Evaluating Ligand Modifications of the Titanocene and Auranofin Moieties for the Development of More Potent Anticancer Drugs

Over time platinum-based anticancer drugs have dominated the market, but their side effects significantly impact the quality of life of patients. Alternative treatments are being developed all over the world. The titanocene and auranofin families of compounds, discovered through an empirical search for other metal-based therapeutics, hold tremendous promise to improve the outcomes of cancer treatment. Herein we present a historical perspective of these compounds and review current efforts focused on the evolution of their ligands to improve their physiological solution stability, cancer selectivity, and antiproliferative performance, guided by a clear understanding of the coordination chemistry and aqueous speciation of the metal ions, of the cytotoxic mechanism of action of the compounds, and the external factors that limit their therapeutic potential. Newer members of these families of compounds and their combination in novel bimetallic complexes are the result of years of scientific research. We believe that this review can have a positive impact in the development and understanding of the metal-based drugs of gold, titanium, and beyond.

Dose and time effects of solar-simulated ultraviolet radiation on the in vivo human skin transcriptome

Background

Terrestrial ultraviolet (UV) radiation causes erythema, oxidative stress, DNA mutations and skin cancer. Skin can adapt to these adverse effects by DNA repair, apoptosis, keratinization and tanning.

Objectives

To investigate the transcriptional response to fluorescent solar‐simulated radiation (FSSR) in sun‐sensitive human skin in vivo.

Methods

Seven healthy male volunteers were exposed to 0, 3 and 6 standard erythemal doses (SED). Skin biopsies were taken at 6 h and 24 h after exposure. Gene and microRNA expression were quantified with next generation sequencing. A set of candidate genes was validated by quantitative polymerase chain reaction (qPCR); and wavelength dependence was examined in other volunteers through microarrays.

Results

The number of differentially expressed genes increased with FSSR dose and decreased between 6 and 24 h. Six hours after 6 SED, 4071 genes were differentially expressed, but only 16 genes were affected at 24 h after 3 SED. Genes for apoptosis and keratinization were prominent at 6 h, whereas inflammation and immunoregulation genes were predominant at 24 h. Validation by qPCR confirmed the altered expression of nine genes detected under all conditions; genes related to DNA repair and apoptosis; immunity and inflammation; pigmentation; and vitamin D synthesis. In general, candidate genes also responded to UVA1 (340–400 nm) and/or UVB (300 nm), but with variations in wavelength dependence and peak expression time. Only four microRNAs were differentially expressed by FSSR.

Conclusions

The UV radiation doses of this acute study are readily achieved daily during holidays in the sun, suggesting that the skin transcriptional profile of ‘typical’ holiday makers is markedly deregulated.

What's already known about this topic?

The skin's transcriptional profile underpins its adverse (i.e. inflammation) and adaptive molecular, cellular and clinical responses (i.e. tanning, hyperkeratosis) to solar ultraviolet radiation.

Few studies have assessed microRNA and gene expression in vivo in humans, and there is a lack of information on dose, time and waveband effects.

What does this study add?

Acute doses of fluorescent solar‐simulated radiation (FSSR), of similar magnitude to those received daily in holiday situations, markedly altered the skin's transcriptional profiles.

The number of differentially expressed genes was FSSR‐dose‐dependent, reached a peak at 6 h and returned to baseline at 24 h.

The initial transcriptional response involved apoptosis and keratinization, followed by inflammation and immune modulation. In these conditions, microRNA expression was less affected than gene expression.

Linked Comment:Hart. Br J Dermatol 2020; 182:1328–1329.

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Assessment of Susceptibility Risk Factors for ADHD in Imaging Genetic Studies

OBJECTIVE

ADHD consists of a count of symptoms that often presents heterogeneity due to overdispersion and excess of zeros. Statistical inference is usually based on a dichotomous outcome that is underpowered. The main goal of this study was to determine a suited probability distribution to analyze ADHD symptoms in Imaging Genetic studies.

METHOD

We used two independent population samples of children to evaluate the consistency of the standard probability distributions based on count data for describing ADHD symptoms.

RESULTS

We showed that the zero-inflated negative binomial (ZINB) distribution provided the best power for modeling ADHD symptoms. ZINB reveals a genetic variant, rs273342 (Microtubule-Associated Protein [MAPRE2]), associated with ADHD ( p value = 2.73E-05). This variant was also associated with perivascular volumes (Virchow-Robin spaces; p values < 1E-03). No associations were found when using dichotomous definition.

CONCLUSION

We suggest that an appropriate modeling of ADHD symptoms increases statistical power to establish significant risk factors.

Genetic risk profiles for a childhood with severe overweight

OBJECTIVE

The objective of this study was the description of a valid genetic risk score (GRS) to predict individuals with high susceptibility to childhood overweight by their genetic profiles.

DESIGN AND METHODS

Case-control study including a group of children with high-risk familial predisposition to morbid obesity. Birth cohort from general population constituted the validation sample. For the discovery sample, 218 children with non-syndromic obesity and 190 control individuals were included. The validation sample was 653 children from two birth cohorts belonging to the INMA (Infancia y Medio Ambiente [Environment and Childhood] )project. 109 SNPs located in the genes FTO, SEC16B, BDNF, ETV5, SH2B1, GNPDA2, LYPLAL1, MSRA, TFAP2, KCTD15, MTCH2 and NEGR1, previously reported in association to body mass index (BMI) were analysed. For the validation sample, association between genome-wide data and BMI measurements between 3.5 and 5 years of age, were evaluated.

