Toxic epidermal necrolysis data from the CELESTE multinational registry. Part I: Epidemiology and general microbiological characteristics

INTRODUCTION

Toxic epidermal necrolysis (TEN) is a rare, life-threatening autoimmune disease predominantly manifested in the skin and mucous membranes. Today, infectious complications have the dominant share in mortality of TEN patients. Due to the nature of the therapy and administration of immunosuppressive medications, a wide range of potentially pathogenic microorganisms, which cause infectious complications in different compartments in these patients, is not surprising.

MATERIAL AND METHODOLOGY

This is a multicentric study, which included all patients with TEN hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area was over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the registry CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation), when specific parameters relating to epidemiological indicators and infectious complications in patients with TEN were evaluated in the form of a retrospective analysis.

RESULTS

In total, 39 patients with TEN were included in the study (12 patients died, mortality was 31%), who were hospitalized in the monitored period. The median age of patients in the group was 63 years (the range was 4-83 years, the mean was 51 years), the median of the exfoliated area was 70% TBSA (total body surface area) (range 30-100%, mean 67%). SCORTEN was calculated for 38 patients on the day of admission. Its median in all patients was 3 (range 1-6; mean 3). Any kind of infectious complication in the study group was recorded in 33 patients in total (85%). In total, 30 patients (77%) were infected with gram-positive cocci, 27 patients (69%) with gram-negative rods, and yeast cells or fibrous sponge were cultivated in 12 patients (31%). A total of 32 patients (82%) were found to have infectious complications in the exfoliated area, 15 patients (39%) had lower respiratory tract infections, 18 patients (46%) urinary tract infections and 15 patients (39%) an infection in the bloodstream. The most common potentially pathogenic microorganism isolated in our study group was coagulase neg. Staphylococcus, which caused infectious complications in 24 patients. Enterococcus faecalis/faecium (19 patients), Pseudomonas aeruginosa (17 patients), Staphylococcus aureus (11 patients) and Escherichia coli (11 patients) were other most frequently isolated micro-organisms.

CONCLUSION

The published data were obtained from the unique registry of TEN patients in Central Europe. In the first part, we have succeeded in defining the basic epidemiological indicators in the group of patients anonymously included in this registry. The study clearly confirms that infectious complications currently play an essential role in TEN patients, often limiting the chances of survival. The study also shows a high prevalence of these complications in the period after 15days from the start of hospitalization, when most patients already have completely regenerated skin cover.

Impurity-Governed Modification of Optical and Structural Properties of ZrO2-Based Composites Doped with Cu and Y

The influence of calcination temperature on copper spatial localization in Y-stabilized ZrO₂ powders was studied by attenuated total reflection, diffuse reflectance, electron paramagnetic resonance, transmission electron microscopy, electron energy loss, and energy-dispersive X-ray spectroscopies. It was found that calcination temperature rise in the range of 500-700 °C caused the increase of copper concentration in the volume of ZrO₂ nanocrystals. This increase was due to Cu in-diffusion from surface complexes that contained copper ions linked with either water molecules or OH groups. This copper in-diffusion led also to an enhancement of absorption band peaked at ~270 nm that was ascribed to the formation of additional oxygen vacancies in nanocrystal volume. Further increasing of calcination temperature from 800 up to 1000 °C resulted in outward Cu diffusion accompanied by a decrease of the intensity of the 270-nm absorption band (i.e., oxygen vacancies' number), the transformation of ZrO₂ tetragonal (cubic) phase to monoclinic one as well as the enhancement of absorption band of dispersed and crystalline CuO in the 600-900 nm range.

Immunohistochemical investigation of P16, P53 and Ki-67's prognostic values in diffuse large B-Cell lymphomas

AIM

The aim of this study is to determine the immunohistochemical properties of Ki-67, P53 expression and loss of P16, and to assess their relationship with both clinical parameters and patient survival in DLBCL.

METHOD

Forty patients, diagnosed at the Pathology Department of our institute with nodal DLBCL were selected as the study group. The relationship between P16, P53, Ki-67 expressions and clinical and laboratory parameters like age, gender, performance status, Eastern Cooperative Oncology Group (ECOG), clinical stage, presence of B-symptoms, bone marrow involvement, International Prognostic Index (IPI) score, lactate dehydrogenase (LDH) level, extranodal extension, relapse, C-reactive protein (CRP), sedimentation, number of leukocytes in patients and patient survival were then statistically evaluated.

RESULTS

Our results display no statistically significant correlation between P53 expression and loss of P16, Ki-67 proliferation index and clinical parameters and overall survival (p > 0.05). The only statistically significant relationship was between loss of P16 and stage (p 0.05).

CONCLUSION

According to the results of our study, the loss of P16, P53 gene expression and Ki-67 proliferation index have no effect on life expectancy of patients with DLBCL (Tab. 2, Fig. 2, Ref. 29).

Pituitary galaninergic system activity in female rats: the regulatory role of gonadal steroids

The well-recognized sensitivity of the galanin gene in the anterior pituitary gland to estrogen suggests that estrogen receptor activity may influence the galaninergic system through modulation of galanin receptor (GALR) gene expression. Here, we evaluated the following: (i) the effects of estrogen on GALR mRNA expression; (ii) the estrogen receptor subtype that is specifically involved in this activity; and (iii) the effects of progesterone in the absence or presence of estrogen on galanin concentration in anterior pituitary gland. In the first experiment, ovariectomized 4-month-old rats were pre-treated subcutaneously with 17β-estradiol (3 x 20 μg), the ESR1 (ERα) agonist propyl pyrazole triol (PPT) (3 x 5 mg), and the ESR2 (ERβ) agonist diarylpropionitrile (DPN) (3 x 0.5 mg). In the second experiment, 4-month-old ovariectomized females received daily subcutaneous injections of 17β-estradiol (3 x 20 μg), progesterone (2 x 5 mg), or combined estradiol (3 x 20 μg) and progesterone (2 x 5 mg). Anterior pituitaries were excised the day after the final 17β-estradiol injection (experiment I) and 1 hour after receiving the second progesterone dose. Relative GALR1, GALR2, and GALR3 mRNA expression was evaluated using quantitative real-time PCR, and pituitary galanin concentration was determined using a specific radioimmunoassay. The results revealed that estrogen predominantly induced a 5-fold increase in GALR3 gene transcription. To a lesser extent, 17β-estradiol also increased GALR1 mRNA expression, but had no effect on GALR2 mRNA levels. The estrogen-induced increase in GALR3 gene expression occurred exclusively through ESR1 activation. The increase in GALR1 gene expression occurred through activation of both estrogen receptor subtypes, but the ESR2 subtype was predominantly involved. Furthermore, the results revealed that progesterone regulates the activity of the pituitary galaninergic system by facilitating estradiol-induced galanin synthesis in the female rat anterior pituitary gland.

