Administration of a human recombinant apyrase (AZD3366) limits myocardial tissue injury and improves cardiac function in a pig model of STEMI assessed by serial CMR

Background

Mitigating myocardial tissue injury (MTI) remains an unmet clinical need in the reperfusion era. Stimulating adenosine synthesis through the breakdown of adenosine triphosphate (ATP) by apyrase (CD39), an endothelial ADPase, has emerged as a potential new avenue in the reduction of MTI.

Purpose

In this study we examined whether the intravenous administration of a recombinant soluble form of human apyrase (AZD3366) prior to reperfusion limits MTI and improves cardiac function in a pig model of STEMI as assessed by serial cardiac magnetic resonance (CMR) imaging.

Methods

Pigs (n=16) were subjected to STEMI induction (1.5h closed-chest complete LAD coronary balloon occlusion). Immediately prior to reperfusion, pigs were randomized to intravenously receive one single dose of 3 mg/kg AZD3366 (n=8) or vehicle (n=8). Serial-CMR imaging was performed at baseline, 3 days, and 42 days post-MI for the assessment of structural and functional readouts at rest and during dobutamine stress. Light transmittance aggregometry (LTA; challenged by 5, 10 and 20 μM ADP) and ear bleeding time were monitored pre-MI, post-MI and at day 3.

Results

AZD3366 significantly reduced MTI by limiting (around 60%) oedema formation (21.3±6.7 vs. 12.3±6.7 g LV) and infarct size (14.3±6.1 vs. 8.4±3.4 g LV) and preventing microvascular obstruction (2.3±0.9 vs. 0.5±0.5 g LV) at 3 days post-MI, compared to vehicle-administered STEMI pigs (p<0.05). At a functional level, LVEDV and LVESV showed less deterioration in AZD3366 treated animal as compared to vehicle 3 days post-MI (p<0.05) and less numerical decrease of LVEF. Furthermore, AZD3366-treated animals showed no deterioration in LVEF upon dobutamine stress in contrast to vehicle-infused animals, (p<0.05). AZD3366 treatment nearly abolished LTA at all tested ADP doses early post-STEMI, an effect that remained up to 3 days post-infusion but did not affect ear bleeding time at any of the tested time points. No additional effects were seen at 42 days.

Conclusion

Infusion of one single dose of the soluble recombinant apyrase AZD3366 prior to reperfusion exerts cardioprotection by reducing oedema formation, microvascular obstruction and necrosis and improving cardiac performance at rest and after dobutamine stress during the acute post-MI period. Administration of AZD3366 as an adjunctive therapy to standard of care for STEMI patients undergoing primary PCI may reduce myocardial tissue injury.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZeneca, Gothenburg, Sweden

Health status and health care utilization after discharge from geriatric in-hospital stay - description of a register-based study

Background

This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge.

Methods

The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8).

Results

Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care.

Conclusion

The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.

Prognostic role of serum thymidine kinase 1 kinetics during neoadjuvant chemotherapy for early breast cancer

Background

Emerging data support the use of thymidine kinase 1 (TK1) activity as a prognostic marker and for monitoring of response in breast cancer (BC). The long-term prognostic value of TK1 kinetics during neoadjuvant chemotherapy is unclear, which this study aimed to elucidate.

Methods

Material from patients enrolled to the single-arm prospective PROMIX trial of neoadjuvant epirubicin, docetaxel and bevacizumab for early BC was used. Ki67 in baseline biopsies was assessed both centrally and by automated digital imaging analysis. TK1 activity was measured from blood samples obtained at baseline and following two cycles of chemotherapy. The associations of TK1 and its kinetics as well as Ki67 with event-free survival and overall survival (OS) were evaluated using multivariable Cox regression models.

Results

Central Ki67 counting had excellent correlation with the results of digital image analysis (r = 0.814), but not with the diagnostic samples (r = 0.234), while it was independently prognostic for worse OS [adjusted hazard ratio (HR_adj) = 2.72, 95% confidence interval (CI) 1.19-6.21, P = 0.02]. Greater increase in TK1 activity after two cycles of chemotherapy resulted in improved event-free survival (HR_adj = 0.50, 95% CI 0.26-0.97, P = 0.04) and OS (HR_adj = 0.46, 95% CI 0.95, P = 0.04). There was significant interaction between the prognostic value of TK1 kinetics and Ki67 (p_interaction 0.04).

Conclusion

Serial measurement of serum TK1 activity during neoadjuvant chemotherapy provides long-term prognostic information in BC patients. The ease of obtaining serial samples for TK1 assessment motivates further evaluation in larger studies.

•

This is a correlative analysis of a prospective phase II study on neoadjuvant chemotherapy for breast cancer.

•

Serial measurement of serum TK1 activity during treatment provides independent long-term prognostic information.

•

We demonstrate the validity and clinical utility of both central and automated image analysis-based Ki67 assessment.

•

Finally, we explore the biologic correlations between TK1 and Ki67.

Administration of a soluble ADPase, AZD3366, on top of ticagrelor confers additional cardioprotective benefits to that of ticagrelor alone

Background

Preclinical and pilot human studies suggest platelet-independent cardioprotective effects of ticagrelor most likely due to its ability to block cellular uptake of adenosine. Adenosine is a potent endogenous protective molecule, concentrations of which locally rise as a response to ischemia because of the breakdown of extracellular ATP by an endothelial ADPase (apyrase, CD39) to AMP that is subsequently converted to adenosine by CD73.

Purpose

In the present study we used cardiac magnetic resonance (CMR) imaging in a pig model of myocardial infarction (MI) to examine whether administration of a recombinant soluble form of ADPase, AZD3366 (APT102), confers additional benefits to that of ticagrelor alone in terms of reduced infarct size and improved heart function.

Methods

Pigs (n=20) were administered an oral loading dose of ticagrelor (180mg) and 2h later subjected to MI induction (1.5h closed-chest LAD coronary balloon occlusion). Prior to reperfusion, pigs were randomized to intravenously receive 1) vehicle (n=5); 2) 1mg/kg AZD3366 (n=5); or 3) 3mg/kg AZD3366 (n=5). After reperfusion all pigs were administered ticagrelor (90mg/bid) for 42 days. A non-treated control-MI group (n=5) was run for comparative purposes. Serial-CMR imaging was performed at baseline and 3 and 42 days post-MI for global and regional structural and functional assessments. Light transmittance aggregometry (LTA; challenged by 5, 10 and 20μM ADP) and ear bleeding time were monitored throughout the study.

Results

Ticagrelor significantly reduced edema formation (29.8±1.9 vs. 13.1±0.9%LV) and limited infarct size (17.7±1.5 vs. 8.2±1.2%LV) at 3 days post-MI as compared to control-MI pigs (p<0.05), an effect that persisted up to 42 days. Infusion of 1mg/kg AZD3366 showed a clear signal towards further prevention of myocardial damage that reached significance at doses of 3mg/kg (additional reduction of 35% and 52% in edema and infarct size, respectively, as compared to pigs treated with ticagrelor alone; p<0.05). Left ventricular ejection fraction was higher in all ticagrelor-treated pigs at 3 and 42 days post-MI vs. control (p<0.05). Yet, regional analysis of the jeopardized myocardium revealed that pigs administered 3mg/kg AZD3366 on top of ticagrelor presented minimal dysfunctional segmental contraction as compared to the mild hypokinetic and akinetic disturbances observed in ticagrelor-alone and control-MI pigs (χ2 p<0.05 vs. all). Ticagrelor inhibited ADP-induced platelet aggregation by 30% and addition of AZD3366 acutely abolished (90% inhibition) LTA at all tested ADP doses, an effect remaining significant up to 3 days post-infusion. Ear bleeding time was not affected by AZD3366.

