Safety and antitumor activity of 3-weekly anti-EpCAM antibody adecatumumab (MT201) in combination with docetaxel for patients with metastatic breast cancer: Results of a multicenter phase Ib trial

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Background: The fully human IgG1 antibody adecatumumab (MT201) binds to the epithelial cell adhesion molecule (EpCAM), which is expressed in over 90% of breast cancers and has been associated with poor prognosis. Data from a previous phase II study in metastatic breast cancer (MBC) indicated that single agent MT201 could prolong progression-free survival in a subset of patients with high EpCAM expression. This study tested safety and tolerability of MT201 treatment in combination with standard docetaxel. Methods: Relapsed or primary refractory, EpCAM-positive MBC patients were treated with docetaxel (100 mg/m2 q21d) in combination with MT201 (dose levels 180 mg/m2, and 550 mg/m2 q21d). A loading dose of 100 mg/m2 and 300 mg/m2, respectively, was administered on day 1 and 7. Patients were grouped into high- and low-level EpCAM expression. Primary objectives were safety and tolerability; anti-tumor activity according to RECIST was a secondary objective. Results: A total of 22 patients with a median of 3 prior chemotherapy lines were enrolled. Most frequent grade 3/4 adverse events (AE) in all patients were leucopenia (90%), neutropenia (77%), lymphopenia (68%), and diarrhea (23%). No evidence for aggravation of grade 3/4 toxicities typically associated with docetaxel was found. The dose level 550 mg/m2 q21d has been determined as MTD in combination with 100 mg/m2 q21d docetaxel. The overall response rate (CR/PR; RECIST) and clinical benefit rate (CR/PR and SD>24wks) in all evaluable patients was 24% and 41%, respectively. Patients with high EpCAM expression showed a response rate of 43%, whereas patients with low EpCAM expression had a response rate of 10%. Median time-to-progression (TTP) in all evaluable patients was 165 days. Conclusions: Combining MT201 with docetaxel for the treatment of MBC appears to be safe and feasible. The DLT of this combination were short and manageable episodes of grade 3 diarrhea. The response rate and TTP observed in this heavily pre-treated population is encouraging and warrant further development of MT201/chemotherapy combinations in patients with tumors of high EpCAM target level.

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Lipidomics of the red cell in diagnosis of human disorders

Applications of tandem mass spectrometry in the field of lipid clinical chemistry are considered. Haemato-logical and biochemical advantages are presented favoring the choice of red blood cell membranes as a starting material in a wide variety of biomedical fields. Practical considerations are discussed with respect to methods of sampling, storage, and lipid extraction of red blood cells. The chapter describes the capabilities of a direct infusion of raw lipid extracts in the electro-spray ionization source compared with the more sophisticated method of high-performance liquid chromatography coupled with hybrid tandem mass spectrometry. Both methods have been evaluated and have been shown to be suitable for diagnosis and/or monitoring for a variety of human disorders.

A novel mutation in the FOXC1 gene in a family with Axenfeld-Rieger syndrome and Peters' anomaly

Peters anomaly and Axenfeld-Rieger syndrome (ARS) belong to the overlapping spectrum of disorders summarized as anterior segment dysgenesis (ASD). Five patients from a family with Peters' anomaly and ARS were screened for mutations in the PITX2, CYP1B1 and FOXC1 genes by direct sequencing. All affected family members examined were heterozygous for a single nucleotide substitution, resulting in a nonsense mutation (Q120X) at a highly conserved residue of the FOXC1 gene that is essential for DNA binding. In this pedigree, all affected family members were diagnosed with ARS except for one who shows bilateral Peters' anomaly. Our findings support the role of FOXC1 mutations in the spectrum of ASD.

Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation

After obtaining informed consent, 80 patients were randomised to undergo a navigated or conventional total knee replacement. All received a cemented, unconstrained, cruciate-retaining implant with a rotating platform. Full-length standing and lateral radiographs and CT scans of the hip, knee and ankle joint were carried out five to seven days after operation. No notable differences were found between computer-assisted navigation and conventional implantation techniques as regards the rotational alignment of the femoral or tibial components. Although the deviation from the transepicondylar axis was relatively low, there was a considerable range of deviation for the tibial rotational alignment. There was no statistically significant difference regarding the occurrence pattern of outliers in mechanical malalignment but the number of outliers was reduced in the navigated group.