Dyslipidaemia in overweight children and adolescents is associated with an increased risk of kidney stones

AIM

There is conflicting evidence about the role of obesity in paediatric nephrolithiasis. This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age.

METHODS

We carried out serum lipid profile evaluations and 24-h urine chemistry analyses on 493 overweight/obese paediatric participants (mean age 13 years) without nephrolithiasis and 492 healthy normal weight sex and age-matched controls.

RESULTS

A third (33%) of the study group had blood lipid disturbances, with more acidic urine, lower urinary citrate excretion and a higher fraction of ionised calcium and higher Bonn Risk Index than the controls. The participants' body mass index standard deviation score (BMI Z-score) was positively correlated with urinary oxalate and uric acid and negatively correlated with citrate excretion. Total cholesterol, low-density lipoprotein cholesterol and triglycerides correlated negatively with citraturia, while high-density lipoprotein cholesterol correlated positively.

CONCLUSION

The main factor that predisposed overweight and obese children to kidney stones was hypocitraturia. Urinary citrate excretion was related to both BMI Z-scores and all lipid fraction abnormalities. However, hypercholesterolaemia and particularly low-density lipoprotein hypercholesterolaemia seemed to play a major role.

The effects of adriamycin on E-cadherin mediated cell-cell adhesion and apoptosis during early kidney development

Adriamycin (ADR) is strongly teratogenic. We investigated the effects of ADR on apoptosis and the intensity of E-cadherin expression in developing kidneys. An experimental group of rats was given 2 mg/kg/day ADR on days 6-9 of gestation and a control group was given saline on the same schedule. Embryos were decapitated on days 13, 15, 17 and 19 of gestation, and processed and embedded in paraffin for routine light microscopy. Kidney specimens were stained with hematoxylin and eosin or periodic acid-Schiff, or immunostained for E-cadherin. Apoptosis was assessed using the TUNEL method. Weight loss and developmental deficiency were determined in embryos of the experimental group. ADR damaged or destroyed tubule epithelial cells, which caused apparent dilatation of the tubule lumen. Also, the brush borders of proximal tubules were damaged and glomerular spaces were dilated. ADR caused apoptosis of kidney tissue by days 15, 17 and 19 of development and E-cadherin expression was up-regulated during kidney development compared to controls. We found that ADR can cause apoptosis and increased E-cadherin expression in the developing rat kidney. E-cadherin expression and apoptosis may contribute to the development of ADR nephrotoxicity.

Abstract B03: Synergistic control of GBM growth by MEK and PI3kinase signaling in a RAS-driven preclinical orthotopic model for human glioblastoma multiforme

PI3K, RTK/RAS, and Rb signaling are commonly altered in human GBM. We utilized a genetically engineered mouse (GEM) model for GBM, designated “TRP,” that expresses GFAP-T121 to suppress Rb (T), the KrasG12D mutation (R), and is heterozygous for a PTEN null allele (P), to develop an efficient and tractable orthotopic mouse model for GBM treatment preclinical evaluation. The orthotopic brain tumors presented linear foci of necrosis with peudopalisading by neoplastic cells described in human GBM, and were highly proliferative, invasive, and vascular. Immunohistochemistry analysis of TRP orthotopic tumors identified markers characteristic of human GBM, and tumor progression was readily examined by serial MRI.

Both PI3K and MAPK pathway inhibitors inhibited growth of TRP GEM-derived primary tumor cells, but did not result in significant apoptosis. However, when GBM derived cells were treated with a combination of pathway inhibitors such as BKM120 (a pan-PI3K inhibitor currently in clinical trials for solid tumors) and PD0325901 (a MEK inhibitor), potency was enhanced with a substantial increase in cell death. Analysis of downstream targets revealed a synergistic effect on target downregulation in the PI3K pathway. In the orthotopic GBM model, the PI3K/MAPK targeted combination delayed tumor growth by increasing GBM cell apoptosis and resulted in significantly increased survival. Taken together, our results validate this new orthotopic model for the assessment of targeted therapeutic regimens for human GBM, and show that the feedback loops and incomplete pathway suppression, observed in vivo with targeted single agents, can be overcome with a combination treatment strategy.

Citation Format: Rajaa El Meskini, Anthony Iacovelli, Alan Kulaga, Michelle Gumprecht, Philip Martin, Maureen Baran, Deborah Householder, Terry van Dyke, Zoe Weaver Ohler. Synergistic control of GBM growth by MEK and PI3kinase signaling in a RAS-driven preclinical orthotopic model for human glioblastoma multiforme. [abstract]. In: Proceedings of the AACR Special Conference on RAS Oncogenes: From Biology to Therapy; Feb 24-27, 2014; Lake Buena Vista, FL. Philadelphia (PA): AACR; Mol Cancer Res 2014;12(12 Suppl):Abstract nr B03. doi: 10.1158/1557-3125.RASONC14-B03

Intermediate filament protein nestin is expressed in developing meninges

BACKGROUND

Nestin is a type VI intermediate filament protein known as a marker for progenitor cells that can be mostly found in tissues during the embryonic and fetal periods. In our study, we aimed to determine the expression of nestin in meninges covering the brain tissue at different developmental stages and in the new born.

