Relationship Between Serum Sodium Level Within the Low-Normal Range on Admission and Long-Term Clinical Outcomes in Patients with Acute Decompensated Heart Failure

Although hyponatremia during hospitalization for acute decompensated heart failure (ADHF) is reportedly related with poor prognosis, the available data regarding the impact of serum sodium level within the low-normal range at admission on clinical events in patients with ADHF is limited.We studied eligible patients admitted to our institution in 2007-2011. All the patients were categorized into 3 groups according to the admission serum sodium levels of < 135 mmol/L (hyponatremia), ≥ 135 and < 140 mmol/L (low-normal range), or ≥ 140 mmol/L (normal range). The association between admission serum sodium levels and long-term clinical events, a composite of all-cause deaths and re-hospitalizations for ADHF, was assessed by multivariable Cox proportional analysis.Of the 584 eligible patients, 208 (35.6%) were in the low-normal range and 99 (16.9%) had hyponatremia on admission. On multivariable analysis, compared with those with a sodium level ≥ 140 mmol/L, patients with hyponatremia were at increased risk for clinical events (hazard ratio [HR], 1.53; P = 0.041), whereas the HR of those in the low-normal range was attenuated and insignificant (HR, 1.08; P = 0.625). However, the HR of each category increased significantly as sodium level decreased (P value for HR trend, 0.024). In addition, when serum sodium level was treated as a continuous variable, the lower the serum sodium level, the greater the risk of clinical events (P = 0.012). The cut-off value of serum sodium level to predict mortality was < 138 mmol/L.In conclusion, a low serum sodium level on admission for ADHF, even if low-normal, can increase the risk of long-term mortality and/or re-hospitalization for ADHF.

Randomized controlled trial of an oral appliance (SomnoDent) for sleep-disordered breathing and cardiac function in patients with heart failure

In patients with heart failure (HF), sleep-disordered breathing (SDB) is a common comorbidity and a risk factor for poor clinical outcomes. SDB can be ameliorated by continuous positive airway pressure; however, inadequate adherence remains a major cause of treatment failure. On the other hand, the efficacy of oral appliance (OA) has been proved in orthodontics and otolaryngology, although the efficacy of OA in patients with HF remains to be elucidated. This trial aims to determine the efficacy of OA for SDB in patients with HF. Patients with HF undergoing optimal medical therapy who were diagnosed as having SDB (apnea-hypopnea index [AHI] ≥ 10 and percentage of central AHI per total AHI ≤ 70%) by using polysomnography (PSG) will be enrolled in the present study. Either patients with HF with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤ 50%) or HF with preserved ejection fraction (history of hospitalization because of acute decompensated HF) or plasma B-type natriuretic peptide (BNP) level ≥ 100 pg/mL will be included. Each patient will be randomly assigned into active OA or sham OA. PSG, laboratory, and echocardiographic data will be obtained after 3 months of intervention. The main outcome measures are AHI, plasma BNP, and E/e' determined with echocardiography. Furthermore, overnight urinary catecholamine, 6-min walk distance, Epworth sleepiness scale, and health-related quality of life will be assessed simultaneously. This trial started on April 1, 2017, and the projected end date is March 31, 2019. This study was registered in the University Hospital Medical Information Network (UMIN000025731).

Independent Factors Contributing to Daytime and Nighttime Asthmatic Cough Refractory to Inhaled Corticosteroids

BACKGROUND

Cough is a common feature of asthma, which is often resistant to inhaled corticosteroids (ICSs). The pathophysiology of this refractoriness may differ between daytime and nighttime asthmatic cough. We sought to identify factors contributing to ICS-refractory daytime and nighttime asthmatic cough.