Conclusion

Infusion of a soluble recombinant ADPase (AZD3366) on top of ticagrelor leads to a greater cardioprotection as compared to ticagrelor alone. Co-administration of both drugs in AMI patients undergoing revascularization deserves to be investigated.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministerio de Ciencia, Innovaciόn y Universidades / Instituto de Salud Carlos III

Fluconazole Therapy for Fungal Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report

Fluconazole proved effective in treating fungal peritonitis caused by Trichosporon cutaneum. Fluconazole seems to offer several advantages over other antifungal drugs in the treatment of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients.

Abstract P1-16-09: Low-dose chemotherapy (CT) + bevacizumab (Bev) combined with unchanged endocrine treatment (ET) in patients with recurrent luminal breast cancer progressing during ET – Effect determined by standard imaging and changes in ctDNA and CTC during treatment

Background: Several mechanisms are involved in the development of endocrine resistance, such as mutations in the ESR1, PIK3CA, and TP53 genes and/or up-regulation of tyrosine kinase receptors such as the endothelial growth factor (VEGF) receptor. Preclinical data have revealed that sensitivity to endocrine therapy may be restored if these pathways are blocked.

Aims: To investigate the progression-free survival (PFS), overall response rate (ORR), and the toxicity of the study treatment. To use circulating tumor cells (CTC) and circulating tumor DNA (ct-DNA) at base-line and during treatment for next generation sequencing (NGS) to investigate whether changes in tumor mutations or in levels of CTC/ct-DNA correlate to treatment efficacy.

Patients and methods: Thirty-two patients aged 46-77 years with confirmed advanced breast cancer (ABC) progressing during ET were included. Treatment consisted of unchanged ET with the addition of cyclophosphamide 50mg x 1 and capecitabine 500mg x 3 daily + bevacizumab 15mg/kg iv. every third week (q21). Blood samples for analysis of CTC and ctDNA were collected at base-line, after the 1st and 2nd course, and at progression. CTC were isolated by use of an immune-magnetic selection (ADNA-test) and sequenced by NGS. ctDNA were analysed by the SiMSen-Seq (Simple Multiplexed PCR-based barcoding of DNA for Sensitive mutation detection using Sequencing) that allows mutant frequencies < 0.1% to be detected.

Results: One patient did not start treatment and 2 were not evaluable. Palliative chemotherapy (1-2 lines) had been delivered before inclusion to 28% and > 1 line of palliative ET to 58% of the patients. A total of 72% (n=21) of the patients had visceral disease (of whom 7 had liver metastases), and 28% (n=8) patients bone-only disease. Median PFS was 9.1 months (range 2.1-59.3 months). Best responses were: 1 patient (3%) received complete remission; 7 patients (24%) partial response; 16 patients (55%) SD (of whom 12 had CB, defined as SD > 24 weeks), and 5 (17%) had progressive disease. The ORR (defined as CR, PR, or CB) was 69%. The most common toxicity was hypertension (62%), that resulted in termination in 2 patients, and 1 patient stopped treatment due to thrombocytopenia. Other side-effects were proteinuria grade 1-3 (24%); hand-foot-syndrome grade 1-2 (45%); mucositis grade 1 (14%); nausea grade 1 (14%) and diarrhea grade 1-3 (10%). CTC was isolated in 12 patients (37%). Three out of the 5 patients with PD at 12 weeks had detectable CTCs at base-line. Base-line ESR1, PIK3CA and TP53 mutations were found in CTC from 2 patients (17%), 7 patients (58%), and 5 patients (42%), respectively, but did not correlate to response.

Conclusion: The treatment was well tolerated with an ORR of 69%, which is considered very good in this setting. CTCs were only isolated in 37% of the patients which is comparable to previously reported results in metastatic luminal breast cancer and thus not a feasible method for monitoring treatment effect. Results on levels of consecutive ctDNA, as well as mutation pattern in relation treatment effect will be presented.

Citation Format: Linderholm BK, Ekholm M, Wännstig A-K, Lundstedt D, Carlsson L, Tzikas A-K, Svensson J, Kristiansson H, Filges S, Ståhlberg A. Low-dose chemotherapy (CT) + bevacizumab (Bev) combined with unchanged endocrine treatment (ET) in patients with recurrent luminal breast cancer progressing during ET – Effect determined by standard imaging and changes in ctDNA and CTC during treatment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-16-09.

Abstract P6-17-24: Use of subcutaneous and intravenous trastuzumab: Real-world experience from three hospitals in Sweden

Background

Trastuzumab (H; F. Hoffmann-La Roche Ltd, Basel, CH) reduces recurrence and improves survival in patients (pts) with HER2-positive early breast cancer (EBC). Two formulations which are noninferior in terms of pathologic complete response and serum trough concentration (Ismael et al. Lancet Oncol 2012) are available, for intravenous (IV) and subcutaneous (SC) administration. A randomized open-label study, PrefHer, reported compelling pt preference for H SC (Pivot et al. Lancet Oncol 2013; Ann Oncol 2014), and a prospective observational study reported less societal cost and pt time associated with H SC vs H IV in Sweden (Olofsson et al. Breast 2016), which may allow for earlier release of pts from hospital. To assess how this may translate to actual practice, we aimed to describe H SC and H IV use in a real-world setting and investigated a potential switch from one formulation to the other in the real world.

Methods

This observational, retrospective, longitudinal cohort study evaluated electronic medical records of adult female pts with a first incident diagnosis of EBC (neoadjuvant or adjuvant settings) and first use of H from 01/01/10–04/24/18 in three mid-size hospitals in Sweden (Sundsvall, Eskilstuna, and Kalmar). Data from first H administration (index date) until last recorded visit up to the day before metastasis (if any) were analyzed. Combination anticancer treatment was defined as any drug recorded from index date to index date +28 days. A switch between formulations was defined as any H administration using a formulation different from that given at the index date.

Results

Four hundred twenty-one pts received initial H (median age 60.2 years, range 23.3–88.5). Of these, 260 (61.8%) started treatment with H SC and 161 (38.2%) with H IV. After H SC was introduced in Nov 2013, use of H SC as the initial formulation increased from 72.7% in 2014 to 100% in 2017 (Table). Both H SC and H IV were mostly initiated with a combination IV chemotherapy e.g., a taxane (65.8% vs 74.5%, respectively). Some combination pertuzumab (F. Hoffmann-La Roche Ltd) was observed (2.3% vs 1.9%). Since 2013, 40 of 63 pts (63.5%) switched from initial H IV to H SC; ten (25.0%) switched back to H IV. Four of 260 pts (1.5%) switched from H SC to H IV; three (75.0%) switched back to H SC.

