First-in-human study of pbi-05204, an oleander-derived inhibitor of akt, fgf-2, nf-κΒ and p70s6k, in patients with advanced solid tumors

BACKGROUND

PBI-05204, a Nerium oleander extract (NOE) containing the cardiac glycoside oleandrin, inhibits the α-3 subunit of Na-K ATPase, as well as FGF-2 export, Akt and p70S6K, hence attenuating mTOR activity. This first-in-human study determined the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of PBI-05204 in patients with advanced cancer. Methods Forty-six patients received PBI-05204 by mouth for 21 of 28 days (3 + 3 trial design). Dose was escalated 100% using an accelerated titration design until grade 2 toxicity was observed. Plasma PK and mTOR effector (p70S6K and pS6) protein expressions were evaluated. Results Dose-limiting toxicities (grade 3 proteinuria, fatigue) were observed at dose level 8 (0.3383 mg/kg/day). Common possible drug-related adverse were fatigue (26 patients, 56.5%), nausea (19 patients, 41.3%) and diarrhea (15 patients, 32.6 %). Electrocardiogram monitoring revealed grade 1 atrioventricular block (N = 10 patients) and grade 2 supraventricular tachycardia (N = 1). The MTD was DL7 (0.2255 mg/kg) where no toxicity of grade ≥ 3 was observed in seven patients treated. Seven patients (15%) had stable disease > 4 months. Mean peak oleandrin concentrations up to 2 ng/mL were achieved, with area under the curves 6.6 to 25.5 μg/L*hr and a half-life range of 5-13 h. There was an average 10% and 35% reduction in the phosphorylation of Akt and pS6 in PBMC samples in 36 and 32 patients, respectively, tested between predose and 21 days of treatment. Conclusions PBI-05204 was well tolerated in heavily pretreated patients with advanced solid tumors. The recommended Phase II dose is 0.2255 mg/kg/day.

A case of insulin and ACTH co-secretion by a neuroendocrine tumour

A 33-year-old male was diagnosed with a metastatic neuroendocrine carcinoma of uncertain primary. He defaulted from follow-up without therapy and some months later developed episodic severe hypoglycaemia, which was found to be associated with inappropriately elevated insulin and C-peptide levels. It was considered likely that the neuroendocrine tumour was the source of the insulin secretion. Diazoxide and somatostatin analogue were used to control hypoglycaemia. Much later in the course of the disease, he developed metabolic derangement, increased skin pigmentation and psychological disturbance, without frankly Cushingoid physical findings. Investigations revealed highly elevated cortisol levels (the levels having previously been normal) with markedly raised ACTH levels, consistent with the co-secretion of ACTH and insulin by the tumour. Treatment with metyrapone improved his psychological state and electrolyte imbalance. Unfortunately, despite several cycles of first-, second- and third-line chemotherapy from the start of the first hormonal presentation onwards, imaging revealed widespread progressive metastatic disease and the patient eventually passed away. This case highlights the importance of keeping in mind the biochemical heterogeneity of endocrine tumours during their treatment.

LEARNING POINTS

The clinical presentation of insulin-secreting tumours includes symptoms of neuroglycopaenia and sympathetic overstimulation.Tumour-associated hypoglycaemia can be due to pancreatic insulinomas, and although ectopic hormone production occurs in a number of tumours, ectopic secretion of insulin is rare.A possible switch in the type of hormone produced can occur during the growth and progression of neuroendocrine tumours and, when treating neuroendocrine tumours, it is important to keep in mind their biochemical heterogeneity.

Lipid profile and glycosylated hemoglobin status of gestational diabetic patients and healthy pregnant women

AIM

Lipid profile and glycosylated hemoglobin level changes in gestational diabetes. The extent to which this alteration takes place is still not clearly documented.

MATERIALS AND METHODS

To add a clear answer to this question, lipid profile parameters, and glycosylated hemoglobin status were determined in patients with gestational diabetes mellitus and compared to healthy pregnant women (controls).

RESULTS

Fasting plasma glucose levels, plasma glucose levels 1 hour, and plasma glucose levels 2 hours after 75 gm oral glucose administration (oral glucose tolerance test) were significantly higher in patients with gestational diabetes as compared to controls. Glycosylated hemoglobin was significantly higher in gestational diabetes than in controls. It was observed that there was a significant increase in serum cholesterol and serum triglyceride level in cases with gestational diabetes when compared to healthy pregnant women.

CONCLUSION

The results of our study suggest that abnormal glucose levels, glycosylated hemoglobin, serum cholesterol, and serum triglycerides play an important role in pathophysiology of gestational diabetes, and therefore, extensive studies are required. Early diagnosis of gestational diabetes will decrease adverse neonatal and maternal outcomes.

