Hypothalamic ATF3 is involved in regulating glucose and energy metabolism in mice

AIMS/HYPOTHESIS

The pancreas and hypothalamus are critical for maintaining nutrient and energy homeostasis, and combined disorders in these organs account for the onset of the metabolic syndrome. Activating transcription factor 3 (ATF3) is an adaptive response transcription factor. The physiological role of ATF3 in the pancreas has been controversial, and its role in the hypothalamus remains unknown. To elucidate the roles of ATF3 in these organs, we generated pancreas- and hypothalamus-specific Atf3 knockout (PHT-Atf3-KO) mice in this study.

METHODS

We crossed mice bearing floxed Atf3 alleles with Pdx1-cre mice, in which cre is specifically expressed in the pancreas and hypothalamus, and analysed metabolic variables, pancreatic morphology, food intake, energy expenditure and sympathetic activity in adipose tissue. We also used a hypothalamic cell line to investigate the molecular mechanism by which ATF3 regulates transcription of the gene encoding agouti-related protein (Agrp).

RESULTS

Although PHT-Atf3-KO mice displayed better glucose tolerance, neither plasma glucagon nor insulin level was altered in these mice. However, these mice exhibited higher insulin sensitivity, which was accompanied by a leaner phenotype due to decreased food intake and increased energy expenditure. We also observed decreased hypothalamic Agrp expression in PHT-Atf3-KO mice. Importantly, an increase in ATF3 levels is induced by fasting or low glucose in the hypothalamus. We also showed that ATF3 interacts with forkhead box-containing protein, O subfamily 1 (FoxO1) on the Agrp promoter and activates Agrp transcription.

CONCLUSIONS/INTERPRETATION

Our results suggest that ATF3 plays an important role in the control of glucose and energy metabolism by regulating Agrp.

Collective excitation of an electric dipole on a molecular dimer in an organic dimer-Mott insulator

The terahertz response in 10-100 cm(-1) was investigated in an organic dimer-Mott (DM) insulator κ-(ET)(2)Cu(2)(CN)(3) that exhibits a relaxorlike dielectric anomaly. An ~30 cm(-1) band in the optical conductivity was attributable to collective excitation of the fluctuating intradimer electric dipoles that are formed by an electron correlation. We succeeded in observing photoinduced enhancement of this ~30 cm(-1) band, reflecting the growth of the electric dipole cluster in the DM phase. Such optical responses in κ-(ET)(2)Cu(2)(CN)(3) reflect an instability near the boundary between the DM-ferroelectric charge ordered phases.

Use of forward genetic screens to identify genes required for RNA-directed DNA methylation in Arabidopsis thaliana

RNA-directed DNA methylation is a small RNA-mediated epigenetic modification that contributes to transcriptional silencing of transposons and repetitive sequences in plants. We have conducted several forward genetic screens to identify factors required for RNA-directed DNA methylation and transcriptional gene silencing in Arabidopsis thaliana. Here, we review the findings from these screens and report on two new mutants, dms12 and dms13, that are defective in Pol V-specific subunits NRPE5 and NRPE9b. Cumulative results from genetic screens performed in our laboratory and those of other investigators have revealed that RNA-directed DNA methylation requires a complex transcriptional machinery comprising a number of plant-specific factors, many of which were functionally uncharacterized before being implicated in this pathway. Future challenges include unraveling the detailed mechanism and full range of functions of RNA-directed DNA methylation.

Effect of inhomogeneity in a patient's body on the accuracy of the pencil beam algorithm in comparison to Monte Carlo

The pencil beam algorithm (PBA) is reasonably accurate and fast. It is, therefore, the primary method used in routine clinical treatment planning for proton radiotherapy; still, it needs to be validated for use in highly inhomogeneous regions. In our investigation of the effect of patient inhomogeneity, PBA was compared with Monte Carlo (MC). A software framework was developed for the MC simulation of radiotherapy based on Geant4. Anatomical sites selected for the comparison were the head/neck, liver, lung and pelvis region. The dose distributions calculated by the two methods in selected examples were compared, as well as a dose volume histogram (DVH) derived from the dose distributions. The comparison of the off-center ratio (OCR) at the iso-center showed good agreement between the PBA and MC, while discrepancies were seen around the distal fall-off regions. While MC showed a fine structure on the OCR in the distal fall-off region, the PBA showed smoother distribution. The fine structures in MC calculation appeared downstream of very low-density regions. Comparison of DVHs showed that most of the target volumes were similarly covered, while some OARs located around the distal region received a higher dose when calculated by MC than the PBA.

