Clinical pharmacology considerations for first-in-human clinical trials for enzyme replacement therapy

Inborn errors of metabolism (IEM) such as lysosomal storage disorders (LSDs) are conditions caused by deficiency of one or more key enzymes, cofactors, or transporters involved in a specific metabolic pathway. Enzyme replacement therapy (ERT) provides an exogenous source of the affected enzyme and is one of the most effective treatment options for IEMs. In this paper, we review the first-in-human (FIH) protocols for ERT drug development programs supporting 20 Biologic License Applications (BLA) approved by the Center for Drug Evaluation and Research (CDER) at the US Food and Drug Administration (FDA) in the period of May 1994 to September 2023. We surveyed study design elements across these FIH protocols including study population, dosage form, dose selection, treatment duration, immunogenicity, biomarkers, and study follow-up. A total of 18 FIH trials from 20 BLAs were identified and of those, 72% (13/18) used single ascending dose (SAD) and/or multiple ascending dose (MAD) study design, 83% (15/18) had a primary objective of assessing the safety and tolerability, 72% (13/18) included clinical endpoint assessments, and 94% (17/18) included biomarker assessments as secondary or exploratory endpoints. Notably, the majority of ERT products tested the approved route of administration and the approved dose was tested in 83% (15/18) of FIH trials. At last, we offer considerations for the design of FIH studies.

FDA Approval Summary: Ivosidenib in Combination with Azacitidine for Treatment of Patients with Newly Diagnosed Acute Myeloid Leukemia with an IDH1 Mutation

On May 25, 2022, FDA approved a supplemental application for ivosidenib (Tibsovo; Servier) extending the indication in patients with newly diagnosed IDH1-mutated acute myeloid leukemia (AML) in older adults or those with comorbidities to include the combination with azacitidine. The efficacy of ivosidenib in combination with azacitidine was evaluated in Study AG120-C-009, a phase 3, multicenter, double-blind, randomized (1:1), controlled study of ivosidenib or matched placebo in combination with azacitidine in adults with previously untreated AML with an IDH1 mutation who were 75 years or older or had comorbidities that precluded use of intensive induction chemotherapy. Efficacy was established on the basis of improved event-free survival and overall survival on the ivosidenib + azacitidine arm [HR, 0.35; 95% confidence interval (CI), 0.17-0.72; P = 0.0038, and HR, 0.44; 95% CI, 0.27-0.73; P = 0.0010], respectively. Furthermore, the rate and duration of complete remission (CR) were improved with ivosidenib versus placebo [CR 47% versus 15%, two-sided P < 0.0001; median duration of CR not estimable (NE; 95% CI, 13.0-NE) months versus 11.2 (95% CI, 3.2-NE) months. The safety profile of ivosidenib in combination with azacitidine was consistent with that of ivosidenib monotherapy, with important adverse reactions including differentiation syndrome (15%) and QT interval prolongation (20%).

Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis

BACKGROUND

Intra-abdominal infections (IAIs) is the most common type of surgical infection, with high associated morbidity and mortality rates. In recent years, due to the use of antibiotics, various drug-resistant bacteria have emerged, making the treatment of abdominal infections more challenging. Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications. However, available evidence regarding the optimal timing of IAI surgery is still weak. In study, we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.

AIM

To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI, in terms of overall mortality.

METHODS

A systematic literature search was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and ScienceDirect. The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Based on the timing of the surgical operation, we divided the literature into two groups: Early surgery and delayed surgery. For the early and delayed surgery groups, the intervention was performed with and after 12 h of the initial surgical intervention, respectively. The main outcome measure was the mortality rate. The literature search was performed from May 5 to 20, 2021. We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20, 2021, for ongoing trials. This study was registered with the International Prospective Register of Systematic Reviews.

RESULTS

We identified nine eligible trial comparisons. Early surgical exploration of patients with IAIs (performed within 12 h) has significantly reduced the mortality and complications of patients, improved the survival rate, and shortened the hospital stay.

CONCLUSION

Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

FDA approval summary for lonafarnib (Zokinvy) for the treatment of Hutchinson-Gilford progeria syndrome and processing-deficient progeroid laminopathies

The U.S. Food and Drug Administration recently approved lonafarnib as the first treatment for Hutchinson-Gilford progeria syndrome (HGPS) and processing-deficient progeroid laminopathies. This approval was primarily based on a comparison of patients with HGPS treated with lonafarnib in 2 open-label trials with an untreated patient cohort. With up to 11 years of follow-up, it was found that the lonafarnib treated patients with HGPS had a survival benefit of 2.5 years compared with the untreated patients with HGPS. This large treatment effect on the objective endpoint of mortality using a well-matched comparator group mitigated potential sources of bias and together with other evidence, established compelling evidence of a drug effect with benefits that outweighed the risks. This approval is an example of U.S. Food and Drug Administration's regulatory flexibility for a rare disease while ensuring that standards for drug approval are met.

Model-Informed Approach Supporting Approval of Nexviazyme (Avalglucosidase Alfa-ngpt) in Pediatric Patients with Late-Onset Pompe Disease

In August 2021, the US Food and Drug Administration approved Nexviazyme (avalglucosidase alfa-ngpt) for intravenous infusion to treat patients 1 year of age and older with late-onset Pompe disease (LOPD). The effectiveness and safety were studied in patients with LOPD and patients with infantile-onset Pompe disease (IOPD). The dosage(s) tested in clinical trials was 20 mg/kg every other week (qow) in patients with LOPD and 20 mg/kg and 40 mg/kg qow in patients with IOPD. While patients 3 years old and greater with LOPD were eligible for participation in the pivotal trial, the youngest patient enrolled was 16 years old. Therefore, pediatric patients with LOPD were not well represented in the clinical trial. The prevalence of LOPD in pediatrics is extremely low. Thus, conducting a clinical trial in pediatric patients with LOPD would be challenging. Given the similar pathophysiology, mechanism of action, and disease manifestations across the age spectrum of patients with LOPD, the approved dosages for pediatric patients younger than 16 years old with LOPD were based on extrapolation of efficacy using a model-informed exposure bridging strategy, leveraging the safety data from pediatric patients with IOPD. Specifically, the exposure associated with 20 mg/kg qow in adult patients with LOPD was the target exposure for bridging of efficacy. The safety data obtained with 40 mg/kg qow in patients with IOPD was leveraged to support approval in pediatric patients with LOPD aged 1 year and older. This article illustrates a regulatory use of model-informed extrapolation approach for dose selection in pediatric patients with a rare disease.

FDA Approval Summary: Belumosudil for Adult and Pediatric Patients 12 Years and Older with Chronic GvHD after Two or More Prior Lines of Systemic Therapy

On July 16, 2021, the FDA approved belumosudil, a kinase inhibitor, for adult and pediatric patients 12 years and older with chronic GvHD (cGvHD) after failure of at least two prior lines of systemic therapy. Approval was based on the results of Study KD025-213, which included 65 patients with cGvHD treated with belumosudil 200 mg daily in an open-label, single-arm cohort. Efficacy was determined by the overall response rate (ORR) through Cycle 7 Day 1, which included complete response (CR) or partial response (PR) according to the 2014 NIH consensus criteria, and durability of response. The ORR through Cycle 7 Day 1 was 75% [95% confidence interval (CI), 63-85]; 6% of patients achieved a CR, and 69% achieved a PR. The median duration of response was 1.9 months (95% CI, 1.2-2.9), and 62% (95% CI, 46-74) of responding patients remained alive without new systemic therapy for at least 12 months from response. The common adverse reactions were infections, asthenia, nausea, diarrhea, dyspnea, cough, edema, hemorrhage, abdominal pain, musculoskeletal pain, headache, phosphate decreased, gamma-glutamyl transferase increased, lymphocytes decreased, and hypertension. Additional study is warranted to confirm safety with long-term use.