 H SC n=260H IV n=161Calendar year of the index date, n (%/year)  2010021 (100)2011026 (100)2012051 (100)20131 (3.7)26 (96.3)201448 (72.7)18 (27.3)201555 (79.7)14 (20.3)201677 (93.9)5 (6.1)201772 (100)0 (0)20187 (100)0 (0)Combination anticancer treatment, n (% of all)  Taxanes171 (65.8)120 (74.5)Anthracyclines5 (1.9)1 (0.6)Pertuzumab6 (2.3)3 (1.9)Other (platinum salts, metabolites, other cytotoxic/cytostatic agents)11 (4.2)4 (2.5)

Conclusion

H SC quickly became the prevailing (practically exclusive) formulation for treatment of pts with HER2-positive EBC. Furthermore, most pts who started on H IV switched to H SC, while a minority switched from H SC to H IV. Most pts also received similar combination IV treatment (e.g., pertuzumab or chemotherapy) regardless of H formulation. Results are in line with pt preference for H SC in the PrefHer study, and the body of evidence that oncology units switch to SC formulations of biologics as an integral part of routine care.

Citation Format: Valachis A, Carlsson L, Sundqvist M, Li B, Chiesa F, Uhde M, Sanglier T. Use of subcutaneous and intravenous trastuzumab: Real-world experience from three hospitals in Sweden [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-24.

Life situation 5 years after subarachnoid haemorrhage

OBJECTIVES

Subarachnoid haemorrhage (SAH) has high mortality and morbidity among survivors. SAH mainly affects young people and may result in long-term disabilities such as decreased Health-related Quality of Life (HRQoL), mental health and cognitive function. The aim of this study was to investigate the life situation 5 years after a SAH including physical/emotional status, participation and HRQoL.

MATERIALS & METHODS

In this cross-sectional descriptive study, a mail survey was sent to all persons treated at a neurosurgery unit in Gothenburg, Sweden, for non-traumatic SAH in 2009-2010, approximately 5 years post-SAH. The survey included questions regarding HRQoL; EuroQol 5-Dimensions (EQ-5D), the impact of the SAH; Stroke Impact Scale (SIS), Occupational Gaps Questionnaire and participation in society; Impact of Participation and Autonomy (IPA).

RESULTS

Forty-two 5 year survivors were sent the survey, of whom 26 (62%) responded (59 years old, range 33-85). The participants had generally low HRQoL and scored low in the domain of anxiety and depression. Many reported problems with emotions, fatigue, memory and executive function, but few problems with physical condition. However, nearly all participants reported to have an acceptable level of participation and 64% were independent in their daily life.

CONCLUSIONS

In this 5-year follow-up after SAH, the participants reported to have a greater number of hidden disabilities compared to physical problems, whereas most had acceptable participation in society. A yearly follow-up after a SAH could be suggested aiming to improving the cognitive and mental health.

Molecular subtype and tumor characteristics of breast cancer metastases as assessed by gene expression significantly influence patient post-relapse survival

BACKGROUND

We and others have recently shown that tumor characteristics are altered throughout tumor progression. These findings emphasize the need for re-examination of tumor characteristics at relapse and have led to recommendations from ESMO and the Swedish Breast Cancer group. Here, we aim to determine whether tumor characteristics and molecular subtypes in breast cancer metastases confer clinically relevant prognostic information for patients.

PATIENTS AND METHODS

The translational aspect of the Swedish multicenter randomized trial called TEX included 111 patients with at least one biopsy from a morphologically confirmed locoregional or distant breast cancer metastasis diagnosed from December 2002 until June 2007. All patients had detailed clinical information, complete follow-up, and metastasis gene expression information (Affymetrix array GPL10379). We assessed the previously published gene expression modules describing biological processes [proliferation, apoptosis, human epidermal receptor 2 (HER2) and estrogen (ER) signaling, tumor invasion, immune response, and angiogenesis] and pathways (Ras, MAPK, PTEN, AKT-MTOR, PI3KCA, IGF1, Src, Myc, E2F3, and β-catenin) and the intrinsic subtypes (PAM50). Furthermore, by contrasting genes expressed in the metastases in relation to survival, we derived a poor metastasis survival signature.

RESULTS

A significant reduction in post-relapse breast cancer-specific survival was associated with low-ER receptor signaling and apoptosis gene module scores, and high AKT-MTOR, Ras, and β-catenin module scores. Similarly, intrinsic subtyping of the metastases provided statistically significant post-relapse survival information with the worst survival outcome in the basal-like [hazard ratio (HR) 3.7; 95% confidence interval (CI) 1.3-10.9] and HER2-enriched (HR 4.4; 95% CI 1.5-12.8) subtypes compared with the luminal A subtype. Overall, 25% of the metastases were basal-like, 32% HER2-enriched, 10% luminal A, 28% luminal B, and 5% normal-like.

CONCLUSIONS

We show that tumor characteristics and molecular subtypes of breast cancer metastases significantly influence post-relapse patient survival, emphasizing that molecular investigations at relapse provide prognostic and clinically relevant information. CLINICALTRIALS.GOV: This is the translational part of the Swedish multicenter and randomized trial TEX, clinicaltrials.gov identifier nct01433614 (http://www.clinicaltrials.gov/ct2/show/nct01433614).

Angiogenic factors in relation to clinical effect in a phase II trial of weekly paclitaxel

BACKGROUND

Several anticancer agents including paclitaxel have an inhibitory effect on angiogenesis.

AIMS

To compare the overall response rate and time to progression with changes in circulating angiogenic factors during palliative treatment with weekly paclitaxel.

MATERIAL AND METHODS

Patients with metastatic BC, ECOG 0-2, received weekly paclitaxel, concomitant with trastuzumab if HER2+ BC (n = 7). Circulating vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were determined at base-line and before start of new course.

RESULTS

Fifty-five of 63 included patients were evaluable. The overall response rate including stable disease ≥24 weeks (CR + PD + SD) was obtained in 25 of the evaluable patients (45%). The median time to progression (TTP) was 5.3 months and overall survival (OS) 16.7 months. Patients with triple negative breast cancer (TNBC) showed a trend towards higher base-line VEGF compared with hormone receptor positive or HER2+ tumours and had shorter TTP. Significant differences in VEGF and bFGF levels at 12 weeks were found between patients with longer versus shorter TTP (VEGF: p = 0.046, bFGF: p = 0.005) and between patients gaining versus lacking clinical benefit (VEGF: p = 0.05, bFGF: p = 0.02).

CONCLUSIONS

The clinical utility of circulating VEGF may be a useful tool for monitoring treatment efficacy.