RESULTS

The GRS includes six SNPs in the genes FTO, TFAP2B, SEC16B, ETV5 and SH2B1. The score distribution differs among cases and controls (P = 9.2 × 10(-14) ) showing a significant linear association with obesity (odds ratio [OR] per allele = 1.69; confidence interval [CI] 95% = 1.46-1.97; P = 4.3 × 10(-1) and area under the receiver operating characteristic curve [AUC] = 0.727; CI 95% = 0.676-0.778). The results were validated by the INMA cohort (OR per allele = 1.23 CI 95% = 1.03-1.48 and AUC = 0.601 CI 95% = 0.522-0.680).

CONCLUSIONS

The use of our proposed genetic score provides useful information to determine those children who are susceptible to obesity. To improve the efficiency of clinical prevention and treatment of obesity, it is essential to design individualized based protocols in advance knowledge of the molecular basis of inherited susceptibility.

Instrumentation for accelerated life tests of concentrator solar cells

Concentrator photovoltaic is an emergent technology that may be a good economical and efficient alternative for the generation of electricity at a competitive cost. However, the reliability of these new solar cells and systems is still an open issue due to the high-irradiation level they are subjected to as well as the electrical and thermal stresses that they are expected to endure. To evaluate the reliability in a short period of time, accelerated aging tests are essential. Thermal aging tests for concentrator photovoltaic solar cells and systems under illumination are not available because no technical solution to the problem of reaching the working concentration inside a climatic chamber has been available. This work presents an automatic instrumentation system that overcomes the aforementioned limitation. Working conditions have been simulated by forward biasing the solar cells to the current they would handle at the working concentration (in this case, 700 and 1050 times the irradiance at one standard sun). The instrumentation system has been deployed for more than 10 000 h in a thermal aging test for III-V concentrator solar cells, in which the generated power evolution at different temperatures has been monitored. As a result of this test, the acceleration factor has been calculated, thus allowing for the degradation evolution at any temperature in addition to normal working conditions to be obtained.

E-cadherin contributes to the bystander effect of TK/GCV suicide therapy and enhances its antitumoral activity in pancreatic cancer models

The thymidine kinase/ganciclovir (TK/GCV) cancer gene therapy approach is based on inducing GCV metabolite cytotoxicity in tumor cells expressing the herpes simplex virus TK gene and exposed to GCV. A bystander effect, mediated by gap junctions, accounts for the transfer of toxic metabolites from TK-expressing cells to neighboring cells. It has been proposed that E-cadherin participates in the formation and function of such gap junctions. In this study we investigate the influence of E-cadherin on TK/GCV suicide therapy with a panel of cellular and in vivo models of pancreatic ductal adenocarcinoma. We observed a strong correlation of E-cadherin expression and the TK/GCV bystander effect, associated with the modulation of gap junction communication and connexin expression or localization. Importantly, the co-expression of TK and E-cadherin genes in the adenoviral vector AdTat8TKIE improved TK/GCV cytotoxicity and triggered a potent antitumoral effect, superior to standard AdTat8TK/GCV in MIAPaCa-2 xenografts. The increased expression of E-cadherin resulted in the reduction of the bcl-2 content. Interestingly, the knockdown of bcl-2 sensitized cells to TK/GCV. Thus, we propose that by restoring E-cadherin in pancreatic tumor cells we will improve TK/GCV therapy, both by enhancing the bystander effect and by facilitating the induction of apoptosis.

Early life environment, neurodevelopment and the interrelation with atopy

Both neurological and immunological systems are vulnerable to early life exposures. Neurological disorders and atopy have been related in animals and humans. Our main objective was to assess whether multiple exposures to early life determinants remain associated with neurodevelopment after considering the potential intermediate role of atopy. A second objective was to assess whether genes associated with atopy may inform about the potential neurotoxical mechanisms. Children were members of the AMICS birth cohort in Menorca (n=418, 87% of the recruited). General cognition was measured with the McCarthy Scales at age 4 and atopy through specific IgE at age 4 and prick test at age 6; 85 single nucleotide polymorphisms (SNPs) in 16 atopy and detoxification genes were genotyped. Among the 27 risk factors assessed, lower maternal social class, maternal smoking during pregnancy, being first born, shorter breastfeeding, higher DDT levels in cord blood, and higher indoor levels of NO2 (among the non-detoxifiers by GSTP1 polymorphism) were independently associated with poorer cognition. These associations were apparently not mediated by the relation between atopy and general cognition. Among the candidate atopic genes, variants in NQ01 (a detoxification gene) and NPRS1 (related with affective disorders like anxiety and stress management) had a significant association with general cognition (p-value<0.001). However, adjustment for the corresponding SNPs did not change the association between the early life determinants and general cognition. Multiple environmental pre-natal exposures were associated with neurodevelopment independently of their role in the immunological system. Atopic genes related to neurodevelopment suggest some potential mechanisms.

Linkage disequilibrium between four MTTP gene polymorphisms in a Mexican population

BACKGROUND

The microsomal triglyceride transfer protein plays an important role in the folding, assembling and secretion of lipoproteins that contain apoprotein B. Different polymorphisms in the MTTP gene have been associated with risk factors for coronary heart disease and diabetes, the first and fourth most common causes of death in Mexico, respectively.

AIM

The objective of this study was to assess allele, genotype and haplotype frequencies of six MTTP polymorphisms in an unselected Mexican population.

SUBJECTS AND METHODS

Six polymorphisms were analysed by DNA sequencing of polymerase chain reaction products in 155 Mexican individuals and Hardy-Weinberg equilibrium, genetic variability, linkage disequilibrium and neutrality test were evaluated.