Model-Informed Drug Development in Pediatric Dose Selection

Model-informed drug development (MIDD) has been a powerful and efficient tool applied widely in pediatric drug development due to its ability to integrate and leverage existing knowledge from different sources to narrow knowledge gaps. The dose selection is the most common MIDD application in regulatory submission related to pediatric drug development. This article aims to give an overview of the 3 broad categories of use of MIDD in pediatric dose selection: leveraging from adults to pediatric patients, leveraging from animals to pediatric patients, and integrating mechanism in infants and neonates. Population pharmacokinetic analyses with allometric scaling can reasonably predict the clearance in pediatric patients aged >5 years. A mechanistic-based approach, such as physiologically based pharmacokinetic accounting for ontogeny, or an allometric model with age-dependent exponent, can be applied to select the dose in pediatric patients aged ≤2 years. The exposure-response relationship from adults or from other drugs in the same class may be useful in aiding the pediatric dose selection and benefit-risk assessment. Increasing application and understanding of use of MIDD have contributed greatly to several policy developments in the pediatric field. With the increasing efforts of MIDD under the Prescription Drug User Fee Act VI, bigger impacts of MIDD approaches in pediatric dose selection can be expected. Due to the complexity of model-based analyses, early engagement between drug developers and regulatory agencies to discuss MIDD issues is highly encouraged, as it is expected to increase the efficiency and reduce the uncertainty.

FDA Approval Summary: Selinexor for Relapsed or Refractory Diffuse Large B-Cell Lymphoma

In June 2020, the U.S. Food and Drug Administration granted accelerated approval to selinexor for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from follicular lymphoma, after at least two lines of systemic therapy. Approval was based on SADAL, a multicenter trial of selinexor monotherapy in patients with DLBCL after two to five systemic regimens. Efficacy was based on independent review committee-assessed objective response rate (ORR) and duration of response using Lugano criteria. In 134 patients treated with the approved dosage (60 mg orally on days 1 and 3 of each week), the ORR was 29% (95% confidence interval, 22-38), with complete response in 13% and with 38% of responses lasting at least 6 months. Gastrointestinal toxicity developed in 80% of patients, hyponatremia in 61%, central neurological toxicity (such as dizziness and mental status changes) in 25%, and ocular toxicity in 18%. New or worsening grade 3 or 4 thrombocytopenia, lymphopenia, neutropenia, anemia, or hyponatremia developed in ≥15%. Adverse reactions led to selinexor dose interruption in 61% of patients, dose reduction in 49%, and permanent discontinuation in 17%, with thrombocytopenia being the leading cause of dose modifications. Postmarketing studies will evaluate reduced dosages of selinexor and further evaluate clinical benefit in patients with relapsed or refractory DLBCL. IMPLICATIONS FOR PRACTICE: Selinexor is a new potential option for adults with relapsed or refractory diffuse large B-cell lymphoma, not otherwise specified, in the third-line setting or beyond. Toxicities are typically manageable but can be difficult to tolerate and necessitate close monitoring and supportive care.

Modeling and improvement of a low-frequency micro-accelerometer

A sensitivity- and resolution-improving method for a low-frequency micro-vibration accelerometer is presented in this paper. A sensitivity model of the measurement system is derived and established. The key parameters that limit the sensitivity and the resolution of the accelerometer were identified through the sensitivity coefficient analysis method. The structural parameters and the signal process method were then optimized. Experimental results show that the sensitivity of the accelerometer has improved from 1.10 V/(m/s²) to 19.21 V/(m/s²), and the resolution has improved from 1.47 mm/s² to 0.21 mm/s². The lowest working frequency range has expanded from 1 Hz to 0.7 Hz. The presented method is effective and cheap and can be applied to other sensors.

[Establishment of nutrition literacy core items for Chinese lactating women]

Objective: To establish the nutrition literacy core items for Chinese lactating women. Methods: The framework system and preliminary items of nutrition literacy were established through literature review and experts consultation. E-Delphi method was used to determine the nutrition literacy items. 11 experts in the field of maternal and child nutrition, obstetrics and gynecology, health education and nutrition and diseases were invited to score the importance of each nutrition literacy item via Email. The judgment basis and familiarity of experts towards the items, active coefficient, authority coefficient and harmony coefficient were evaluated and analyzed to generate the final list of nutrition literacy items. Results: The active coefficients of consultation in two rounds were 81.8% (9/11) and 87.5% (8/9). The authority coefficients were (0.86±0.11) and (0.85±0.06). The average scores of importance were (4.03±1.24) and (4.64±0.50)and the harmony coefficients were 0.556 (χ²=163.42, P<0.001) and 0.40 (χ²=64.41, P<0.001). After the second round of consultation, all selected items met the inclusion criteria. We identified the final list of nutrition literacy items consisting of 3 scales (basic knowledge and concept, lifestyles and dietary behaviors, and basic skills), 10 subscales (basic nutrition concept, food and nutrition knowledge, feeding knowledge, lifestyles, dietary behaviors, feeding behaviors, weight management, complementary food production, acquisition, understanding and application of nutrition information, judgement of nutrition information, and nutrition decision making) with 24 items in total. Conclusions: The framework system and core items of nutrition literacy were established for Chinese lactating women based on E-Delphi method. The experts involved in the consultation process presented a performance with good representativeness, enthusiasm and authority. All experts' opinions are coordinated and unified, which could satisfy the demand of developing nutrition literacy core items for target population.

Role of Model-Informed Drug Development in Pediatric Drug Development, Regulatory Evaluation, and Labeling

The unique challenges in pediatric drug development require efficient and innovative tools. Model-informed drug development (MIDD) offers many powerful tools that have been frequently applied in pediatric drug development. MIDD refers to the application of quantitative models to integrate and leverage existing knowledge to bridge knowledge gaps and facilitate development and decision-making processes. This article discusses the current practices and visions of applying MIDD in pediatric drug development, regulatory evaluation, and labeling, with detailed examples. The application of MIDD in pediatric drug development can be broadly classified into 3 categories: leveraging knowledge for bridging the gap, dose selection and optimization, and informing clinical trial design. In particular, MIDD can provide evidence for the assumption of exposure-response similarity in bridging existing knowledge from reference to target population, support the dose selection and optimization based on the "exposure-matching" principle in the pediatric population, and increase the efficiency and success rate of pediatric trials. In addition, the role of physiologically based pharmacokinetics in drug-drug interaction in children and adolescents and in utilizing ontogeny data to predict pharmacokinetics in neonates and infants has also been illustrated. Moving forward, MIDD should be incorporated into all pediatric drug development programs at every stage to inform clinical trial design and dose selection, with both its strengths and limitations clearly laid out. The accumulated experience and knowledge of MIDD has and will continue to drive regulatory policy development and refinement, which will ultimately improve the consistency and efficiency of pediatric drug development.