Free flap transfer in cranio-maxillofacial surgery: a review of the current data

BACKGROUND

The advances of cranio-maxillofacilal surgery are considerably driven by the evolution of microsurgical techniques. At present, these methods continue to provide new therapeutic options to the field. Especially, free flap transfer has evolved to become an integral part of current treatment protocols for head and neck malignancies. It ensures uneventful wound healing even after previous radiotherapy and can often preserve form and function. For many patients, this may lead to a significant improvement in their quality of life.

OBJECTIVES

This review summarizes aspects of tumor therapy, the impact of radiation, and discusses different techniques of microvascular tissue transfer.

DISCUSSION

Specific advantages in different anatomical sites of the head and neck region are highlighted in contrast to existing alternatives. Selected cases exemplify the use of popular transplants.

SUMMARY

While planning reconstructions, it is important to consider both the functional and aesthetic aspects. The best individual outcome is based on a thoughtful match of available methods to a given defect and the patient's condition.

Detection of Circumstellar Material in a Normal Type Ia Supernova

Type Ia supernovae are important cosmological distance indicators. Each of these bright supernovae supposedly results from the thermonuclear explosion of a white dwarf star that, after accreting material from a companion star, exceeds some mass limit, but the true nature of the progenitor star system remains controversial. Here we report the spectroscopic detection of circumstellar material in a normal type Ia supernova explosion. The expansion velocities, densities, and dimensions of the circumstellar envelope indicate that this material was ejected from the progenitor system. In particular, the relatively low expansion velocities suggest that the white dwarf was accreting material from a companion star that was in the red-giant phase at the time of the explosion.

Encephalitis in a stone marten (Martes foina) after natural infection with highly pathogenic avian influenza virus subtype H5N1

Recent outbreaks of disease in different avian species, caused by the highly pathogenic avian influenza virus (HPAIV), have involved infection by subtype H5N1 of the virus. This virus has also crossed species barriers and infected felines and humans. Here, we report the natural infection of a stone marten (Martes foina) from an area with numerous confirmed cases of H5N1 HPAIV infection in wild birds. Histopathological examination of tissues from this animal revealed a diffuse nonsuppurative panencephalitis with perivascular cuffing, multifocal gliosis and neuronal necrosis. Additionally, focal necrosis of pancreatic acinar cells was observed. Immunohistochemically, lesions in these organs were associated with avian influenza virus antigen in neurons, glial cells and pancreatic acinar cells. Thus, the microscopical lesions and viral antigen distribution in this stone marten differs from that recently described for cats naturally and experimentally infected with the same virus subtype. This is the first report of natural infection of a mustelid with HPAIV H5N1.

Developmental defects and seedling lethality in apyrase AtAPY1 and AtAPY2 double knockout mutants

Previously it was shown that the Arabidopsis apyrase genes AtAPY1 and AtAPY2 are crucial for male fertility because mutant pollen (apy1-1; apy2-1) with T-DNA insertions in both genes could not germinate (Steinebrunner et al. (2003) Plant Physiol. 131: 1638-1647). In this study, pollen germination was restored and apyrase T-DNA double knockouts (DKO) apy1-1/apy1-1; apy2-1/apy2-1 were generated by complementation with AtAPY2 under the control of a pollen-specific promoter. The DKO phenotype displayed developmental defects including the lack of functional root and shoot meristems. In cotyledons, morphogenetic and patterning abnormalities were apparent, e.g., unlobed pavement cells and stomatal clusters. Another set of lines was created which carried either AtAPY1 or AtAPY2 under a dexamethasone-(DEX)-inducible promoter as an additional transgene to the pollen-specific gene construct. Application of DEX did not reverse the DKO phenotype to wild-type, but some inducible lines exhibited less severe defects even in the absence of the inducer, probably due to some background expression. However, even these DKO mutants were seedling-lethal and shared other defects regarding cell division, cell expansion and stomatal patterning. Taken together, the defects in the DKO mutants demonstrate that AtAPY1 and AtAPY2 are essential for normal plant development.

