DSM-III-R major depression or adjustment disorder with depressed mood were randomly assigned to treatment with paroxetine (N=13), desipramine (N=11), or placebo (N=11) for 6 weeks. Primary efficacy was assessed by change from baseline in score on the 21-item Hamilton Rating Scale for Depression (HAM-D), and the secondary outcome measure was change from baseline in the Clinical Global Impressions-Severity of Illness scale (CGI-S) score.

RESULTS

Mean changes in the total HAM-D and CGI-S scores from baseline to 6-week endpoint for the paroxetine and desipramine groups were not significantly different than those for the placebo-treated group. An unusually high rate of response (defined as >or=50% improvement in the HAM-D score) in the placebo group was observed (55% [N=6]); adverse events precipitated patient discontinuation in the active treatment groups (9% [N=1] for desipramine, 15% [N=2] for paroxetine) similar to that in the placebo-treated patients (18% [N=2]). Improvement on symptom dimensions within the HAM-D and Hamilton Rating Scale for Anxiety (depressive, anxiety, cognitive, neurovegetative, or somatic) was also similar between groups.

CONCLUSION

The small number of women in this study most likely contributed to the lack of observed differences in efficacy observed during the 6 weeks of treatment. Randomized, placebo-controlled trials of adequate power seeking to determine efficacy of antidepressants in the United States for the treatment of women with breast cancer and comorbid depression remain of paramount importance.

Stress-like cardiovascular responses to common procedures in male versus female spontaneously hypertensive rats

We sought to determine the effects of gender on cardiovascular function of spontaneously hypertensive (SH) rats under basal conditions and after several common husbandry and experimental procedures. Heart rate (HR) and mean arterial blood pressure (MAP) were monitored by radiotelemetry during undisturbed periods in the morning, at night, and after acute and chronic procedures. When undisturbed in the morning and at night, female rats had significantly (P < 0.05) higher HR than male rats, whereas male rats had significantly (P < 0.05) higher MAP. In response to all the acute procedures examined except prolonged restraint and introduction of an intruder rat of the same sex, female rats had significantly (P < 0.05) greater changes in HR or MAP than did male rats. In contrast, male rats had a greater change in MAP in response to prolonged restraint (P < 0.05) and greater HR and MAP responses (P < 0.05) in response to an intruder rat. Likewise, chronic exposure to an intruder rat increased HR and MAP significantly (P < 0.05) more in males than females, and both strains partially adapted to the introduction of the unfamiliar rat after the first day. There were no significant sex-associated differences in the HR or MAP responses to transport and subcutaneous injection on four consecutive days, and neither male nor female rats adapted to the repeated procedure. We conclude that sex-associated differences in cardiovascular responses do occur in SH rats, but the direction of the difference varies with the stimulus used.

Effects of a cage enrichment program on heart rate, blood pressure, and activity of male sprague-dawley and spontaneously hypertensive rats monitored by radiotelemetry

To determine whether a nonsocial enrichment program affects cardiovascular responses of individually housed male Sprague-Dawley (SD) and spontaneously hypertensive (SH) rats under basal conditions and after potentially stressful procedures, we used radiotelemetry to record heart rate (HR), systolic blood pressure (SBP), and activity in the cage. Enrichment comprised a simulated burrow (Rodent Retreat), then a food foraging item ("rat cannoli") 2 days later, and a paper bag of bedding for shredding (Nestpak) after another 2 days. Data were collected under undisturbed conditions and before and after several acute and chronic manipulations mimicking common husbandry, experimental, and stressful procedures. Enrichment often, but not always, reduced HR and SBP in male rats, suggesting decreased arousal and stress, and the effects depended on the parameter measured, strain of rat, and nature of the procedure to which animals were exposed. In general, HR varied more than SBP; enrichment affected SH rats more than SD rats; effects of enrichment were more consistently observed under undisturbed conditions than after manipulations of the rats; moderate responses to acute husbandry and experimental procedures were affected more than the larger changes produced by very stressful procedures; and responses to social interactions were unaffected by the enrichment program. What accounts for these variable effects of enrichment is unclear, and more studies are required to resolve the mechanisms. Whether this enrichment program should be used in an animal facility depends on several factors, particularly the professional judgment of the research, veterinary, and animal care staffs involved.