[Study on syndromic deafness caused by novel pattern of compound heterozygous variants in the CDH23 gene]

Objective: To explore the pathogenic variants of a family with syndromic deafness by high-throughput sequencing. Methods: The family was from Puyang City, Henan Province, and had four members, including two with syndromic deafness. The proband and his sister had congenital deafness, and their parents had normal phenotypes. The clinical phenotype of the family was characterized using clinical examinations and pedigree analysis. The clinical examinations included imaging examination, audiometry (pure tone audiometry, acoustic immittance, brainstem auditory evoked potential, and otoacoustic emission), vestibular function test, and ophthalmic examination (visual acuity test, visual field test, fundus examination, visual evoked potential, and electroretinogram). Target exome sequencing of 129 known deafness genes and bioinformatics analysis were used to screen suspected pathogenic variants. Sanger sequencing and minigene assay were used to verify and functionally investigate the mutation detected, respectively. According to the standards and guidelines for interpreting genetic variants proposed by the American College of Medical Genetics and Genomics, the variants c.6049G>A and c.8699A>G were classified as pathogenic/likely pathogenic, and the variant c.9856C>G was classified as variants of uncertain significance. Results: The probands and his sister had severe sensorineural hearing loss with decreased binocular vision, night blindness, decreased peripheral visual field sensitivity and partial visual field defect, and normal vestibular function. Both of them had three CDH23 mutations, including CDH23 (NM_022124.5) c.6049G>A (p.Gly2017Ser),c.9856C>G (p.His3286Asp), and c.8699A>G (p. Asp2900Gly), The first two were inherited from the father, and the last one was from the mother. The missense variants c.9856C>G and c.8699A>G were not included in the gnomad database. The missense mutation c.6049G>A was located in the last position of exon 46 and was predicted to affect splicing by bioinformatics software. The minigene experiment showed that the mutation cause exon skipping of exon 46, resulting in an abnormal protein. Conclusions: Compound heterozygous variations of the CDH23 are the leading cause of USH1D in the family. This study confirms that the compound heterozygosity of splicing and missense variants of the CDH23 gene could lead to USH1D.

[Non-occupational post-exposure prophylaxis in men who have sex with men in Guangxi Zhuang Autonomous Region]

Objective: To analyze the effects of HIV non-occupational post-exposure prophylaxis (nPEP) in men who have sex with men (MSM) in Nanning and Liuzhou, Guangxi Zhuang Autonomous Region. Methods: Participants were recruited through community publicity and advocacy under a "Trinity" approach among non-governmental organizations (NGO), CDCs/hospitals and pharmacies. Basic information, drug taking and follow-up tests of participants who had enrolled for 28 days of the research were collected. Descriptive statistics were used for data analysis. Results: From September 2017 to March 2019, a total of 213 MSM cases consulted for nPEP service, 159 of them were eligible for nPEP, and 154 were enrolled in the study for drug taking. For 132 cases enrolled in the study for 28 days and above, 118 completed the 28-day course of antiretroviral therapy (ART), while 10 failed to complete the 28-day course of ART, and 4 could not be confirmed whether completed the full course of ART due to loss of contact. For those who completed 28-day course of ART, 94.1% (111/118) and 75.4% (89/118) respectively received HIV tests at 4-6 weeks and 3 months after exposure, the results were all HIV negative. Conclusion: Under the "Trinity" approach, taking antiviral drugs earlier after HIV non-occupational exposure can effectively reduce the risk of HIV infection and to some extent, reduce the new infection cases.

Knockdown of lncRNA HCP5 protects against cerebral ischemia/reperfusion injury by regulating miR-652-3p

Previous studies have shown that lncRNAs play crucial roles in cerebral ischemia/reperfusion injury. In this study, the function and possible mechanism of lncRNA HCP5 in cerebral ischemia/reperfusion injury was investigated. An oxygen glucose deprivation (OGD) model in N2a cells was used to simulate cerebral ischemia/reperfusion injury in vitro. The functional mechanism of lncRNA HCP5 was detected using Trypan blue staining, JC-1, MTT and dual luciferase reporter assays. The expression of apoptosis-related proteins (Bcl-2 and Bax) was measured by Western blot analysis. We found that lncRNA HCP5 was upregulated in N2a cells treated with OGD/R, and knockdown of lncRNA HCP5 enhanced cell viability and reduced cell death. In addition, miR-652-3p was found to act as a sponge for lncRNA HCP5. The overexpression of miR- 652-3p can prevent cerebral ischemic reperfusion injury, however, lncRNA HCP5 attenuated the protective effect of miR-652-3p in cerebral ischemic reperfusion injury. In conclusion, upregulation of lncRNA HCP5 may exacerbate cerebral ischemic reperfusion injury by sponging miR-652-3p.

A new micro/nano-touch-trigger probe using an optoelectronic sensor with a wedge prism

In this paper, we propose a new touch-trigger probe with high precision and a large permissible measurement range. A wedge prism was used in the sensing unit to achieve 3D detection using only one optoelectronic sensor. The measurement range was expanded from ±8 µm to ±14 µm through the new optical structure. The probe has uniform stiffness and uniform sensitivity. Some experiments were performed to investigate the performance of the probe. It was found that the probe has a resolution of 10 nm and a repeatability of less than 9.1 nm. The applicability of the probe was also verified.

Design and Synthesis of Tetrazole- and Pyridine-Containing Itraconazole Analogs as Potent Angiogenesis Inhibitors

Itraconazole, a widely used antifungal drug, was found to possess antiangiogenic activity and is currently undergoing multiple clinical trials for the treatment of different types of cancer. However, it suffers from extremely low solubility and strong interactions with many drugs through inhibition of CYP3A4, limiting its potential as a new antiangiogenic and anticancer drug. To address these issues, a series of analogs in which the phenyl group is replaced with pyridine or fluorine-substituted benzene was synthesized. Among them the pyridine- and tetrazole-containing compound 24 has significantly improved solubility and reduced CYP3A4 inhibition compared to itraconazole. Similar to itraconazole, compound 24 inhibited the AMPK/mTOR signaling axis and the glycosylation of VEGFR2. It also induced cholesterol accumulation in the endolysosome and demonstrated binding to the sterol-sensing domain of NPC1 in a simulation study. These results suggested that compound 24 may serve as an attractive candidate for the development of a new generation of antiangiogenic drug.

The role of Sigma-1 receptor agonist in hepatic ischemiareperfusion injury

Sigma-1 receptor (Sig-1R) is a ligand-operated protein that modulates activity of various proteins. It is expressed within the endoplasmic reticulum membranes of multiple organs. We examined the role of Sig-1R in hepatic ischemia-reperfusion injury (IRI). We studied IRI indicators in Sig-1R-/- mice and compared them with wild-type controls. In addition, we assessed the influence of Sig-1R agonist, fluvoxamine, on IRI in both types of animals. We found that Sig-1R-/- mice exhibited significantly decreased liver damage after hepatic IRI as compared to wild-type mice. This effect was manifested by decreased serum levels of alanine aminotransferase (AST), aspartate aminotransferase (ALT), myeloperoxidase (MPO), and supernatant level of lactate dehydrogenase (LDH), decreased endothelial glycocalyx shedding indexed by decreased serum levels of heparan sulfate and syndecan-1, slightly improved liver histology and reduced metalloproteinase-9 expression. Furthermore, in comparison to Sig-1R-/- mice, fluvoxamine significantly increased serum levels of AST, ALT, MPO, and LDH in wildtype animals in a dose-dependent manner at 6 h after IRI. Our findings demonstrate that the absence of Sig-1R provides a protective effect during hepatic IRI. Sig-1R-mediated signaling pathways may play distinct roles in IRI in different organs. The dynamic interaction between Sig-1R and other signaling molecules in different organs needs to be examined further.