Role of EPI-FLAIR in patients with acute stroke: a comparative analysis with FLAIR

BACKGROUND AND PURPOSE

Further improvement in acquisition speed is needed, if MR imaging is to compete with CT for evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of implementing an echo-planar fluid-attenuated inversion recovery (EPI-FLAIR) sequence into an acute MR stroke protocol with potential reduction in scan time and to compare the results with conventional FLAIR images.

MATERIALS AND METHODS

Fifty-two patients (28 men and 24 women; age range, 32-96 years) with acute ischemic stroke were prospectively evaluated with an acute stroke MR protocol, which included both conventional FLAIR and EPI-FLAIR imaging with integration of parallel acquisition. The image acquisition time was 52 seconds for EPI-FLAIR and 3 minutes for conventional FLAIR. FLAIR and EPI-FLAIR studies were assessed by 2 observers independently for image quality and conspicuity of hyperintensity in correlation with DWI and were rated as concordant or discordant. Coregistered FLAIR and EPI-FLAIR images were evaluated for signal intensity ratio of the DWI-positive lesion to contralateral normal white matter.

RESULTS

An estimated 96% of all FLAIR and EPI-FLAIR studies were rated of diagnostic image quality by both observers, with interobserver agreements of κ = 0.82 and κ = 0.63 for FLAIR and EPI-FLAIR, respectively. In 36 (95%) of 38 patients with acute infarction, FLAIR and EPI-FLAIR were rated concordant regarding DWI lesion. The mean ± standard deviation of the signal intensity ratio values on EPI-FLAIR and FLAIR for DWI-positive lesions were 1.28 ± 0.16 and 1.25 ± 0.17, respectively (P = .47), and demonstrated significant correlation (r = 0.899, z value = 8.677, P < .0001).

CONCLUSIONS

In patients with acute stroke, EPI-FLAIR is feasible with comparable qualitative and quantitative results to conventional FLAIR and results in reduced acquisition time.

MR imaging evaluation of inferior olivary nuclei: comparison of postoperative subjects with and without posterior fossa syndrome

BACKGROUND AND PURPOSE

Posterior fossa syndrome is a severe postoperative complication occurring in up to 29% of children undergoing posterior fossa tumor resection; it is most likely caused by bilateral damage to the proximal efferent cerebellar pathways, whose fibers contribute to the Guillain-Mollaret triangle. When the triangle is disrupted, hypertrophic olivary degeneration develops. We hypothesized that MR imaging patterns of inferior olivary nucleus changes reflect patterns of damage to the proximal efferent cerebellar pathways and show association with clinical findings, in particular the presence or absence of posterior fossa syndrome.

MATERIALS AND METHODS

We performed blinded, randomized longitudinal MR imaging analyses of the inferior olivary nuclei of 12 children with and 12 without posterior fossa syndrome after surgery for midline intraventricular tumor in the posterior fossa. The Fisher exact test was performed to investigate the association between posterior fossa syndrome and hypertrophic olivary degeneration on MR imaging. The sensitivity and specificity of MR imaging findings of bilateral hypertrophic olivary degeneration for posterior fossa syndrome were measured.

RESULTS

Of the 12 patients with posterior fossa syndrome, 9 had bilateral inferior olivary nucleus abnormalities. The 12 patients without posterior fossa syndrome had either unilateral or no inferior olivary nucleus abnormalities. The association of posterior fossa syndrome and hypertrophic olivary degeneration was statistically significant (P < .0001).

CONCLUSIONS

Hypertrophic olivary degeneration may be a surrogate imaging indicator for damage to the contralateral proximal efferent cerebellar pathway. In the appropriate clinical setting, bilateral hypertrophic olivary degeneration may be a sensitive and specific indicator of posterior fossa syndrome.

Differential S-nitrosylation of proteins in Alzheimer's disease

Numerous studies have provided evidence regarding the involvement of protein S-nitrosylation in the progression of Alzheimer's disease (AD) pathology and its implication in the formation and accumulation of misfolded protein aggregates. The identification of S-nitrosylated proteins can be a major step toward the understanding of mechanisms leading to neuronal degeneration. The present study targeted S-nitrosylated proteins in AD hippocampus, substantia nigra and cortex using the following work-flow that combines S-nitrosothiol-specific antibody detection, classical biotin switch method labeled with fluorescence dye followed by electrospray ionization quadrupole time of flight tandem MS (ESI-QTOF MS/MS) identification. Endogenous nitrosocysteines were identified in 45 proteins, mainly involved in metabolism, signaling pathways, apoptosis and redox regulation as assigned by REACTOME and KEGG pathway database analysis. Superoxide dismutase (SOD2) [Mn], fructose-bisphosphate aldolase C (ALDOC) and voltage-dependent anion-selective channel protein 2 (VDAC2) showed differential S-nitrosylation signal, not previously reported in AD regions. Extensive neuronal atrophy with increased protein S-nitrosylation in AD regions is also evident from immunofluorescence studies using S-nitrosocysteine antibody. A number of plausible cysteine modification sites were predicted via Group-based Prediction System-S-nitrosothiols (GPS-SNO) 1.0 while STRING 8.3 analysis revealed functional annotations in the modified proteins. The findings are helpful in characterization of functional abnormalities and may facilitate the understanding of molecular mechanisms and biological function of S-nitrosylation in AD pathology.