Selective adaptation of male rats to repeated social encounters and experimental manipulations

The objective of the present study was to determine how rats adapt to repeated encounters with an unfamiliar male or group of males and to experimental manipulations. Male rats were instrumented with radiotelemetry transmitters to monitor heart rate (HR), mean arterial blood pressure (MAP), and movements in the home cage as indices of arousal and stress. Groups of eight singly housed rats were exposed in their home cages to encounters with an unfamiliar rat or a group of three rats of the same strain, age, and sex for a period of 18 h (1600 to 1000 h) on four consecutive days. On separate occasions, the instrumented rats were given a subcutaneous injection of sterile saline in the animal room or were transported from the animal room to the laboratory and then injected at 1000 h on four consecutive days. Exposure to an unfamiliar rat or a group of 3 rats induced significant (P < 0.05) increases in HR, MAP, and movement in the first 30 min of exposure, and these responses partially but significantly (P < 0.05) adapted by the second or third day. Nocturnal movement in the home cage also was significantly (P < 0.05) increased on the first night and partially reduced on subsequent nights, but nocturnal HR responses were absent or significantly blunted. Nocturnal MAP was not increased. Subcutaneous injection in the animal room or after transport to the laboratory produced significant (P < 0.05) increases in HR, MAP, and movement in the cage 30 min after the injection, and these responses did not adapt over the four days of the experiment. We concluded that male Sprague-Dawley rats adapted quickly, albeit partially, to social encounters but did not adapt to repeated injections, suggesting selective adaptation depending on the type of stimulus used.

Effects of Chinese herbal medicine on bone structure and function

This study examined the effects of four-months of treatment using Chinese herbal Shu Di Shan Zha Formula on bone health. Fourteen Australian menopausal women participated in this paired study and completed all the tests at the commencement, 4th month (when the treatment group and control group cross over) and the 8th month (end) of the study. Data from bone structure and function tests (broadband ultrasonic attenuation--BUA and velocity of sound--VOS), biomarkers of bone turnover (osteocalcin--OSTN and urinary pyridum crosslinks--PYR and D-PYR) were collected from each subject. Results showed that Shu Di Shan Zha Formula was able to affect the level of BUA, and reduce the level of D-PYR in menopausal women.

Correlation of the response of recurrent malignant gliomas treated with interferon alpha with tumor interferon alpha gene content

Malignant gliomas are treated by combining surgery and radiation with chemotherapy. Cure is rare and utilizing information arising from our improved understanding of brain tumor biology may be of value. Interferon alpha (IFNalpha) treatment as restorative immunotherapy has been utilized in malignant gliomas in the past. Interferon alpha/beta gene presence is variable in these tumors. The relationship between response to IFNalpha therapy and gene status has not been assessed prospectively. Patients with recurrent malignant gliomas were treated with 8-week courses of IFNalpha. Clinical and laboratory toxicity was assessed and response determined by MRI scans. Tumor interferon alpha/beta gene content was measured. Toxicities included fourteen grade 3/4 neuro-motor events, and eleven grade 3 neuro-cortical events. Rapid tolerance developed and with dose reductions few doses were missed. Three individuals with glioblastoma multiforme demonstrated a partial response. Median time to progression was 24.6 (+/-17.6) weeks for all glioblastomas. The correlation between longer time to progression and lower tumor IFNalpha gene content as measured here was significant. A minority of patients with recurrent malignant gliomas will respond to IFNalpha therapy at starting doses of 20 Mu/m(2) and above. These doses are associated with significant toxicity. A relationship between the tumor IFNalpha gene status and tumor response to therapy may be present. With current improved understanding of IFNalpha toxicities and ability to measure tumor IFNalpha function, this therapy warrants further evaluation for identifying patients whose tumors are likely to be responsive to IFNalpha therapy.

Theories and practice in prevention and treatment principles in relation to Chinese herbal medicine and bone loss

Osteoporosis is a world wide problem that is increasing in significance as the global population both increases and ages. While osteoporosis has been extensively studied in recent years, the utilization of Traditional Chinese Herbal Medicine for the prevention and treatment of this condition have seldom been examined in the Western world. This paper reviews the theories and the literature that relate to prevention and treatment of bone loss at the time of menopause according to the principles of Traditional Chinese Herbal Medicine. Practical developments in these areas are also illustrated in this paper based on the authors' research findings in recent studies.