The extent of degeneration of cruciate ligament is associated with chondrogenic differentiation in patients with osteoarthritis of the knee

OBJECTIVE

Degeneration in cruciate ligaments results from abnormal biomechanical stress and the aging process. Such degeneration is a common outcome in patients with osteoarthritis (OA) of the knee and contributes to the progression of OA. However, to date, there are no specific markers that can predict the extent of ligament degeneration. We hypothesized that the extent of degeneration has correlations to increased chondrogenic potential.

METHODS

Twenty anterior cruciate ligaments (ACLs) and 30 posterior cruciate ligaments (PCLs) from 30 knees of 28 adult patients with OA at the time of total knee arthroplasty were used for the study. Degeneration was histologically assessed using a grading system. Expressions of Scleraxis (as a ligament cell marker) and Sry-type HMG box 9 (SOX9) (as a chondrogenic marker) were immunohistochemically assessed in each grade.

RESULTS

We found the opposite expression pattern between Scleraxis and SOX9 according to the grade. The percentage of Scleraxis-positive cells decreased significantly by grade (60.9±23.7 in grade 1, 39.7±30.5 in grade 2, and 13.9±27.1 in grade 3, P<0.0001). In contrast, the percentage of SOX9-positive cells increased significantly by grade (2.5±4.9 in grade 1, 17.5±13.4 in grade 2, and 50.9±27.1 in grade 3, P<0.0001). Furthermore, co-localized expression of both Scleraxis and SOX9 was demonstrated in chondrocyte-like cells.

CONCLUSIONS

This study indicates that chondrogenic differentiation is associated with the progression of degeneration in human ligaments. Our results suggest that the expression of SOX9 as a chondrogenic marker could be an indicator for the extent of degeneration in human ligaments. It remains to be elucidated whether suppression of chondrogenic differentiation can prevent progression of the degenerative process of cruciate ligaments in patients with OA.

Antitumor effect of a novel multifunctional antitumor nucleoside, 3'-ethynylcytidine, on human cancers

The antitumor activity of 1-(3-C-ethynyl-beta-D-ribopentofuranosyl) cytosine (ECyd), designed as a potential multifunctional antitumor nucleoside that could be expected to inhibit RNA and DNA syntheses, was examined. ECyd inhibited the growth of 47 kinds of cultured human cells in vitro, and also showed strong antitumor effects on 15 human solid cancers xenografted into nude mice at a dose of 0.25 mg/kg by intravenous administration for 10 consecutive days. The in vitro cytotoxic effect of ECyd was prevented dose dependently by cytidine and uridine, suggesting that ECyd may require phosphorylation by uridine/cytidine kinase for antitumor activity. ECyd strongly inhibited RNA synthesis and also slightly inhibited DNA synthesis. ECyd has shown potent antitumor activity against human experimental solid type tumors with minimal toxic effects in vivo, suggesting that ECyd will be a promising agent with a unique mechanism of action for the treatment of cancer.