Serum thymidine kinase activity compared with CA 15-3 in locally advanced and metastatic breast cancer within a randomized trial

The primary objective was to estimate serum thymidine kinase 1 (TK1) activity, reflecting total body cell proliferation rate including cancer cell proliferation, in women with loco regional inoperable or metastatic breast cancer participating in a prospective and randomized study. Secondary objectives were to analyze TK1 in relation to progression-free survival (PFS), overall survival (OS), therapy response and other tumour characteristics, including CA 15-3, widely used as a standard serum marker for disease progression. TK1 and CA 15-3 were analysed in 198 serum samples collected prospectively from women included in the randomized TEX trial between December 2002 and June 2007. TK1 activity was determined by the ELISA based DiviTum™ assay, and CA 15-3 analyses was generated with the electrochemiluminescence immunoassay Cobas Elecsys CA 15-3 II. High pre-treatment TK1 activity predicted shorter PFS (10 vs. 15 months p = 0.02) and OS (21 vs. 38 months, p < 0.0001), respectively. After adjustment for age, metastatic site and study treatment TK1 showed a trend as predictor of PFS (p = 0.059) and was an independent prognostic factor for OS, (HR 1.81, 95 % confidence interval (CI) 1.26-2.61, p = 0.001). There was a trend of shortened OS for women with high CA 15-3 (p = 0.054) in univariate analysis, but not after adjustment for the above mentioned covariates. Both TK1 (p = 0.0011) and CA 15-3 (p = 0.0004) predicted response to treatment. There were statistically different distributions of TK1 and CA 15-3 in relation to the site of metastases. TK1 activity measured by DiviTum™ predicted therapy response, PFS and OS in loco regional inoperable or disseminated breast cancer. These results suggest that this factor is a useful serum marker. In the present material, a prognostic value of CA 15-3 could not be proven.

Pegylated liposomal doxorubicin as first-line monotherapy in elderly women with locally advanced or metastatic breast cancer: novel treatment predictive factors identified

We investigated the efficacy and safety of single-agent pegylated liposomal doxorubicin (PLD) as first-line treatment for elderly women with advanced breast cancer and evaluated predictive markers for response and toxicity. Twenty-five women ≥ 65 years received 40 mg/m(2) PLD every 28 days. Time to treatment failure (TTF), response rate, time to progression (TTP) and overall survival (OS) was calculated. The ABCB1 single nucleotide polymorphisms (SNP), tumor MRN complex, and TOPOIIα were analyzed. A mean of 7.4 cycles PLD were administered and TTF was 5.5 months and OS 20.6 months. ABCB1 SNPs were found to correlate to both efficacy and toxicity, while tumor expression of the MRN complex and TOPOIIα correlated to TTP. PLD is a safe and effective treatment for elderly breast cancer patients. Also potential predictive markers were identified.

P4-10-02: A Meta-Analysis of the Association of Blood Levels of Vitamin-D and the Risk of Breast Cancer

Background: A considerable body of literature has examined the association of vitamin-D with breast cancer risk and the potential role in its prevention. Geographic studies show higher incidence of breast cancer in patients residing at high latitudes. Other data linking vitamin-D deficiency to breast cancer risk are inconsistent.

Materials and Methods: A literature based meta-analysis was conducted. Odds ratios (OR) for breast cancer based on blood levels of 25-hydroxy or 1,25-hydroxy vitamin-D were computed and pooled. Analysis was conducted separately for studies where blood levels were taken before (group A) or after (group B) breast cancer diagnosis.

Results: Thirteen studies were identified. Nine studies were included in group A and 4 studies included in group B. For group A, there was no significant association between lower vitamin-D levels and breast cancer risk (pooled OR = 1.09, 95% confidence intervals 0.99−1.20, p=0.08). For group B, there was a highly significant association between lower vitamin-D levels and breast cancer (pooled OR = 2.81, 95% confidence intervals 1.70−4.65, p&lt;0.001). The test for interaction between groups was highly significant (p&lt;0.001). When all studies were pooled, the OR was 1.38 (95% confidence intervals 1.13−1.70, p=0.002).

Conclusion: When measured before breast cancer diagnosis, blood levels of vitamin-D are not associated with breast cancer risk. Breast tumors have been shown to differentially express vitamin-D hydroxylase. Therefore, any association of vitamin-D and breast cancer in studies measuring blood levels after breast cancer diagnosis may be confounded by reverse causation bias.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-10-02.

P2-12-07: Pooled Analysis of Outcomes of T1a/bN0, HER2−Amplified Breast Cancer

Background: Breast tumors with HER2 amplification have a worse prognosis than those with normal HER2 expression. This finding is independent of tumor size and other classical prognostic factors used in the adjuvant setting. The prognosis of node negative, sub-centimeter (T1a/bN0) tumors is usually excellent. However, little is known about the prognostic impact of HER2−amplification in this group. This study therefore, aimed to evaluate the relative and absolute prognostic impact of HER2−amplification in T1a/bN0 tumors.

Materials and Methods: Published data from studies assessing the outcomes of patients with HER2−amplified, node negative, T1a/bN0 tumors were included in a pooled analysis. Odds ratios (OR), 95% confidence intervals (CI) and absolute risks were computed for recurrence and distant recurrence at 5 years. Pooled hazard ratios (HR) for disease-free survival (DFS), were also assessed.

Results: A total of 3 case-control studies were included in the analysis and comprised 485 patients with HER2−amplified breast cancer (57.3% were also hormone receptor positive) and 1096 patients with HER2−normal disease (82.2% were hormone receptor positive). Among the HER2−amplified group, 4.1% received trastuzumab and 18.6% received chemotherapy. In the HER2−normal group, 4.3% received chemotherapy Estimated median follow-up was 5.7 years. HER2−amplification was associated worse DFS (HR = 2.60, 95% CI 1.53−4.41, p&lt;.001) and increased odds for recurrence at 5 years (OR = 3.79, 95% CI 2.35−6.10, p&lt;.001). There was a non-significant trend towards increased odds of distant recurrence at 5 years (OR = 2.51, 95% CI 0.82−7.67, p=.11). Compared with HER2−normal cancers, those with HER2−amplification showed lower absolute probability of recurrence-free survival at 5 years (90.1% vs. 94.6%, p&lt;.001) and distant recurrence-free survival at 5 years (95.1% vs. 97.6%, p&lt;.001). Among HER2−amplified cancers, tumor size 0.6−1.0cm (T1b) was associated with a trend for higher odds of recurrence at 5 years compared with those 0.5cm or smaller (T1a, pooled OR = 1.58, 95% CI 0.96−2.60, p=.07).

Conclusions: HER2−amplification is associated with worse outcome in T1a/bN0 tumors. However, recurrence-free and distant recurrence-free survival at 5 years is excellent in this group, particularly in those with T1a tumors. These data question the role of adjuvant chemotherapy and trastuzumab in these patients unless associated with other high risk features. A differentially lower risk for distant recurrence suggests the possible role for more aggressive local therapy such as surgery and/or radiation therapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-07.

P4-16-08: Pilot Randomized Trial of De-Escalated (q12 Weekly) Versus Standard (q3-4 Weekly) Intravenous Bisphosphonates in Women with Low-Risk Bone Metastases from Breast Cancer

Background: Bone-targeted agent such as bisphosphonates (BPs) can reduce skeletal complications from bone metastases but have no effect on either disease progression or survival. Despite substantial variability in the frequency and severity of skeletal complications, patients are empirically treated with BPs at the same dose and schedule irrespective of their individual risk.