RESULTS

The rare alleles of the six polymorphisms analysed had frequencies greater than 1% and their genotype distributions were in accordance with Hardy-Weinberg equilibrium. All three promoter and I/T 128 polymorphisms were in linkage disequilibrium. Twelve different haplotypes were observed; GATGGT (70.44%) and TTCGGC (13.91%) were the most common. Diversity patterns in this Mexican population deviate significantly from expectations of the standard neutral model for infinite allele.

CONCLUSION

The -493 G/T, -400 A/T, -164 T/C and I/T 128 polymorphisms can be useful for association studies in this population.

Genetic susceptibility to obsessive-compulsive hoarding: the contribution of neurotrophic tyrosine kinase receptor type 3 gene

Recent work suggests that neurotrophic factors may contribute to the genetic susceptibility to obsessive-compulsive disorder (OCD). Among other clinical dimensions, the presence of hoarding obsessions and compulsions has been shown to be correlated with a number of clinical and neuroimaging findings, as well as with a different pattern of genetic inheritance. We used a linkage disequilibrium (LD)-mapping approach to investigate whether neurotrophic tyrosine kinase receptor type 3 (NTRK3), the high-affinity receptor of neurotrophin 3 (NT-3), plays a role in increasing susceptibility to hoarding in OCD. We performed an association study of 52 tag single nucleotide polymorphisms (tagSNPs) covering the whole NTRK3 gene in a sample comprising 120 OCD patients and 342 controls. Single nucleotide polymorphism association and haplotype analysis were performed. Thirty-six of our patients (30%) exhibited significant hoarding obsessions and compulsions. A significant association of two SNPs in the 3' downstream region of NTRK3 gene and obsessive-compulsive hoarding was identified: rs1017412 [odds ratio (OR) = 2.16; P = 0.001] and rs7176429 (OR = 2.78; P = 0.0001), although only the latter remained significant after Bonferroni correction. Although the haplotype analysis did not show significant results, a more extended block of LD in the OCD hoarders with respect to the control group was observed, suggesting a lower haplotype diversity in these individuals. Our findings suggest that NTRK3 may contribute to the genetic susceptibility to hoarding in OCD and may constitute an interesting gene to focus on in studies of the genetic basis of obsessive-compulsive hoarding.

Altered brain-derived neurotrophic factor blood levels and gene variability are associated with anorexia and bulimia

Murine models and association studies in eating disorder (ED) patients have shown a role for the brain-derived neurotrophic factor (BDNF) in eating behavior. Some studies have shown association of BDNF -270C/T single-nucleotide polymorphism (SNP) with bulimia nervosa (BN), while BDNF Val66Met variant has been shown to be associated with both BN and anorexia nervosa (AN). To further test the role of this neurotrophin in humans, we screened 36 SNPs in the BDNF gene and tested for their association with ED and plasma BDNF levels as a quantitative trait. We performed a family-based association study in 106 ED nuclear families and analyzed BDNF blood levels in 110 ED patients and in 50 sib pairs discordant for ED. The rs7124442T/rs11030102C/rs11030119G haplotype was found associated with high BDNF levels (mean BDNF TCG haplotype carriers = 43.6 ng/ml vs. mean others 23.0 ng/ml, P = 0.016) and BN (Z = 2.64; P recessive = 0.008), and the rs7934165A/270T haplotype was associated with AN (Z =-2.64; P additive = 0.008). The comparison of BDNF levels in 50 ED discordant sib pairs showed elevated plasma BDNF levels for the ED group (mean controls = 41.0 vs. mean ED = 52.7; P = 0.004). Our data strongly suggest that altered BDNF levels modulated by BDNF gene variability are associated with the susceptibility to ED, providing physiological evidence that BDNF plays a role in the development of AN and BN, and strongly arguing for its involvement in eating behavior and body weight regulation.

GCV modulates the antitumoural efficacy of a replicative adenovirus expressing the Tat8-TK as a late gene in a pancreatic tumour model

Replication-competent adenoviruses carrying the herpes simplex thymidine kinase (TK) gene have shown contradictory evidence with regard to their antitumoural efficacy in combination with ganciclovir (GCV) treatment. We generated a replication-competent adenovirus carrying Tat8-TK, a modified form of the TK gene, under the control of the adenoviral major late promoter (AdRGDTat8-TK-L). Pancreatic cancer cell lines with different sensitivity to the TK/GCV system were infected with AdRGDTat8-TK-L, both in the presence and absence of GCV, and tested for treatment efficacy. We observed that, although the presence of GCV reduced viral replication in all infected cell lines, in three out of four GCV significantly enhanced the efficacy of the virotherapy. Interestingly, the cytotoxicity of the AdRGD-Tat8-TK-L/GCV was found more potent than that of a first generation AdTK/GCV system. In tumour xenografts from BxPC-3 and NP-18 pancreatic cells, both AdRGDTat8-TK-L and AdRGDTat8-TK-L/GCV treatment showed antitumoural activity. In BxPC-3 tumours scheduling of virus and prodrug was a key factor to determine the outcome of the therapy. Importantly, the addition of GCV enhanced the antitumoural effect of AdRGDTat8-TK-L only when applied in two rounds of virus+GCV. Interestingly, in spite of interfering with viral replication in vitro, GCV treatment of NP-18 tumours did not compromise the antitumoural efficacy of the AdRGDTat8-TK-L adenovirus. Thus, our results show that the combination therapy of a replicative adenovirus and the Tat8-TK/GCV suicide system can prove beneficial, when the appropriate regimen of virus and GCV is applied.