Discovery of a Potent GLUT Inhibitor from a Library of Rapafucins by Using 3D Microarrays

Glucose transporters play an essential role in cancer cell proliferation and survival and have been pursued as promising cancer drug targets. Using microarrays of a library of new macrocycles known as rapafucins, which were inspired by the natural product rapamycin, we screened for new inhibitors of GLUT1. We identified multiple hits from the rapafucin 3D microarray and confirmed one hit as a bona fide GLUT1 ligand, which we named rapaglutin A (RgA). We demonstrate that RgA is a potent inhibitor of GLUT1 as well as GLUT3 and GLUT4, with an IC₅₀ value of low nanomolar for GLUT1. RgA was found to inhibit glucose uptake, leading to a decrease in cellular ATP synthesis, activation of AMP-dependent kinase, inhibition of mTOR signaling, and induction of cell-cycle arrest and apoptosis in cancer cells. Moreover, RgA was capable of inhibiting tumor xenografts in vivo without obvious side effects. RgA could thus be a new chemical tool to study GLUT function and a promising lead for developing anticancer drugs.

Novel Tetrazole-Containing Analogues of Itraconazole as Potent Antiangiogenic Agents with Reduced Cytochrome P450 3A4 Inhibition

Itraconazole has been found to possess potent antiangiogenic activity, exhibiting promising antitumor activity in several human clinical studies. The wider use of itraconazole in the treatment of cancer, however, has been limited by its potent inhibition of the drug metabolizing enzyme cytochrome P450 3A4 (CYP3A4). In an effort to eliminate the CYP3A4 inhibition while retaining its antiangiogenic activity, we designed and synthesized a series of derivatives in which the 1,2,4-triazole ring is replaced with various azoles and nonazoles. Among these analogues, 15n with tetrazole in place of 1,2,4-triazole exhibited optimal inhibition of human umbilical vein endothelial cell proliferation with an IC₅₀ of 73 nM without a significant effect on CYP3A4 (EC₅₀ > 20 μM). Similar to itraconazole, 15n induced Niemann-Pick C phenotype (NPC phenotype) and blocked AMPK/mechanistic target of rapamycin signaling. These results suggest that 15n is a promising angiogenesis inhibitor that can be used in combination with most other known anticancer drugs.

[Investigation on the normal value of urinary arsenic in healthy people in different areas of Guangxi, China]

Objective: To investigate the upper limit of the normal value of arsenic in healthy adult population in different areas of Guangxi. Methods: From 2015 to 2016, 1533 subjects from 14 counties and cities in Guangxi were collected by age, gender, stratified random sampling and questionnaire survey. 1417 urine samples with satisfactory urine quality and complete information were collected.The content of arsenic in urine was determined by atomic fluorescence spectrometry. Results: The upper limit of normal arsenic in healthy adults in guangxi was 0.053 mg/L. Male urinary arsenicP(50)(0.011mg/L)was higher than that of the female(0.008mg/L), the difference was statistically significant(Z=5.352,P<0.01). Smoking urinary arsenicP(50)(0.012mg/L) was higher than that of nonsmokers(0.009mg/L), the difference was statistically significant(Z=3.404,P<0.01). GroupP(5)0 urine arsenic in coastal areas(0.012mg/L) the crowd was higher than that in non coastal areas(0.009mg/L), the difference was statistically significant(Z=-7.522,P<0.01). Conclusion: The upper limit of normal arsenic in healthy adults in Guangxi area is 0.053mg/L,and there are differences in the levels of arsenic in healthy adults, such as different genders and regions.

[An investigation of normal urinary manganese value in healthy adults in different places in Guangxi, China]

Objective: To investigate the normal urinary manganese value in healthy adults in Guangxi, China and its distribution characteristics. Methods: From 2015 to 2016, stratified random sampling based on age and sex was performed to select 1533 healthy adults aged 18-60 years in Nanning,Liuzhou,Guilin,Hezhou,Wuzhou,Yulin,Guigang,Beihai,Qinzhou,Laibin,Hechi Nandan,Bose Jingxi,Chongzuo Daxin,and Fangchenggang.All of them had no history of occupational manganese exposure or acute or chronic liver/renal diseases and had lived in the local area for more than one year. A total of 1417 urine samples with normal specific gravity and complete data were obtained, and graphite furnace atomic absorption spectrometry was used to measure urinary manganese.The distribution characteristics of urinary manganese level were analyzed among adults with different ages,sexes,or presence or absence of smoking habits or among those who lived or did not live in the mining area. Results: The geometric mean of urinary manganese among healthy adults in Guangxi was 0.52 μg/L,and the upper limit of normal was 5.68μg/L. There was no significant difference in urinary manganese level between the healthy adults with different ages, sexes,or presence or absence of smoking habits (P>0.05).The healthy adults who lived in the mining area of nonferrous metal mines had a significantly higher geometric mean of urinary manganese than those who did not live in such areas(1.65μg/Lvs0.34μg/L,P<0.01). Conclusion: The upper limit of normal of urinary manganese is 5.68 μg/L among healthy adults in Guangxi,and the healthy adults who live in the mining area of manganese mine or nonferrous metal mines have a significantly higher urinary manganese level than those who do not live in such areas.

Diagnosis and treatment of distal limb microcirculatory disturbance caused by steroid injection

Corticosteroid is commonly used for the clinical treatment of pain. It is safe, reliable and a simple procedure with other advantages. However, a possible potential catastrophic complication of corticosteroid injections in distal limbs (e.g., the wrist) is acute radial artery ischemia due to the injection into the radial artery. This may result from spasm attributed to the steroids. While the complication of corticosteroids in the wrist is rare, ischemia of the hand caused by corticosteroid injections in radial artery has been reported in several articles. We treated five patients with microcirculation disturbance of distal limb caused by corticosteroid treatment. Here, we report the two different treatment strategies adopted according to the severity of the disease which achieved good therapeutic effects.

Astemizole Inhibits mTOR Signaling and Angiogenesis by Blocking Cholesterol Trafficking

Cholesterol plays a key role in membrane protein function and signaling in endothelial cells. Thus, disturbing cholesterol trafficking is an effective approach for inhibiting angiogenesis. We recently identified astemizole (AST), an antihistamine drug, as a cholesterol trafficking inhibitor from a phenotypic screen. In this study, we found that AST induced cholesterol accumulation in the lysosome by binding to the sterol-sensing domain of Niemann-Pick disease, type C1 (NPC1), a lysosomal surface protein responsible for cholesterol transport. Inhibition of cholesterol trafficking by AST led to the depletion of membrane cholesterol, causing SREBP1 nuclear localization. The depletion of membrane cholesterol resulted in dissociation of mammalian target of rapamycin (mTOR) from the lysosomal surface and inactivation of mTOR signaling. These effects were effectively rescued by addition of exogenous cholesterol. AST inhibited endothelial cell proliferation, migration and tube formation in a cholesterol-dependent manner. Furthermore, AST inhibited zebrafish angiogenesis in a cholesterol-dependent manner. Together, our data suggest that AST is a new class of NPC1 antagonist that inhibits cholesterol trafficking in endothelial cells and angiogenesis.