Mechanisms of the formation of the peritoneal dissemination in gastric cancer

To clarify the mechanisms of the formation of peritoneal dissemination, a new animal model by the i.p. inoculation of highly metastatic gastric cancer cell line MKN-45-P was developed. Peritoneal dissemination with bloody ascites was found in 100% of nude mice, injected 1x10(7) MKN-45-P cells in suspension into the peritoneal cavity. By a highly sensitive method for specific detection of metastasized human tumor cells in nude mice using polymerase chain reaction, a human beta-globin-related sequence in the DNA from various parts of the peritoneum was specifically amplified and detected by gel electrophoresis and by a specific oligonucleotide probe. Greater omentum showed a strong signal of the amplified fragments of human beta-globin gene from the 1st day and the signals gradually increased. The signals in the gonadal fat, mesentery and ovarium could be weakly detected on the Ist day, transiently decreased on the 3rd day, and then increased from the 7th day. In the diaphragm, and abdominal wall, signals could be detected from the 7th day. In contrast, small intestine and colon did not show any human beta-globin signals. In greater omentum and gonadal fat, cancer cells were selectively detected in the milky spots stained by activated carbon on the 3rd day. In the diaphragm, cancer cells adhered to the small pores termed stomata, and invaded into the subdiaphragmatic lymphatic lacunae connected with stomata. From the 3rd day, mesothelial cells of the abdominal cavity became round and separated, resulting in the exposure of the underlying connective tissue. MKN-45-P cells were found to adhere to the naked areas of the submesothelial connective tissue. From these results, we conclude that the major metastatic route of the peritoneum may be firstly through milky spots, secondly through the diaphragmatic stomata, and thirdly by the adhesion to the naked connective tissue exposed after shrinkage of the mesothelial cells. The third process may be related to the interaction between some adhesion molecules and their ligands.

Enhanced tumorigenic and metastatic potential of an androgen-sensitive human prostate cancer cell line, LNCaP, by intratesticular inoculation in SCID mice

To establish a prostate cancer model expressing prostate-specific antigen (PSA) with metastatic potential, LNCaP or PC-3 cells were inoculated into the testis of SCID mice, resulting in a 100% rate of tumor formation. A significant increase in serum PSA was found in mice with LNCaP xenografts. Circulating tumor cells and micrometastases to organs such as lung, liver, spleen, and omentum were detected for both cell lines by PCR of the human beta-globin gene. Lymph node metastases occurred more frequently with PC-3 than LNCaP cells. This is the first report showing stable growth of LNCaP cells in mice with metastases to the regional lymph nodes. This model of prostate cancer should help to assess treatment strategies targeting PSA.

E-cadherin and c-met expression as a prognostic factor in gastric cancer

E-cadherin has an important role in the cell-cell adhesion and is known as an invasion suppressor gene. The c-met, which is a receptor of hepatocyte growth factor receptor, is involved in the proliferative and motile activity in cancer cells. The invasive and metastatic capacities of gastric cancer were studied from the immunohistochemically examined expression of MET and E-cadherin. Among 127 primary gastric cancers, 47 (34%) tumors were found to have preserved E-cadherin expression and the other 84 tumors showed reduced E-cadherin expression. MET expression was found in 55 (43%) tumors. A strong correlation was found between reduced E-cadherin expression and a larger tumor, positive serosal invasion, lymph node metastases or poor prognosis. Tumors with MET expression have the tendencies to invade deeply, to metastasize in more remote lymph nodes or peritoneum and to run a poor prognosis. MET over-expression and reduced E-cadherin expression were strongly associated with lymph node metastasis, peritoneal dissemination and poor prognosis. This group of patients with simultaneously abnormal expressions of these genes had a sixfold relative risk of death, as compared with patients with tumors showing MET negative or preserved E-cadherin expression. These results indicate that immunohistochemical combined analyses of MET and E-cadherin expression may be a powerful tool for the evaluation of invasive capacity and the prognosis of gastric cancer patients.

Comparison off genetic distance and order off DNA markers in five populations of rice

A group of about 300 evenly distributed DNA markers from a high density RFLP linkage map of rice constructed using an F2 population derived from a japonica variety, Nipponbare, and an indica variety, Kasalath, were used to evaluate gene order and genetic distance in four other rice mapping populations. The purpose of this study was to determine the degree to which information gained from the high density linkage map could be applied to other mapping populations, particularly with regard to its utility in bridging quantitative traits and molecular and physical mapping information. The mapping populations consisted of two F2 populations derived from Dao Ren Qiao/Fl-1084 and Kinandangputi/Fl-1007, recombinant inbred lines from Asominori/IR24, and a backcross population from Sasanishiki/Habataki//Sasanishiki. All DNA markers commonly mapped in the four populations showed the same linkage groups as in the Nipponbare/Kasalath linkage map with conserved linkage order. The genetic distance between markers among the different populations did not vary to a significant level in any of the 12 chromosomes. The differences in some markers could be attributed to the size of the population used in the construction of the linkage maps. Furthermore, the conservation of linkage order found in the distal region of chromosomes 11 and 12 was also confirmed in the RFLP maps based on the four populations of rice. These suggest that any major genetic information from the Nipponbare/Kasalath map can be expected to be approximately the same in other crosses or populations. This high density RFLP linkage map, which is being utilized in constructing a physical map of rice, can be very useful in interpreting genome structure with great accuracy in other populations. Key words : linkage map, japonica, indica, gene order, genetic distance.