Materials and Methods: A pilot, randomized, non-inferiority trial was conducted. Patients with low-risk bone metastases (serum C-telopeptide [CTx] &lt;600ng/L after at least 3 cycles of monthly IV BP) were assigned to pamidronate 90mg IV either every 3–4 weeks (control) or every 12 weeks (de-escalated). Data on serum CTx and bone alkaline phosphatase (BAP), pain scores (brief pain inventory [BPI] and functional assessment of cancer therapy-bone pain [FACT-BP]) were collected at 12 weekly intervals for 48 weeks.

Results: Fifty-four patients were approached, 44 provided consent and 38 were eligible for randomization. Median age was 55 (range 29–77) and mean baseline CTx was 319ng/L (range 10–526). Thirty-five participants (92%) completed the trial, 2 withdrew consent and one participant died. Fourteen control group participants (73.7%) and 13 experimental group participants (68.4%) maintained CTx in the low risk range (test for two proportions p=0.64). All patients not maintaining CTx in the low risk range showed evidence of both visceral and bone progression. Compared to the control group, there was a trend towards increasing CTx with time in the experimental group (p=0.10). There was no significant difference in BAP (p=0.37), BPI (p=0.21) or FACT-BP scores (p=0.59) between the two groups. Over the 48 week follow-up, two skeletal events were observed in each group.

Conclusions: Randomized trials of de-escalated BP therapy in women with low-risk bone metastases are feasible. Twelve-weekly pamidronate appears non-inferior to 3–4 weekly treatment. Larger trials are required to assess whether; 1) increasing CTx levels with de-escalated therapy will lead to higher rates of skeletal complications and 2) whether BP should be given every 3–4 weeks in patients with progressive visceral and bone disease.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-16-08.

Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry

Our knowledge about acute promyelocytic leukemia (APL) patients is mainly based on data from clinical trials, whereas population-based information is scarce. We studied APL patients diagnosed between 1997 and 2006 in the population-based Swedish Adult Acute Leukemia Registry. Of a total of 3897 acute leukemia cases, 3205 (82%) had non-APL acute myeloid leukemia (AML) and 105 (2.7%) had APL. The incidence of APL was 0.145 per 100,000 inhabitants per year. The median age at the time of diagnosis was 54 years; 62% were female and 38% male. Among younger APL patients, female sex predominated (89% of patients <40 years). Of the 105 APL patients, 30 (29%) died within 30 days (that is, early death (ED)) (median 4 days) and 28 (26%) within 14 days from diagnosis. In all, 41% of the EDs were due to hemorrhage; 35% of ED patients never received all-trans-retinoic acid treatment. ED rates increased with age but more clearly with poor performance status. ED was also associated with high white blood cells, lactate dehydrogenase, creatinine, C-reactive protein and low platelet count. Of non-ED patients, 97% achieved complete remission of which 16% subsequently relapsed. In total, 62% are still alive at 6.4 years median follow-up. We conclude that ED rates remain very high in an unselected APL population.

In humans the adiponectin receptor R2 is expressed predominantly in adipose tissue and linked to the adipose tissue expression of MMIF-1

In this study, the regional adipose tissue-adiponectin (AT-ADN) and adiponectin receptor (R1 and R2) expression and their relation with metabolic parameters, circulating and AT-derived cytokine expressions were compared. Paired subcutaneous adipose tissue (SCAT) and visceral adipose tissue (VAT) were taken from 18 lean and 39 obese humans, AT-mRNA expression of adipokines analysed by RT-PCR and corresponding serum levels by enzyme-linked immunosorbent assay (ELISA). R1 and R2 adipocyte expression was compared with 17 other human tissues. ADN-gene expression was lower in VAT than SCAT [mean (SD) 1.54 (1.1) vs. 2.84 (0.87); p < 0.001], and lower in obese subjects (VAT : p = 0.01;SCAT : p < 0.001). SCAT-ADN correlated positively with serum ADN (r = 0.33;p = 0.036) but not VAT-ADN. AT expressions of ADN and macrophage migration inhibiting factor (MMIF), IL18 and cluster of differentiation factor 14 (CD14) in both depots showed inverse correlations. R1 and R2 were expressed ubiquitously and R2 highest in SCAT, and this is much higher (x100) than R1 (x100). R expression was similar in lean and obese subjects and unrelated to the metabolic syndrome, however, receptors correlated with VAT-MMIF (R 1: r = 0.4;p = 0.008;R 2: r = 0.35,p = 0.02) and SCAT-MMIF expression (R 2: r = 0.43;p = 0.004). Unlike ADN, its receptors are expressed in many human tissues. Human R2 expression is not highest in the liver but in AT where it is associated with MMIF expression. The adiponectin-dependent insulin-sensitizing action of thiazolidinediones is thus probably to differ amongst species with weaker effects on the human liver.

Glare from outdoor high mast lighting: effects on visual acuity and contrast sensitivity in comparative studies of different floodlighting systems

Glare effects on visual acuity and contrast sensitivity were studied at outdoor timber terminal work with conventional far-reaching floodlighting and with a new type of oblique floodlighting with an asymmetrical light distribution. The binocular work visual acuity of 19 volunteers was measured at 40, 55 and 80 per cent contrast and the contrast sensitivity of 14 volunteers at spatial frequencies of 0.5, 1, 2, 4, 8 and 16 cycles/degree. With the light source 15 degrees from the centre of the visual fields the visual acuity as well as the contrast sensitivity was consistently lower with the conventional type than the new type of floodlight . The results thus indicate that not only the vision of details is impaired by glare but also the contrast perception of sparse patterns. In standardized rating scales the timber terminal workers scored the difference in glare between the two floodlight systems as "great"--"very great".

DPP-IV inhibition enhances the antilipolytic action of NPY in human adipose tissue

CONTEXT

Dipeptidyl peptidase IV (DPP-IV) inactivates the incretin hormone glucagon-like peptide. It can also affect the orexigenic hormone neuropeptide Y (NPY(1-36)) which is truncated by DPP-IV to NPY(3-36), as a consequence NPY's affinity changes from receptor Y1, which mediates the antilipolytic function of NPY, to other NPY receptors. Little is known whether DPP-IV inhibitors for the treatment of type 2 diabetic (T2DM) patients could influence these pathways.

AIMS

To investigate the in vitro effects of NPY with DPP-IV inhibition in isolated abdominal subcutaneous (AbdSc) adipocytes on fat metabolism, and assessment of NPY receptor and DPP-IV expression in adipose tissue (AT).

METHODS

Ex vivo human AT was taken from women undergoing elective surgery (body mass index: 27.5 (mean +/- s.d.) +/- 5 kg/m2, age: 43.7 +/- 10 years, n = 36). Isolated AbdSc adipocytes were treated with human recombinant (rh)NPY (1-100 nM) with and without DPP-IV inhibitor (1 M); glycerol release and tissue distribution of DPP-IV, Y1 and Y5 messenger RNA (mRNA) were measured and compared between lean and obese subjects.