Inositol Polyphosphate Multikinase Inhibits Angiogenesis via Inositol Pentakisphosphate-Induced HIF-1α Degradation

RATIONALE

Inositol polyphosphate multikinase (IPMK) and its major product inositol pentakisphosphate (IP5) regulate a variety of cellular functions, but their role in vascular biology remains unexplored.

OBJECTIVE

We have investigated the role of IPMK in regulating angiogenesis.

METHODS AND RESULTS

Deletion of IPMK in fibroblasts induces angiogenesis in both in vitro and in vivo models. IPMK deletion elicits a substantial increase of VEGF (vascular endothelial growth factor), which mediates the regulation of angiogenesis by IPMK. The regulation of VEGF by IPMK requires its catalytic activity. IPMK is predominantly nuclear and regulates gene transcription. However, IPMK does not apparently serve as a transcription factor for VEGF. HIF (hypoxia-inducible factor)-1α is a major determinant of angiogenesis and induces VEGF transcription. IPMK deletion elicits a major enrichment of HIF-1α protein and thus VEGF. HIF-1α is constitutively ubiquitinated by pVHL (von Hippel-Lindau protein) followed by proteasomal degradation under normal conditions. However, HIF-1α is not recognized and ubiquitinated by pVHL in IPMK KO (knockout) cells. IP5 reinstates the interaction of HIF-1α and pVHL. HIF-1α prolyl hydroxylation, which is prerequisite for pVHL recognition, is interrupted in IPMK-deleted cells. IP5 promotes HIF-1α prolyl hydroxylation and thus pVHL-dependent degradation of HIF-1α. Deletion of IPMK in mouse brain increases HIF-1α/VEGF levels and vascularization. The increased VEGF in IPMK KO disrupts blood-brain barrier and enhances brain blood vessel permeability.

CONCLUSIONS

IPMK, via its product IP5, negatively regulates angiogenesis by inhibiting VEGF expression. IP5 acts by enhancing HIF-1α hydroxylation and thus pVHL-dependent degradation of HIF-1α.

[Unilateral patellar resurfacing in bilateral total knee arthroplasty: a randomized controlled study]

OBJECTIVE

To perform unilateral patellar resurfacing and contralateral patellar retention in bilateral total knee arthroplasty (TKA) randomly, and to compare the clinical effects of patellar retention with patellar resurfacing in TKA.

METHODS

In the study, 14 bilateral knee osteoarthritis (OA) patients were randomized in the bilateral TKA to receive unilateral patellar resurfacing and contralateral patellar retention, including 28 knees, all were females, 53 to 78 years old, with average (66.9±7.8) years, and the BMI was (26.3±1.8) kg/m². All subjects were followed up from 3 to 12 months. The clinical effects were evaluated based on measurements of American Knee Society score (KSS), range of motion (ROM), anterior knee pain, patellar clunk, and patellar tilt angle (PTA).

RESULTS

All the wounds healed primarily without significant complications, such as infection, aseptic loosening, patellar fracture and so on. The preoperative KSS scores of patellar resurfacing group were 38.9±22.2, and the scores changed to be 92.4±6.7 after operation, which were added by 53.5±20.3. While in the patellar retention group, the KSS scores were 38.4 ± 20.5 preoperatively, and after operation, which were added to be 92.1±4.2, and improved by 53.7±21.4. The differences in the changed KSS scores between TKA with and without patellar resurfacing were not statistically significant (Independent t-test, P=0.98). The ROM was changed from 95.4°±13.5° preoperatively to 120.4°±8.9° postoperatively in the patellar resurfacing group and from 92.9°±19.1° preoperatively to 120.4±8.4° postoperatively in the patellar retention group. The ROM of the two group were increased by 25.0°±14.5° and 27.5°±19.4° respectively. However, no remarkable differences were observed between the 2 groups in the knee ROM (Independent t-test, P=0.70). At the end of the latest follow-up, 3 knees in the patellar resurfacing group and 2 knees in the patellar retention group had knee anterior pain, the incidences of anterior knee pain were 21.4% and 14.3% respectively. There was no obvious difference for the incidence of post-operative anterior knee pain (Chi-square test, P=0.62). The incidences of post-operative patellar clunk in the 2 groups were all with 3 knees (21.4%), which had no significant difference in the 2 groups (Chi-square test, P=1.00). The post-operative PTA were 2.6°±2.6° in the patellar resurfacing group and 3.6°±2.9° in the patellar retention group, respectively. There was also no statistical difference between the 2 groups (Chi-square test, P=0.36).

CONCLUSION

For knee OA patients with mild or moderate patellar cartilage damage, performing patellar resurfacing or not didn't significantly affect anterior knee pain, patellar clunk, functional outcomes or patellar tracking after TKA. So we suggest retain patella in TKA for OA patients with mild or moderate patellar cartilage damage.

Pharmacological blockade of cholesterol trafficking by cepharanthine in endothelial cells suppresses angiogenesis and tumor growth

Cholesterol is an important modulator of membrane protein function and signaling in endothelial cells, thus making it an emerging target for anti-angiogenic agents. In this study, we employed a phenotypic screen that detects intracellular cholesterol distribution in endothelial cells (HUVEC) and identified 13 existing drugs as cholesterol trafficking inhibitors. Cepharanthine, an approved drug for anti-inflammatory and cancer management use, was amongst the candidates, which was selected for in-depth mechanistic studies to link cholesterol trafficking and angiogenesis. Cepharanthine inhibited the endolysosomal trafficking of free-cholesterol and low-density lipoprotein in HUVEC by binding to Niemann-Pick disease, type C1 (NPC1) protein and increasing the lysosomal pH. The blockade of cholesterol trafficking led to a cholesterol-dependent dissociation of mTOR from the lysosomes and inhibition of its downstream signaling. Cepharanthine inhibited angiogenesis in HUVEC and in zebrafish in a cholesterol-dependent manner. Furthermore, cepharanthine suppressed tumor growth in vivo by inhibiting angiogenesis and it enhanced the antitumor activity of the standard chemotherapy cisplatin in lung and breast cancer xenografts in mice. Altogether, these results strongly support the idea that cholesterol trafficking is a viable drug target for anti-angiogenesis and that the inhibitors identified among existing drugs, such as cepharanthine, could be potential anti-angiogenic and antitumor agents.

Small incision releasing of transverse carpal ligament in diagnosis and treatment of mild carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Few studies have been carried out to examine the effectiveness of mini-open technique for carpal tunnel release using minor wrist skin crease incision in patients with mild CTS. Therefore, the present study was designed to improve the neurophysiological parameters for the diagnosis of mild CTS, and to examine the effectiveness of small incision surgery for the clinical treatment of mild CTS. To this end, we applied the electrophysiological diagnosis of difference between median and ulnar palmar latencies (PMPU) and the difference of median and ulnar latencies from D4 stimulation (D4MD4U) in 80 patients with mild CTS, whom were diagnosed by hand surgeon at the First Hospital of Jilin University. Those patients showed normal in median nerve electrophysiological examination, and received minor wrist skin crease incision surgery. All patients were followed up and received electromyography (EMG) examination. We showed that D4MD4U and PMPU methods are sensitive diagnosis methods for mild CTS, and mini-open wrist crease incision is beneficial for the treatment of mild CTS in clinical settings.