METHODS

Sixty-seven patients with asthma presenting solely or predominantly with chronic cough were prospectively enrolled from April 2012 to December 2014. At baseline and 12 weeks after ICS treatment, the capsaicin cough threshold (C2, C5) and methacholine airway sensitivity and reactivity were examined. A visual analog scale (VAS) and numeric scores were used to evaluate daytime and nighttime cough symptoms separately. The Japanese version of the Leicester Cough Questionnaire was also completed. When either the VAS or numeric scores showed an improvement of ≥50% or ≥2 points, patients were considered responders to ICS treatment.

RESULTS

Fifty-five patients were eligible for evaluation. Subjective cough indices improved significantly at 12 weeks after ICS treatment (P<.001). Multivariate analysis revealed that lower C2 significantly contributed to residual daytime cough (P=.04). Meanwhile, methacholine hyperreactivity and lower IgE levels were predictors of the nighttime residual cough (P=.002 and P=.03, respectively).

CONCLUSIONS

Heightened cough reflex sensitivity is an independent factor of daytime asthmatic cough that is refractory to ICSs. In contrast, airway hyperreactivity and less atopic status contribute to ICS-refractory nighttime cough.

Integrated treatment using intraperitoneal radioimmunotherapy and positron emission tomography-guided surgery with 64Cu-labeled cetuximab to treat early- and late-phase peritoneal dissemination in human gastrointestinal cancer xenografts

Peritoneal dissemination is a common cause of death from gastrointestinal cancers and is difficult to treat using current therapeutic options, particularly late-phase disease. Here, we investigated the feasibility of integrated therapy using ⁶⁴Cu-intraperitoneal radioimmunotherapy (ipRIT), alone or in combination with positron emission tomography (PET)-guided surgery using a theranostic agent (⁶⁴Cu-labeled anti-epidermal growth factor receptor antibody cetuximab) to treat early- and late-phase peritoneal dissemination in mouse models. In this study, we utilized the OpenPET system, which has open space for conducting surgery while monitoring objects at high resolution in real time, as a novel approach to make PET-guided surgery feasible. ⁶⁴Cu-ipRIT with cetuximab inhibited tumor growth and prolonged survival with little toxicity in mice with early-phase peritoneal dissemination of small lesions. For late-phase peritoneal dissemination, a combination of ⁶⁴Cu-ipRIT for down-staging and subsequent OpenPET-guided surgery for resecting large tumor masses effectively prolonged survival. OpenPET clearly detected tumors (≥3 mm in size) behind other organs in the peritoneal cavity and was useful for confirming the presence or absence of residual tumors during an operation. These findings suggest that integrated ⁶⁴Cu therapy can serve as a novel treatment strategy for peritoneal dissemination.

Design, Synthesis, and Preliminary Evaluation of SPECT Probes for Imaging β-Amyloid in Alzheimer's Disease Affected Brain

In this study, we synthesized of a series of 2-phenyl- and 2-pyridyl-imidazo[1,2- a]pyridine derivatives and examine their suitability as novel probes for single-photon emission computed tomography (SPECT)-based imaging of β-amyloid (Aβ). Among the 11 evaluated compounds, 10 showed moderate affinity to Aβ(1-42) aggregates, exhibiting half-maximal inhibitory concentrations (IC₅₀) of 14.7 ± 6.07-87.6 ± 39.8 nM. In vitro autoradiography indicated that ¹²³I-labeled triazole-substituted derivatives displayed highly selective binding to Aβ plaques in the hippocampal region of Alzheimer's disease (AD)-affected brain. Moreover, biodistribution studies performed on normal rats demonstrated that all ¹²³I-labeled probes featured high initial uptake into the brain followed by a rapid washout and were thus well suited for imaging Aβ plaques, with the highest selectivity observed for a 1 H-1,2,3-triazole-substituted 2-pyridyl-imidazopyridine derivative, [¹²³I]ABC577. This compound showed good kinetics in rat brain as well as moderate in vivo stability in rats and is thus a promising SPECT imaging probe for AD in clinical settings.

