Circulating tumor and endothelial cells as pharmacodynamic biomarkers in a phase I clinical trial of intravenous bevacizumab in combination with escalating doses of oral cediranib for patients with advanced malignancies

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Background: Rare circulating tumor cells (CTCs) and endothelial cells (CECs) offer a feasible approach for studying the pharmacodynamic effects of investigational agents. We investigated the effects of bevacizumab (B) and cediranib (C) on inhibition of the VEGFR pathway and correlated these changes with dose and clinical response. Methods: Peripheral blood was obtained at baseline, 24hrs and at C2D26–30 post-treatment from patients (n=14) undergoing dose escalation of intravenous B and oral C. CTCs and CECs (CD31+ or CD105+) were isolated and immunofluorescently stained. Laser scanning cytometry (LSC) was used to quantify phosphorylated and total-VEGFR2 (pVEGFR2/VEGFR2), pERK/ERK, and apoptosis in each phenotype. Changes in each biomarker were correlated with partial response (PR) or stable disease and progression > 2 months, evaluated using RECIST. Results: Overall, immature CECs (CD105+) enumerated by CellSearch™ revealed a dose-dependent significant decrease (p=0.0001). A 3-fold induction in apoptosis was observed at 24 hrs compared to baseline in the CD105+ CECs. Mature CD31+ cells assessed for VEGFR2 activity revealed an 83% and 1.9% significant (p=0.019) inhibition in pVEGFR2 expression at low (B;3mg/kg) and high (B;5mg/kg) doses, respectively. In the non-responders, mature CECs revealed a dose-dependent significant increase (-6.8% to 63%;p=0.031) in pERK/ERK expression levels. No significant changes were observed in CTC enumeration by CellSearch™. LSC-mediated CTC enumeration revealed a 4.77 % and 2.33% increase in CTCs following treatment in the non- responders and responder (p=0.809), respectively. Analysis of pVEGFR2 in CTCs revealed a 58% inhibition in the responder versus a 163% increase in expression in the non-responders (p=0.63). Conclusions: Inhibition of pVEGFR2 and induction of apoptosis in CECs confirmed the target therapy. An increase in CD105+ CECs is consistent with the hypothesis that anti-angiogenic efficacy induces endothelial cell shedding. Assessment of CECs indicates that B and C are more biologically active at lower doses, and resistance may be attributed to ERK activity. Support: UO1 CA062461 (RK)

No significant financial relationships to disclose.

Effect of lenalidomide on the antiproliferative effect of gemcitabine against pancreatic tumor cells and on immune-mediated pancreatic cancer cell death

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Background: Lenalidomide is an immunomodulatory and anti-angiogenic agent that has demonstrated activity against a range of hematological malignancies. Despite evidence of direct anti-proliferative activity against hematological cells in vitro, there is no evidence of single agent direct activity against solid tumor cells in vitro. To take advantage of its known immune-enhancing properties alongside direct anti-tumor agents, lenalidomide is being advanced in solid tumor indications in combination with other agents. There are few data regarding the combination of lenalidomide and standard of care chemotherapeutic agents, such as gemcitabine. Methods: Here, we assess the effects of lenalidomide alone, and in combination with gemcitabine, on pancreatic cancer cell growth and survival, and the ability of lenalidomide to enhance the ability of human PBMC to kill allogeneic pancreatic tumor cells (BxPC3, PANC-1 and MiaPaCa) in a PBMC:tumor cell co-culture model. Results: Lenalidomide alone had no effect on the proliferation of pancreatic cancer cells (BxPC-3 and Panc-1) whereas gemcitabine had moderate anti-proliferative activity. With combination therapy there was clear synergistic enhancement of anti-proliferative activity in both cell lines and additive effects were observed in a BxPC-3 xenograft mouse model of pancreatic cancer. About 20% of tumor cells were sensitive to immune-mediated cell death and, for BxPC3, this was increased significantly in the presence of lenalidomide. Lenalidomide significantly and dose-dependently enhanced immune-mediated killing (both T and NK cells are required for tumor cell killing in this model). For PANC-1 and MiaPaCa, immune-mediated killing was also increased by lenalidomide, albeit non-significantly. Conclusions: These results suggest that, in addition to anti-angiogenic and other effects within the tumor microenvironment, lenalidomide may act as an immune adjuvant to enhance the recognition and apoptosis of tumor cells by host T and NK cells. These studies support the potential utility of lenalidomide in combination with chemotherapeutic agents, gemcitabine in particular, in the treatment of patients with solid tumors including pancreatic cancer.