Simultaneous Targeting of NPC1 and VDAC1 by Itraconazole Leads to Synergistic Inhibition of mTOR Signaling and Angiogenesis

The antifungal drug itraconazole was recently found to exhibit potent antiangiogenic activity and has since been repurposed as an investigational anticancer agent. Itraconazole has been shown to exert its antiangiogenic activity through inhibition of the mTOR signaling pathway, but the molecular mechanism of action was unknown. We recently identified the mitochondrial protein VDAC1 as a target of itraconazole and a mediator of its activation of AMPK, an upstream regulator of mTOR. However, VDAC1 could not account for the previously reported inhibition of cholesterol trafficking by itraconazole, which was also demonstrated to lead to mTOR inhibition. In this study, we demonstrate that cholesterol trafficking inhibition by itraconazole is due to direct inhibition of the lysosomal protein NPC1. We further map the binding site of itraconazole to the sterol-sensing domain of NPC1 using mutagenesis, competition with U18666A, and molecular docking. Finally, we demonstrate that simultaneous AMPK activation and cholesterol trafficking inhibition leads to synergistic inhibition of mTOR, endothelial cell proliferation, and angiogenesis.

Regulation of mTORC1 by lysosomal calcium and calmodulin

Blockade of lysosomal calcium release due to lysosomal lipid accumulation has been shown to inhibit mTORC1 signaling. However, the mechanism by which lysosomal calcium regulates mTORC1 has remained undefined. Herein we report that proper lysosomal calcium release through the calcium channel TRPML1 is required for mTORC1 activation. TRPML1 depletion inhibits mTORC1 activity, while overexpression or pharmacologic activation of TRPML1 has the opposite effect. Lysosomal calcium activates mTORC1 by inducing association of calmodulin (CaM) with mTOR. Blocking the interaction between mTOR and CaM by antagonists of CaM significantly inhibits mTORC1 activity. Moreover, CaM is capable of stimulating the kinase activity of mTORC1 in a calcium-dependent manner in vitro. These results reveal that mTOR is a new type of CaM-dependent kinase, and TRPML1, lysosomal calcium and CaM play essential regulatory roles in the mTORC1 signaling pathway.

Structural and biochemical characteristics of chitin-binding protein SeCBP66 from Spodoptera exigua (Hübner)

Peritrophic membrane proteins are important components of the insect peritrophic membrane. A novel cDNA gene encoding a chitin-binding protein, named secbp66, was identified by immunization screening of the cDNA library of Spodoptera exigua. The full length of secbp66 is 1806 bp, which encodes 602 amino acids. The predicted weight of the protein is 64.2 kDa. Bioinformatic analysis showed that a signal peptide composed of 17 amino acids located at the N-terminal of SeCBP66 contained seven tandem putative Type-II functional chitin-binding domains and five potential N-glycosylation sites, but no O-linked glycosylation sites. To study the properties of SeCBP66, recombinant SeCBP66 was successfully expressed in the insect cell line BTI-Tn-5B1-4 with a Bac-to-Bac expression system. A chitin binding experiment showed that the recombinant SeCBP66 protein could bind to chitin strongly. This study of the novel chitin-binding protein SeCBP66 provides a basis for developing new control targets for S. exigua.

Association between the pre-miR-196a2 rs11614913 polymorphism and gastric cancer susceptibility in a Chinese population

We did a case-control study to provide a more comprehensive evaluation of the association of the pre-miR-196a2 rs11614913 polymorphism with gastric cancer. Between January 2013 and December 2014, 182 patients newly diagnosed with primary gastric cancer and 182 control subjects were recruited at Zhengzhou People's Hospital. For SNP genotyping, we used the Assay Designer 3.1 to design the primers of polymerase chain reaction. Using the chi-square test, we found that patients with gastric cancer were more likely to be alcohol drinkers (χ(2) = 4.4, P = 0.04), to have a family history of cancer in the first relatives (χ(2) = 5.29, P = 0.02), and to be infected with Helicobacter pylori (χ(2) = 23.39, P < 0.001). A significant difference in the genotype distributions of rs11614913 was observed in our study (χ(2) = 6.66, P = 0.04). By logistic regression analysis, we found that the CC genotype of rs11614913 was associated with an increased risk of gastric cancer in a codominant model (OR = 2.68, 95%CI = 1.17-6.44). By stratification analysis, we found that the CC genotype was associated with a strongly increased risk of gastric cancer in drinkers when compared with the TT+TC genotype (OR = 5.63, 95%CI = 1.54-30.76). In conclusion, the results of our study suggest an association between the rs11614913 gene polymorphism and an elevated risk of gastric cancer, especially in drinkers.

Association between ERCC5 gene polymorphisms and gastric cancer risk in a Chinese population

We conducted a hospital-based case-control study to investigate the association between 3 common SNPs in the ERCC5 gene (rs1047768, rs751402, and rs17655) and the risk of developing gastric cancer. Between January 2013 and December 2014, samples were collected from 216 gastric cancer patients and 216 control subjects. ERCC5 rs1047768, rs751402, and rs17655 polymorphisms were genotyped by polymerase chain reaction combined with restriction fragment length polymorphism analysis. By conditional logistic regression analysis, the GG genotype of rs17655 was found to be associated with an elevated risk of gastric cancer in a codominant model, and the adjusted OR (95%CI) was 1.96 (1.10-3.50). Moreover, in a dominant model, the CG + GG genotype of rs17655 was correlated with an increased risk of gastric cancer compared to the CC genotype (OR = 1.48; 95%CI = 1.00-2.22). rs1047768 and rs751402 were not significantly correlated with an increased or decreased gastric cancer risk.

Divergence of Antiangiogenic Activity and Hepatotoxicity of Different Stereoisomers of Itraconazole

PURPOSE

Itraconazole is a triazole antifungal drug that has recently been found to inhibit angiogenesis. Itraconazole is a relatively well-tolerated drug but shows hepatotoxicity in a small subset of patients. Itraconazole contains three chiral centers and the commercial itraconazole is composed of four cis-stereoisomers (named IT-A, IT-B, IT-C, and IT-D). We sought to determine whether the stereoisomers of itraconazole might differ in their antiangiogenic activity and hepatotoxicity.

EXPERIMENTAL DESIGN

We assessed in vitro antiangiogenic activity of itraconazole and each stereoisomer using human umbilical vein endothelial cell (HUVEC) proliferation and tube formation assays. We also determined their hepatotoxicity using primary human hepatocytes in vitro and a mouse model in vivo Mouse Matrigel plug and tumor xenograft models were used to evaluate in vivo antiangiogenic and antitumor activities of the stereoisomers.

RESULTS

Of the four stereoisomers contained in commercial itraconazole, we found that IT-A (2S,4R,2'R) and IT-C (2S,4R,2'S) were more potent for inhibition of angiogenesis than IT-B (2R,4S,2'R) and IT-D (2R,4S,2'S). Interestingly, IT-A and IT-B were more hepatotoxic than IT-C and IT-D. In mouse models, IT-C showed more potent antiangiogenic/antitumor activity with lower hepatotoxicity compared with itraconazole and IT-A.

CONCLUSIONS

These results demonstrate the segregation of influence of stereochemistry at different positions of itraconazole on its antiangiogenic activity and hepatotoxicity, with the 2 and 4 positions affecting the former and the 2' position affecting the latter. They also suggest that IT-C may be superior to the racemic mixture of itraconazole as an anticancer drug candidate due to its lower hepatotoxicity and improved antiangiogenic activity. Clin Cancer Res; 22(11); 2709-20. ©2016 AACR.