Influence of backrest angle on swallowing musculature activity and physical strain during the head lift exercise in elderly women compared with young women

The head lift exercise (HLE) is the most common exercise for strengthening the swallowing musculature in clinical situations. This study investigated whether a change in the backrest angle of a bed influences swallowing musculature activity and physical strain during the HLE and whether it can generate an appropriate exercise load for swallowing musculature activity for older women compared with younger women. Participants were 10 elderly women and 10 young women, each of whom performed the HLE with a backrest randomly angled at 0°, 15°, 30° and 45°. The activity of the suprahyoid, infrahyoid and sternocleidomastoid muscles was assessed with electromyography. The perception of fatigue was measured with the Borg Rating of Perceived Exertion Scale. The activity of the infrahyoid and sternocleidomastoid muscles in elderly women was significantly lower when the angle of the backrest was raised to 45° vs 0°. In both groups, the Borg rating decreased significantly at the 30° and 45° backrest positions vs the 0° and 15° positions. The activity required for the suprahyoid and infrahyoid muscles in elderly women at a 30° backrest position was almost equal to the activity required by these muscles in young women at a 0° backrest position. In elderly women, it is possible that the HLE with the backrest at a 30° angle may be easier and provide a more appropriate exercise load for strengthening the swallowing muscles.

Effect of Disturbances of Zinc and Copper on the Physical and Mental Health Status of Patients with Alcohol Dependence

The concentrations of copper and zinc in the tissues of alcohol-addicted people can significantly correlate with the variables describing their mental state. Studies on the homeostasis of zinc in alcohol-dependent patients have often been characterized by low hypozincemia detection. This may be caused by a low content of zinc in blood serum (1%) compared to the average zinc level in the body. Unfortunately, most authors have identified extracellular zinc in their studies. In the available literature, data on the level of copper in patients suffering from alcohol dependence are inconsistent. Our study included 100 alcohol-addicted patients (the study group) and 50 healthy subjects (the control group). Mental state was measured using appropriate psychometric scales. We used inductively coupled plasma mass spectrometry (ICP-MS) to determine copper and zinc content. Our results confirm the purposefulness of the use of zinc concentration in erythrocytes as a diagnostic parameter for low zinc status in alcohol-dependent patients. Alcohol-dependent patients with reduced concentrations of zinc in erythrocytes/copper in blood plasma differed significantly from alcohol-dependent patients with normal concentrations in terms of clinical parameters. With regard to zinc in blood plasma and copper in erythrocytes, this situation has not been found. The clinical symptoms of hypozincemia and copper deficiency in patients addicted to alcohol usually relate to disorders in central nervous system functioning, and they result in a decreased quality of physical and mental life.

Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention

BACKGROUND

Sleep-disordered breathing (SDB) has been recognized as an important risk factor for coronary artery disease (CAD). However, SDB was not fully examined, because sleep studies are limited. Nocturnal pulse oximetry has been suggested to be a useful tool for evaluating SDB. Therefore, the aim of this study was to investigate the influence of SDB assessed by nocturnal pulse oximetry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI).

METHODS

We conducted a prospective, multicenter, observational cohort study, wherein SDB was assessed by finger pulse oximetry in patients who underwent PCI from January 2014 to December 2016. SDB was defined as 4% oxygen desaturation index of 5 and higher. The primary endpoint was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of all-cause mortality, acute coronary syndrome, and/or stroke.

RESULTS

Of 539 patients, 296 (54.9%) had SDB. MACCE occurred in 32 patients (5.8%) during a median follow-up of 1.9 years. The cumulative incidence of MACCE was significantly higher in patients with SDB (P = 0.0134). In the stepwise multivariable Cox proportional model, the presence of SDB was a significant predictor of MACCE (hazard ratio 2.26; 95% confidence interval 1.05-5.4, P = 0.036).

CONCLUSIONS

SDB determined by nocturnal pulse oximetry was associated with worse clinical outcomes in patients who underwent PCI. Screening for SDB with nocturnal pulse oximetry was considered to be important for risk stratification in patients with CAD.