A brain-derived neurotrophic factor (BDNF) haplotype is associated with antidepressant treatment outcome in mood disorders

Brain-derived neurotrophic factor (BDNF) has been studied extensively in relation to the susceptibility to mood disorders (MD), although it remains to be clarified whether BDNF is a susceptibility locus for MD phenotypes, including therapeutic response to antidepressants. We have performed a single-marker and haplotype association study of eight TagSNPs polymorphisms in the genomic region containing the BDNF gene in 342 control subjects and 374 patients with MD, and have tested the association with antidepressant treatment outcome. None of the eight single nucleotide polymorphisms (TagSNPs) was significantly associated with MD phenotype after Bonferroni correction. In the single-marker analysis, a SNP was found to be associated with the patient's state of 'remitter' after adequate trial with a single antidepressant phenotype (odds ratio (OR)=2.95; P=0.0025). We also identified a haplotype associated with this phenotype. This study supports the implication of BDNF in antidepressant treatment outcome in MD, with specific association with 5' upstream region of BDNF gene.

Characterization of the novel ophthalmic drug carrier Sophisen in two of its derivatives: 3A Ofteno and Modusik-A Ofteno

Sophisen, a new ophthalmic drug carrier, was characterized using physicochemical and morphological criteria. Diclofenac belongs to a nonsteroidal anti-inflammatory molecule group and its ophthalmic use avoids side effects produced by steroid drugs. Cyclosporine-A is a cyclic peptide used as an immunosuppressive when administrated systemically. Its application in ophthalmology has been reported, but it is a very poor soluble drug. Diclofenac sodium and Cyclosporine-A were mixed with Sophisen to render two new ophthalmic solutions that were named 3A Ofteno and Modusik-A Ofteno, respectively. Based on transmission electron microscopy and dynamic light scattering studies, we concluded that Sophisen is a polydisperse solution with a molecular weight of 413 +/-122 kDa, whereas 3A Ofteno and Modusik-A Ofteno are monodisperse solutions with molecular weights of 169 +/- 44 and 153 +/- 10, respectively. Sophisen was shown to be a good carrier for diclofenac sodium as evaluated by passive diffusion through the cornea. A comparative study suggests that diclofenac applied as eye drops was better tolerated when associated with Sophisen. In addition, Modusik-A Ofteno, a new aqueous solution of Cyclosporine-A, improved tear production in patients with moderate or severe dry eye condition.

Melatonin as protective agent for the cytotoxic effects of diazinon in the spermatogenesis in the earthworm Eisenia foetida

Diazinon (D) is an organophosphorate synthetic insecticide widely used in the world. It inhibits acetylcholinesterase activity and damages reproduction as well as other organic functions mostly by increasing lipid peroxidation. Melatonin (M) is an indolamine secreted by the pineal gland. It performs numerous functions but recently it has been proposed as a good scavenger of oxygen radicals. The earthworm E. foetida is reputed as an excellent bioindicator of environmental chemical pollution. The testicular toxic effect of D and the protective role of M was analyzed in adult E. foetida, at 1, 7, 10, 15 and 30 days after exposure to 1/4, 1/2 and 3/4 of LD50. Sperm counts and the diameter of the seminal receptacles and of their lumina were altered in D exposed worms, which in addition have a lower percentage of survival, decreased weight and show cholinergic effect (coiling of the tail). All these changes were prevented fully or in part by simultaneous exposure to M. The observations confirm that D is a general and testicular toxicant for E. foetida, a good sentinel indicator and stresses the role of M as a protective agent.

[Some methodological aspects of age-period-cohort models. Application to cancer mortality trends]

Age-period-cohort models are usually used in descriptive epidemiological studies to analyze time trends in incidence or mortality. The exact linear relationship between the three effects of these models has the effect of making the parameters of the full model impossible to estimate, which is called non-identifiability. In these notes two of the most frequently used methods to analyze age-period-cohort models will be explained. One is based on penalty functions and the other on estimable functions (drift and curvatures or deviation from linearity). Both methods will be illustrated with two examples in which temporal trends of breast and lung cancer mortality in women from Catalonia in Spain will be studied. These examples show how the methods based on penalty functions tend to attribute the trend exclusively to a cohort effect. Consequently, the use of methods based on estimate functions is recommended.

Trends in smoking-related cancer incidence in Tarragona, Spain, 1980-96

OBJECTIVES

To analyze recent trends (1980-96) in the incidence of smoking-related cancers among men and women in Tarragona, Spain.

METHODS

Data were obtained from a population-based cancer registry. Age-standardized incidence rates were computed. Secular trends, between 1980 and 1996, were estimated using a Poisson regression model. From these figures, age, period, and cohort effects were assessed using the method proposed by Holford.

RESULTS

The incidence of all smoking-related cancers combined increased significantly in both sexes. The annual increase was 3.0% in men and 4.5% in women. By sites the annual increase was 4.3% in oral cavity, 5.1% in pancreas, 2.5% in lung, 3.2% in bladder, and 7.7% in kidney cancers among men. Among women the corresponding increments were 7.0% in oral cavity, 7.3% in pancreas, 3.1% in lung, 2.1% in bladder, and 6.9% in kidney cancers. The increasing incidence of lung cancer in women was mostly due to the adenocarcinoma histological type. No increase was observed in esophagus and larynx cancer either in men or women. It was not possible to determine whether the increases are due to a period or cohort effect since the curvature analysis was found to be non-significant.

