Combined venetoclax and alvocidib in acute myeloid leukemia

More effective treatment options for elderly acute myeloid leukemia (AML) patients are needed as only 25-50% of patients respond to standard-of-care therapies, response duration is typically short, and disease progression is inevitable even with some novel therapies and ongoing clinical trials. Anti-apoptotic BCL-2 family inhibitors, such as venetoclax, are promising therapies for AML. Nonetheless, resistance is emerging. We demonstrate that venetoclax combined with cyclin-dependent kinase (CDK) inhibitor alvocidib is potently synergistic in venetoclax-sensitive and -resistant AML models in vitro, ex vivo and in vivo. Alvocidib decreased MCL-1, and/or increased pro-apoptotic proteins such as BIM or NOXA, often synergistically with venetoclax. Over-expression of BCL-XL diminished synergy, while knock-down of BIM almost entirely abrogated synergy, demonstrating that the synergistic interaction between alvocidib and venetoclax is primarily dependent on intrinsic apoptosis. CDK9 inhibition predominantly mediated venetoclax sensitization, while CDK4/6 inhibition with palbociclib did not potentiate venetoclax activity. Combined, venetoclax and alvocidib modulate the balance of BCL-2 family proteins through complementary, yet variable mechanisms favoring apoptosis, highlighting this combination as a promising therapy for AML or high-risk MDS with the capacity to overcome intrinsic apoptosis mechanisms of resistance. These results support clinical testing of combined venetoclax and alvocidib for the treatment of AML and advanced MDS.

Regional cerebral blood flow in aphasia

Regional cerebral blood flow (rCBF) was studied in 13 aphasic patients with left hemisphere lesions, using the intracarotid xenon 133 injection method and a 254-detector gamma camera system. The rCBF was measured during rest and during various function tests, including a simple speech test. In motor (nonfluent) aphasia, the rCBF method showed areas of cortical dysfunction that always included the lower part of the rolandic area while Broca's area was not consistently affected. In sensory (fluent) aphasia, the superior-posterior temporal cortex was involved in all cases. In global aphasia, the abnormalities included both regions consistently involved in the other types of aphasia. The 133Xe injection method for mapping abnormalities relevant for localizing the cortical speech areas was superior to the classical neuroradiological methods in that several cases failed to show any relevant lesion whatsoever. This is probably related to the functional nature of the rCBF method: subnormal flow values and lack of the normal flow increase during function tests apparently may disclose functionally inactivated but structurally intact cortex.

A Novel Multi-Biomarker Assay for Non-Invasive Quantitative Monitoring of Kidney Injury

The current standard of care measures for kidney function, proteinuria, and serum creatinine (SCr) are poor predictors of early-stage kidney disease. Measures that can detect chronic kidney disease in its earlier stages are needed to enable therapeutic intervention and reduce adverse outcomes of chronic kidney disease. We have developed the Kidney Injury Test (KIT) and a novel KIT Score based on the composite measurement and validation of multiple biomarkers across a unique set of 397 urine samples. The test is performed on urine samples that require no processing at the site of collection and without target sequencing or amplification. We sought to verify that the pre-defined KIT test, KIT Score, and clinical thresholds correlate with established chronic kidney disease (CKD) and may provide predictive information on early kidney injury status above and beyond proteinuria and renal function measurements alone. Statistical analyses across six DNA, protein, and metabolite markers were performed on a subset of residual spot urine samples with CKD that met assay performance quality controls from patients attending the clinical labs at the University of California, San Francisco (UCSF) as part of an ongoing IRB-approved prospective study. Inclusion criteria included selection of patients with confirmed CKD and normal healthy controls; exclusion criteria included incomplete or missing information for sample classification, logistical delays in transport/processing of urine samples or low sample volume, and acute kidney injury. Multivariate logistic regression of kidney injury status and likelihood ratio statistics were used to assess the contribution of the KIT Score for prediction of kidney injury status and stage of CKD as well as assess the potential contribution of the KIT Score for detection of early-stage CKD above and beyond traditional measures of renal function. Urine samples were processed by a proprietary immunoprobe for measuring cell-free DNA (cfDNA), methylated cfDNA, clusterin, CXCL10, total protein, and creatinine. The KIT Score and stratified KIT Score Risk Group (high versus low) had a sensitivity and specificity for detection of kidney injury status (healthy or CKD) of 97.3% (95% CI: 94.6-99.3%) and 94.1% (95% CI: 82.3-100%). In addition, in patients with normal renal function (estimated glomerular filtration rate (eGFR) ≥ 90), the KIT Score clearly identifies those with predisposing risk factors for CKD, which could not be detected by eGFR or proteinuria (p < 0.001). The KIT Score uncovers a burden of kidney injury that may yet be incompletely recognized, opening the door for earlier detection, intervention and preservation of renal function.