Impact of Exercise Capacity on Myocardial High-Energy Phosphate Metabolism

31-Phosphorous magnetic resonance spectroscopy (31P MRS) is a unique tool to investigate IN VIVO high-energy phosphates (HEP) in the human heart. We hypothesized that physical capacity may be associated with myocardial HEP status. Healthy, male volunteers (n = 105, mean age 51 +/- 7 years) underwent bicycle ergometry with a stepwise increasing workload to determine maximal working capacity (MWC). Heart rate (HR) and blood pressure (BP) were measured continuously during exercise and 4 minutes of recovery. Further 31-Phosphorous 2-dimensional chemical shift imaging (31P 2D CSI) MRS was performed to assess myocardial HEP metabolism by determining phosphocreatinine to beta-ATP ratios (PCr/b-ATP) using a 1.5 tesla scanner. Volunteers with MWC > 230 Watt had significantly higher PCr/b-ATP ratios than those with MWC < 200 Watt (1.93 +/- 0.36 vs. 1.59 +/- 0.35; p < 0.001). Additionally, those with a recovery systolic (S)BP < 195 mmHg had significantly higher ratios than those with a recovery SBP > 195 mmHg (1.74 +/- 0.3 vs. 1.51 +/- 0.2; p < 0.05). We observed a linear correlation between the PCr/b-ATP ratio and MWC (r = 0.411; p < 0.001) and recovery SBP (r = - 0.290; p < 0.01). After statistical correction for age, these correlations remained significant. In this study, we observed a correlation of parameters of physical fitness determined by bicycle exercise testing and cardiac PCr/b-ATP ratios.

Fast-Track-Rehabilitation am Beispiel der Kolonchirurgie

Fast-track rehabilitation refers to an interdisciplinary multimodal procedure to improve and accelerate recovery and avoid perioperative complications. The concept aims at reducing morbidity and discharging patients faster. It includes preoperative patient information, atraumatic surgical technique, stress reduction, pain therapy mostly via regional anesthetic techniques (frequently, thoracic epidural anesthesia), optimized fluid and temperature management, early enteral feeding, prophylaxis of gastrointestinal atony and postoperative nausea and vomiting, fast postoperative patient mobilization, and earlier hospital discharge. Fast-track protocols exist for all kind of surgical procedures but are best established for colon surgery.

Protein expression in the tissues of the cardiovascular system of the rat under selenium deficiency and adequate conditions

We investigate the effects of selenium in tissues of the cardiovascular system. In order to examine the expression of the heart and aorta proteins (part of them) in the homogenate of selenium-deficient (Se(-)) and selenium control rats (Se(+)), two-dimensional electrophoresis was used by means of giga gels (30 x 35 cm). After electrophoresis, the protein expression pattern of the (Se(-)) gel and (Se(+)) gel was compared. The evaluation of the protein difference was implemented by means of a computer program suitable for the analysis of protein separated by the two-dimensional electrophoresis. In this way more than 2000 proteins a gel (heart) were detected and more than 1900 protein spots were detected in the aorta fraction. Ten significant differences were found between the gel of (Se(+)) and (Se(-)) heart homogenate of the rat and more than 15 significant differences between the gel of (Se(+)) and (Se(-)) of the aorta. By means of MALDI-MS-ESI-MS some of these proteins with different expression levels were not determined until now. Of those, three proteins were detected as the alpha myosin heavy chain (alpha-MHC), myosin light chain 1 and 2 (MLC 1 and 2), and the mitochondrial enzyme creatinine kinase. First results suggest that selenium deficiency affects myocardial energy metabolism and contractile proteins.

Evaluation of transient apical ballooning with cardiac magnetic resonance imaging and 31-phosphorous magnetic resonance spectroscopy

Apical ballooning is an increasingly reported transient cardiomyopathy with yet unknown origin. In this study 2 cases of apical ballooning are described in whom we used a combined approach of cardiac magnetic resonance imaging (CMR) and 31-Phosphorous magnetic resonance spectroscopy (31P MRS). Electrocardiogram showed ST abnormalities and cardiac serum markers were mildly elevated, but CAG demonstrated smooth coronary arteries. Cine-CMR revealed severe apical akinesia and significantly decreased ejection fraction. Furthermore we detected reduced myocardial phosphocreatine to beta-ATP (PCr/b-ATP) ratios during the first week of acute disease. After 1 week we observed an improvement of PCr/b-ATP ratios by 68% and 34%, which was associated with an increase in left ventricular function. Our data suggest that 31P MRS might be a valuable tool in the evaluation of apical ballooning, but larger cohorts are needed to improve the understanding of metabolic changes during transient apical ballooning.