METHODS

In this study 10 human fetuses in different development stages between developmental weeks 9-34 and a newborn brain tissue were used. Fetuses in paraffin section were stained with H+E and nestin immunohistochemical staining protocol was performed.

RESULTS

In this study, in the human meninges intense nestin expression was detected as early as in the 9th week of development. Intensity of this expression gradually decreased in later stages of development and nestin expression still persisted in a small population of newborn meningeal cells.

CONCLUSION

In the present study, nestin positive cells gradually diminished in the developing and maturing meninges during the fetal period. This probably depends on initiation of a decrease in nestin expression and replacement with other tissue-specific intermediate filaments while the differentiation process continues. These differences can make significant contributions to the investigation and diagnosis of various pathological disorders (Tab. 1, Fig. 3, Ref. 36).

A preclinical orthotopic model for glioblastoma recapitulates key features of human tumors and demonstrates sensitivity to a combination of MEK and PI3K pathway inhibitors

Current therapies for glioblastoma multiforme (GBM), the highest grade malignant brain tumor, are mostly ineffective, and better preclinical model systems are needed to increase the successful translation of drug discovery efforts into the clinic. Previous work describes a genetically engineered mouse (GEM) model that contains perturbations in the most frequently dysregulated networks in GBM (driven by RB, KRAS and/or PI3K signaling and PTEN) that induce development of Grade IV astrocytoma with properties of the human disease. Here, we developed and characterized an orthotopic mouse model derived from the GEM that retains the features of the GEM model in an immunocompetent background; however, this model is also tractable and efficient for preclinical evaluation of candidate therapeutic regimens. Orthotopic brain tumors are highly proliferative, invasive and vascular, and express histology markers characteristic of human GBM. Primary tumor cells were examined for sensitivity to chemotherapeutics and targeted drugs. PI3K and MAPK pathway inhibitors, when used as single agents, inhibited cell proliferation but did not result in significant apoptosis. However, in combination, these inhibitors resulted in a substantial increase in cell death. Moreover, these findings translated into the in vivo orthotopic model: PI3K or MAPK inhibitor treatment regimens resulted in incomplete pathway suppression and feedback loops, whereas dual treatment delayed tumor growth through increased apoptosis and decreased tumor cell proliferation. Analysis of downstream pathway components revealed a cooperative effect on target downregulation. These concordant results, together with the morphologic similarities to the human GBM disease characteristics of the model, validate it as a new platform for the evaluation of GBM treatment.

Abstract 3137: Combined inhibition of MEK and PI3 kinase signaling results in improved survival in a preclinical orthotopic model for human glioblastoma multiforme

Glioblastoma multiforme (GBM; astrocytoma grade IV) is the most frequent and aggressive brain tumor for which no effective therapy is currently available. It has been shown that PI3K, RTK/RAS, and Rb signaling are commonly altered in human GBM. We utilized a genetically engineered mouse (GEM) model for GBM, designated

“TRP,” that expresses GFAP-T121 (T; for Rb suppression), the KrasG12D mutation (R), and is heterozygous for a PTEN null allele (P), to develop an orthotopic mouse model for the preclinical evaluation of potential therapeutics for GBM treatment. Although the de novo TRP brain tumor GEM model recapitulates features of human GBM including tissue invasion, pseudopalisading necrosis and dense vascularization, the latency to tumorigenesis (4-6 months) makes its use as a preclinical model for drug screening challenging. Therefore we isolated primary GBM cells from TRP GEMs and injected cells intracranially (IC) into syngeneic mouse brains. Recipient mice developed grade IV astrocytomas and recapitulated TRP GEM tumor histopathology. The orthotopic tumors presented linear foci of necrosis with peudopalisading by neoplastic cells that are hallmarks of human GBM, and were highly proliferative, invasive, and vascular. In addition, immunohistochemistry analysis of TRP orthotopic tumors identified markers characteristic of human GBM, and tumor progression was readily examined by serial MRI.

We used primary tumor cells derived from the TRP model in cell proliferation assays and found that PI3K and MAPK pathway inhibitors used as single agents inhibited cell growth alone, but did not result in significant apoptosis. However, when cells were treated with a combination of agents such as BKM120 (a pan-PI3K inhibitor currently in clinical trials for solid tumors) and PD0325901 (a MEK inhibitor), potency was enhanced and there was a substantial increase in cell death. Analysis of downstream targets revealed a synergistic effect on target downregulation in the PI3K pathway. The drug combination was also evaluated in vivo in the orthotopic model. We found that it delayed tumor growth by increasing GBM cell apoptosis, resulting in significantly increased survival. Our results show that combined targeting of the PI3K and MAPK pathways can have a synergistic effect in glioblastoma, and that our primary cells were a valuable tool to predict the in vivo outcome. We also validated this new orthotopic model of GBM and showed that it is tractable for the assessment of potential therapeutic regimens for human GBM.

Citation Format: Rajaa El Meskini, Anthony Iacovelli, Alan Kulaga, Michelle Gumprecht, Philip Martin, Maureen Baran, Deborah Householder, Terry Van Dyke, Zoe Weaver Ohler. Combined inhibition of MEK and PI3 kinase signaling results in improved survival in a preclinical orthotopic model for human glioblastoma multiforme. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3137. doi:10.1158/1538-7445.AM2014-3137

Outpatient renal needle biopsy of the transplanted kidney: safety profile

Since May 2005, we began performing renal graft biopsies as outpatient procedures when the patient's condition did not require hospitalization. To evaluate the safety profile of the 137 procedures performed in 111 patients, we performed a retrospective analysis of complications after all biopsies between 4 May 2005 and 6 January 6, 2011. The analysis focused on types of complications as well as needs for hospitalization with length of stay, for blood transfusion or for a further intervention. There were complications in 10.9% of procedures (n = 15) with 8% requiring hospitalization (n = 11). The complications were: gross hematuria (n = 10) including blockage of urinary flow (n = 2) with one subject requiring urologic intervention, and one patient experienced severe pain at the puncture site. Neither renal graft nor patient survival was threatened; there was no hemodynamic decompensation needing blood transfusions. The average hospital stay was 2.27 days (range = 1-8). Outpatient renal biopsies in 111 patients (137 procedures) had an 8% incidence of complications requiring admission and an average length of hospitalization of 2.27 days. Gross hematuria the most frequent problem, in no way compromised patient or graft survival showing it to be a safe outpatient procedure.