Roles of VLA-2 and VLA-3 on the formation of peritoneal dissemination in gastric cancer

To clarify the mechanisms of the metastasis on the peritoneal surface from gastric cancer, a novel ex vivo co-culture system using human greater omentum and a highly metastatic cell line, MKN-45-P was developed. MKN-45-P was established from a gastric cancer cell line of MKN-45 by the progressive growing of the intraperitoneal passages. The differences of the expression of metastasis related genes between MKN-45 and MKN-45-P were examined by RT-PCR. Cancer cells adhered only to the naked area of the submesothelial basement membrane, which was exposed by the shrinkage and exfoliation of mesothelial cells of the omentum. The expressions of integrin alpha 2 and alpha 3 subunits in MKN-45-P were extremely elevated compared to those in MKN-45. Integrin beta 1 subunit expression did not change during the intraperitoneal passages. Anti-beta 1 integrin subunit antibody significantly inhibited the adherent number of MKN-45-P on the omentum. These results indicate that VLA-2 and VLA-3 may have an important role in the formation of the peritoneal dissemination from gastric cancer.

Spermine enhances IgM productivity of human-human hybridoma HB4C5 cells and human peripheral blood lymphocytes

The polyamine spermine was assessed for enhancement of IgM production by human-human hybridoma, HB4C5 cells, under serum-free conditions. IgM production of HB4C5 cells was stimulated approximately 6-fold by the addition of 7.3 mM of spermine. The facilitating effect was observed soon after inoculation. In spite of suppression of cell growth, the IgM production rate was accelerated for at least 5 days without medium change. Moreover, laser confocal microscopic analysis revealed that the IgM content inside HB4C5 cells was increased by spermine treatment. These findings suggest that spermine enhances specific IgM productivity of the hybridoma line. Spermine also facilitated IgM production by human peripheral blood lymphocytes under serum-free conditions. This result implies that spermine enhances immunoglobulin production of not only specific hybridoma lines, but also non-specific immunoglobulin producers. Immunoglobulin production stimulating activity of spermine was accelerated 2-fold by the addition of DNA whith a chain length of about 400-7000 base pairs (bp). However, degraded short-chain DNA fragments (less than 200 bp) did not facilitate the immunoglobulin production stimulating activity of spermine.

Prognostic value of urokinase-type plasminogen activators in gastric-cancer

To elucidate the relation between urokinase-type plasminogen activator (U-PA) and metastasis in gastric cancer, we examined U-PA tissue status immunohistochemically. Ninety-eight primary gastric cancer, prepared by AMeX method, were analyzed with anti-U-PA and anti-proliferating cell nuclear antigen (PCNA) monoclonal antibody. In addition, DNA ploidy patterns were determined by cytofluorometer after staining with propidium iodide. U-PA immunoreactivity can be observed as diffuse cytoplasmic staining, as intensely outlined luminal borders or in desquameted cells in the lumens. U-PA expression-positive tumors showed higher incidence of serosal invasion, lymph node involvement or larger tumors than did U-PA negative ones. There was no correlation between U-PA tissue status and PCNA labeling rates or DNA ploidy patterns. Patients with a U-PA positive tumor survived significantly shorter than those with U-PA negative ones. These results may indicate that U-PA tissue status is a useful biological prognostic indicator in gastric cancer. The high malignant potential of U-PA positive tumors may be associated with a rapid infiltrating capacity through gastric wall but not with a high proliferative activity.