RESULTS AND CONCLUSION

rhNPY reduced glycerol release, an effect that was further enhanced by co-incubation with a DPP-IV inhibitor [control: 224 (mean +/- s.e.) +/- 37 micromol/l; NPY, 100 nM: 161 +/- 27 micromol/l**; NPY 100 nM/DPP-IV inhibitor, 1 M: 127 +/- 14 micromol/l**; **p < 0.01, n = 14]. DPP-IV was expressed in AbdSc AT and omental AT with relative DPP-IV mRNA expression lower in AbdSc AT taken from obese [77 +/- 6 signal units (SU)] vs. lean subjects (186 +/- 29 SU*, n = 10). Y1 was predominantly expressed in fat and present in all fat depots but higher in obese subjects, particularly the AbdSc AT-depot (obese: 1944 +/- 111 SU vs. lean: 711 +/- 112 SU**, n = 10). NPY appears to be regulated by AT-derived DPP-IV. DPP-IV inhibitors augment the antilipolytic effect of NPY in AT. Further studies are required to show whether this explains the lack of weight loss in T2DM patients treated with DPP-IV inhibitors.

Serum antibodies against prostasomal clusterin in prostate cancer patients

OBJECTIVE

Clusterin is a ubiquitous secretory sulphated glycoprotein present in prostasomes. It is an anti-apoptotic mediator in prostate cancer and is among the most frequently occurring prostasomal proteins immunogenic in prostate cancer patients. The aim of the present study was to investigate the occurrence of anti-clusterin antibodies in the serum of patients with prostate cancer and whether there is a relationship between anti-clusterin antibody titres and other clinico-pathological variables.

MATERIAL AND METHODS

Serum samples were collected from 391 consecutive patients with suspected prostate cancer (150 benign prostate and 241 prostate cancer). The patients' serum samples were used in an ELISA where microtitre wells were coated with purified clusterin from serum of a healthy volunteer. Flow cytometric studies of clusterin and prostasomes were performed.

RESULTS

Flow cytometric analyses revealed the presence of clusterin on the surface of seminal prostasomes. Anti-clusterin ELISA titres in sera of patients did not differ significantly from those of a control group. A significant "inverse" correlation existed between anti-clusterin ELISA titres and lymph node metastases (p = 0.047), but only 11 out of 161 patients had metastases. These titres correlated significantly with total prostate (p = 0.021) and transitional zone (p = 0.015) volumes of the patients.

CONCLUSIONS

The correlation between serum anti-clusterin antibody titres and other clinico-pathological variables was generally weak in prostate cancer patients, although clusterin has been assigned an important role in tumourigenesis and progression of prostate cancer. However, the anti-clusterin antibody titre appeared to be related to prostate volume, correlating to both transitional zone volume and total volume of the prostate.

Cemented versus hydroxyapatite fixation of the femoral component of the Freeman-Samuelson total knee replacement

We have carried out a radiostereometric study of 50 patients (54 knees) with osteoarthritis of the knee who were randomly allocated to receive a cemented or a hydroxyapatite-coated femoral component for total knee replacement. The patients were also stratified to receive one of three types of articulating surface (standard, rotating platform, Freeman-Samuelson (FS)1000) all based on the Freeman-Samuelson design. The tibial components were cemented in all cases. Radiostereometry was performed post-operatively and at 3, 12 and 24 months. The analysis was restricted to rotation of the femoral component over time.

After two years, rotation of the femoral components in the transverse, longitudinal and sagittal planes did not differ between the cemented and the hydroxyapatite-coated implants (p = 0.2 to 0.9).

In total knee replacements with a rotating platform, the femoral component tended to tilt more posteriorly than in the other two designs, regardless of the choice of fixation (cemented or hydroxyapatite-coated, p = 0.04). The standard version of the femoral component, whether cemented or hydroxyapatite-coated, rotated more into valgus than was observed with the rotating-platform and FS1000 designs (p = 0.005). The increased constraint provided by the FS1000 component did not appear to have any adverse effect on fixation of the femoral component.

Influence of joint area design on tibial component migration: comparison among a fixed symmetrical, asymmetrical, and moveable bearing

Fifty-four knees (50 patients) were allocated to three different tibial polyethylene inserts (standard/rotating platform/FS1000) in the Freeman-Samuelson (Finsbury Orthopaedics Ltd, Surrey, United Kingdom) total knee arthroplasty. The FS1000 design has a spherical medial and a roller-in-trough configuration laterally. Radiostereometric examinations were done postoperatively and after 3, 12, and 24 months. The median migration of the metal-backing and the Hospital for Special Surgery scores did not differ between the three groups. At 2 years, the median external/ internal displacements for the rotating platforms were 2.8 degrees and 0.2 degrees, respectively (rotating platforms versus standard inserts/rotating platforms versus FS1000: P < .0005). Longitudinal rotations above the detection limits for radiostereometry were observed in some of the fixed implants (standard and FS1000 designs), indicating conditions for backside wear.

Increased expression of aquaporin 3 in atopic eczema

BACKGROUND

Dry skin in atopic eczema depends on increased water loss. The mechanisms behind this are poorly understood. The aim of this work was to identify genes that may contribute to water loss in eczema.

METHODS

Affymetrix DNA microarrays U133A were used to analyse gene expression in skin biopsies from 10 patients with atopic eczema and 10 healthy controls.

RESULTS

DNA microarray analysis showed up-regulation of 262 genes and down-regulation of 129 genes in atopic eczema. The known functions of these genes were analysed using Gene Ontology to identify genes that could contribute to increased water loss. This led to identification of aquaporin 3 (AQP3), which has a key role in hydrating healthy epidermis. Increased expression of AQP3 was found in eczema compared with healthy skin. This was confirmed with real-time polymerase chain reaction (P<0.001). In healthy skin, epidermal AQP3 immunoreactivity was weak and mainly found in the stratum basale. A gradient was formed with decreasing AQP3 staining in the lower layers of the stratum spinosum. By contrast, in acute and chronic atopic eczema strong AQP3 staining was found in both the stratum basale and the stratum spinosum.

CONCLUSIONS

Aquaporin 3 is the predominant aquaporin in human skin. Increased expression and altered cellular distribution of AQP3 is found in eczema and this may contribute to water loss.

A network-based analysis of allergen-challenged CD4+ T cells from patients with allergic rhinitis

We performed a network-based analysis of DNA microarray data from allergen-challenged CD4(+) T cells from patients with seasonal allergic rhinitis. Differentially expressed genes were organized into a functionally annotated network using the Ingenuity Knowledge Database, which is based on manual review of more than 200,000 publications. The main function of this network is the regulation of lymphocyte apoptosis, a role associated with several genes of the tuber necrosis factor superfamily. The expression of TNFRSF4, one of the genes in this family, was found to be 48 times higher in allergen-challenged cells than in diluent-challenged cells. TNFRSF4 is known to inhibit apoptosis and to enhance Th2 proliferation. Examination of a different material of allergen-stimulated peripheral blood mononuclear cells showed a higher number of interleukin-4(+) type 2 CD4(+) T (Th2) cells in patients than in controls (P<0.01), as well as a higher number of non-apoptotic Th2 cells in patients (P<0.01). The number of Th2 cells expressing TNFRSF4, TNFSF7 and TNFRSF1B was also significantly higher in patients. Treatment with anti-TNFSF4 resulted in a significantly decreased number of Th2 cells (P<0.05). A logical inference from all this is that the proliferation of allergen-challenged Th2 cells is associated with a decreased apoptosis of Th2 cells and an increase in TNFRSF4 signalling.