CONCLUSIONS

All smoking-related cancers combined, except larynx and esophagus, are increasing in both sexes. The effect of tobacco, alcohol, and occupational exposure to carcinogens could explain the high rates of larynx, bladder, and upper digestive tract cancer in men. The rising incidence rates of lung cancer observed in younger women indicate a change in recent trends that is consistent with changes observed in smoking prevalence. Unless recent upward smoking trends in young women can be reversed, lung cancer in women will rise rapidly in the next few years. New smoking prevention strategies aimed at Spanish women, especially in the younger age groups, should be developed.

Recent decline in cancer mortality in Catalonia (Spain). A joinpoint regression analysis

The aim of this paper was to analyse recent changes in cancer mortality in Catalonia (Spain) between 1975 and 1998 using joinpoint regression models. Mortality data were obtained from the Mortality Registry of Catalonia. For each sex, age-standardised (standard world population) mortality rates were computed by the direct method, and joinpoint analysis was used to identify the best fitting points where a statistically significant change in the rates had occurred. In men, the overall cancer mortality (except skin non-melanoma) was highest in 1991 and decreased thereafter. Lung cancer was the main cause of cancer mortality, with an increase until 1989, and a subsequent levelling off (-0.8% annual between 1989 and 1998). Colorectal cancer was the second cause of cancer death, both in men and women, with a levelling-off of the rates since 1991 and 1989, respectively. In women, the mortality rate decreased for total cancer (except skin non-melanoma) since 1991 (-0.9% annually). Breast cancer increased until 1975, levelled-off and begun to decline since 1992 (-3.8% annual). Lung cancer increased since 1988 (+2.1%) and became the third cancer cause of death among women in 1998. These changes are mainly due to the decline of smoking prevalence in males, but not in females, and to the introduction of new diagnostic techniques and improved therapies for female breast cancer.

Medium-dose UVA1 phototherapy in localized scleroderma and its effect in CD34-positive dendritic cells

BACKGROUND

UVA1 radiation seems to be effective in morphea. CD34+ dendritic cells are significantly decreased in lesional skin of morphea patients.

OBJECTIVE

We evaluated the therapeutic effectiveness of medium-dose UVA1 phototherapy in localized scleroderma and its effect in the number of dermal CD34+ dendritic cells in skin biopsy specimens of these patients.

METHOD

Patients were irradiated with UVA1 (30 J/cm(2)) 30 times. Dermal CD34+ dendritic cells were counted before and after therapy.

RESULTS

There was clinical improvement after UVA1 irradiation. Dermal CD34+ dendritic cells significantly increased after UVA1 irradiation.

CONCLUSION

Medium-dose UVA1 therapy is effective in the treatment of localized morphea. Effectiveness is associated with an increase in the number of CD34+ dendritic cells in the dermis.

[Cancer incidence estimation in Spain: period 1993-1996]

OBJECTIVE

To estimate the number of incident cases of cancer in Spain between 1993 and 1996.

METHODS

We used data on the incidence of cancer from nine Spanish population-based cancer registries published in the monograph Cancer incidence in Five Continents, vols. VI and VII (period 1983-92). The National Institute of Statistics provided mortality data (period 1983-96). Generalized linear mixed models were used to estimate the number of incident cases. The incidence/mortality ratio was modeled. To account for heterogeneity, the providence of residence was considered as a random effect. Other factors analyzed were sex, age and period. Model parameters were estimated using a Bayesian approach with BUGS software. Estimates were valdated by comparing the observed number of cases with those predicted by the model in the regions with cancer registry data.

RESULTS

The average number of incident cases per annum for all cancer sites except non-melanoma skin cancer was 78,440 for men and 55,480 for women. The most frequent neoplasm in men was lung with 15,480 cases followed by bladder with 9,445 cases and colorectal with 8,876 cases. In women the most frequent cancer was breast with 13,490 cases followed by colorectal with 8,274 cases. These absolute frequencies showed an increasing time trend for all cancers and for the most frequent sites, with the exception of stomach and uterine cervix. Internal validation of the estimates allowed calculation of a relative error smaller than 10%.

IMPLICATIONS

This is the first time that the number of incident cases of cancer in Spain has been estimated with methods that account for heterogeneity. These figures show the importance of cancer as a public health problem in our community.

Neurodevelopmental delay, motor abnormalities and cognitive deficits in transgenic mice overexpressing Dyrk1A (minibrain), a murine model of Down's syndrome

Down's syndrome (DS) is a major cause of mental retardation, hypotonia and delayed development. Murine models of DS carrying large murine or human genomic fragments show motor alterations and memory deficits. The specific genes responsible for these phenotypic alterations have not yet been defined. DYRK1A, the human homolog of the Drosophila minibrain gene, maps to the DS critical region of human chromosome 21 and is overexpressed in DS fetal brain. DYRK1A encodes a serine-threonine kinase, probably involved in neuroblast proliferation. Mutant Drosophila minibrain flies have a reduction in both optic lobes and central brain, showing learning deficits and hypoactivity. We have generated transgenic mice (TgDyrk1A) overexpressing the full-length cDNA of Dyrk1A. TgDyrk1A mice exhibit delayed cranio-caudal maturation with functional consequences in neuromotor development. TgDyrk1A mice also show altered motor skill acquisition and hyperactivity, which is maintained to adulthood. In the Morris water maze, TgDyrk1A mice show a significant impairment in spatial learning and cognitive flexibility, indicative of hippocampal and prefrontal cortex dysfunction. In the more complex repeated reversal learning paradigm, this defect turned out to be specifically related to reference memory, whereas working memory was almost unimpaired. These alterations are comparable with those found in the partial trisomy chromosome 16 murine models of DS and suggest a causative role of DYRK1A in mental retardation and in motor anomalies of DS.