Fast neutron spectrum unfolding of a TRIGA Mark II reactor and measurement of spectrum-averaged cross sections: integral tests of differential cross sections of neutron threshold reactions

The spectrum of fast neutrons having energies from 0.5 to 20 MeV in the core of the 3MW TRIGA Mark II reactor at Savar, Dhaka, Bangladesh, was unfolded by activating several metal foils to induce threshold nuclear reactions covering the whole spectrum, and then doing necessary iterative calculations utilizing the activation results and the code SULSA. The analysed shape of the spectrum in the TRIGA core was found to be similar to that of the pure 235U-fission spectrum, except for the energies between 0.5 and 1.5 MeV, where it was slightly higher than the fission spectrum. Spectrum-averaged cross sections were determined by integral measurements. The integral values measured in this work were compared with the recommended values for a pure fission spectrum as well as with the integrated data deduced from measured and evaluated excitation functions of a few reactions given in some data files. The good agreement between integral measurements and integrated data in case of well-investigated reactions shows that the fast neutron field at the TRIGA Mark II reactor can be used for validation of evaluated data of neutron threshold reactions.

Increasing prevalence and incidence rates of multiple sclerosis in Kuwait

Background:

Kuwait was considered as low to intermediate risk area for MS.

Objectives:

To determine the prevalence and incidence rates of MS among Kuwaiti nationals based on 2011 population census.

Methods:

This cross-sectional study was conducted between October 2010 and April 2013 using the newly developed national MS registry in Kuwait. Patients with a diagnosis of MS according to 2010 revised McDonald criteria were identified. The crude, age- and sex-specific prevalence and incidence rates among Kuwaiti patients were calculated.

Results:

1176 MS patients were identified of which 927 (78.8%) were Kuwaitis and 249 (21.2%) were expatriates. Among Kuwaiti patients, female to male ratio was 1.8:1 with a mean age of 35.40 ± 10.99 years. The prevalence rate of MS was 85.05 per 100,000 persons (95% CI: 82.80 – 87.04). There was a peak in prevalence among patients aged 30–39 years. The incidence of MS was 6.88 per 100,000 persons (95% CI 5.52–8.55). Between 2003 and 2011, the incidence increased 3.22 and 2.54 times in women and men respectively.

Conclusion:

Kuwait is considered a high-risk area for MS. The significant increase in prevalence and incidence rates may represent a true increase despite the improvement in case ascertainment and case definition.

Chemopreventive effects of aloin against 1,2-dimethylhydrazine-induced preneoplastic lesions in the colon of Wistar rats

Chemoprevention opens new window in the prevention of all types of cancers including colon cancer. Aloin, an anthracycline in plant pigment, can be utilized as a protective agent in cancer induction. In the present study, we have evaluated the chemopreventive efficacy of aloin against 1,2-dimethylhydrazine (DMH)-induced preneoplastic lesions in the colon of Wistar rats. DMH-induced aberrant crypt foci (ACF) and mucin-depleted foci (MDF) have been used as biomarkers of colon cancer. Efficacy of aloin against the colon toxicity was evaluated in terms of biochemical estimation of antioxidant enzyme activities, lipid peroxidation, ACF, MDF, histopathological changes, and expression levels of molecular markers of inflammation and tumor promotion. Aloin pretreatment ameliorates the damaging effects induced by DMH through a protective mechanism that involved reduction in increased oxidative stress enzymes (p < 0.001), ACF, MDF, cyclooxygenase-2, inducible nitric oxide synthase, interleukin-6, proliferating cell nuclear antigen protein expression, and tumor necrosis factor-α (p < 0.001) release. From the results, it could be concluded that aloin clearly protects against chemically induced colon toxicity and acts reasonably by inducing antioxidant level, anti-inflammatory and antiproliferative markers.

Laparoscopic findings of subfertile women attended in a tertiary level care centre

This retrospective study was done in the Obstetrics and Gynaecology Department of Bangladesh Medical College hospital during the period of July 2003 to June 2004 in the women suffering from primary and secondary subfertility, who underwent laparoscopy. The aim of this study was to see the laparoscopic findings of internal genitalia and other pelvic structures in subfertile women. The study group comprises 55 cases of which 67.37% of primary and 32.73% were of secondary subfertility. Both the ovaries were normal looking in 41.81% cases. Endometriosis was present in 5.45% of both the ovaries. Corpus luteum was seen in 20% cases on right ovary and in 27.27% cases on left ovary. Laparoscopy shows normal looking fallopian tube in 65.45% cases in right side and 61.81% cases in the left side. Right sided tubal block was in 5.46% and 9.10 % in the left side. Both the tubes were patent in 81.6% cases.