[Table: see text]

Gemcitabine in combination with intraperitoneal cisplatin in advanced hepatobiliary cancers

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Background: Standard chemotherapy for advanced hepatobiliary cancers remains undefined. This study was to observe the therapeutic effect of gemcitabine combined with intraperitoneal cisplatin for the treatment of advanced hepatobiliary cancers and analyze their toxicities. Methods: Patients with measurable hepatobiliary cancers were unrandomized into gemcitabine (GEM) + cisplatin (DDP) (GEM group) and epirubicin (EPI) + DDP (EPI group). GEM was used intravenously by infusion for 30 min with the dose to 1,000 mg/m2 on day 1 and 8; cisplatin was infused intraperitoneal with a dose of 25mg/m2 on day1, 3 and 5. Twenty-one days counted as one cycle. After 2 cycles, treatment efficacy and adverse events were evaluated according to WHO criteria. Results: A total of 76 patients were enrolled from May 2004 to May 2006, with 30 patients for EPI group and 46 patients for GEM group, and all the patients were eligible for effectiveness analysis. Among GEM group patients, there was no complete response. The partial response rate was 32.61% and clinical benefit response (CR+ PR +SD) was 67.39%. All those data mentioned above were significantly higher than that of EPI group. The main adverse re-ction was hematologic toxicity, while nonhematologic toxicity was mild. Conclusions: This study demonstrated that combination gemcitabine with intraperitoneal infusion of cisplatin was an effective and safety treatment for the patients with advanced hepatobiliary cancers.

No significant financial relationships to disclose.

Breast cancer patients stratification by microarray-based gene expression profiling from FFPET samples

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Background: Microarrays have been used to monitor global genes expression and have aided the identification of novel biomarkers for patients stratification and drug response prediction . To date there has been limited application of microarray- based gene expression analysis to formalin fixed paraffin embedded tissues (FFPET). FFPE tissues are the most commonly available clinical samples with documented clinical information for retrospective clinical analysis. However, FFPET RNA has proven to be an obstacle for microarray analysis because of low yield and compromised RNA integrity. Methods: Using a novel RNA amplification method, Single Primer Isothermal Amplification (SPIA, NuGEN Inc, San Carlos, CA), we amplified FFPET RNA, hybridized amplified, and labeled cDNA onto Affymetrix HG U133plus2 GeneChips. Results: We found that SPIA amplification successfully overcomes the problems of poor quality of FFPET RNA, and produced informative biological data. Comparing the gene expression data from 5 different types of FFPET archival cancer samples (breast, lung, ovarian, colon, and melanoma), we demonstrated that gene expression signatures clearly distinguish the tissue of origin. Further, from an analysis of 91 FFPET samples comprised of ER+, HER2+, triple negative breast cancer patients, and normal breast tissue, we have identified a 103 gene signature that distinguishes the intrinsic sub-types of breast cancer. Finally, the accuracy of gene expression measured by microarray was verified by real time PCR quantitation of the ERBB2 gene, resulting in a significant correlation (R = 0.88). Conclusions: We have demonstrated the feasibility of global gene expression profiling using RNA extracted from FFPET and have shown that a gene expression signature can stratify patient samples into different subtypes of disease. This study paves the way to identify novel molecular biomarkers for disease stratification and therapy response from archival FFPET samples, leading to the goals of personalized medicine.

No significant financial relationships to disclose.

Hepatitis B virus subgenotype C2 is the most prevalent subgenotype in northeast China