Electrical burns in our workplace

BACKGROUND

There were totally 2320 patients during the period 2004-2013 hospitalised in our workplace with thermal injury, 87 of which were electric burns (3.75%).

RESULTS

The majority of electric burns occurred to men 67 cases (76.74%), then to children - 18 cases (20.94%) and the rest to women - 2 cases (2.32%). The mechanism of injury to the group of men was direct contact with the source of current (54.5%), electric arc injury (37.9%), ignition of clothes and subsequently flame (6.1%), and lightning injury (1.5%). The cause of injury to the group of children was contact injury (83.4%), electric arc injury (16.6%); no ignition or lightning injury occurred. The cause of injury in the group of women (2 cases) was contact injury for both; no arc, ignition or lighting injury occurred. The average extent of burn wounds was 11.7% in the group of men, 5.83% in the group of children and 2% in the group of women. Surgical treatment (necrectomy, skin grafting, flap, and amputation) was necessary in 41 cases in the group of men, in 15 cases in the group of children and in 2 cases in the group of women.

DISCUSSION AND CONCLUSION

Electric injury is a common problem in modern world. Some authors reported a 16.9% contribution of electric injuries of all hospitalised burn patients. There were 3.75% electric injury cases of all hospitalised burn patients in our department in the last nine years. The occurrence varies from year to year.

Abstract 1809: Analysis of molecular networks that drive astrocytoma initiation and progression

High grade astrocytomas, anaplastic astrocytoma and glioblastoma multiforme (GBM) remain incurable in spite of advanced aggressive treatments including surgery, radiation and chemotherapy. To study pathways and mechanisms involved in the development of high grade astrocytomas, we used mouse models wherein key molecular pathways perturbed in human GBMs were inactivated or induced via Cre-driven adult astrocyte-specific system. Inhibition of Rb pathway via expression of T121, a N-terminal fragment of SV40 large T antigen (T: TgGZT121, GFAP-CreERTM) initiated diffuse grade II astrocytoma formation by 2 months after tamoxifen treatment which in some cases developed to grade III pathology 1.5 year after induction. Activation of KRas pathway (TR: TgGZT121, Kras+/lsl-G12D, GFAP-CreERTM) facilitated progression to grade III anaplastic astrocytoma tumor masses 4-5 months post induction which in a few cases developed to grade IV glioblastoma with some features of human disease. Additional PTEN loss or haploinsufficiency (TRPhet: TgGZT121, Kras+/lsl-G12D, PTEN+/fl, GFAP-CreERTM; TRPnull: TgGZT121, Kras+/lsl-G12D, PTENfl/fl, GFAP-CreERTM) led to rapid development of glioblastoma with characteristic features of angiogenesis and necrosis observed in human disease. Transcriptome analyses of GBM in our mouse models showed concordance with highly aggressive mesenchymal and proneural subclasses.

To identify disease-specific gene networks involved in astrocytoma initiation and progression, we analyzed more than 300 brain samples from tamoxifen-induced T, TR, TRPhet and TRPnull mice and corresponding controls at different time points after induction for gene and miRNA expression by microarray and Nanostring technology. The genes that were induced early and gradually increased in expression with tumor grade belonged to several key molecular networks: DNA replication and repair, cell division and chromosome transmission fidelity, cell cycle progression, metabolism, and pathways important for embryonic stem cell biology. Pathways significantly induced at later stages of disease (grades III-IV) included Notch and Wnt signaling, inflammatory response genes, p53 signaling, and RNA processing. Significantly downregulated pathways were related to neuronal development and function. We have confirmed expression of several candidate genes in mouse tumor samples and cell lines derived from low and high grade tumors. Currently we are investigating potential role of the selected candidates in astrocytoma development by in vitro and in vivo functional analysis. In summary, we utilized mouse models to determine global molecular changes during astrocytoma initiation and progression to high grade. These studies are important for understanding the mechanisms of the disease and may facilitate the development of new therapies.

Citation Format: Yaroslava Ruzankina, Burak Kutlu, Sophie Wang, Yurong Song, Deborah Householder, Philip Martin, Maureen Baran, Simone Difilippantonio, Leroy Hood, Terry Van Dyke. Analysis of molecular networks that drive astrocytoma initiation and progression. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1809. doi:10.1158/1538-7445.AM2013-1809

Temporal molecular and biological assessment of an erlotinib-resistant lung adenocarcinoma model reveals markers of tumor progression and treatment response

Patients with lung cancer with activating mutations in the EGF receptor (EGFR) kinase, who are treated long-term with tyrosine kinase inhibitors (TKI), often develop secondary mutations in EGFR associated with resistance. Mice engineered to develop lung adenocarcinomas driven by the human EGFR T790M resistance mutation are similarly resistant to the EGFR TKI erlotinib. By tumor volume endpoint analysis, these mouse tumors respond to BIBW 2992 (an irreversible EGFR/HER2 TKI) and rapamycin combination therapy. To correlate EGFR-driven changes in the lung with response to drug treatment, we conducted an integrative analysis of global transcriptome and metabolite profiling compared with quantitative imaging and histopathology at several time points during tumor progression and treatment. Responses to single-drug treatments were temporary, whereas combination therapy elicited a sustained response. During tumor development, metabolomic signatures indicated a shift to high anabolic activity and suppression of antitumor programs with 11 metabolites consistently present in both lung tissue and blood. Combination drug treatment reversed many of the molecular changes found in tumored lung. Data integration linking cancer signaling networks with metabolic activity identified key pathways such as glutamine and glutathione metabolism that signified response to single or dual treatments. Results from combination drug treatment suggest that metabolic transcriptional control through C-MYC and SREBP, as well as ELK1, NRF1, and NRF2, depends on both EGFR and mTORC1 signaling. Our findings establish the importance of kinetic therapeutic studies in preclinical assessment and provide in vivo evidence that TKI-mediated antiproliferative effects also manifest in specific metabolic regulation.