Relationship between expression of plasminogen activator system and metastatic ability in human cancers

The gene expressions of urokinase-type plasminogen activator (u-PA), u-PA receptor (u-PR), and plasminogen activator inhibitor (PAI)-1 and -2 in human tumor cell lines and human gastric cancer tissues were analyzed using the reverse transcription (RT)-PCR. The expression patterns were compared with experimental metastatic ability in chick embryo or clinicopathological findings. The results indicate that the function of u-PA binding to u-PR and the diminished expression of PAI-2 are significantly involved in the process of cancer metastasis and PAI-2 may be more effective in regulating u-PA activity than PAI-1.

Application of wavelet analysis to the plethysmogram for the evaluation of mental stress

The present study proposes a new stress evaluation technique using the photoplethysmogram (PTG). Heart rate variability (HRV) is often used to evaluate mental stress. HRV can be measured from an electrocardiogram (ECG). The frequency variability of HRV and mental stress response are related. PTG also indicates changes in emotional response. PTG can easily be measured without body surface electrodes. This method is less invasive than ECG measurement. We attempt herein to evaluate mental stress by wavelet analysis of the PTG. PTG was measured in the resting and mental stress states, and wavelet transformed PTGs were compared. In nine out of ten subjects, the wavelet result for PTG revealed a decrease in the frequency band.

Correlation between expression of urokinase-type plasminogen activator receptor and metastasis in gastric carcinoma

To clarify the interrelationship between urokinase-type plasminogen activator receptor (uPAR) and the progression of gastric cancer, uPAR expression in gastric cancer was studied by the reverse transcription (RT)-PCR and immunohistochemistry. uPAR mRNA was expressed in 44 of 46 primary gastric cancers and uPAR immunoreactivity was found in 21 (14%) of 155 tumors. uPAR immunoreactivity was also observed in the fibroblast-like cells and the inflammatory cells including macrophages. The intensity of uPAR immunoreactivity of these cells was weaker than that of cancer cells. uPAR expression detected by RT-PCR may be from cancer cells and/or non-cancerous stromal cells. uPAR immunoreactivity in cancer cells was closely associated with histologic type, nodal status, and macroscopic type. The uPAR positive tumors were closely associated with the macroscopically infiltrating type, undifferentiated type and stage IV disease. Poorly differentiated carcinomas with rich intestitial fibrosis (scirrhous carcinoma) expressed uPAR with a significantly higher incidence than the other histologic types of carcinoma. Growth of scirrhous carcinoma may be a result of a concerted action of the players in the plasminogen activator system, consisting of cancer cells and stromal elements. Furthermore, there was an intimate relationship between the grade of lymph node metastasis and uPAR tissue status. Patients with a uPAR positive tumor had a significantly poorer prognosis than those with uPAR negative tumor. These results indicate that the immunohistochemical diagnosis of uPAR tissue status on the primary tumor of gastric cancer may be a good predictor for the prognosis of patients with gastric cancer.

Lysozyme stimulates immunoglobulin production by human-human hybridoma and human peripheral blood lymphocytes

Lysozyme [EC 3.2.1.17] derived from hen egg white stimulated immunoglobulin production by human-human hybridoma, HB4C5 cells producing human lung cancer specific monoclonal IgM. IgM production by HB4C5 cells was enhanced more than 13-fold by the addition of lysozyme at 380 μg/ml in a serum-free medium. The immunoglobulin production stimulating effect of lysozyme was observed immediately after inoculation and maintained for 5 days. Lysozyme enhanced immunoglobulin production by the hybridoma line without growth promotion. This enzyme also accelerated IgM and IgG production of human peripheral blood lymphocytes 5.3-fold and 2.3-fold, respectively. These results suggest that lysozyme stimulates immunoglobuling production of not only specific hybridoma line, but also non-specific immunoglobulin producers. However, although the enzymatic activity of lysozyme was almost lost by heat-treatment at 100 °C for 30 min, the IPSF activity was retained. This fact suggests that IPSF activity of lysozyme does not come from its enzymatic activity or reaction products. All these findings clearly indicate that lysozyme has a novel function as an immunoglobulin production stimulating factor. GAPDH - glyceraldehyde-3-phosphate dehydrogenase; Ig - immunoglobulin; IPSF - immunoglobulin production stimulating factor; PBL - peripheral blood lymphocytes; HPLC - high-performance liquid chromatography.