[Trends in cancer mortality in Catalonia (1975-1998)]

BACKGROUND

Aimed at assessing recent trends of cancer mortality in Catalonia (Spain), we analysed mortality rates for main tumour locations in men and women between 1975 and 1998.

MATERIAL AND METHOD

Mortality data were obtained from the Mortality Registry of Catalonia. For each sex, age-standardized (standard world population) mortality rates were determined by means of the direct method, and generalized lineal models with Poisson distribution were adjusted to obtain annual change percentages.

RESULTS

In men, the overall cancer mortality (except skin non-melanoma) was highest within 1991-1992 (age-standardized rate: 181.39/100,000) and decreased thereafter until 169.47/100,000 in 1995-1996. Lung cancer was the main cause of cancer mortality, displaying a 4% annual increase until 1989-1990, and a subsequent stabilization (-0.5% annual between 1989 -1990 and 1997 - 1998); Colorectal cancer was the second cause of cancer death, both in men and women, with a mortality rate stabilization since the 1990s. Prostate cancer became the third cause of cancer death in 1997-1998. In women, overall cancer (except skin non-melanoma) mortality rate was of 77.98/100,000 in 1997-98, showing a 0.9% annual decrease since 1989-1990. Breast cancer was the chief cause of cancer death within 1997-1998: after a sustained increase since 1975-1976, mortality started to decline (-2.0% annual) since 1989-1990. Lung cancer became the third cause of cancer death among women within 1997-1998, just after breast cancer and colorectal cancer, while gastric and uterine cancer became the fourth and fifth cancer death causes during this period, respectively.

CONCLUSION

After years of a steady increase, mortality rates for main cancer types stabilized since 1989-1990 in Catalonia.

[Incidence and survival of leukemias according to the different histologic subsets, in Tarragona, Spain, between 1980-1994]

BACKGROUND

To study the incidence and survival of leukemias according to the different histologic types in Tarragona, Spain.

MATERIAL AND METHOD

Analysis of the information obtained from the Cancer Registry of Tarragona (Spain) between 1980-1994. The leukemias were classified in: acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), chronic lymphoid leukemia (CLL) and chronic myeloid leukemia (CML). The estimated incidence rates have been adjusted to the worldwide population, the percentage of the incidence annual change through Poisson regression models and the relative survival using the registry of death rate of Catalonia.

RESULTS

The adjusted rate for leukemias between the period 1990-1994 was 8.0 per 100,000 inhabitants in men and of 5.2 in women, being the CLL the most frequent subtype. Regarding the trend of incidence an increase of the CLL of 2.2% annual (CI 95%, 0.1-6.6) in men and of 7.7% (CI 95%, 1.4-14.4) in women was observed. In the remaining subtypes, there was no trend, but the non-classified leukemias decreased a -10.8% annual (CI 95%, -15.0 to -6.4) in men and a -9.9% annual (CI 95%, 15.4 to -4.0) in women. 5-year relative survival (RS5y) for the total leukemias was 37.7% in men and 45.3% in women. It stands out the CLL with a RS5y of 64.8% in men and of 75.7% in women and childhood ALL with a RS5y of 83.0% in boys and of 84.9% in girls.

CONCLUSIONS

In Tarragona, Spain, an increase of the CLL incidence has been observed suggesting an improvement in the diagnosis, parallel to a decrease of the non-classified leukemias. The survival in this cohort of patients was similar to the that reported in other european registries.

Mitoxantrone, etoposide, carboplatinum and ara-C combination therapy (MECA) in refractory and relapsed acute leukemia

The present study was undertaken to assess the feasibility, toxicity and antileukemic activity of sequential chemotherapy including mitoxantrone, etoposide, carboplatin and intermediate-dose cytarabine in adult patients with refractory and relapsed acute myelogenous (AML) or lymphoid (ALL) leukemia. Fifty-one patients with poor-risk AML and ALL received 64 courses of MECA therapy. The overall response in the entire group was 51% (43% complete remission). The stage of the disease (relapsed or primarily refractory) and the age of the patients did not strongly affect the response rate. MECA therapy was more effective in ALL than in AML, and in those patients who presented at salvage treatment with a bone marrow infiltration lower than 25% blasts. Hematological and extra-hematological toxicities were tolerable and there were 6 deaths related to the treatment (11%). The incidence of documented infectious episodes was 71%. MECA therapy is a safe treatment and has a high antileukemic activity in relapsed and primarily refractory AML or ALL.

HLA-B44 subtyping in the Catalan population using reference strand mediated conformation analysis. Implications for the selection of unrelated bone marrow donors

Cytotoxic T lymphocytes (CTLs) reactive against the disparity between HLA-B*4402 and HLA-B*4403 have been reported after unrelated donor bone marrow transplantation. These CTLs have been associated with acute graft-versus-host disease and graft rejection. This study describes the HLA-B44-subtyping in the Catalan population using reference-strand mediated conformation analysis. It has been performed on 297 unrelated HLA-B44+ cord blood units from the Barcelona Cord Blood Bank (Barcelona, Spain). We have found a predominance of HLA-B*4403 (66.04%) over HLA-B*4402 (33.02%), whereas the predominant HLA-B44 allele in Northern Europe and the United States is HLA-B*4402. This inverted proportion between HLA-B44 subtypes in Mediterranean populations compared with other Caucasian populations suggests that HLA-B44 subtyping should be performed when an HLA-B44+ unrelated donor marrow is identified.