Abstract A42: Sensitivity and resistance to a p-AKT inhibitor in an erlotinib-sensitive model for lung cancer

Activating mutations in EGFR, such as the L858R mutation, are effective predictors of response to EGFR tyrosine kinase inhibitor (TKI) therapy. While most patients initially respond to EGFR TKIs, the majority relapse within 6-12 months, underscoring the importance of identifying therapies that enhance and prolong EGFR TKI activity in patients. Agents targeting additional nodes in the EGFR pathway have the potential to overcome such resistance but single-agent activity must be understood first. We utilized mice engineered to develop erlotinib-sensitive lung adenocarcinomas driven by the human EGFR L858R mutation to evaluate the efficacy of a p-AKT inhibitor, MK-2206, currently in clinical trials for a variety of solid tumor malignancies. MK-2206 concentration and target activity were assessed in short-term PK/PD studies in both the lungs and blood of tumor-bearing mice. MK-2206 was then evaluated in an efficacy study using a twice-weekly dosing regimen, both as a single agent and in combination with other TKIs. MK-2206 alone resulted in tumor regression or tumor growth inhibition in ∼50% of the mice, but exhibited greater efficacy in combination with other upstream pathway inhibitors. Temporal evaluation of tumor growth inhibition indicated that MK-2206 was most effective at early time points and did not produce a sustained pathway and growth response as treatment continued. Analysis of gene expression changes in mice treated with MK-2006 alone vs. MK-2206 in combination with EGFR TKIs highlighted the pathways perturbed by both drugs.

Abstract 4322: A preclinical orthotopic mouse model for human GBM: Recapitulation of features of GEM model of origin and potency of PI3K inhibitors

Glioblastoma (GBM; grade IV) is the most frequent and aggressive brain tumor for which no effective therapy is currently available. It has been shown that PI3 kinase, involving both PI3 kinase – Ras activation and PTEN inhibition, and RB signaling are commonly altered in human GBM. We utilized a GEM model expressing GFAP-T121, KrasG12D and heterozygous mutant in PTEN +/- (TRP+/-) to develop an orthotopic mouse model for the preclinical evaluation of potential therapeutics for GBM treatment. The TRP+/- GEM model recapitulates features of human GBM including tissue invasion, pseudopalisading necrosis and dense vascularisation, however the latency to tumorigenesis (4-6 months) makes its use as a preclinical model for drug screening challenging. Therefore we isolated primary tumor cells from induced TRP+/- GEMs with Grade III or Grade IV astrocytoma and injected cells intracranially (IC) into syngeneic mouse brains. Primary cells induced grade IV tumors and recapitulated TRP+/- GEM tumor histopathology. Highly proliferative, invasive, and vascular, the orthotopic grade IV tumors presented linear foci of necrosis with peudopalisading by neoplastic cells that is characteristic of human GBM. Immunohistochemistry characterization of TRP+/- orthotopic tumors revealed similar T121, GFAP and PTEN expression profile to TRP+/- GEM grade IV tumors. Other cellular markers known to be expressed in neuronal progenitors, glial cells or found to be associated with human GBM aggressiveness were assessed in the orthotopic mouse model GBM tumors in comparison with the TRP+/- GEM model. By adjusting the number of primary cells IC injected, the time period of tumor growth and assessment by MRI was increased from 3 weeks to 6 weeks allowing reasonable time for tumor growth assessment, before potential drug efficacy testing. We used primary cells of grade IV tumor origin from TRP+/- GEM to evaluate the effect of PI3 kinase pathway inhibition on cell proliferation. BEZ235, PI103 and PIK75, compounds that target the PI3 kinase pathway, are effective inhibitors of primary tumor cell proliferation with an EC50 in the 10-100 nM range. MK2206, an Akt inhibitor, was found to be a potential inhibitor of tumor cell proliferation. Although MAPK pathway activation through RB inactivation has been found to be key in triggering cell proliferation in TRP+/- GEM model, MEK inhibitors, namely AZD6244, PD0325901 and UO126 did not have a strong effect on cell proliferation. In vitro inhibition of cell proliferation assays and target validation in TRP+/- GEM primary cells are useful tools to choose compounds for orthotopic mouse efficacy studies. Preliminary in vivo mouse pharmacokinetic studies are underway to insure potential drug distribution in the brain tissue. Using the orthotopic model, we found that PI3 kinase inhibitors may be effective against brain tumors in the mouse orthotopic model for human GBM.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4322. doi:10.1158/1538-7445.AM2011-4322

Right-sided diaphragmatic hernia after orthotopic liver transplantation: report of two cases

Diaphragmatic hernia after OLT is a rare surgical complication. We here report successful diagnosis and treatment of two cases with right-sided diaphragmatic hernia developed after OLT both utilizing left-sided allografts. Combination of factors related to the surgical techniques and patient characteristics might explain the pathophysiology behind the diaphragmatic hernias following liver transplantation. Respiratory as well as non-specific gastrointestinal symptoms may be hints for an overlooked diaphragmatic hernia after liver transplantation. Diaphragmatic hernia should be added to the list of potential complications of liver transplantation for prompt diagnosis and appropriate treatment.