Prevalence and Clinical Correlates of Sleep-Disordered Breathing in Patients Hospitalized With Acute Decompensated Heart Failure

BACKGROUND

Limited data are available regarding the presence of sleep-disordered breathing (SDB) assessed using polysomnography in patients hospitalized with left ventricular (LV) systolic dysfunction after acute decompensated heart failure (ADHF). We investigated the prevalence and clinical correlates of SDB in patients hospitalized with ADHF and LV systolic dysfunction.

METHODS

Prospectively collected data from 105 consecutive patients with an LV ejection fraction < 50% who were hospitalized with ADHF from May 2012 to July 2014 were retrospectively assessed. Polysomnography was performed during the initial hospitalization after the initial improvement in ADHF acute signs and symptoms. The apnea-hypopnea index (AHI), including obstructive or central AHI, was computed as a severity of obstructive or central sleep apnea. Echocardiography and blood sampling for various parameters, such as B-type natriuretic peptide level, were performed systematically.

RESULTS

The proportions of patients with an AHI ≥ 5 events per hour and those with an AHI ≥ 15 events per hour were 93% and 69%, respectively, and central sleep apnea was predominant (66% and 44%, respectively). In the multivariate analysis, only body mass index (BMI) was independently correlated with AHI, whereas age, BMI, and E/e' level were independently correlated with obstructive AHI. In addition, use of loop diuretics and E/e' level were independently correlated with central AHI.

CONCLUSIONS

SDB determined using polysomnography was common in hospitalized patients with ADHF and LV systolic dysfunction. Age, BMI, and E/e' levels were significantly correlated with obstructive sleep apnea severity, whereas E/e' levels and use of loop diuretics were significantly correlated with central sleep apnea severity.

Abstract OT2-01-01: Observational study of axilla treatment for breast cancer patients with 1 to 3 positive micrometastases or macrometastases in sentinel lymph nodes

[Background] Axilla surgery in node-positive breast cancer is dramatically changing from axillary lymph node dissection (ALND) to sentinel node biopsy (SNB). From the results of ACOSOG Z0011, IBCSG23-01 and AMAROS trials, adjuvant therapy and regional node irradiation could reduce regional lymph node recurrence for sentinel node-positive breast cancer patients. However, optimal indication of SNB alone remains uncertain. Trial design: To evaluate the outcome of sentinel node-positive breast cancer patients, the Japanese Society for Sentinel Node Navigation Surgery (SNNS) conducted a prospective cohort study in 2013 (UMIN000011782, Jpn J Clin Oncol, p.876-9, 2014). [Eligibility criteria] For eligible patients, SNB was performed or scheduled after 1 January 2012. Then 1 to 3 positive micrometastases or macrometastases in sentinel lymph nodes are confirmed by histological or molecular diagnosis. Primary chemotherapy before or after SNB is also acceptable for registration. [Specific aims] The primary endpoint is the 5-year recurrence rate of regional lymph node in patients treated with SNB alone. The secondary endpoint is the 5-year overall survival rate of this cohort. Patients treated with SNB followed by ALND are also registered simultaneously to compare the prognosis. The propensity score matching (PSM) is used to make the distributions of baseline risk factors comparable. [Statistical method] Based on an estimated recurrence rate of 5% at 5 years among patients treated with SNB alone, 240 patients are needed to give a 80% power to reject the null hypothesis that the recurrence rate is 10% with a one-sided type I error rate of 2.5%. If we consider that some patients will be lost to follow-up or become ineligible, a total of 250 patients will be needed to comprise the sample. [Present accrual] Eight hundred and eighty patients who underwent SNB alone or SNB followed by ALND were registered from 27 participating institutes between 2013 and 2016. Data cleaning is being performed. Patient's background and PSM will be reported.