Variation in K-ras codon 12 point mutation rate with histological atypia within individual colorectal tumors

To elucidate genetic alteration in relation to morphology and also to confirm more directly the proposed adenoma-carcinoma sequence, we analyzed thirty-eight colorectal "cancer in adenoma" lesions exhibiting areas of different atypia, in terms of K-ras codon 12 point mutation. The mutation incidence was 26.3% (10/38) for all cancerous areas. Well-differentiated and very well-differentiated carcinoma exhibited values of 17.6% (3/17) and 30.4% (7/23), respectively (statistically not significant). Positive cases of adenoma with severe atypia and adenoma with moderate or slight atypia were 26.7% (8/30) and 8.3% (3/36) respectively (statistically significant). Thus, K-ras point mutation, as indicated previously, may play an important role in the early stages of colorectal tumorigenesis. As for the nature of the mutation, GGT(Gly) to GAT(Asp) was the most frequent (80%). Eight cases had mutations concurrently in different areas of the same tumor and in all of these the mutation was homogeneous (6 cases to GAT, 1 case to TGT and 1 case to GTT). This provides genetic support for the "adenoma-carcinoma sequence" theory proposed on the basis of morphological considerations. All lesions with a mutation were of polypoid type, and no mutation was found in the flat type.

Relationship between eye movements and oneiric behavior in cats

The relation between oneiric behavior and rapid eye movements (REMs) in paradoxical sleep (PS) without muscle atonia was analyzed in cats. Most isolated REMs were related to orienting behavior, whereas most REM bursts were related to generalized body movements (jumping, attacking, etc.). Only isolated, high amplitude REMs had any possibility of corresponding to visual images in dreams. From these findings we propose the existence of both dream-related and nondream-related REMs even in animals.

Sister chromatid exchanges in human lymphocytes after exposure to pulse-wave ultrasound

We have investigated the frequencies of sister chromatid exchange (SCE) induced by pulse-wave ultrasound in lymphocytes obtained from the human umbilical vein. The following results were obtained: There is an increase in the frequency of SCEs with increases in acoustic power. The critical acoustic power was 37.3-73 mW/cm2 (spatial average temporal average, SATA). Regardless of changes in pulse duration and repeated pulse frequency, if the acoustic power remains constant, the SCE frequency does not change significantly.

Chromosome analysis in couples with recurrent abortions

Chromosome analysis using a G-Banding technique was performed in 35 couples (70 individuals) with a history of two or more spontaneous abortions of unknown cause. Among these individuals, 5 (7%) showed balanced translocations, all of whom were female. The outcome of 31 pregnancies of 10 balanced translocation carriers was as follows: Ten of the offspring had normal phenotypes (32%), 5 (16%) were born with chromosomal abnormalities and 16 (52%) were spontaneously aborted.

Enantioselective biotransformation of 1-isopropylnaphthalene in rabbits

1-Isopropylnaphthalene (1) was administered orally to rabbits and the following eight metabolites, 2-(1-naphthyl)-2-propanol (7), 2-(1-naphthyl)-1-propanol (8: R/S = 83:17), 2-(1-naphthyl)-1,2-propanediol (9:R/S = 40:60), 4-isopropyl-1,2-naphthoquinone (10), 4-isopropyl-1-naphthol (11), 4-isopropyl-2-naphthol (12), 5-isopropyl-2-naphthol (13), and 2-(1-naphthyl)propanoic acid (14') as its methyl ester (14: R/S = 52:48), were isolated from urine. Among them, three metabolites (8, 9, and 14), possessing an asymmetric carbon atom in the molecule, were formed enantioselectively and five metabolites (7, 10, 11, 12, and 13) were formed regioselectively. The presumed metabolic pathways of 1-isopropylnaphthalene (1) in rabbits leading to these metabolites are discussed.

Juvenile angiofibroma: case report and the role of endoscopic resection

Juvenile angiofibroma is benign yet aggressive. Due to its inaccessible location in the nasopharynx, open surgery usually requires osteotomies which cause stunting of facial growth in adolescent males. Advances in imaging and treatment techniques have now facilitated more accurate staging of this disease. For small, extracranial tumours limited to the nasal cavity and paranasal sinus, endoscopic resection is a viable alternative. This case report will illustrate how endoscopic resection allows good control with minimal morbidity compared to open surgery or radiotherapy.