Arabinoxylan-oligosaccharides (AXOS) affect the protein/carbohydrate fermentation balance and microbial population dynamics of the Simulator of Human Intestinal Microbial Ecosystem

Arabinoxylan‐oligosaccharides (AXOS) are a recently newly discovered class of candidate prebiotics as – depending on their structure – they are fermented in different regions of gastrointestinal tract. This can have an impact on the protein/carbohydrate fermentation balance in the large intestine and, thus, affect the generation of potentially toxic metabolites in the colon originating from proteolytic activity. In this study, we screened different AXOS preparations for their impact on the in vitro intestinal fermentation activity and microbial community structure. Short‐term fermentation experiments with AXOS with an average degree of polymerization (avDP) of 29 allowed part of the oligosaccharides to reach the distal colon, and decreased the concentration of proteolytic markers, whereas AXOS with lower avDP were primarily fermented in the proximal colon. Additionally, prolonged supplementation of AXOS with avDP 29 to the Simulator of Human Intestinal Microbial Ecosystem (SHIME) reactor decreased levels of the toxic proteolytic markers phenol and p‐cresol in the two distal colon compartments and increased concentrations of beneficial short‐chain fatty acids (SCFA) in all colon vessels (25–48%). Denaturant gradient gel electrophoresis (DGGE) analysis indicated that AXOS supplementation only slightly modified the total microbial community, implying that the observed effects on fermentation markers are mainly caused by changes in fermentation activity. Finally, specific quantitative PCR (qPCR) analysis showed that AXOS supplementation significantly increased the amount of health‐promoting lactobacilli as well as of Bacteroides–Prevotella and Clostridium coccoides–Eubacterium rectale groups. These data allow concluding that AXOS are promising candidates to modulate the microbial metabolism in the distal colon.

Magnetic properties of gamma-Fe2O3/poly(ether-ester) nanocomposites

The magnetic properties of gamma-Fe2O3 nanoparticles embedded in a thermoplastic elastomer poly(ether-ester) copolymer by the in situ polycondensation reaction process have been investigated by means of magnetization and ferromagnetic resonance (FMR) measurements at low filler concentrations of 0.1 and 0.3 wt% with the magnetic additive introduced in the polymer matrix in powder and solution form. The magnetic behavior of the magnetopolymeric nanocomposites indicates significant interparticle interaction effects that depend mainly on the dispersion state of the magnetic nanoparticles as well as their concentration, consistent with the variation of the particle microstructure characterized by magnetic aggregates in the nanometer and micron scale for the solution and powder dispersions, respectively. The magnetization and FMR results at different filler concentrations and dispersions show a close correspondence to the relaxation processes of the copolymer, implying the coupling of polymeric and magnetic properties.

Use of Enteric-Coated Mycophenolate Sodium in De Novo Renal Transplant Recipients With High Incidence of Delayed Graft Function

Patients with delayed graft function (DGF) are at risk of increased incidence for acute rejection episodes (ARE). Mycophenolate mofetil or induction therapy has produced a reduction in ARE incidence. An open, prospective, 3-month trial was performed in a group of Argentinian renal transplant recipients. We recruited 46 patients, 71.7% men, aged 41.7 +/- 13.8 years; including 36 (78.3%) recipients of cadaveric donors (CD) who were aged 43.4 +/- 15.5 years with a cold ischemia time of 19.4 hours +/- 5.4 minutes, and 10 (27.7%) recipients of living donors (LD) aged 37.8 +/- 12.9 years. HLA mismatches >or= 3 were observed in 58.4% of CD and in 7% of LD. All patients received two doses of basiliximab (20 mg each, days 0 and 4), cyclosporine microemulsion (CsA-ME) monitored by the second-hour concentrations (C2), enteric-coated mycophenolate sodium (EC-MPS; 720 mg twice a day, and steroids. A 58% incidence of DGF was observed. At the end of the third month the incidence of biopsy-proven ARE was 15%, with a median serum creatinine of was 1.54 +/- 0.42 mg/dL, including three grafts lost. Two patients died. No patient required EC-MPS dose discontinuation but 20% of patients required dose adjustments. The absence of discontinuations and the low incidence of dose adjustments of EC-MPS in this high-risk de novo population provided support of a suitable tolerability profile for this EC-MPS, and the possibility to impact efficacy results.

Parathyroidectomy for Parathyroid Carcinoma in Renal Transplantation

INTRODUCTION

Hyperparathyroidism (HPT) is a highly prevalent pathology in the chronic renal disease population, which is associated with considerable morbidity, and mortality. The histopathological findings most often reported are solitary adenoma, diffuse hyperplasia, and autonomous hyperplasia. Carcinoma is an unusual cause of primary parathyroid hyperfunction (0.5% to 4% according to data); in renal transplanted patients it is exceptional. We sought to analyze parathyroid gland histology from renal transplant patients in comparison with nontransplanted patients and to report a parathyroid carcinoma case in a renal transplant patient.

METHODS

We retrospectively analyzed parathyroidectomies (PTX) and histopathological reports between March 1989 and December 2003.

RESULTS

Among 72 PTXs 41 were performed because of primary HPT; 26, secondary HPT; and five, tertiary HPT. Among the 41 primary HPT cases there were two carcinomas (4.88% primary HPT operated patients), one of whom was in a kidney transplant recipient. Among the total number of surgeries, seven were performed in six renal transplant patients, including five diffuse hyperplasia cases; one, nodular hyperplasia with an adenoma focus; and one, parathyroid carcinoma.

CONCLUSIONS

Parathyroidectomy indications in the renal transplant population are usually associated with the clinical picture of tertiary HPT, which does not resolve after a functional renal transplant. In spite of this, diffuse hyperplasia, which is associated with secondary HPT, was the most frequent hystological finding. Two carcinomas were observed: one in a renal transplant patient (16.6% parathyroidectomies) and the other in a patient who did not show renal failure. These data coincide with international records.