The geographical distribution of hepatitis B virus (HBV) subgenotypes and their clinical implications in patients with acute and chronic hepatitis B in the Heilung-kiang province of northeast China were investigated. Nested PCR and multiplex PCR were performed with genotype-specific primers and with subgenotype-specific primers to identify genotypes and subgenotypes from serum samples of 412 HBV infections including 69 with acute self-limited hepatitis (ASH) and 343 with chronic hepatitis (CH). A total of 361 samples were genotyped and 304 were further subgenotyped. The most common HBV genotype was C (93.63%, 338/361), with subgenotype group C2 (83.73%, 283/338) predominating. Genotype B was also found and subgenotype B2 predominated within this genotype. Out of 69 infected patients with ASH, 48 were identified as genotype C and all belonged to subgenotype C2. Of 343 infected patients with CH, 313 were genotyped and 256 were subgenotyped; amongst these, C2 (91.80%, 235/256), B2 (7.42%, 19/256) and mixed subgenotypes B2 and C2 (0.78%, 2/256) were found. In HBV subgenotype C2 infections, ASH had a higher ratio of women than CH patients. These results show that HBV subgenotypes C2 and B2 were found in Heilung-kiang province of northeast China. In ASH and CH groups, the distributions of subgenotypes were coincident with C2, the predominant subgenotype. Analysis of the association between subgenotype and the outcomes of HBV infection was inconclusive in our study.

Dual effects of hyperbaric oxygen on proliferation and cytotoxic T lymphocyte activity of rat splenic lymphocytes

Contradictory reports exist regarding the effects of hyperbaric oxygen (HBO2) on immune functions. We hypothesized that the intensity of exposure is a key factor, which leads to the different effects of HBO2 on immunity. In this study, we determined the function of rat splenic lymphocytes after in vitro exposure to different pressure-durations of HBO2. The proliferation rate and total cytotoxic T lymphocyte (CTL) activity stimulated by concanavalin A were enhanced by exposure to low (100 kPa for 60 or 90 minutes and 150 kPa for 30 or 60 minutes) HBO2 pressure-durations, but were inhibited by exposure to higher pressure-durations. We conclude that HBO2 exerts dual effects on lymphocyte function, as appropriate exposure promotes and excessive exposure inhibits the functions.

[Effect of liposomal albendazole on the ultrastructure of Echinococcus granulosus cysts in mice]

AIM

To observe the histopathological changes of Echinococcus granulosus cysts in mice treated with liposomal albendazole and co-administration with cimetidine by light microscopy and electron microscopy.

METHODS

An oral dose of liposomal ABZ with different formulations was given at 200 mg/kg.d. Cimetidine was administered daily at an oral dose of 100 mg/kg.d. Sixty-seven mice were orally given different drugs six days per week for a total of twelve weeks.

RESULTS

The histopathological changes indicated that there were significant differences (P < 0.01) between treated groups and control group. The degeneration and necrosis of E. granulosus cysts were marked in liposomal albendazole combined with cimetidin group.

CONCLUSION

Liposomal albendazole was more effective against E. granulosus cyst than albendazole. Cimetidine had an apparent synergistic effect when given in combination with liposomal albendazle.

More vaccine efficacy studies on the recombinant Bacille Calmette-Guerin co-expressing Ag85B, Mpt64 and Mtb8.4

The immunogenicity of the recombinant Bacille Calmette-Guerin: rBCG-Ag85B-Mpt64(190-198)-Mtb8.4 (rBCG-AMM) was evaluated in our previous study. This paper compares the protective efficacy of rBCG-AMM, rBCG-A which overexpresses Ag85B and BCG in C57BL/6 mice. There was no significant difference in proliferation characteristics among rBCG-AMM, rBCG-A and BCG. The growth characteristics of rBCG-AMM in host tissue were identical to control BCG, suggesting the improved protective efficacy was directly related to the expression of the Ag85B-Mpt64(190-198)-Mtb8.4 fusion protein. The protective experiment demonstrated that rBCG-AMM could confer similar or even better protective efficacy against Mycobacterium tuberculosis infection compared with BCG or rBCG-A as evaluated by bacterial organ loads, lung histopathology and net weight gain or loss. The results suggested that the recombinant BCG: rBCG-Ag85B-Mpt64(190-198)-Mtb8.4 is a potential vaccine candidate for further study.

Bevacizumab and chemotherapy for recurrent glioblastoma: a single-institution experience

OBJECTIVE

Bevacizumab has been shown to be effective in the treatment of recurrent glioblastoma in combination with chemotherapy compared with historic controls but not in randomized trials.

METHODS

We conducted a retrospective analysis of patients treated for recurrent glioblastoma with bevacizumab vs a control group of patients, comparing progression-free survival (PFS) and overall survival (OS) between the two groups, and performed subgroup analysis based on age and performance status. Expression of vascular endothelial growth factor (VEGF) based on age was examined using DNA microarray analysis. We also evaluated the impact of bevacizumab on quality of life.