Effects of DNA on immunoglobulin production stimulating activity of alcohol dehydrogenase

Alcohol dehydrogenase-I (ADH-I) derived from horse liver stimulated IgM production by human-human hybridoma, HB4C5 cells and lymphocytes. The IPSF activity of ADH-I was suppressed by coexistence of short DNA whose chain length is less than 200 base pairs (bp) and fibrous DNA in a dose-dependent manner. These DNA preparations completely inhibited the IPSF activity at the concentration of 250 mug/ml and 1.0 mg/ml, respectively. DNA sample termed long DNA whose average chain length is 400-7000 bp slightly stimulated IPSF activity at 0.06 mug/ml. However, long DNA suppressed IPSF activity by half at 1.0 mg/ml. The laser confocal microscopic analysis had revealed that ADH-I was incorporated by HB4C5 cells. The uptake of ADH-I was strongly inhibited by short DNA and fibrous DNA. However, long DNA did not suppress the internalization of ADH-I into HB4C5 cells. These findings indicate that short DNA and fibrous DNA depress IPSF activity of ADH-I by inhibiting the internalization of this enzyme. According to the gel-filtration analysis using HPLC, ADH-I did not directly interact with short DNA. It is expected from these findings that short DNA influences HB4C5 cells to suppress the internalization of ADH-I. Moreover, these facts also strongly suggest that ADH-I acts as IPSF after internalization into the cell.

A possible role of cytokines in the formation of peritoneal dissemination

The earliest event in the formation of peritoneal dissemination is considered through the process of the attachment of intraperitoneal free cancer cells to the submesothelial basement membrane, exposed after contraction of mesothelial cells. We studied the mechanisms of the contraction of mesothelial cells using a. highly metastatic sell line (MKN-45-P) to the peritoneum. Four hours after intraperitoneal inoculation of MKN-45-P, mouse mesothelial cells began to contract, and submesothelial basement membrane was widely exposed after 24 h. The same changes developed four hours after i.p. injection of IL-6, TNF-alpha and IL-8, and were most prominently observed in mice treated with IL-8. However, no significant changes were observed after treatment of HGF, EGF and TGF-beta. Furthermore, IL-1 alpha, IL-6, IL-8, TNF and EGF increased the number of intercellular gaps of a human mesothelial cell monolayer, which was incubated on Matrigel coated dishes. Normal mesothelial cells form a contiguous monolayer of closely apposed polygonal cells, each of which had prominent and peripheral bands of F-actin. After incubation with IL-1 alpha, IL-6, IL-8, TNF and EGF, peripheral actin bands became indistinct and the central stress fibers became numerous. However, no significant changes were found in mesothelial cells, which were treated with TGF-beta and HGF. In addition, the number of attached MKN-45-P cells on a mesothelial cell monolayer after treatment of IL-1 alpha (0.1-1 ng/ml), IL-8 (10-100 ng/ml), and TNF-alpha (100 ng/ml) was significantly larger than that of control and TGF-beta significantly reduced the number of attached cells. Concentration of IL-8 in the serum-free medium of MKN-45-P cells was high (3.4 ng/ml), but IL-1 alpha, IL-6, TNF-alpha, TGF-beta, EGF and HGF could not be detected. None of these cytokines were detected in the conditioning medium of human mesothelial cells. Based on these results, mesothelial cell contraction may be mediated by IL-1 alpha, IL-6, IL-8, TNF-alpha, and EGF, and these cytokines may be produced from cancer cells and/or intraperitoneal inflammatory cells. In contrast, TGF-beta have an inhibitory effect on the mesothelial cell contraction and attachment of cancer cells to a mesothelial monolayer. The attachment of free cancer cells on the peritoneum may be controlled with these cytokines.