In vitro and in vivo models for testing arrhythmogenesis in drugs

The steadily increasing list of drugs associated with prolongation of the QT interval and torsades de pointes (TdP) constitute a medical problem of major concern. Hence, there is a need at an early stage to identify drug candidates with an inherent capacity to induce repolarization-related proarrhythmias, avoiding exposure of large populations to potentially harmful drugs. Furthermore, the availability of clinically relevant and predictive animal models should reduce the risk that effective and potentially life-saving drugs never reach the market. This review will discuss the pros and cons of some in vivo and in vitro animal models for assessing proarrhythmia liability.

Prostasome antigens as targets for sperm agglutinating antibodies demonstrated by 1-D gel electrophoresis and immunoblottings

Many immunoinfertile men have sperm agglutinating antibodies that are directed against prostasome-derived antigens, but these antigens have not been defined so far. We selected serum samples with high ELISA titres against prostasomes from a group of immunoinfertile patients with sperm agglutinating antibodies and used the sera for immunoblottings on 1-D SDS-PAGE of prostasomes and sperm cells. The immunoblottings with individual antiprostasome antisera on 1-D SDS-PAGE of prostasomes, revealed three to 10 bands for each serum. Eighty-five per cent of the serum samples contained bands in the 70-75 kDa region and 80% of the samples contained bands in the 50-55 kDa region. Immunoblottings of extracted sperm cells, revealed one to six bands in the molecular weight range 25-82 kDa and two of the samples recognized two bands with molecular weights (50 and 43 kDa) similar to immunoblottings of prostasomes. The prostasomal antigens recognized by the high titre-antisera of immunoinfertile men were generally different from the sperm antigens recognized by the same sera. This suggests that prostasomes offer a new set of antigens available for research on male immunoinfertility and immunocontraception.

A new test for immunological infertility: an ELISA based on prostasomes

Antisperm antibodies (ASA) are present in patients with immunological infertility, but the antigens are poorly characterized. Prostasomes adhere to sperm cells and are recognized as antigens for ASA. This investigation aimed to study the prevalence of antiprostasome antibodies in ASA-classified sera. We studied the reactivity of ASA-positive sera from 116 immunoinfertile patients. Ninety-seven per cent (113 of 116) of the patients' sera contained IgG antibodies against seminal prostasomes. Accordingly, prostasomes are one of the major targets for ASA. An enzyme-linked immunosorbent assay based on prostasomes is simpler to perform than ASA tests presently in use. It is also easier to achieve reproducible and standardized results.

The FcgammaRIIa polymorphism in children with atopic diseases

BACKGROUND

Fcgamma receptor II (FcgammaRIIa) is the most widely distributed of the classes of FcR and is expressed in polymorphic forms on most types of hematopoietic cells. Recent data suggest that this polymorphism may be relevant to FcgammaRIIa function. This might be linked to variability in immune response and therefore related to the pathogenesis of atopic diseases. The aim of the study was to evaluate the FcgammaRIIa polymorphism in children with atopic diseases.

METHODS

In the study were included 140 atopic children, 77 with food allergy and 126 healthy subjects as the control group. The FcgammaRIIa polymorphism was determined using the polymerase chain reaction method.

RESULTS

The distribution of FcgammaRIIa genotypes in atopic children did not differ from that of healthy controls. Moreover, there was no association between the FcgammaRIIa genotypes and atopic diseases.

CONCLUSION

It seems that the FcgammaRIIa polymorphism does not represent an important genetic risk factor for atopic diseases susceptibility.

Recombinant human erythropoietin in preoperative autologous blood donation did not influence the haemoglobin recovery after surgery

BACKGROUND

Recombinant human erythropoietin in combination with preoperative autologous blood donation is an established regime for avoiding allogenic blood transfusions. The aim of the study was to determine endogenous erythropoietin production and haemoglobin recovery after preoperative autologous blood donation and surgery, with or without recombinant human erythropoietin treatment.

METHODS

Thirty-eight patients having total hip joint replacement surgery were randomised to receive either autologous blood transfusion (control group) or autologous transfusion plus preoperative recombinant human erythropoietin treatment (EPO group). Haemoglobin, haematocrit, erythropoietin and reticulocyte concentrations were repeatedly analysed, before, during, and after surgery.

RESULTS

No significant differences were found between the groups regarding haemoglobin, haematocrit, and erythropoietin, but the reticulocyte count increased significantly more in the EPO group. There was no difference in the requirement for allogeneic blood transfusions between the groups. The baseline haemoglobin was >13 g dL-1 in all but four patients.

CONCLUSIONS

In patients with normal preoperative haemoglobin levels, recombinant human erythropoietin treatment did not improve haemoglobin levels, or reduce the need for allogenic blood transfusion. There were no differences in serum erythropoietin concentrations between the groups. We question whether recombinant human erythropoietin treatment facilitates preoperative autologous blood donation in patients with normal haemoglobin levels.

Relationships between preclinical cardiac electrophysiology, clinical QT interval prolongation and torsade de pointes for a broad range of drugs: evidence for a provisional safety margin in drug development

OBJECTIVE

To attempt to determine the relative value of preclinical cardiac electrophysiology data (in vitro and in vivo) for predicting risk of torsade de pointes (TdP) in clinical use.

METHODS

Published data on hERG (or I(Kr)) activity, cardiac action potential duration (at 90% repolarisation; APD(90)), and QT prolongation in dogs were compared against QT effects and reports of TdP in humans for 100 drugs. These data were set against the free plasma concentrations attained during clinical use (effective therapeutic plasma concentrations; ETPC(unbound)). The drugs were divided into five categories: (1) Class Ia and III antiarrhythmics; (2) Withdrawn from market due to TdP; (3) Measurable incidence/numerous reports of TdP in humans; (4) Isolated reports of TdP in humans; (5) No reports of TdP in humans.

RESULTS

Data from hERG (or I(Kr)) assays in addition to ETPC(unbound) data were available for 52 drugs. For Category 1 drugs, data for hERG/I(Kr) IC(50), APD(90), QTc in animals and QTc in humans were generally close to or superimposed on the ETPC(unbound) values. This relationship was uncoupled in the other categories, with more complex relationships between the data. In Category 1 (except amiodarone), the ratios between hERG/I(Kr) IC(50) and ETPC(unbound) (max) ranged from 0.1- to 31-fold. Similar ranges were obtained for drugs in Category 2 (0.31- to 13-fold) and Category 3 (0.03- to 35-fold). A large spread was found for Category 4 drugs (0.13- to 35700-fold); this category embraced an assortment of mechanisms ranging from drugs which may well be affecting I(Kr) currents in clinical use (e.g. sparfloxacin) to others such as nifedipine (35700-fold) where channel block is not involved. Finally, for the majority of Category 5 drugs there was a >30-fold separation between hERG/I(Kr) activity and ETPC(unbound) values, with the notable exception of verapamil (1.7-fold), which is free from QT prolongation in man; this is probably explained by its multiple interactions with cardiac ion channels.