RESULTS

We identified 44 patients who received bevacizumab and 79 patients who had not been treated with bevacizumab. There was a significant improvement in PFS and OS in the bevacizumab-treated group. Patients of older age (> or =55 years) and poor performance status (Karnofsky Performance Status < or =80) had significantly better PFS when treated with bevacizumab, and bevacizumab-treated older patients had significantly increased OS. VEGF expression was significantly higher in older glioblastoma patients (aged > or =55 years). Patients treated with bevacizumab also required less dexamethasone use and maintained their functional status longer than the control group.

CONCLUSIONS

Bevacizumab in combination with chemotherapy may be a more effective treatment for recurrent glioblastoma and warrants further randomized prospective studies to determine its effect on survival. Bevacizumab also has more effect in those with older age and might reflect biologic differences in glioblastoma in different age groups as seen with the expression of vascular endothelial growth factor.

Possible involvement of brain tumour stem cells in the emergence of a fast-growing malignant meningioma after surgical resection and radiotherapy of high-grade astrocytoma: case report and preliminary laboratory investigation

The case of a 62-year old man diagnosed with radiation-induced meningioma (RIM) after treatment for astrocytoma with an unusually short latency period of 7 months is reported. The patient first presented with a 2-month history of memory decline. Magnetic resonance imaging (MRI) showed a tumour in the left parieto-temporal lobe. Gross total resection was performed and the tumour was confirmed to be an astrocytoma. The patient received cranial radiotherapy 2 weeks later, however 7 months after radiation treatment the patient presented with headache and vomiting. MRI showed massive meningeal enhancement in the left frontal lobe, which progressively enlarged. The patient's clinical condition deteriorated and a second craniotomy was performed with complete removal of the secondary tumour, which was shown to be a malignant meningioma. Immunohistochemical staining identified CD133-positive cells in both tumours. A rare fraction of brain tumour stem cells (BTSC) was isolated from the primary astrocytoma using a serum-free culture system, suggesting that BTSC may have been involved in the rapid emergence of RIM after resection and radiation of the primary astrocytoma.

Dentine bond strength and microleakage of flowable composite, compomer and glass ionomer cement

BACKGROUND

To assess in vitro the dentine bond strength and microleakage of three Class V restorations viz. flowable composite, compomer and glass ionomer cement.

METHODS

Eighteen dentine specimens were prepared and randomly distributed among three groups. Three kinds of restoration materials were each bonded on prepared dentine surfaces in three groups as per the manufacturers' instructions. Group Aelite: Tyrian SPE (a no-rinse, self-priming etchant) + One Step Plus (an universal dental adhesive) + Aeliteflo (a flowable composite); Group Dyract: Prime & Bond NT (a no-rinse, self-priming dental adhesive) + Dyract AP (a compomer); Group GlasIonomer: GlasIonomer Type II (a self-cured restorative glass ionomer). Fifteen dentine/restoration microtensile bond test specimens were prepared from each group and were subjected to microtensile bond strength testing. The bond interfaces were observed morphologically using a scanning electron microscope (SEM). Twenty-four cervical cavities of 4.0 mm mesiodistal length, 2.0 mm occlusogingival height and 1.5 mm depth were prepared at the cemento-enamel junction (CEJ) on both buccal and lingual surfaces of each tooth. The cavities were each filled with flowable composite (Group Aelite), compomer (Group Dyract) and glass ionomer cement (Group GlasIonomer) using the same material and methods as for the microtensile bond tests. Microleakage of each restoration was evaluated by the ratio of the length of methylene blue penetration along the tooth-restoration interface and the total length of the dentine cavity wall on the cut surface.

RESULTS

One-way ANOVA and least significant difference (LSD) tests revealed statistically significant differences among the dentine bond strength for Group Aelite (28.4 MPa), Group Dyract (15.1 MPa) and Group GlasIonomer (2.5 MPa). SEM images showed intimate adaptation in the restoration/dentine interfaces of Group Aelite and Group Dyract. All of the systems tested in this study presented microleakage. However, both Group Aelite (0.808) and Group Dyract (0.863) had significantly less microleakage than Group GlasIonomer (0.964). There were no statistically significant microleakage differences between Group Aelite and Group Dyract, and no statistically significant microleakage differences between the occlusal margin and gingival margin.