Metal-containing proteins in the apoptosis and redox processes in the rat prostate and human prostate cells

Several trace elements, such as Se, Cu, Mn, and Zn are bound to proteins (metallo- and metalloidproteins) in the prostate gland. Currently, it is known that some of those elements play a role in the apoptosis of different cells and redox processes. For the detection of such proteins, analytical and biochemical procedures were combined. SEC and ICP-MS were used to detect some trace elements, which are bound to proteins in the prostate cytosol and/or in the human prostate cell lines. Several antibodies against specific proteins were tested. By means of some of these antibodies several trace element-containing proteins, such as selenoproteins and Cu- and Cu-Zn-proteins, could be identified in the prostate. In addition, the localization of such metal- and metalloid-containing proteins in the micro organelles and cytosol of the prostate indicates specific functions of these proteins because, as it is known, such metal- and metalloid proteins play a role in the apoptosis and especially in the redox processes.

Animal experiments with ultra-high molecular weight polyethylene (UHMW-PE) stabilised with alpha-tocopherol used for articulating surfaces in joint endoprostheses

Numerous investigations proved the impressive suitability of alpha-tocopherol as a stabilizer for ultra-high molecular weight polyethylene (UHMW-PE) used for endoprostheses. Regarding the biocompatibility of this new biomaterial, in-vitro celltoxicity tests gave no hint for a cyto- or genotoxic activity. In this study, animal experiments are carried out to further ensure the biocompatibility of this biomaterial. Thin UHMW-PE-films (20 x 6 x 0.23 mm3) were implanted subcutaneously into rats. Morphology and reactivity of surrounding connective tissue against either pure UHMW-PE material or UHMW-PE containing alpha-tocopherol were studied at timed intervals (2 weeks, 3 month, and 6 month after operation) in 3 groups of animals, each group comprising 10 animals. Parallel to these tests, material changes were investigated in these 3 groups of 10 animals at the same intervals after operation with the help of infrared spectroscopy (FTIR). Within the implantation time, no noteworthy oxidative degradation could be observed. The amount of lost alpha-tocopherol due to diffusion is low enough to ensure a lifetime stabilisation of the UHMW-PE. The implants were all well tolerated and definitely encapsulated already 2 weeks after operation. Presence or absence of alpha-tocopherol in the implants did not evince morphological differences. Therefore, negative consequences were not manifest in the presence of alpha-tocopherol.

Accelerated ageing experiments with crosslinked and conventional ultra-high molecular weight polyethylene (UHMW-PE) stabilised with alpha-tocopherol for total joint arthroplasty

Samples of untreated ultra-high molecular weight polyethylene (UHMW-PE), UHMW-PE sterilized with gamma-rays in nitrogen atmosphere (conventional UHMW-PE, widely used for articulating surfaces in endoprostheses) and UHMW-PE, which has been crosslinked by electron beam irradiation and annealed subsequently, were stabilized with alpha-tocopherol and aged in air at 120 degrees C as well as in 10% aqueous hydrogenperoxide with 0.04 mg/ml FeCl3 as catalyst at 50 degrees C. The oxidative degradation was monitored with the help of infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), solubility measurements and size exclusion chromatography (SEC) and were compared to unstabilized samples. When aged in air at 120 degrees C, the crosslinked UHMW-PE showed a slightly slower increase of the carbonyl (CO)-number (according to DIN 53383) in FTIR than conventional UHMW-PE. A stabilisation with 0.4% w/w alpha-tocopherol resulted in an increase of lifetime by a factor of approx. 40 for all samples. Ageing in 10% aqueous H2O2 at 50 degrees C yielded similar results for all three unstabilised samples. The addition of the natural antioxidant alpha-tocopherol led to a prolongation of lifetime by a factor of approx. 2.5. A linear loss of alpha-tocopherol was detected during ageing. An increase of crystallinity as well as lamella thickness during ageing was observed with the help of DSC. The two-phase structure of crosslinked UHMW-PE with two melting endotherms at 114 degrees C and 137 degrees C was replaced very quickly by a single melting point at 130 degrees C. This effect was delayed with the stabilized samples. In the solubility and SEC measurements, a severe molecular degradation and drop of molar mass of all materials could be observed after ageing in H2O2, leading to a complete destruction and, in case of crosslinked UHMW-PE, to a serious damage of the molecular network, respectively.