Citation Format: Imoto S, Saito Oba M, Masuda N, Nagashima T, Wada N, Takashima T, Kitada M, Kawada M, Hayashida T, Taguchi T, Aihara T, Miura D, Toh U, Yoshida M, Sugae S, Yoneyama K, Matsumoto H, Jinno H, Sakamoto J. Observational study of axilla treatment for breast cancer patients with 1 to 3 positive micrometastases or macrometastases in sentinel lymph nodes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-01-01.

Abstract P2-01-08: Enumeration of heterogeneous circulating tumor cells (CTCs) using size-based method in early, and metastatic, breast cancer patients

Background

The detection of circulating tumor cells (CTCs) in peripheral blood is an independent predictor of the efficacy of systemic therapy, and also a prognostic marker for patients with metastatic breast cancer. One of the main methods to detect CTCs is CellSearch system, which uses immune-magnetic separation followed by immunocytochemistry. A microdevice (CTChip from ClearCell system) can capture and enumerate CTCs based on distinctive physiological differences (size and deformability) between cancer cells and blood cells. CTChip thus obtains a larger CTC yield than affinity-based separation, which enriches a particular subgroup of cells expressing EpCAM. In this study, we enumerate CTCs in peripheral blood from early and metastatic breast cancer patients using a size-based method.

Patients and methods

We examined blood samples from a total of 18 early and metastatic breast cancer patients, after obtaining written informed consent. Blood samples were taken in sodium EDTA tubes after discarding the first 1ml of blood from the syringe. Two ml blood samples were applied to CTChip (ClearCell system), and CTCs were eventually trapped in the microwells of the CTChip. Trapped cells were analyzed by immunocytochemistry with monoclonal antibodies specific for leukocytes (CD45) and epithelial cells (CK8/18), along with 4',6-diamidino-2-phenylindole (DAPI) for nuclei: CK8/18-positive, DAPI-positive and CD45-negative cells more than 10 μm in diameter were defined as CTCs. Eight patients were examined using both the CTChip and CellSearch system to compare the yield of CTCs.

Results

Of 18 patients, 6 were de novo stage IV, 6 were recurrent and 6 were early stage breast cancer patients. Of primary tumors, 8 were HER2- and ER and/or PR +, 6 were HER2-and ER- and PR-, 3 were HER2+ and ER and/or PR +, and one was HER2+ and ER- and PR-. Using CTChip, detected CTCs ranged from 3 - 107 cells/2 ml in all cases: 3 - 83 for early stage, 19 - 156 for stage IV and 21 - 146 for recurrent. The number of CTCs found in recurrent patients tended to be higher than in early stage patients. Size-based method using CTChip clearly showed high sensitivity compared with the CellSearch system, which detected CTCs in only 2 cases out of 8. In analysis by immunochemistry, we found CK-negative, CD45-negative and DAPI positive cells with larger diameter (&gt;16 μm) than CK-positive CTCs in most patients, and the numbers were higher in stage IV (8.5 cells of median value) and recurrent (13 cells) patients than in early stage patients (1.5 cells). Our study suggested that CK-negative large cells might be CTCs with epithelial–mesenchymal transition (EMT).

Conclusion

This size-based technology enables us to capture CTCs regardless of EpCAM expression. Enumerated CTCs varied in size and positivity of CK8/18, suggesting the heterogeneity of CTCs. Further research, especially focusing on EMT will be crucial to understand the key mechanism of metastasis and drug resistance.

Citation Format: Tozuka K, Nagai SE, Kubo K, Komatsu K, Takai K, Inoue K, Matsumoto H, Hayashi Y, Tsuboi M, Yamada Y, Wang X, Suganuma M. Enumeration of heterogeneous circulating tumor cells (CTCs) using size-based method in early, and metastatic, breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-01-08.