[Composition of the 32-detector rCBF system (Meditronic) and experience in its use (author's transl)]

Regional cerebral blood flow (rCBF) was measured in patients with no neurological deficit and no abnormal findings of cerebral angiograms except aneurysm itself with Xenon-133 injection technique by using the computerized 32-detector rCBF system (rCBF-322, Meditronic, Denmark). This system consists of a 32-detector head with a concave surface and a 32 pulse height analyser and analog-digital ratemeter as the accumulator connected to display units with an oscilloscope for 32 clearance curves and also a microcomputer programmed for calculating the rCBF initial with the initial slope analysis, for calculating the rCBF 10 with the height-over-area method and the rCBF gray, rCBF white, weight gray and weight white with the SHAM method. The results obtained were as follows: 1) The mean value and SD of rCBF initial was 58.4 +/- 6.2 ml/100 g brain/min; rCBF 10, 50.6 +/- 5.0 ml/100 g brain/min; rCBF gray, 78.0 +/- 14.0 ml/100 g brain/min; rCBF white, 22.1 +/- 6.6 ml/100 g brain/min; weight gray, 49.0 +/- 3.7%; weight white, 51.0 +/- 3.7%. These data should be considered normal values as reported also by others. 2) Reproducibilities were estimated by measuring twice the rCBF initial and the rCBF 10 at rest with closed eyes. The reproducibilities of the rCBF initial eyes 13.55% (P less than 0.05) and one of the rCBF 10 was 8.85% (P less than 0.05). It was concluded that this system should be widely used for measuring the rCBF in patients with various cerebral diseases.

[Establishment and characterization of human ovarian endometrioid carcinoma cell line]

Ascitic fluid was obtained from the patient of ovarian endometrioid cancer. Collected cells were incubated with Eagle's MEM containing 15% fetal calf serum at 37 degrees C under humidified 5% CO2 and 95% air. The epithelial colonies grew rapidly and were released without fibroblast cells. After the first passage, the cells are growing without interruption for over one year and 35 transfer generations. This cell line has following charactors: 1) The monolayer cultured cells appeared epithelial, pavement like arrangement and piling up, without contact inhibition. 2) In the cytoplasma PAS positive substance can be seen. 3) Desmosome-like structure, gap junction, microvilli and well developed cell organelles can be found by electron microscopy. 4) Chromosomal number shows pseudodiploidy which mode is 47. A submetacentric chromosome was present in all karyotype and identified by G-banding. It consists of No. 11 and a part of No. 1. 5) By heterotransplantation to the nude athymic mouse, the tumor easily develops. 6) By estradiol and promegestone its growth was inhibited. 7) Estrogen and progesterone receptors were not detected in the cytosol.

Effects of radiotherapy and chemotherapy on sister chromatid exchanges in peripheral lymphocytes of the patients with gynecologic cancer

Studies were done on the influence of radiotherapy or chemotherapy on peripheral lymphocyte SCE (sister chromatid exchange) frequency in patients with gynecologic cancer. The average value of spontaneous SCE frequency in 10 patients who had received radiotherapy was 6.94 +/- 2.57 (mean +/- S.D.), which was significantly lower than the control value of 8.59 +/- 2.99 ( p less than 0.001). The rate of decline of these frequency values was negatively correlated with the irradiation dosage. In contrast, the average spontaneous SCE frequency in the patients who had received combination chemotherapy was 12.48 +/- 4.02, which was significantly higher than the control value ( p less than 0.001). The average value of MMC-induced SCE frequency in patients under chemotherapy was much the same as the control value of 26.16 +/- 5.77. That is patients under radiotherapy was 23.88 +/- 5.65, which was slightly lower than the control value. There was, however, no significant difference in the MMC-induced SCE frequency value among these 3 groups.

Prevalence of diabetic retinopathy and distribution of its severity among patients of a university clinic of diabetes in Osaka

We have been following longitudinal changes of diabetic retinopathy by periodic fundoscopy in patients at our out-patient clinic for diabetes mellitus. In this study, we reviewed the prevalence of diabetic retinopathy and the distribution of its severities. Funduscopic examinations for retinopathy were performed on 242 patients. They ranged in age from 13 to 84 years (52.9 +/- 0.9, mean +/- s.e.). Duration of diabetes ranged from 1 to 31 years (10.7 +/- 0.4). Forty patients were treated with diet alone, 112 with oral hypoglycemic agents and 90 with insulin administration. No retinopathy was found in 83 patients (34%), background retinopathy in 113 (47%), preproliferative retinopathy in 24 (10%) and proliferative retinopathy in 17 (7%). Five patients (2%) were blind. Twenty-seven patients (60%) of 45 with a less than 5-year duration of diabetes were apparently without retinopathy, while the incidence of proliferative retinopathy increased in proportion to the duration. Fasting plasma glucose and glycosylated hemoglobin levels were higher in the patients with proliferative retinopathy than in any other group. All of the blind patients had a long history of untreated diabetes. Whether diabetic control assessed by glycosylated hemoglobin influences the progression of retinopathy could not be demonstrated by a 2-year observation. Further analysis based on a longer duration is needed in this respect.