Wirksamkeit verschiedener Brunstsynchronisationsmethoden bei Ziegen in und außerhalb der Reproduktionssaison

Bei 244 Ziegen (147 Weiße Edelziegen und 97 Anglo-Nubier-Ziegen) im Alter von 1,5 bis 5 Jahren wurden verschiedene Brunstsynchronisationsverfahren angewandt. Die Untersuchung gliederte sich in zwei Versuchsabschnitte: Brunstsynchronisation in und außerhalb der Saison. In der Reproduktionssaison (Ende August/ Anfang September) wurde bei 160 Tieren (95 Weiße Edelziegen und 65 Anglo-Nubier-Ziegen) die Brunst nach vier Verfahren synchronisiert: Gruppe I: vaginale Einlage eines Chronogest-Tampons für 12 Tage, am Tag der Entnahme 500 IE PMSG i. m.; Gruppe II: vaginale Einlage eines Chronogest-Tampons für 12 Tage, vier Tage vor der Entnahme 50 IE PMSG i. m. + am Tag des Entzugs 500 IE PMSG i. m.; Gruppe III: vaginale Einlage eines Chronogest-Tampons für 12 Tage, zwei Tage vor der Entnahme 0,1 mg PGF2α i. m. + am Tag des Entzugs 500 IE PMSG i. m.; Gruppe IV: zweimalige Applikation von 0,1 mg PGF2α im Abstand von 11 Tagen. Ziegen aller Gruppen wurden 48 und 60 Stunden nach dem Entzug des Vaginaltampons bzw. nach der zweiten PGF2α-Injektion (Gruppe IV) mit Böcken (Sprung aus der Hand) bedeckt. Als Kontrolltiere dienten 52 Weiße Edelziegen und 32 Anglo-Nubier-Ziegen, die nach Feststellung der spontanen Brunst gedeckt wurden. Zur Frühträchtigkeitsdiagnose wurde die Messung des Progesteronspiegels im Blut verwendet. In der Saison kamen insgesamt 92 (62,6%) Weiße Edelziegen und 96 (98,9%) Anglo-Nubier-Ziegen in die Brunst. Bei den Weißen Edelziegen traten signifikante Unterschiede zwischen dem I. und II. Verfahren und dem IV. Verfahren sowie den Kontrolltieren auf. Die Konzeptionsrate lag bei 36,1% (Weiße Edelziegen) und 68,4% (Anglo-Nubier-Ziegen). Hierbei fanden sich auch signifikante Unterschiede zwischen dem I. Verfahren und den Kontrolltieren bei Weißen Edelziegen und zwischen dem I., II. und III. Verfahren und den Kontrolltieren bei Anglo-Nubier-Ziegen. Das II. Verfahren erwies sich als das beste hinsichtlich dieser beiden genannten Parameter sowohl bei Weißen Edelziegen als auch bei Anglo-Nubier-Ziegen. Im zweiten Versuchsabschnitt wurden Ziegen außerhalb der Saison (April/Mai) brunstsynchronisiert (10 Weiße Edelziegen und 44 Anglo-Nubier-Ziegen). Als Kontrolltiere dienten 10 Weiße Edelziegen und 10 Anglo-Nubier-Ziegen. Die angewandte Methode der Brunstauslösung außerhalb der Saison war bei allen Tieren erfolgreich. Das Ablammergebnis (203,4%) bei diesen Ziegen war zufrieden stellend, die Ablammrate hingegen gering (53,7%). Bei Kontrolltieren wurden außerhalb der Saison keine Anzeichen von Sexualaktivität festgestellt.

Effect of monensin sodium on fermentation efficiency in sheep rumen (short communication)

Abstract. The efficiency of rumen fermentation was studied in lambs and wethers using 14 experimental rations with and without monensin sodium. The 7 pairs of rations (the first a control diet, the second a monensin treated one) consisted of hay and concentrate at ratios of 60:40, 40:60, 100:0, 50:50 (lambs), 100:0, 75:25 and 50:50 (wethers), respectively. The molar % of acetic, propionic, butyric and valeric acids were taken into stoichiometric calculations of rumen fermentation. In most of the rations monensin increased rumen fermentation efficiency. Of all lamb and wether rations the highest efficiency was recorded in the monensin treated ones consisting of 40 % hay and 60 % concentrates and 50 % hay and 50 % concentrates, respectively. The high fermentation efficiency was probably due to the lowest methane production observed with these rations. This means that monensin increased the amount of metabolizable energy by decreasing methane energy losses. The increase in fermentation efficiency is associated with a high production of propionic acid and in wethers also with an increase in the gross efficiency of feed conversion.

Effect of feeding supplemental copper on performance, fatty acid profile and on cholesterol contents and oxidative stability of meat of rabbits

One hundred and four rabbits, five weeks old at the beginning of the experiment, were divided into four groups according to a feed additive treatment. Rabbits of the 1st, 2nd, 3rd and 4th group were fed a basal granulated feed (control), basal feed supplemented with CuSO4.5H2O at 50 mg Cu.kg-1, basal feed supplemented with 150 mg Cu.kg-1, and the latter feed supplemented with 100 mg.kg-1 vitamin E, respectively. The duration of the experiment was 42 days. Addition of Cu at 150 mg.kg-1 increased weight gain non-significantly by 9.1%. This effect was the most pronounced in the first two weeks of fattening. The lowest mortality was observed in rabbits fed the highest amount of additives (7.7% vs. 19.2% in the control). Rabbits were slaughtered at the age of 11 weeks. Neither treatment influenced proportions of saturated, monounsaturated and polyunsaturated fatty acids in lipids extracted from the loin and hindleg muscles. In rabbits fed the highest amount of copper and vitamin E, the cholesterol concentration was significantly decreased by 13.6% and 17.9% in the loin and hindleg meat, respectively. Effects of Cu added at 50 mg.kg-1 were marginal. Copper had no effect on the oxidative stability of meat, measured as thiobarbituric acid-reactive substances in meat stored at 4 degrees C for 0, 3 and 8 days. Vitamin E added in excess of nutritional requirement improved the oxidative stability of meat. In copper-fed rabbits, Cu accumulated in the liver, but not in muscles. Feeding of the basal feed for 7 days to rabbits previously fed copper sulphate decreased the hepatic Cu concentration by 14.0 to 24.4%.

[Changes in the state of air ionization caused by medical equipment]

The author discusses the effect of the ion-emitting medical equipment on changes in the air-ions concentration. The study shows that in the majority of cases (except for cobalt bomb) the changes observed fall within the range of the binding norms.