Abstract P4-13-11: A complication analysis between complete and partial tissue expander coverage using autologous flaps in cases of immediate breast reconstruction

Background:

To avoid tissue expander exposure following mastectomy flap necrosis, several methods for covering expander by autologous flap in cases of immediate breast reconstruction have been reported. These methods are classified into two groups, complete or partial expander coverage. Two methods have potential risks of postoperative complications following: insufficient lower pole expansion and cranial migration in complete coverage methods, and lateral migration in partial coverage methods. However, the comparisons of complication rates between these two methods have not been reported. This study aims to compare the incidence of expander exposure following mastectomy flap necrosis and expander migration between two methods.

Methods:

A retrospective review of 93 patients (99 breasts) who underwent immediate expander-based breast reconstruction was performed. Patients were divided into two groups, complete or partial expander coverage by autologous flaps. In both groups, expanders were placed into subpectral position. In partial coverage group, the lateral borders of pectralis major muscles were sutured to the mastectomy skin flaps. If the skin flap was too thin to be sutured, the serratus anterior muscro-fascial flap was dissected and sutured to the lateral border of pectralis major muscle to cover the expander completely. Allograft products were not used in both groups. Demographics, intraoperative findings, and postoperative complications were compared between two groups.

Results:

Of the 99 breasts, 56 underwent complete expander coverage and 43 underwent partial coverage. Mastectomy flap necrosis rate was higher in the complete coverage group (Complete 14.3% versus Partial 0%; p=0.0091), however, there was no incidence of expander exposure in both groups. Lateral migration rate was higher in the partial coverage group (Complete 0% versus Partial 9.3%; p=0.033). There was no difference in cranial migration rate between two groups (Complete 12.5% versus Partial 2.3%; p=0.133).

Conclusions:

The thinness of the mastectomy flaps was considered to provide the higher incidence of mastectomy flap necrosis in the complete coverage group. The complete expander coverage reduced lateral migration rate and prevented expander exposure in cases of mastectomy flap necrosis.

Citation Format: Kubo K, Hamahata A, Tozuka K, Tsuboi M, Hayashi Y, Takai K, Saito T, Sakurai H, Matsumoto H. A complication analysis between complete and partial tissue expander coverage using autologous flaps in cases of immediate breast reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-11.

Non-invasive Ultrasonic Urination Sensor for Ambulatory Patient Support

It is estimated that, in Japan, several million people suffer from urinary incontinence caused by, e.g., cerebrovascular disease, abdominal operations, spinal-cord damage, etc. Urinary incontinence is said to be a ‘hidden’ disease. When no adequate treatment is given, a serious situation may arise for both patients and their family. A non-invasive and unconstrained ultrasonic sensor has been designed enabling patients to discretely manage urination. The major problem of the sensor is how to maintain a proper irradiation angle to obtain an anteroposterior bladder diameter which corresponds to the actual bladder volume. Many types of ultrasonic probe holders have been tested and promising results have been obtained. The most practical, but as yet experimental, method is a four-element ultrasonic sensor, embedded in a flat probe.

Acute Effects of Positive Airway Pressure on Functional Mitral Regurgitation in Patients with Systolic Heart Failure