Stabilisation of crosslinked ultra-high molecular weight polyethylene (UHMW-PE)-acetabular components with alpha-tocopherol

A stabilisation of crosslinked ultra-high molecular weight polyethylene (UHMW-PE) with alpha-tocopherol (vitamin E) used for endoprostheses can increase its resistance against oxidative degradation remarkably. However, the method used for conventional UHMW-PE of adding alpha-tocopherol to the UHMW-PE powder before processing can not be applied for crosslinked UHMW-PE, since the alpha-tocopherol hinders the crosslinking process, which would be accompanied by a heavy degradation of this vitamin. The alpha-tocopherol has therefore to be added after the crosslinking process. This paper presents two methods for a stabilisation of finished products with alpha-tocopherol. In method 1, UHMW-PE-cubes (20 x 20 x 20 mm3) were stored in pure alpha-tocopherol under inert atmosphere at temperatures from 100 degrees C to 150 degrees C resulting in a high mass fraction of alpha-tocopherol in the edge zones. For further homogenisation, the cubes were stored in inert atmosphere at temperatures from 160 degrees C to 200 degrees C. In method 2, supercritical CO2 was used to incorporate the vitamin into the UHMW-PE. In an autoclave vessel, the cubes were treated with alpha-tocopherol dissolved in supercritical CO2 for several hours at temperatures from 100 degrees C to 170 degrees C. In both cases, the mass fraction of alpha-tocopherol was detected with the help of a FTIR-microscope. Both methods are well suited to stabilise crosslinked UHMW-PE with alpha-tocopherol. A stabilisation of the sensitive edge layer as well as a nearly homogenous distribution with varying alpha-tocopherol content may be realised by varying the process parameters. Using method 2, standard hip cups were stabilized nearly homogeneously with varying mass fraction of alpha-tocopherol. No oxidation of the UHMW-PE could be detected by infrared spectroscopy (FTIR) and HPLC studies showed a very low degradation of the alpha-tocopherol for both processes.

Blockade of chemokine signaling in patients with multiple sclerosis

We assessed the safety and efficacy of orally administered CC chemokine receptor 1 (CCR1) antagonist in 105 patients with relapsing/remitting MS (RRMS) in a 16-week, randomized, double-blind, placebo-controlled trial. The primary endpoint was the cumulative number of newly active lesions on serial MRI scans. Other MRI, immunologic, and clinical outcomes were also explored. No significant treatment difference was observed for any tested MRI variable. CCR1 does not contribute to initial leukocyte infiltration in RRMS.

Molecular basis for the antiproliferative effect of agmatine in tumor cells of colonic, hepatic, and neuronal origin

The aim of the present study was to challenge potential mechanisms of action underlying the inhibition of tumor cell proliferation by agmatine. Agmatine inhibited proliferation of the human hepatoma cells HepG2, the human adenocarcinoma cells HT29, the rat hepatoma cells McRH7777, and the rat pheochromocytoma cells PC-12. Inhibition of proliferation of HepG2 cells was associated with an abolition of expression of ornithine decarboxylase (ODC) protein and a doubling of mRNA content encoding ODC. In HepG2 cells, silencing of ODC-antizyme-1, but not of antizyme inhibitor, by RNA interference resulted in an increase of agmatine's antiproliferative effect. Thus, the distinct decrease in intracellular polyamine content by agmatine was due to a reduced translation of the synthesizing protein ODC but was not essentially mediated by induction of ODC-antizyme or blockade of antizyme inhibitor. In interaction experiments 1 mM L-arginine, 1 mM D-arginine, 1 mM citrulline, 100 microM N(omega)-nitro-L-arginine methyl ester, 1 and 10 microM sodium nitroprusside, and 1 microM N1-guanyl-1,7-diaminoheptane failed to alter agmatine's antiproliferative effect. Hence, the antiproliferative effect of agmatine in HT29 and HepG2 cells is due to an interaction with neither the NO synthases, the hypusination of eIF5A, nor an agmatine-induced reduction in availability of intracellular L-arginine. L-Arginine and citrulline, but not d-arginine, inhibited tumor cell proliferation by themselves. Their inhibitory effect was abolished after silencing of arginine decarboxylase (ADC) expression by RNA interference indicating the conversion to agmatine by ADC. Finally, in the four cell lines under study, agmatine-induced inhibition of cell proliferation was paralleled by an increase in intracellular caspase-3 activity, indicating a promotion of apoptosis.