CONCLUSIONS

The dataset confirms the widely-held belief that most drugs associated with TdP in humans are also associated with hERG K(+) channel block at concentrations close to or superimposed upon the free plasma concentrations found in clinical use. A 30-fold margin between C(max) and hERG IC(50) may suffice for drugs currently undergoing clinical evaluation, but for future drug discovery programmes, pharmaceutical companies should consider increasing this margin, particularly for drugs aimed at non-debilitating diseases. However, interactions with multiple cardiac ion channels can either mitigate or exacerbate the prolongation of APD and QT that would ensue from block of I(Kr) currents alone, and delay of repolarisation per se is not necessarily torsadogenic. Clearly, an integrated assessment of in vitro and in vivo data is required in order to predict the torsadogenic risk of a new candidate drug in humans.

Increased serum erythropoietin concentration after allogeneic compared with autologous blood transfusion

Serum erythropoietin (sEPO) level is known to increase as hemoglobin (Hb) concentration decreases during and after preoperative autologous blood donation (PAD). The endogenous erythropoietin (EPO) production after allogeneic blood transfusion has not to our knowledge, been studied. The aim of the present study was to determine whether there is, after surgery, any change in sEPO concentration after allogeneic blood transfusion, and whether there is any difference in EPO response after autologous or allogeneic blood transfusion. Thirty-one patients approaching total hip-joint replacement surgery, were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). The relationship between Hb, sEPO, and reticulocytes in the recipients were repeatedly analyzed before, during and after surgery. The Hb followed an expected pattern, with a decreased concentration after PAD in the autologous group, then in both groups after surgery. The sEPO concentration was significantly higher in the allogeneic than in the autologous group on day one and day 4-5 postoperatively. The reticulocyte level, on the contrary, was higher in the autologous patients before, one hour after, and one day after surgery. The study showed a greater increase in sEPO concentration after allogeneic blood transfusion than after autologous blood transfusion. There may be an inverse relationship between sEPO and the reticulocyte level.

Patient based 'burden-of-illness' in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records

Patients from one municipality in Sweden utilizing primary health care (PHC) during 1998 and 1999 have been categorized into 81 groups. The groups show each patient's own case-mix in terms of illness. Grouping was carried out using the case-mix instrument adjusted clinical groups (ACG), developed by the School of Hygiene and Public Health at Johns Hopkins University in Baltimore, USA. The resulting pattern provided a more adequate reflection of the scope of primary care's task than that yielded by diagnoses alone. Changes over time in terms of illness patterns for a population could be described, analysed and assessed from medical and health economic perspectives. One of the conclusions from this study was that the ACG instrument is a relevant tool in describing the outcome of work by the primary health care centre. The ACG is of interest in the improvement of the quality of primary care in Sweden. The ACG should be a driving force in the development of health indices in both national and international comparisons, as a result of its focus on the health status of patients and populations instead of on diagnoses and diseases.

DNA microarrays to study gene expression in allergic airways

BACKGROUND

Allergic rhinitis results from interactions between a large number of cells and mediators in different compartments of the body. DNA microarrays allow simultaneous measurement of expression of thousands of genes in the same tissue sample.

OBJECTIVE

To study gene expression in nasal mucosal biopsies from patients with allergic rhinitis using DNA micro-arrays.

METHODS

Nasal biopsies were obtained from 14 patients with symptomatic birch pollen-induced allergic rhinitis and five healthy controls. RNA was extracted from the biopsies and pooled into one patient pool and one control pool. These were analysed in duplicate with DNA micro-arrays containing more than 12 000 known genes.

RESULTS

Approximately half of the genes were expressed in the patient and control samples. Guided by the current literature we chose 32 genes of possible relevance to allergic airway inflammation and investigated their relative expression. Among these, transcripts encoding immunoglobulins and their receptors were most abundant. The expression of cytokines and growth factors was low, whereas their corresponding receptors and cell surface markers displayed higher expression levels. IgA had the highest expression of all 12 626 genes. RT-PCR showed that IgA1 was the predominant subclass. This was confirmed by the protein level in nasal fluids. Allergen-specific IgA was significantly higher in patients than in controls and correlated significantly with eosinophil granulae proteins.

CONCLUSION

DNA micro-array analysis can be used to identify genes of possible relevance to allergic airway inflammation. In this study, the expression profile in the nasal mucosa was quantitatively dominated by immunoglobulins, particularly IgA. Protein analyses in nasal fluids indicated a role for allergen-specific IgA in eosinophil degranulation.

Effects of fatty acids and growth hormone on liver fatty acid binding protein and PPARalpha in rat liver

The aim of this study was to investigate the interaction between long-chain fatty acids (LCFA) and growth hormone (GH) in the regulation of liver fatty acid binding protein (LFABP) and peroxisome proliferator-activated receptor-alpha (PPARalpha). Cultured rat hepatocytes were given oleic acid (OA; 500 microM) and GH (100 ng/ml) for 3 days. LFABP mRNA increased 3.6-fold by GH and 5.7-fold by OA, and combined incubation with GH and OA increased LFABP mRNA 17.6-fold. PPARalpha mRNA was decreased 50% by GH, but OA had no effect. Hypophysectomized (Hx) female rats were treated with L-thyroxine, cortisol, GH, and dietary fat for 7 days. PPARalpha mRNA levels were three- to fourfold higher in Hx than in normal female rats. GH decreased PPARalpha mRNA 50% in Hx rats. Dietary triglycerides (10% corn oil) increased LFABP mRNA and cytosolic LFABP about twofold but had no effect on PPARalpha mRNA in Hx rats. GH and dietary triglycerides had an additive effect on LFABP expression. Dietary triglycerides increased mitochondrial hydroxymethylglutaryl-CoA synthase mRNA only in the presence of GH. The diet increased serum triglycerides in Hx rats, and GH treatment prevented this increase. Addition of cholesterol to the diet did not influence LFABP levels but mitigated increased hepatic triglyceride content. In summary, these studies show that GH regulates LFABP expression independently of PPARalpha. Moreover, GH has different effects on PPARalpha-responsive genes and does not counteract the effect of LCFA on the expression of these gene products.

Contamination of polyethylene cups with polymethyl methacrylate particles: an experimental study

The articulating surfaces of 6 ultra-high molecular weight polyethylene cups were exposed to curing polymethyl methacrylate (PMMA) bone-cement and examined with scanning electron microscopy and laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS). Three of the cups were exposed to blood and bone-cement, and the rest were exposed to bone-cement only. After removal of the bone-cement bulk, PMMA particles were found and identified in all 6 cups. The particles were verified by identifying zirconium with energy-dispersive x-ray fluorescence spectroscopy in 5 cups and with LA-ICPMS in 1 cup. The degree of surface contamination was estimated with LA-ICPMS. The number of zirconium-containing particles detected was on average 10 to 20/mm2. PMMA bone-cement left in polyethylene cups during polymerization can contaminate the articulating surface with adherent PMMA particles.