Involvement of ADAMTS5 and hyaluronidase in aggrecan degradation and release from OSM-stimulated cartilage

The relative contribution of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)4 and ADAMTS5 to aggrecan degradation under oncostatin M (OSM) stimulation, the role of the ancillary domains of the aggrecanases on their ability to cleave within the chondroitin sulfate (CS)-2 region, the role of hyaluronidases (HYAL) in stimulating aggrecan release in the absence of proteolysis, and the identity of the hyaluronidase involved in OSM-mediated cartilage breakdown were investigated. Bovine articular cartilage explants were cultured in the presence of interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNFalpha) and/or OSM, or treated with trypsin and/or hyaluronidase. Aggrecan was digested with various domain-truncated isoforms of ADAMTS4 and ADAMTS5. Aggrecan and link protein degradation and release were analyzed by immunoblotting. Aggrecanase and HYAL gene expression were determined. ADAMTS4 was the most inducible aggrecanase upon cytokine stimulation, whereas ADAMTS5 was the most abundant aggrecanase. ADAMTS5 was the most active aggrecanase and was responsible for the generation of an OSM-specific degradation pattern in the CS-2 region. Its ability to cleave at the OSM-specific site adjacent to the aggrecan G3 region was enhanced by truncation of the C-terminal thrombospondin domain, but reduced by further truncation of both the spacer and cysteine-rich domains of the enzyme. OSM has the ability to mediate proteoglycan release through hyaluronan degradation, under conditions where HYAL-2 is the predominant hyaluronidase being expressed. Compared to other catabolic cytokines, OSM exhibits a unique potential at degrading the proteoglycan aggregate, by promoting early robust aggrecanolysis, primarily through the action of ADAMTS5, and hyaluronan degradation.

[The case of a person who let to umbilicus metastasis at a year after PD]

We present the case of a 70-year-old female who was admitted to our hospital due to jaundice. Abdominal computed tomography revealed stenosis of periampullary region that was led to cancer of pancreas, so PTCD tube was taken into intrahepatic bile duct before surgery, and we carried out pancreaticoduodenectomy (PD) + D2, #16 lymph node dissection. Four months after PD, abdominal computer tomography revealed 1 cm-in-diameter skin metastatic lesion that pulled out the PTCD tube 2 weeks after PD, so she underwent a tumor resection and chemo-radiation (50 Gy (2 Gy × 25 times) + GEM 1,000 mg/m2). Seventeen months after PD, a metastatic lesion in 19 mm-in-diameter appeared in umbilicus. We resected the umbilicus tumor because local recurrence at the pulled out PTCD tube took a good control. At an umbilicus resection, there was peritoneal dissemination. Therefore, we kept her to undergo GEM 1 ,000 mg/m2, but she was dead (2 years after PD). Umbilicus metastasis creates the appearance of the patient looks bad. So we thought that the umbilicus resection was meaningful even if the resection did not contribute her prognosis.

[Idiopathic thrombocytopenic purpura during chemotherapy for liver metastasis of rectal cancer]

Neoadjuavnt chemotherapy for liver metastasis of colorectal cancer implies issues about timing for resection and management for adverse events due to chemotherapy.

CASE

A 50-year-old male patient with synchronous liver metastasis from rectal cancer had a surgery for primary lesion followed by neo-adjuvant chemotherapy for liver resection. Chemotherapy of bevacizumab + mFOLFOX6 achieved a partial response for liver metastasis. When we planned a liver resection, platelet count decreased to 1.4 × 10(4)/µL. The patient was diagnosed as idiopathic thrombocytopenic purpura (ITP) by several examinations but medical control including steroids failed. Partial splenic artery embolization could recover platelet count successfully. However, during the period of therapy for ITP, liver metastasis became unresectable. The patient is currently treated by FOLFIRI and with stable disease for three months.

CONCLUSION

NeoPyloriadjuvant chemotherapy for respectable liver metastasis should be considered carefully in terms of timing for resection and prompt management for adverse events.

[The case of a person who was revealed by adrenal metastasis of pulmonary pleomorphic carcinoma]

We report a case of fifties man. He admitted to our hospital due to a hypochondralgia. Computed tomography revealed a tumor of right adrenal gland and a tumor of upper lobe of the right lung. Adrenal tumor had rapidly increased, so we performed adrenectomy. At first adrenal tumor was diagnosed as primary adrenal cancer because its histological findings did not coincide with those of common histologic types of lung cancer. As there were possibilities that one of adrenal or lung tumor was primary and the other was metastatic or both of the two were double primary, we performed right upper lobectomy. Lung tumor was diagnosed as primary pleomorphic carcinoma containing spindle-shaped tumor cells and adenocarcinoma, and then the diagnosis of adrenal tumor was corrected as metastasis of lung cancer. Two months after the lung operation, cervical lymph node swelling, metastasis of stomach and local recurrence of adrenal tumor appeared. After he underwent six courses of systemic chemotherapy of carboplatin and paclitaxel, a clinical complete response was obtained and no recurrence is observed for 4 years.