Role of atrium in automaticity of the sinus node

As the electrical source of hearts, sino-atrial node cells (SANCs) play significant roles in rhythmic firings. Due to the complex structure and function of SANCs, electrical interactions of SAN and its surrounding atrium has not yet been fully understood. The aim of the present study is to investigate effects of coupling conductance between SAN and atrial cells as well as the ectopic beats in atrium on automaticity of the SAN by computer simulation methods. On the basis of a dynamic mathematical single cell model considering the heterogeneity of central and peripheral SANCs, a two-dimensional inhomogeneous tissue slice including SAN and atrium was developed. The operator splitting method was used to integrate the tissue model. The results demonstrated that the coupling conductance between SAN and atrium had effects on the direction of spontaneous action potential conduction in SAN. Weak coupling resulted in a shift of the earliest pacemaker site from central to peripheral SANCs. Additionally, the ectopic beat-induced excitation in atrium was found to be able to enter into and overdrive suppress the automaticity of SAN. Even if the ectopic beat was delivered after the spontaneous firing had started in central SANCs, the spontaneous conduction toward the periphery could also be suppressed by the retrograde activation from the entering atrial depolarization wave. These findings suggested a direct link between sinus node dysfunction and atrial arrhythmias, and therefore were helpful in explaining the role of atrium in sinus node dysfunction.

Tunable deep-subwavelength superscattering using graphene monolayers

In this Letter, we theoretically propose for the first time that graphene monolayers can be used for superscatterer designs. We show that the scattering cross-section of the bare deep-subwavelength dielectric cylinder is markedly enhanced by six orders of magnitude due to the excitation of the first-order resonance of graphene plamons. By utilizing the tunability of the plasmonic resonance through tuning graphene's chemical potential, the graphene superscatterer works in a wide range of frequencies from several terahertz to tens of terahertz.

Single nucleotide polymorphisms in the mitochondrial displacement loop and age-at-onset of non-small cell lung cancer

The associations between single nucleotide polymorphisms (SNPs) in the displacement loop (D-loop) of mitochondrial DNA (mtDNA) and cancer risk and disease outcome have been extensively analyzed. We investigated the association between age-at-onset and SNPs in the mitochondrial D-loop using a population-based series of non-small cell lung cancer (NSCLC) patients. The D-loop region of mtDNA from NSCLC patients was amplified and sequenced. The age-at-onset curve of NSCLC patients was calculated using the Kaplan-Meier method at each SNP site and values were compared using the log-rank test. The SNP sites of nucleotides 200G/A and 16362T/C were identified to determine their association with age-at-onset of NSCLC using the log-rank test. The nucleotide 207G/A was identified for its association with age-at-onset at a borderline significance level (P = 0.060). We found that genetic polymorphisms in the D-loop were predictive markers for age-at-onset in NSCLC patients. Accordingly, the analysis of genetic polymorphisms in the mitochondrial D-loop can be used to identify NSCLC patient subgroups at high risk of early onset.

Inhibition of angiogenesis by selective estrogen receptor modulators through blockade of cholesterol trafficking rather than estrogen receptor antagonism

Selective estrogen receptor modulators (SERM) including tamoxifen are known to inhibit angiogenesis. However, the underlying mechanism, which is independent of their action on the estrogen receptor (ER), has remained largely unknown. In the present study, we found that tamoxifen and other SERM inhibited cholesterol trafficking in endothelial cells, causing a hyper-accumulation of cholesterol in late endosomes/lysosomes. Inhibition of cholesterol trafficking by tamoxifen was accompanied by abnormal subcellular distribution of vascular endothelial growth factor receptor-2 (VEGFR2) and inhibition of the terminal glycosylation of the receptor. Tamoxifen also caused perinuclear positioning of lysosomes, which in turn trapped the mammalian target of rapamycin (mTOR) in the perinuclear region of endothelial cells. Abnormal distribution of VEGFR2 and mTOR and inhibition of VEGFR2 and mTOR activities by tamoxifen were significantly reversed by addition of cholesterol-cyclodextrin complex to the culture media of endothelial cells. Moreover, high concentrations of tamoxifen inhibited endothelial and breast cancer cell proliferation in a cholesterol-dependent, but ER-independent, manner. Together, these results unraveled a previously unrecognized mechanism of angiogenesis inhibition by tamoxifen and other SERM, implicating cholesterol trafficking as an attractive therapeutic target for cancer treatment.

Identification of an old antibiotic clofoctol as a novel activator of unfolded protein response pathways and an inhibitor of prostate cancer

BACKGROUND AND PURPOSE

Finding new indications for existing drugs, also known as drug repositioning or repurposing, is a powerful approach to accelerate drug discovery and development. The unfolded protein response pathways have been proposed to be a viable target for developing new anticancer drugs.

EXPERIMENTAL APPROACH

We screened the Johns Hopkins Drug Library for inhibitors of prostate cancer cell proliferation to identify new antiprostate cancer treatments among known drugs. We systematically investigated the mechanism underlying the anticancer activity of a hit and assessed its efficacy in blocking prostate tumour growth in a mouse model.

KEY RESULTS

The antibacterial drug clofoctol was identified as a novel inhibitor of prostate cancer cell proliferation. Morphologically, cells treated with clofoctol were found to undergo massive vacuolization, reminiscent of endoplasmic reticulum stress. Indeed, all three unfolded protein response pathways including inositol requiring enzyme 1, double-stranded RNA-activated PK-like ER kinase and activating transcription factor 6 were found to be activated by clofoctol. Activation of unfolded protein response pathways by clofoctol led to the inhibition of protein translation in cells and the induction of G1 cell cycle arrest in prostate cancer cells. Clofoctol also inhibited prostate cancer xenograft growth in vivo without apparent toxicity.

CONCLUSION AND IMPLICATIONS

Our findings revealed clofoctol as a novel activator of the unfolded protein response pathways and a promising inhibitor of prostate cancer. As clofoctol has been used in the clinic for years, it is ready for clinical evaluation as a novel antiprostate cancer drug candidate.

Hand and wrist research productivity in journals with high impact factors: a 20 year analysis

Bibliometric analyses, which study trends in research productivity, have not previously been applied to hand and wrist research. This study analyses temporal and geographic trends in hand and wrist research from 1988 to 2007. Original research articles were collected from seven English language journals selected on the basis of impact factor. Research production and quality (level of evidence) were determined by country and global region. Linear regression analysis was used to investigate trends. No significant increase in research volume was observed, but journal impact factors have risen significantly since 1988. Western Europe contributed significantly more high-quality (Level I and II) studies than the United States. Research contributions show a geographical distribution concentrated in the US and Western Europe, but considerable changes in this distribution have occurred. From 1988 to 2007, there was a relative increase in research production from Europe, Latin America and Asia, and a relative decline from the US.

The efficacy of mitochondrial targeting antiresistant epirubicin liposomes in treating resistant leukemia in animals

Background

Multidrug resistance (MDR) of cancers can be circumvented by inducing programmed cell death, which is known as apoptosis. Mitochondria play a crucial role in apoptosis. Mitochondria-specific therapy would provide an efficient strategy for treating resistant cancers.

