Laser-induced weal and flare reactions: clinical aspects and pharmacological modulation

Serum biomarkers for neurofibromatosis type 1 and early detection of malignant peripheral nerve-sheath tumors

BACKGROUND

Neurofibromatosis type 1 (NF1) is a hereditary tumor syndrome characterized by the development of benign nerve-sheath tumors, which transform to malignant peripheral nerve-sheath tumors (MPNST) in about 8 to 13% of patients with NF1. MPNST are invasive sarcomas with extremely poor prognosis, and their development may correlate with internal tumor load of patients with NF1. Because early identification of patients with NF1 at risk for developing MPNST should improve their clinical outcome, the aim of this study was to identify serum biomarkers for tumor progression in NF1, and to analyze their correlation with tumor type and internal tumor load.

METHODS

We selected candidate biomarkers for NF1 by manually mining published data sources, and conducted a systematic screen of 56 candidate serum biomarkers using customized antibody arrays. Serum from 104 patients with NF1 with and without MPNST, and from 41 healthy control subjects, was analyzed. Statistical analysis was performed using the non-parametric Mann-Whitney U-test, followed by Bonferroni correction.

RESULTS

Our analysis identified four markers (epidermal growth factor receptor, interferon-γ, interleukin-6, and tumor necrosis factor-α) for which significantly different serum concentrations were seen in patients with NF1 compared with healthy controls. Two markers (insulin-like growth factor binding protein 1 (IGFBP1) and regulated upon activation, normal T-cell expressed and secreted (RANTES)) showed significantly higher concentrations in patients with NF1 and MPNST compared with patients with NF1 without MPNST. A correlation with internal tumor load was found for IGFBP1.

CONCLUSION

Our study identified two serum markers with potential for early detection of patients with NF1 at risk for developing MPNST, and four markers that could distinguish between patients with NF1 and healthy subjects. Such markers may be useful as diagnostic tools to support the diagnosis of NF1 and for timely identification of MPNST. Moreover, the data suggest that there is a systemic increase in inflammatory cytokines independently of tumor load in patients with NF1.

Formalin injection into knee joints of rats: pharmacologic characterization of a deep somatic nociceptive model

Formalin (0.25, 0.5, 3, and 5%) injected into the knee joint of rats induced a dose-dependent nociception that was featured by 2 phases of intense guarding behavior of the affected limb, interposed by a period of quasinormal gait (quiescent phase). The guarding behavior during a period of forced gait was measured by the total time the paw of the affected limb was not in contact with the surface of a revolving cylinder (paw elevation time [PET]). Pretreatment with morphine (4 mg/kg, subcutaneously) reduced PET in both nocifensive phases, and naloxone (1 mg/kg, subcutaneously) antagonized morphine's effect. The cyclooxygenase inhibitor diclofenac (5 mg/kg, intraperitoneal) reduced only the second phase of nocifensive responses. A low dose of the benzodiazepine midazolam (0.25 mg/kg, intraperitoneal) significantly reduced only the second phase of response, but a higher dose (1 mg/kg, intraperitoneal) had no effect. A subconvulsant, anxiogenic dose of pentylenetetrazol (30 mg/kg, intraperitoneal) also did not affect the PET increase induced by formalin. The antihistamine meclizine (2.5 mg/kg, intraperitoneal) caused an increase of the response in the second phase, but a higher dose (7.5 mg/kg, intraperitoneal) caused inhibition. The peripheral antihistamine loratadine (5 and 10 mg/kg, intraperitoneal) also caused an increase of the second phase. Neither antihistamine altered the first phase of PET. These results reproduced previous findings with classical analgesics in formalin-induced nociception. However, the pronociceptive effect of antihistamines, and the antinociceptive effect of midazolam observed here suggest that formalin-induced incapacitation introduces new characterists of nociceptive system that may complement the study of analgesics.

PERSPECTIVES

Anxiety is thought to influence pain experience in an opposing manner depending on nociception originates in cutaneous or deep somatic/visceral tissues. The present formalin-induced nociceptive test may help to predict more reliably the pain-killing effect of new pharmacologic strategies, with classical or nonclassical mechanisms, for the treatment of clinically relevant pains, which are generally originated in deep structures.