Background: Acute effects of positive airway pressure (PAP) [including continuous PAP (CPAP) and adaptive servo-ventilation, an advanced form of bi-level PAP] on functional mitral regurgitation (fMR) in patients with heart failure (HF) with left ventricular (LV) systolic dysfunction remain unclear. Thus, whether PAP therapy reduces fMR in such patients with HF was investigated. Methods and Results: Twenty patients with HF and LV systolic dysfunction defined as LV ejection fraction (LVEF) <50% (14 men; mean LVEF, 35.0 ± 11.5%) with fMR underwent echocardiography during 10-min CPAP (4 and 8 cm H₂O) and adaptive servo-ventilation. For fMR assessment, MR jet area fraction, defined as the ratio of MR jet on color Doppler to the left atrial area, was measured. The forward stroke volume (SV) index (fSVI) was calculated from the time-velocity integral, cross-sectional area of the aortic annulus, and body surface area. fMR significantly reduced on CPAP at 8 cm H₂O (0.30 ± 0.12) and adaptive servo-ventilation (0.29 ± 0.12), compared with the baseline phase (0.37 ± 0.12) and CPAP at 4 cm H₂O (0.34 ± 0.12) (P < 0.001). The fSVI did not change in any of the PAP sessions (P = 0.888). However, significant differences in fSVI responses to PAP were found between sexes (P for interaction, 0.006), with a significant reduction in fSVI in women (P = 0.041) and between patients with baseline fSVI ≥ and < the median value (27.8 ml/m², P for interaction, 0.018), with a significant fSVI reduction in patients with high baseline fSVI (P = 0.028). In addition, significant differences were found in fSVI responses to PAP between patients with LV end-systolic volume (LVESV) index ≥ and < the median value (62.0 ml/m², P for interaction, 0.034), with a significant fSVI increase in patients with a high LVESV index (P = 0.023). Conclusion: In patients with HF, LV systolic dysfunction, and fMR, PAP can alleviate fMR without any overall changes in forward SV. However, MR alleviation due to PAP might be associated with a decrease in forward SV in women with high baseline SV, whereas MR alleviation due to PAP might be accompanied by increased forward SV in patients with a dilated LV.

Multiple Administrations of 64Cu-ATSM as a Novel Therapeutic Option for Glioblastoma: a Translational Study Using Mice with Xenografts

Glioblastoma is the most aggressive malignant brain tumor in humans and is difficult to cure using current treatment options. Hypoxic regions are frequently found in glioblastoma, and increased levels of hypoxia are associated with poor clinical outcomes of glioblastoma patients. Hypoxia plays important roles in the progression and recurrence of glioblastoma because of drug delivery deficiencies and induction of hypoxia-inducible factor-1α in tumor cells, which lead to poor prognosis. We focused on a promising hypoxia-targeted internal radiotherapy agent, ⁶⁴Cu-diacetyl-bis (N⁴-methylthiosemicarbazone) (⁶⁴Cu-ATSM), to address the need for additional treatment for glioblastoma. This compound can target the overreduced state under hypoxic conditions within tumors. Clinical positron emission tomography studies using radiolabeled Cu-ATSM have shown that Cu-ATSM accumulates in glioblastoma and its uptake is associated with high hypoxia-inducible factor-1α expression. To evaluate the therapeutic potential of this agent for glioblastoma, we examined the efficacy of ⁶⁴Cu-ATSM in mice bearing U87MG glioblastoma tumors. Administration of single dosage (18.5, 37, 74, 111, and 148 MBq) and multiple dosages (37 MBq × 4) of ⁶⁴Cu-ATSM was investigated. Single administration of ⁶⁴Cu-ATSM in high-dose groups dose-dependently inhibited tumor growth and prolonged survival, with slight and reverse signs of adverse events. Multiple dosages of ⁶⁴Cu-ATSM remarkably inhibited tumor growth and prolonged survival. By splitting the dose of ⁶⁴Cu-ATSM, no adverse effects were observed. Our findings indicate that multiple administrations of ⁶⁴Cu-ATSM have effective antitumor effects in glioblastoma without side effects, indicating its potential for treating this fatal disease.

A Comprehensive LC-MS and Isolation Study of Cicada Slough as a Crude Drug

Cicada slough is one of the traditional crude drugs in East Asia. A comprehensive LC-MS analysis was conducted to overview constituents in a commercially purchased cicada slough as a crude drug. It revealed that there were oligomers of N-acetyldopamine with the degree of polymerization of up to 8. High-resolution tandem mass spectrometry could enable a detailed analysis on their structures by uncovering the presumed fragmentation pathways. Additional isolation experiments disclosed the presence of four known compounds: 2,3’,4’-trihydroxyacetophenone, 2-oxo- N-acetyldopamine, protocatechuic acid, and paeonol. The quantified paeonol content for purchased cicada slough ranged from 3 to 290 μg/g dw crude drug, although wild cicada slough did not show the presence of paeonol.