A qualitative evaluation of an assisted self-help group for drug-addicted clients in a structured outpatient treatment setting

We conducted a qualitative evaluation of a semi-structured, client-led support group that addressed drug use recovery issues and was assisted by a psychological consultant. Seven regular group members and their counselors were interviewed about the effect of the assisted self-help group on drug use and the clients' quality of life, and these interviews were content analyzed. In addition, the psychological consultant made group process observations for each session of the first three months. Clients reported group strengths as: Feeling supported and understood, being able to speak freely without fear of staff reprisals, obtaining information/feedback, improved mood, and decreased drug use. With the provision of professional support and guidance, this group shows promise as an adjunct to standard outpatient drug abuse treatment by allowing for some degree of client independence and extending the scarce resource of professional counseling.

L-selectin expression is low on CD34+ cells from patients with chronic myeloid leukemia and interferon-a up-regulates this expression

BACKGROUND AND OBJECTIVE

Altered adhesive interaction between bone marrow (BM) stroma and progenitors in chronic myeloid leukemia (CML) may be in part caused by abnormal expression of cell adhesion molecules (CAMs) on malignant progenitor cells. Treatment of CML with interferon-a (IFN-a) re-establishes normal hemopoiesis in some patients in part by restoring normal adhesive interactions between CML progenitors and BM microenvironment, which may in turn be mediated by correcting CAM expression on progenitors.

DESIGN AND METHODS

We investigated the expression of CAMs (L-selectin, b((2))-integrin, LFA-3, ICAM-1, ICAM-3, NCAM) on purified BM CD34(+) cells from CML patients (n= 34) and healthy adults (n= 15) by flow cytometry. Modulation of L-selectin expression on CD34(+) cells from CML after in vitro treatment with IFN-a was also investigated.

RESULTS

The mean percentage of CD34(+ )cells expressing L-selectin was significantly lower in CML patients (25.4+/-12.8%) than in normal controls (68.7+/-8.3%, n=15). CD34(+)/HLA-DR(&endash;/low) and CD34(+)/ CD38(&endash;/low) co-expressing L-selectin were also significantly lower in untreated CML (27.4+/-21.5% and 39.8+/-26.7%, respectively, n=8) than in controls (61+/-17% and 83.7+/-10%, respectively, n=7). In vitro treatment with IFN-a of purified CD34(+) BM cells from untreated CML patients (n=8) induced a significant, dose and time-dependent increase in the L-selectin expression as indicated by FACS analysis.

INTERPRETATION AND CONCLUSIONS

We hypothesize that this L-selectin deficiency reflects a cell surface adhesion defect of progenitors from CML that is partially restored by in vitro IFN-a treatment. These data may help to explain the adhesive abnormalities of CML progenitors to the BM microenvironment and the in vitro restoration of adhesion capacity after IFN-a treatment.

Isolation of CD34+ progenitor cells from peripheral blood by use of an automated immunomagnetic selection system: factors affecting the results

BACKGROUND

The isolation of CD34+ cells from mobilized peripheral blood is being increasingly used in the setting of allogeneic or autologous hematopoietic cell transplantation. Investigation of variables that may influence the effectiveness of CD34+ cell selection is of interest.

STUDY DESIGN AND METHODS

Fifty-one CD34+ cell selections from peripheral blood progenitor cells (PBPCs) (39 allogeneic and 12 autologous) were performed using a magnetic cell separator (Isolex 300i, Baxter), including version 2.0 software. The results obtained were analyzed for different processing variables. The feasibility of transplanting these isolated CD34+ cells was also analyzed.

RESULTS

The isolated CD34+ cell fraction had a median purity of 88.9 percent (range, 47.8-98.3). The median recovery of CD34+ cells was 45.1 percent (13.8-76.2), and the median colony-forming unit- granulocyte-macrophage (CFU-GM) content was 17. 2 percent (0.8-58.6). Logarithms of T- and B-cell depletion had median values of 3.7 and 2.8, respectively. The version 2.0 software of the Isolex 300i gave a higher CD34+ cell recovery in the enriched cell fraction (median 57.8%) than did version 1.11 (39.4%) or 1.12 (44.4%) (p = 0.01). The use of recombinant human deoxyribonuclease I during cell processing yielded more CD34+ cells (53% vs. 41%, p = 0. 01) and higher purity (92.8% vs. 87%, p = 0.03). There was a correlation between the percentage of CD34+ cells labeled with the monoclonal antibody 8G12 clone and the percentage of CD34+ cells labeled with the monoclonal antibody used during the processing technique (9C5 clone) in the initial, enriched, and depleted CD34+ cell fractions (R(2) = 0.95; 0.92; 0.78, p< 0.005, respectively). Median times for recovering >0.5 x 10(9) per L of granulocytes and >20 x 10(9) per L of platelets were 13 and 16 days in the allograft patients and 13 and 14 days in the autograft patients.

CONCLUSION

CD34+ cells can be highly and effectively isolated from allogeneic and autologous grafts by use of this automated technique, with a high grade of T- and B-cell depletion. These purified CD34+ cell components can engraft normally.