Replication and meta-analysis of TMEM132D gene variants in panic disorder

A recent genome-wide association study in patients with panic disorder (PD) identified a risk haplotype consisting of two single-nucleotide polymorphisms (SNPs) (rs7309727 and rs11060369) located in intron 3 of TMEM132D to be associated with PD in three independent samples. Now we report a subsequent confirmation study using five additional PD case-control samples (n = 1670 cases and n = 2266 controls) assembled as part of the Panic Disorder International Consortium (PanIC) study for a total of 2678 cases and 3262 controls in the analysis. In the new independent samples of European ancestry (EA), the association of rs7309727 and the risk haplotype rs7309727-rs11060369 was, indeed, replicated, with the strongest signal coming from patients with primary PD, that is, patients without major psychiatric comorbidities (n = 1038 cases and n = 2411 controls). This finding was paralleled by the results of the meta-analysis across all samples, in which the risk haplotype and rs7309727 reached P-levels of P = 1.4e-8 and P = 1.1e-8, respectively, when restricting the samples to individuals of EA with primary PD. In the Japanese sample no associations with PD could be found. The present results support the initial finding that TMEM132D gene contributes to genetic susceptibility for PD in individuals of EA. Our results also indicate that patient ascertainment and genetic background could be important sources of heterogeneity modifying this association signal in different populations.

Phase I study of TAS-102 treatment in Japanese patients with advanced solid tumours

BACKGROUND

TAS-102 consists of α, α, α-trifluorothymidine (TFT) and an inhibitor of thymidine phosphorylase (TPI). We conducted a dose-escalation phase I study in Japanese patients with advanced solid tumours.

METHODS

TAS-102 was administered twice daily on days 1-5 and days 8-12 in a 28-day cycle to patients with solid tumours refractory to standard chemotherapy, to determine its maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), and pharmacokinetics (PKs). MTD was evaluated in cycle 1.

RESULTS

Safety and PKs were evaluated in 21 patients treated with TAS-102 at 30, 40, 50, 60, or 70 mg m(-2) per day. DLTs, such as grade 4 leucopenia, grade 4 neutropenia, and grade 4 thrombocytopenia, were observed in two patients at doses of 30 and 70 mg m(-2). α, α, α-trifluorothymidine and TPI exposures increased dose dependently, and the percentage of decrease in neutrophil count and TFT exposure were significantly correlated. The disease control rate was 50.0% with a median progression-free survival of 2.4 months in 18 colorectal cancer patients. The dose of TAS-102 was not increased above 70 mg m(-2) per day because of the increased tendency for grade 3 and 4 neutropenia, and 70 mg m(-2) per day was the recommended dose for phase II studies.

CONCLUSIONS

TAS-102 at 70 mg m(-2) per day was tolerated in Japanese patients with advanced solid tumours. Phase II studies are ongoing in patients with colorectal cancer.

Propofol sedation with bispectral index monitoring is useful for endoscopic submucosal dissection: a randomized prospective phase II clinical trial

BACKGROUND AND STUDY AIMS

Endoscopic submucosal dissection (ESD) has become a standard treatment. However, the treatment time tends to be relatively long and insufflation and manipulation of the endoscope can increase pain and discomfort. We aimed to find an optimal method for sedation during ESD.

PATIENTS AND METHODS

Patients scheduled to undergo ESD for early gastric cancer or adenoma were randomly assigned to sedation with midazolam or propofol, and consciousness level was evaluated by bispectral index (BIS) monitoring. Primary end points of effectiveness (three parameters) and secondary end points of safety during ESD and after return to the ward were compared between the groups. Study registration was in the UMIN Clinical Trial Registry (UMIN 000001497), and the institutional trial number was KDOG 0801.

RESULTS

From June 2008 through June 2009, we enrolled 178 patients (90 midazolam, 88 propofol). Regarding safety after ESD, recovery was significantly better in the propofol group immediately after and at 1 hour and 2 hours after return to the ward (P < 0.001). The number of patients who required a continuous supply of oxygen 2 hours after returning to the ward was significantly lower in the propofol group (midazolam 18; propofol 6; P = 0.010). Though propofol seemed to be better for effectiveness and safety, there were no statistically significant differences for all three primary end points and the safety parameters (hypotension, hypoxia, bradycardia).

CONCLUSIONS

Propofol with BIS monitoring improved recovery of patients after ESD, though this study was underpowered to prove the effectiveness and safety of propofol.