Design and methods

A strategy was proposed here to overcome MDR by designing cancer mitochondria-specific drug-loaded liposomes, namely, antiresistant epirubicin mitosomes, aimed at treating resistant leukemia by targeting mitochondria. Evaluations were performed on human chronic leukemia K562, MDR K562/ADR cells, and female BALB/c nude mice xenografted with MDR K562/ADR cells. The liposomes were characterized through assays of cytotoxicity, mitochondrial targeting, caspase-9 and caspase-3, antitumor activities, and TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) analysis.

Results

The average size of antiresistant epirubicin mitosomes was in the range of 105–115 nm. Antiresistant epirubicin mitosomes were effective in inhibiting proliferation of MDR K562/ADR cells in vitro and selectively accumulated into the mitochondria. Caspase-9 and caspase-3 activity was increased after applying antiresistant epirubicin mitosomes. In xenografted resistant MDR K562/ADR tumor in nude mice, antiresistant tumor effect of antiresistant epirubicin mitosomes was evidently observed. Apoptotic inducing effects by antiresistant epirubicin mitosomes were noticeably evidenced via mitochondrial pathway.

Conclusions

Antiresistant epirubicin mitosomes had significant inhibitory effect against resistant leukemia in vitro and in vivo, hence providing a promising strategy for improving therapeutic efficacy in resistant human leukemia.

Mitochondrial targeting topotecan-loaded liposomes for treating drug-resistant breast cancer and inhibiting invasive metastases of melanoma

Multidrug resistance and cancer metastases are two obstacles to a successful chemotherapy and metastases are closely associated with drug resistance. Mitochondrial targeting topotecan-loaded liposomes have been developed to overcome this resistance and resistance-related metastases. Investigations were performed on breast cancer MCF-7 and resistant MCF-7/adr cells, MCF-7 and resistant MCF-7/adr tumor spheroids, resistant MCF-7/adr cell xenografts in nude mice, and a naturally resistant B16 melanoma metastatic model in nude mice. The mitochondrial targeting topotecan-loaded liposomes were approximately 64 nm in size, and exhibited the strongest inhibitory effects on MCF-7 cells and resistant MCF-7/adr cells. Mitochondrial targeting effects were demonstrated by co-localization in mitochondria, enhanced drug content in mitochondria, dissipated mitochondrial membrane potential, opening of mitochondrial permeability transition pores, release of cytochrome C, and activation of caspase 9 and 3. The targeting liposomes had a stronger inhibitory effect on the resistant tumor spheroids in vitro, enhanced accumulation in resistant MCF-7/adr cell xenografts in mice, as well as being very effective on resistant MCF-7/adr cell xenografts in mice, and having a marked anti-metastastic effect on the naturally resistant B16 melanoma metastatic model in mice. In conclusion, mitochondrial targeting topotecan-loaded liposomes could be a promising strategy for treating resistant cancers and resistance-related metastases.

Mitochondrial targeting liposomes incorporating daunorubicin and quinacrine for treatment of relapsed breast cancer arising from cancer stem cells

Breast cancer stem cells play a crucial role in the relapse of breast cancers because they are resistant to a standard chemotherapy and the residual cancer stem cells are able to proliferate indefinitely. The objectives of present study were to construct a kind of mitochondrial targeting daunorubicin plus quinacrine liposomes for treating and for preventing the recurrence of breast cancer arising from the cancer stem cells. MCF-7 cancer stem cells were identified as CD44(+)/CD24(-) cells and cultured in free-serum medium. Evaluations were performed on MCF-7 cancer stem cells, MCF-7 cancer stem cell mammospheres, and the relapsed tumor by xenografting MCF-7 cancer stem cells into female NOD/SCID mice. The particle size of mitochondrial targeting daunorubicin plus quinacrine liposomes was approximately 98 nm. The mitochondrial targeting liposomes evidently increased the mitochondrial uptake of drugs, were selectively accumulated into mitochondria, activated the pro-apoptotic Bax protein, dissipated the mitochondrial membrane potential, opened the mitochondrial permeability transition pores, released cytochrome C by translocation, and initiated a cascade of caspase 9 and 3 reactions, thereby inducing apoptosis of MCF-7 cancer stem cells. The mitochondrial targeting liposomes showed the strongest efficacy in treating MCF-7 cancer cells in vitro, in treating MCF-7 cancer stem cells in vitro, and in treating the relapsed tumor in mice. Mitochondrial targeting daunorubicin plus quinacrine liposomes would provide a new strategy for treating and preventing the relapse of breast cancers arising from cancer stem cells.

Clopidogrel 150 vs. 75 mg day(-1) in patients undergoing percutaneous coronary intervention: a meta-analysis

BACKGROUND

Whether an increase in the daily oral maintenance dose of clopidogrel may improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.

OBJECTIVES

This meta-analysis aimed to estimate the relative effect of a 150- vs. 75-mg daily maintenance dosage of clopidogrel on clinical and laboratory end-points in patients undergoing PCI.

METHODS

We searched electronic and printed sources (up to 14 December 2010) for both randomized control trials and observational studies satisfying the predefined inclusion criteria.

RESULTS

We retrieved 12 reports of studies including a total of 23,814 patients. Clopidogrel, 150 mg day(-1), was associated with significant reductions in major adverse cardiac and/or cerebrovascular events (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.48-0.94), myocardial infarction (OR, 0.72; 95% CI, 0.60-0.86), target vessel revascularization (OR, 0.27; 95% CI, 0.12-0.62) and stent thrombosis (OR, 0.64; 95% CI, 0.53-0.77) and decreased adenosine diphosphate-induced maximal platelet aggregation. However, as compared with 75 mg day(-1), the 150-mg daily maintenance dosage significantly increased the risk of minor bleeding (OR, 1.21; 95% CI, 1.08-1.36).

CONCLUSION

As compared with the currently recommended 75-mg day(-1) maintenance dosage of clopidogrel, the 150-mg day(-1) dosage can reduce major adverse cardiac and/or cerebrovascular events but may increase the risk of minor bleeding.

Effects of stealth liposomal daunorubicin plus tamoxifen on the breast cancer and cancer stem cells

PURPOSE

The cancer stem cells play an important role in the invasion, metastasis and relapse of cancers as they are resistant to regular chemotherapy. In the present study, stealth liposomal daunorubicin plus tamoxifen was developed for eradicating breast cancer cells together with cancer stem cells.

METHODS

Inhibitory effects were performed on the bulk human breast cancer cells (MCF-7), the sorted MCF-7 cancer stem-like cells (side population, SP), and the sorted MCF-7 cancer cells (NSP), respectively. Antitumor activity and TUNEL analysis were evaluated on the MCF-7 xenografts in nude mice.

RESULTS

The encapsulation efficiencies of daunorubicin and tamoxifen were 95% and 90%, respectively. The mean particle size of the stealth liposomes was about 100 nm. Breast cancer stem cells were identified by the specific markers CD44+/CD24-, and isolated from bulk MCF-7 cells. When applying stealth liposomal daunorubicin plus tamoxifen, the inhibitory effects on both the breast cancer cells and the cancer stem cells were significantly increased in vitro, respectively. In the MCF-7 xenografts in mice, stealth liposomal daunorubicin plus tamoxifen showed the most favorable antitumor activity due to the passive targeting the tumor tissue and the synergistic effects in eliminating breast cancer cells and cancer stem cells.

CONCLUSION

Stealth liposomal daunorubicin plus tamoxifen could have the potentials in eliminating both breast cancer cells and cancer stem cells.