Mini-ICE regimen as mobilization therapy for chronic myelogenous leukaemia patients at diagnosis

Between April 1996 and May 1998, 20 consecutive patients with Ph chromosome-positive CML in first chronic phase without an HLA-identical sibling received the mini-ICE regimen shortly after diagnosis to mobilize progenitor cells into the peripheral blood (PBPCs). The sex distribution was 12 males and eight females and the median (range) age 48.5 (22-62) years. The time interval between diagnosis and mobilization was a median (range) of 2 (0-5) months. Leukaphereses were initiated during recovery from chemotherapy-induced aplasia. A median number of 3 (1-7) aphereses per patient were performed to collect >/=2.0 x 106 CD34+cells/kg. Cytogenetic analysis was performed on the aphereses products of 18 patients. Complete cytogenetic Ph chromosome negativity was observed in four patients, nine had a partial negativity, three a minimal negativity and two no negative cells. Southern blot for bcr-abl was negative in the remaining two patients but the polymerase chain reaction analysis was positive. Following reinfusion, severe neutropenia was present for a median of 8.5 (3-19) days and severe thrombocytopenia lasted a median of 8 (3-18) days. Ten patients did not develop febrile neutropenia with four of them being treated on an outpatient basis. Treatment-related mortality was not observed. In conclusion, our experience demonstrates the feasibility of mobilizing PBPCs shortly after the diagnosis of CML with a safe regimen. Of note, mini-ICE allowed the collection of apheresis products with at least a major component of Ph-negative cells in almost 75% of the patients.

Papillon-Lefevre syndrome: a case report and review of the literature

Papillon-Lefevre syndrome is a rare autosomal recessive syndrome associated with palmoplantar keratoderma and early onset periodontal disease that results in loss of the teeth. Actinomyces Actinomycetemcomitans causing periodontal damage, and alterations in the polymorphonuclear leukocyte function have been postulated or probable pathogenetic mechanism. Early recognition of this entity as well as a multidisciplinary management may help in the prognosis of these cases.

The effects of age and reproductive status on serum and blood parameters in merino breed sheep

Merino breed female sheep (225 in total) were used to study the effects of age and reproductive state on the values of 31 physiological parameters. Of these 31 parameters, 23 were affected by the age of animals, by their reproductive state, or by the interaction between these two factors. The statistical weighing of each of the factors of variability was determined. This revealed that the effects produced by them were indeed systematic. In order to demonstrate the systematic nature of the factors of variability, an attempt was made to classify each animal with respect to its reproductive state and age group, given only the set of biochemical values relating to it. The number of correct assignments to an age group achieved was 84.41%, and this rose to 92.17% with regard to reproductive state. A figure of 100% of correct assignments was reached with the adult age group and animals in oestrus. Thus, although the range of values observed for physiological parameters can, on occasions, be very large, this must be seen as a result of physiological deviations from average. These deviations are systematic and quantifiable, whether analysed in isolation or together as part of a multivariate analysis.

Morvan's fibrillary chorea: remission after plasmapheresis

We evaluated the effects of plasmapheresis in two patients with Morvan's fibrillary chorea, one of whom had sigmoid carcinoma, with oligoclonal bands in the cerebrospinal fluid, and modifications of the lipid-oxidative muscle pattern. The use of plasmapheresis in the treatment of Morvan's fibrillary chorea has not been reported previously and in our patients improved the symptoms markedly.

Cutaneous drug reactions

Cutaneous drug reactions are among the most common causes of skin eruptions in hospitalized patients. In outpatient clinics, drug eruptions represent a diagnostic and therapeutic challenge to the physician as any drug can cause an adverse cutaneous reaction. These reactions may be mediated by immunologic or nonimmunologic mechanisms. Cutaneous drug reactions may manifest themselves in various clinical morphologic patterns. Factors such as sun-exposure, concomitant drugs or diseases and host immune status can influence the type and morphology of lesions. History taking is one of the most important aspects in the evaluation of these patients and must be oriented so as to provide the information that will lead to the final diagnosis.

Treatment of psoriasis with triamcinolone acetonide 0.1% under occlusion: a comparison of two hydrocolloid dressings

A clinical, randomized, parallel study was undertaken to compare the efficacy of a widely known steroid preparation, triamcinolone acetonide 0.1% cream, in occlusion with two different hydrocolloid dressings, namely Duoderm and Actiderm, in the treatment of chronic plaques of psoriasis. A total of 23 patients with psoriasis were entered in the study. Two similar psoriatic plaques were identified in each patient, triamcinolone acetonide cream was applied, and a randomized table assigned the sides of the body to which each dressing was to be used for each patient. Changing of the dressing, with reapplication of the cream was done every 48 hours on each side until the lesions cleared or for a maximum of three weeks. At the end of the three weeks-therapy, period, 12 lesions had totally cleared with Duoderm and 13 with Actiderm. Seven lesions had achieved either marked or moderate improvement with duoderm and the same results were observed with Actiderm. Only three of 22 had mild improvement with Duoderm and two of 22 with Actiderm. No side effect were noted and none of the patients became worse during this treatment. This study demonstrated the beneficial effects of triamcinolone acetonide 0.1% cream under occlusion with two different hydrocolloid dressings in the treatment of chronic resistant plaques of psoriasis. The use of a hydrocolloid dressing in combination with steroid adds another therapeutic option for the treatment of chronic localized psoriatic lesions.

Primary inoculation complex of skin by Mycobacterium chelonei

We report a patient with a primary inoculation complex of the skin caused by Mycobacterium chelonei, a facultative pathogen that belongs to group IV of Runyon's classification of atypical mycobacteria. This organism is seldom responsible for disease in humans, although cutaneous, pulmonary, heart, bone, and disseminated infections have been reported. An unusual cutaneous manifestation of this organism is presented with a review of the literature.

Acromelanosis. A case report

The case of a 2-year-old Puerto Rican boy is presented. Clinical and histologic features are detailed because he showed peculiar jet black patches of pigmentation on the fingers of the right hand. This case, except for the lack of progression of the disease after a 2-year period of follow-up, shows many similarities to the case of a Japanese child reported by Furuya and Mishima as "acromelanosis progressiva." This condition is viewed as the epidermal counterpart of pigmentary disorders composed of dermal melanocytes, "epidermal melanocytosis."