[Surgical treatment for peritoneal metastasis of hepatocellular carcinoma after hepatectomy--a case report]

A patient was a 61-year-old male. In December 2005, abdominal computer tomography (CT) revealed at a 4 cm-in-diameter early enhanced lesion in S6 and a 1.5 cm-in-diameter early enhanced lesion in S5/8, which were diagnosed as hepatocellular carcinomas. He underwent S6 partial hepatectomy and S5/8 partial hepatectomy. However, multiple lung metastatic lesions and a peritoneal metastatic lesion were detected by computer tomography (CT) in July 2007, led to a diagnosis as recurrence of HCC. Although he received S-1/IFN-α combination systemic chemotherapy, no effect was shown and peritoneal metastatic lesion grew to 10 cm-in-diameter. We thought that this lesion might lead to ileus, therefore, he received peritoneal tumor resection in December 2007. Multiple lung metastases grew and he was dead 13 months after the surgery: no abdominal symptom and sign due to ileus was noted. In this case, it was considered that a resection of peritoneal metastasis might be attempted to prevent ileus, even if there were other metastatic lesions, such as multiple lung metastases.

[Two cases of lung cancer patients with postoperative brain metastases obtaining long-term survival after gamma knife radiosurgery]

We report two cases of lung cancer patients with postoperative solitary brain metastases obtaining long-term survival after gamma knife stereotactic radiosurgery. Both were seventies men and had good performance status without active extracranial disease. In one case, an asymptomatic metastatic brain tumor 1.8 cm in maximum diameter appeared one year and two months after the operation and was irradiated with gamma knife resulting in complete local control for seven years. He is alive with solitary lung metastasis in good performance status. In the other case, gamma knife was employed for a metastatic brain tumor 2.7 cm in maximum diameter that appeared nine months after the operation accompanying incomplete left hemiplegia. Six months later, the tumor was enlarged and gamma knife was repeated, but the tumor growth could not be suppressed. Following deterioration of hemiplegia and appearance of convulsion, he died of neurological disorder three years and two months after the onset of brain metastasis. Gamma knife stereotactic radiosurgery for metastatic brain tumors is less invasive and a repeatable technique, and is expected to provide a good local control and a survival benefit for appropriately selected patients.

Effect of tiotropium bromide on airway inflammation and remodelling in a mouse model of asthma

BACKGROUND

Tiotropium bromide, a long acting muscarinic receptor inhibitor, is a potent agent for patients with bronchial asthma as well as chronic obstructive pulmonary disease.

OBJECTIVE

The aim of this study was to evaluate whether tiotropium bromide can inhibit allergen-induced acute and chronic airway inflammation, T helper (Th)2 cytokine production, and airway remodelling in a murine model of asthma.

METHODS

Balb/c mice were sensitized and challenged acutely or chronically to ovalbumin (OVA). The impact of tiotropium bromide was assessed using these mice models by histologic, morphometric, and molecular techniques. Moreover, the effect of tiotropium bromide on Th2 cytokine production from purified human peripheral blood mononuclear cells (PBMCs) was assessed.

RESULTS

Treatment with tiotropium bromide significantly reduced airway inflammation and the Th2 cytokine production in bronchoalveolar lavage fluid (BALF) in both acute and chronic models of asthma. The levels of TGF-beta1 were also reduced by tiotropium bromide in BALF in a chronic model. The goblet cell metaplasia, thickness of airway smooth muscle, and airway fibrosis were all significantly decreased in tiotropium bromide-treated mice. Moreover, airway hyperresponsiveness (AHR) to serotonin was significantly abrogated by tiotropium bromide in a chronic model. Th2 cytokine production from spleen cells isolated from OVA-sensitized mice was also significantly inhibited by tiotropium bromide and 4-diphenylacetoxy-N-methylpiperidine methiodide, which is a selective antagonist to the M3 receptor. Finally, treatment with tiotropium bromide inhibited the Th2 cytokine production from PBMCs.

CONCLUSION

These results indicate that tiotropium bromide can inhibit Th2 cytokine production and airway inflammation, and thus may reduce airway remodelling and AHR in a murine model of asthma.

[A case of liver metastasis treated by cetuximab monotherapy with partial response]

BACKGROUND

Cetuximab in Japan is currently approved as a second or more line therapy for advanced metastatic colorectal cancer.