CONCLUSIONS

None of the systems tested in this study completely eliminated microleakage. However, both the flowable composite and compomer provided stronger dentine bond strengths and better margin sealing than the conventional glass ionomer cement. Occlusal forces exerted the same effects on microleakage of the occlusal margin and gingival margin in cervical cavities.

Heart rate variation and electroencephalograph--the potential physiological factors for thermal comfort study

Human thermal comfort researches mainly focus on the relation between the environmental factors (e.g. ambient temperature, air humidity, and air velocity, etc.) and the thermal comfort sensation based on a large amount of subjective field investigations. Although some physiological factors, such as skin temperature and metabolism were used in many thermal comfort models,they are not enough to establish a perfect thermal comfort model. In this paper,another two physiological factors, i.e. heart rate variation (HRV) and electroencephalograph (EEG), are explored for the thermal comfort study. Experiments were performed to investigate how these physiological factors respond to the environmental temperatures, and what is the relationship between HRV and EEG and thermal comfort. The experimental results indicate that HRV and EEG may be related to thermal comfort, and they may be useful to understand the mechanism of thermal comfort.

Effects of pig antibacterial peptides on growth performance and intestine mucosal immune of broiler chickens

Currently, substitutions for antibiotic growth promoters in animals are attracting interest. This study investigated the effects of pig antibacterial peptides (PABP) on growth performance and small intestine mucosal immune responses in broilers. Three hundred 1-d-old Arbor Acre male broiler chickens were randomly allocated to 5 groups with 60 birds per group. The groups were control group; PABP administered in drinking water at 20 and 30 mg/L of water; or PABP supplemented in feed at 150 and 200 mg/kg of diet. The birds were fed a corn-soybean based diet for 6 wk. Chickens were weighed weekly and killed after 42 d of feeding, and growth performance was measured. Samples of the duodenum and jejunum were collected. The villus height, mucosa thickness, alkaline phosphatase activity, and numbers of secreting IgA and goblet cells were evaluated. The PABP-treated groups had greater BW and average daily gain, greater height of villus and thickness of gut mucosa, greater activity of alkaline phosphatase, higher ratio of secreting IgA, and a greater number of goblet cells compared with the control group (P<0.05). In conclusion, PABP can improve the growth performance, increase the intestinal ability to absorb nutrients, and improve the mucosal immunity of the intestine.

Elevated expression of transmembrane IL-15 in immune cells correlates with the development of murine lupus: a potential target for immunotherapy against SLE

Presentation in trans by the Interleukin-15 receptor alpha chain (IL-15Ralpha) has been suggested as the main mechanism for IL-15 anchoring to the cell surface, but it is also evident that IL-15 can exist as a transmembrane protein. We herein demonstrate that replacement of the first 41 residues of human IL-15 (hIL-15) with Igkappa chain leader sequence resulted in secretion of most of the recombinant hIL-15 expressed in transfectant cells, thus identifying the transmembrane region of IL-15. A fusion protein (hIL-15Ralpha-Fc) between the extracellular domain of hIL-15Ralpha and the Fc fragment of IgG1 was prepared and shown to be able to bind with transmembrane IL-15 (tmIL-15). The level of tmIL-15 expression in macrophages, activated T cells and B cells from 6-month-old BXSB male mice, an animal model for systemic lupus erythematosus (SLE), was significantly increased compared with that from BXSB females or young males. In addition, hIL-15Ralpha-Fc was able to block the T cell stimulating and anti-apoptotic effect of the tmIL-15-positive BXSB macrophages in vitro. Intravenous administration of hIL-15Ralpha-Fc reduced the titre of autoantibodies against dsDNA and also proteinuria in aged BXSB males, implying that neutralization of IL-15 activity in vivo may be an effective way of treating SLE.

Development of a magnetic Single Cell Micro Array

Experiments using single cells are valuable for revealing individual cell behaviour, which is of interest to many biomedical researchers. In such experiments, various types of devices capable of aligning cells into organized arrays are often used. In this paper, we present a novel Single Cell Micro Array device that makes use of magnetic forces. Prototypes of this device have been fabricated, and successfully tested using Jurkat cells that have been labelled with nano-magnetic particles. Experimental results show that the prototypes are effective on capturing and placing the labelled cells in an array.