Fermentation of carbohydrates and yield of microbial protein in mixed cultures of rabbit caecal microorganisms

Fermentation pattern and yields of microbial protein were investigated in cultures of the rabbit caecal contents supplied with glucose, xylose, starch, pectin and xylan. Rabbits at the age of 4 weeks (before weaning) and 3 months were slaughtered, their caecal contents added at 1.1% to growth media and incubated anaerobically at 39 degrees C for 18 h. Caecal microorganisms of 4-week-old rabbits produced no methane and caproate, less butyrate, but more propionate than microorganisms of 3-month-old rabbits. In both groups of rabbits, fermentation of xylose produced significantly more propionate and less butyrate than fermentation of glucose. More propionate and less acetate was formed from starch than from pectin. In caecal cultures from 4-week-old rabbits with pectin, the molar percentages of acetate was significantly higher and percentages of other short-chain fatty acids (SCFA) lower than in cultures with starch or xylan. In cultures from 3-month-old rabbits, fermentation of pectin and xylan produced similar SCFA profiles, different from SCFA molar composition in cultures with starch. Average production of microbial protein was 129 mg per 1 g of carbohydrate digested (range 110 to 141 mg/g). Protein yields were the same on glucose and xylose, but nonsignificantly higher on starch than on pectin and xylan. It can be concluded that the characteristics of substrate affected fermentation pattern in mixed cultures of rabbit caecal microorganisms. Substrate effects on protein yields were not statistically significant, due to high variation.

Structural units of cuprates in natural Cu-oxysalts

The structure of copper oxysalt minerals is analyzed on the basis of the classification scheme developed earlier for synthetic cuprates. The copper-oxygen compounds were considered as the salts of hypothetical copper acids with characteristic Cu-containing structural units of various dimensions formed by a polymerization of the CuO squares. The results of magnetic susceptibility measurements performed recently were analyzed from the viewpoint of the developed extended structural classification scheme. The dimerization of magnetic moments was considered as a property of cuprates which was strongly dependent on the type of Cu-containing structural unit. A further extension of the structural classification scheme for cuprates is also discussed.

Dengue in the State of Rio de Janeiro, Brazil, 1986-1998

This paper presents epidemiological, laboratory, and clinical data on 12 years of dengue virus activity in the State of Rio de Janeiro from the time the disease was first confirmed virologically in April 1986 through April 1998. DEN-1 and DEN-2 viruses are the serotypes circulating in the state and were responsible for the epidemics reported during the last 12 years. The results published here show both the impact of dengue virus infections on the population and laboratory advances that have improved dengue diagnosis.

[The effect of monensin on a rumen strain of Enterococcus faecium CCM 4231]

Monensin from three different manufacturing companies (Eli Lilly Co., Indianapolis, USA; Pharmachim, Bulgaria; Spofa Prague, Czech Republic) were added to pure cultures of rumen strain Enterococcus faecium CCM 4231 at final concentrations 25 micrograms per ml and 50 microgram per ml. Enterococci represent a strong bacterial group colonizing the rumen regarding to lactic acid production. Ent. faecium CCM 4231 is own, lactic acid-producing isolate from the rumen content of calf with a broad antimicrobial activity (bacteriocin production). This strain was obtained in the microbial preparation Inhicol to protect enteritis in young ruminants, especially. The growth of CCm 4231 strain was inhibited at both concentrations (25 microgram/ml; 50 micrograms/ml) using all three monensins in comparison with controls (Figs. 1 and 2). The beginning of the growth inhibition was detected within 2 hours after ionophore addition. Monensin made in Bulgaria was the most effective of all when the three monensins were compared. No significant differences are found in the effect of monensins made in different production companies. Our results extend the knowledge about inhibition effect of monensin on Gram-positive bacteria, enterococci including. Moreover, the quality of monensins made by different companies is attested synchronous. In general, regarding the practical point of view, it is also contribution for the selection and application of the most suitable additives.

The effect of salinomycin and lasalocid on laboratory cultures of Enterococcus faecium and Staphylococcus gallinarum strains

The growth of Enterococcus faecium strains CCM 4231 and EF 26, and Staphylococcus gallinarum SG 31 was inhibited by salinomycin and lasalocid at concentrations of 25 and 50 mg/L. Staphylococcus gallinarum was more sensitive to the additives used than were enterococci. Maximum inhibition (90%) was measured after the growth with the SG 31 strain in the presence of both ionophores. Growth of organisms was more inhibited by salinomycin at 25 mg/L (67.5%) than at 50 mg/L (63%). The inhibitory effect in enterococcal strains reached after the addition of salinomycin and lasalocid (on average) 63 and 58%, respectively. The CCM 4231 strain was more inhibited by salinomycin as well as by lasalocid than was the EF 26 strain.

Influence of Rhaponticum carthamoides Wild on the growth of ruminal bacteria in vitro and on fermentation in an artificial rumen (Rusitec)

The fermentation of a basal diet composed of hay and barley (80:20%) was compared with fermentation of three rations in which 5 and 10% of hay and 10% of basal diet were replaced with the above-ground part of Rhaponticum carthamoides Wild in an artificial rumen (Rusitec). Results of 14 days experiments indicated that the digestibility of dry matter, organic matter, detergent fibre, production of CO2 and methane, NH3-N in effluent and total and individual VFA (mmol/day) were not affected in the process of fermentation of experimental diets in comparison with the basal diet. Addition of Rhaponticum carthamoides did not modify the production, utilization and recovery of metabolic hydrogen, glucose utilization, ATP production, YATP and effectiveness of microbial biomass synthesis expressed in g of microbial N/kg of organic fermented biomass. Water extracts of Rhaponticum carthamoides had no influence on growth parameters of a mixed culture of rumen bacteria. Overall results of this experiment indicated that the above-ground part of Rhaponticum carthomoides fully replaced the 5 and 10% portions of hay or 10% portion of the whole diet.