CASE

We report a case of liver metastasis of colon cancer effectively treated by cetuximab after the progression and prolonged neural toxicity of the prior chemotherapy including oxaliplatin and irinotecan. A 61-year-old female suffered from unresectable multiple liver metastases of sigmoid colon cancer. She had already received irinotecan+S-1, mFOLFOX6+bevacizumab, FOLFIRI+bevacizumab, and hepatic arterial infusion of 5-FU+systemic infusion of irinotecan. Although liver metastases were stably controlled by those therapies, her peripheral neural symptom, initially caused by oxaliplatin, became worse after infusion of irinotecan. We decided to give her cetuximab monotherapy in the fifth-line setting. We investigated K-ras gene status on her colon cancer tissue previously resected, which showed a wild-type. Her liver tumor showed a partial response evaluated with RECIST, and the status was maintained for more than four months.

CONCLUSION

Cetuximab monotherapy can be used for those with prolonged neurotoxicity and might be effective for the patients with second or more line setting.

[Intrapleural hypotonic cisplatin treatment for carcinomatous pleuritis in cases of primary lung cancer]

Intrapleural hypotonic cisplatin treatment, which was introduced by Ichinose and colleagues, was performed for 5 cases of primary lung cancer with carcinomatous pleuritis: one case intraoperatively, one case postoperatively and 3 unresected cases. Fifty microg/mL of cisplatin distilled water solution was administered into pleural cavity and drained 10 minutes later in the intraoperative case or 30 minutes later in the bedside cases. No adverse effect was observed. For 2 dissemination- dominant cases, 2 regimens of single cytotoxic agent followed by gefitinib were administered, and the two patients died in 26 and 69 months, respectively. For one case with dissemination and effusion, 5 regimens including combination chemotherapy were administered, and the patient died in 41 months. For 2 effusion-dominant cases, gefitinib was administered and one case is still in PR status for 21 months, and the other was alive for 19 months. Ipsilateral pleural effusion was controlled in all 5 cases. This therapy is helpful for systemic chemotherapy as a main therapeutic means in cases of lung cancer with carcinomatous pleuritis by controlling malignant pleural effusion and relieving dyspnea.

[A case of hepatocellular carcinoma which could be diagnosed with Gd-EOB-DTPA enhanced MRI]

The patient was a 75-year-old female. In 2005, abdominal computer tomography (CT) revealed a 18 mm-in-diameter early enhanced lesion (tumor A) in S8, which was diagnosed as hemangioma of liver with abdominal simple MRI examination. However, abdominal computer tomography (CT) revealed a 16 mm-in-diameter early enhanced lesion (tumor B) near the tumor A to at S8 in April 2008. Both tumor A and tumor B led to a diagnosis of hepatocellular carcinoma (HCC) with Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) (tumor A was suspected to HCC with adipose components, and tumor B was suspected to HCC with bile excretion disorder). In July 2008, he received S8 partial hepatectomy at these hepatic tumors. In this resected specimen, a new lesion was detected as a 7 mm-in-diameter HCC, sandwiched in previous two tumors. Previous two tumors were diagnosed as well differentiated HCCs and a new lesion was diagnosed as moderately differentiated HCC. This patient is still alive with no recurrence after 14 months from hepatectomy. In conclusion, Gd-EOB-DTPA enhanced MRI might be useful in diagnosis of hepatic tumor characteristics.

[A case of glycogen storage disease type I with hepatocellular carcinoma]

The patient was a 55-year-old female. In 1997, she was diagnosed as type-I glycogen storage disease (von Gierke disease). In March 2002, abdominal ultrasound tomography revealed an early enhanced lesion at liver S2, which suspected to a well differentiated hepatocellular carcinoma (HCC) with super-paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI). From 2002 to 2006, she received three times trans-arterial chemo-embolization (TACE) at enhanced lesions. But abdominal computer tomography (CT) revealed a 3.6 cm-in diameter early enhanced lesion near this tumor at S2, which was suspected to a diagnosis of recurrent HCC in December 2008. Therefore, she received a partial hepatectomy at S2. This resected specimen was diagnosed as poorly differentiated HCC. This patient is still alive with no recurrence after 6 months from operation. In conclusion, it might be effective for an early detection of recurrent HCC to see the doctor for a long regular checkup, because the growth of HCC with glycogen storage disease would be very slow.