Follow-up of genetic linkage findings on chromosome 16p13: evidence of association of N-methyl-D aspartate glutamate receptor 2A gene polymorphism with ADHD

Attention deficit hyperactivity disorder (ADHD) is a childhood onset disorder, for which there is good evidence that genetic factors contribute to the aetiology. Recently reported linkage findings suggested evidence of a susceptibility locus on chromosome 16p13 (maximum LOD score of 4.2, P=5 x 10(-6)). The GRIN2A (glutamate receptor, ionotropic, N-methyl D-aspartate 2A) gene that encodes the N-methyl D-aspartate receptor subunit 2A (NMDA2A) maps to this region of linkage. As this is also a good functional candidate gene for ADHD, we undertook family-based association analysis in a sample of 238 families. We found significant evidence of association with a GRIN2A exon 5 polymorphism (chi(2)=5.7, P=0.01). Our data suggest that genetic variation in GRIN2A may confer increased risk for ADHD and that this, at least in part, might be responsible for the linkage result on 16p reported by Smalley et al. We conclude that replication is required and that further work examining for association of GRIN2A polymorphisms with ADHD is warranted.

Recovery of male rats from major abdominal surgery after treatment with various analgesics

The objective of this study was to compare the recovery of male rats after a major abdominal surgical procedure (the implantation of a radiotelemetry transmitter) when treated with buprenorphine, butorphanol, or ketoprofen and subcutaneous fluids (5% dextrose) or with subcutaneous fluids only. The parameters for assessing recovery were heart rate (HR), mean arterial blood pressure (MAP), home cage activity, food and water consumption, and body weight. HR, MAP, and activity were continuously monitored by radiotelemetry methods, food and water intakes were determined daily, and body weights were measured once or three times a week. In light of HR, nocturnal home cage activity, water consumption, and body weight gain, animals were recovered by about 7 days after surgery. MAP normalized by 1 to 2 days postsurgery, and food consumption returned to presurgical levels 5 to 12 days after surgery, depending on the analgesic treatment. On the basis of nocturnal activity, HR, and food and water intakes, buprenorphine-treated animals recovered more slowly than did the other two analgesic-treated groups. By the other parameters, all three analgesic-treated groups showed very similar responses across time. Surprisingly, when compared with the groups receiving only subcutaneous fluids, buprenorphine and butorphanol delayed or did not advance recovery, whereas ketoprofen neither retarded nor advanced recovery. Explanations for these results include: (a) the analgesics were effective in relieving pain but had pharmacological side effects that altered the measured parameters, making it difficult to determine recovery; (b) the level of pain experienced did not notably affect recovery; (c) the analgesics, at the doses and/or dosing schedules used, were not effective in the relief of pain, thereby causing both groups of animals to recover at the same rate; and (d) the analgesics interfered with recovery. Final resolution of these issues awaits further investigation.

Activation of spinal histamine H3 receptors inhibits mechanical nociception

Previous studies have suggested a possible pain-modulatory role for histamine H(3) receptors, but the localization of these receptors and nature of this modulation is not clear. In order to explore the role of spinal histamine H(3) receptors in the inhibition of nociception, the effects of systemically (subcutaneous, s.c.) and intrathecally (i.t.) administered histamine H(3) receptor agonists were studied in rats and mice. Immepip (5 mg/kg, s.c.) produced robust antinociception in rats on a mechanical (tail pinch) test but did not alter nociceptive responses on a thermal (tail flick) test. In contrast, this treatment in mice (immepip, 5 and 30 mg/kg, s.c.) did not change either mechanically or thermally evoked nociceptive responses. When administered directly into the spinal subarachnoid space, immepip (15-50 microg, i.t.) and R-alpha-methylhistamine (50 microg, i.t.) had no effect in rats on the tail flick and hot plate tests, but produced a dose- and time-dependent inhibition (90-100%) of nociceptive responses on the tail pinch test. This attenuation was blocked by administration of thioperamide (10 mg/kg, s.c.), a histamine H(3) receptor antagonist. Intrathecally administered thioperamide also reversed antinociceptive responses induced by systemically administered immepip, which demonstrates a spinal site of action for the histamine H(3) receptor agonist. In addition, intrathecally administered immepip (25 microg) produced maximal antinociception on the tail pinch test in wild type, but not in histamine H(3) receptor knockout (H(3)KO) mice. These findings demonstrate an antinociceptive role for spinal histamine H(3) receptors. Further studies are needed to confirm the existence of modality-specific (i.e. mechanical vs. thermal) inhibition of nociception by these receptors, and to assess the efficacy of spinally delivered histamine H(3) receptor agonists for the treatment for pain.