[A case of superior sulcus tumor resected after chemoradiotherapy and resulted in complete response]

We report a case of superior sulcus tumor performed chemoradiation followed by operation obtaining a long-term survival without relapse. A case is a male of fifties, who visited our hospital with the complaint of numbness in the ulnar side of the left arm and scapular pain. Computed tomography revealed a mass, 4 cm in diameter in the apical portion of the left lung extending to superior sulcus and supraclavicular region. The tumor decreased in size by 2 cm after induction chemoradiotherapy under clinical diagnosis of T3N0M0 superior sulcus tumor and then the apex of the lung and the chest wall was resected with some superior mediastinal lymph nodes. No residual viable tumor cells were seen in the resected tissues. He was followed-up by CT without adjuvant therapy and is alive with no sign of relapse 6 years after the operation, so the effect of induction chemoradiotherapy is evaluated to be complete response. Multimodality therapy with induction chemoradiation and surgery for superior sulcus tumor without lymph node metastasis appears promising.

Zonisamide enhances delta receptor-associated neurotransmitter release in striato-pallidal pathway

A recent randomized control study demonstrated that zonisamide (ZNS), an antiepileptic drug, is effective in Parkinson's disease at the lower than the therapeutic doses against epilepsy (25-50 mg/day); however, the detailed mechanism of antiparkinsonian effects of ZNS remains to be clarified. To determine the mechanism of antiparkinsonian effect of ZNS, we investigated the effects of ZNS on extracellular levels of dopamine in the striatum (STR), glutamate in substantia nigra pars reticulata (SNr), GABA in globus pallidus (GP), subthalamic nucleus (STN) and SNr, using multiple microdialysis probes. Striatal perfusion of 1000 microM ZNS (within therapeutic-relevant concentration against epilepsy) increased extracellular levels of dopamine in STR, whereas 100 microM ZNS (lower than the therapeutic-relevant concentration against epilepsy but within the therapeutic rage against Parkinson's disease) did not affect it. Striatal perfusion of ZNS (100 and 1000 microM) decreased the extracellular levels of GABA in STN and glutamate in SNr, but decreased extracellular GABA level in GP without affecting GABA level in SNr. These concentration-dependent effects of ZNS on extracellular neurotransmitter levels were independent of dopamine and delta(2) receptors; however, blockade of delta(1) receptor inhibited the effects of ZNS. Furthermore, activation of delta(1) receptor enhanced the effects of ZNS on neurotransmitter level. These results suggest that ZNS does not affect the direct pathway but inhibits the indirect pathway, which is mediated by delta(1) receptor. Therefore, the antiparkinsonian effects of ZNS seem to be mediated through the interaction between lower than therapeutically-relevant concentration against epilepsy of ZNS (100 microM) and delta(1) receptor.

Covalent modification of matrix metalloproteinases by a photoaffinity probe: influence of nucleophilicity and flexibility of the residue in position 241

A photoaffinity probe, developed for the specific labeling of matrix metalloproteinase (MMP) active sites, was recently shown to covalently modify a single residue in human MMP-12, namely, Lys(241), by reacting selectively with the side chain epsilon-amino group of that residue. The residue in position 241 of MMPs is not conserved; thus, variability in this position may be responsible for the dispersion in cross-linking yield observed between MMPs when labeled by this photoaffinity probe. By studying the pH dependence of the labeling properties of this probe toward different MMPs (MMP-12, MMP-3, MMP-9, and various mutants of human MMP-12) and identifying the site of covalent modification of MMP-3 by this probe, our new data demonstrated that the nucleophilicity of the residue in position 241 plays a key role in determining the cross-linking yield of MMP modification by the probe. However, these studies also reveal that subtle additional structural parameters, including local conformation and flexibility, of the residue in position 241 should also be taken into consideration, a property adding a further degree of complexity in our understanding of the photolabeling probe reactivity and in designing optimal photoaffinity probes for performing functional proteomic studies of zinc proteinases like MMPs.

[A case of gastrointestinal stromal tumor of the stomach with rapid growth in a short term]

A 75-year-old man was admitted to our hospital with massive hematemesis. Upper gastrointestinal endoscopy revealed a submucosal gastric tumor with ulcer lesion, about 30 mm in diameter, in the anterior wall of the cardia. Pathological findings of biopsy specimens showed a gastrointestinal stromal tumor (GIST) of the stomach. Abdominal computed tomography (CT) showed an extramural low density mass, measuring 27 mm, in the cardia. From these findings, we thought we should be performing a wedge resection of the stomach for this tumor. After one month from the first examination, preoperative upper gastrointestinal endoscopy revealed a growth of the tumor. Abdominal CT also showed an obvious growth of the tumor, measuring 50 mm. Thus, laparoscopy-assisted proximal gastrectomy was performed, because the tumor was close to the cardia. Postoperative diagnosis of the tumor was pathologically confirmed to be a GIST with a high malignant potential. The case report of GIST that shows rapid growth for a short term is rare. We herein describe a case of GIST with rapid growth during one month before the operation.