Cross-talk between different enhancer elements during mitogenic induction of the human stromelysin-1 gene

Platelet-derived growth factor (PDGF) induces the expression of human stromelysin-1, a matrix metalloproteinase involved in tumor invasion and metastasis. Here it is shown that stromelysin-1 gene induction by PDGF depends on Ras and involves three previously identified promoter elements (the stromelysin-1 PDGF-responsive element (SPRE) site, the two head-to-head polyomavirus enhancer A-binding protein-3 (PEA3) sites, and the activator protein-1 (AP-1) binding site). During mitogenic induction, these responsive elements appear to be organized in two independent transcriptional units, SPRE-AP-1 and PEA3-AP-1, which result from specific element cross-talking. Interestingly, expression of a dominant negative mutant of Raf-1 significantly interfered with the induction through PEA3-AP-1 but not with that operating through SPRE-AP-1. Conversely, only the induction operating through SPRE-AP-1 was affected significantly by the expression of a dominant negative mutant of the atypical lambda/iota protein kinase C (lambda/iotaPKC). These data strongly suggest that the signal triggered by PDGF flows through Ras and bifurcates toward two distinct pathways, one operating through Raf and involving PEA3-AP-1 and the other one Raf-independent, operating through lambda/iotaPKC and SPRE-AP-1. Furthermore, we present evidence suggesting that the novel SPRE-binding transcription factor SPBP cross-couples with c-Jun to transactivate the SPRE site.

Doxazosin in physiologically and pharmacologically normotensive men with benign prostatic hyperplasia

OBJECTIVES

To compare the effects of doxazosin on blood pressure when used for the treatment of benign prostatic hyperplasia (BPH) in men who are either physiologically or pharmacologically normotensive.

METHODS

Sixty-three men with BPH were enrolled in two open-label, parallel, randomized studies. Thirty-one were physiologically normotensive and 32 had hypertension controlled by antihypertensive therapy (pharmacologically normotensive). Of these, 17 were taking calcium channel blockers; 6, angiotensin-converting enzyme inhibitors; and 9, beta blockers. After a 3-week titration period, patients from one study received doxazosin (4 mg/day) for 3 months, given as a single dose in either the morning or evening, and in the second study patients were randomized to receive either 4 mg or 8 mg daily, either in the morning or evening. Effects on blood pressure, maximum uroflow, and the Boyarsky symptom score were measured.

RESULTS

Doxazosin produced statistically significant but clinically unimportant reductions in blood pressure in both physiologically and pharmacologically normotensive groups. Statistically and clinically significant improvements in BPH symptoms and maximal perfusion occurred in both groups within 1 month, and further improvements were improved after 3 months. These effects were evident whether doxazosin was administered in the morning or evening. Doxazosin was well tolerated, the only adverse events being dizziness in 5 patients and fatigue in 4. By protocol, all patients reporting adverse events were required to be discontinued from the study. Adverse events did not differ between the groups. There was some indication that patients experiencing adverse events also experienced greater reductions in blood pressure.

CONCLUSIONS

Doxazosin may be introduced for the treatment of BPH in hypertensive men whose blood pressure is already controlled by another antihypertensive agent, without a further clinical reduction in blood pressure. It is effective and well tolerated as a once-daily dose given in the morning or evening.

Protein kinase C-independent expression of stromelysin by platelet-derived growth factor, ras oncogene, and phosphatidylcholine-hydrolyzing phospholipase C

Changes in the expression of several genes play critical roles in cell growth and tumor transformation. A number of proteases are increased in some tumors, and the level of these enzymes correlates with the metastatic potential of several cancer cell lines. Stromelysin, with the widest substrate specificity, can degrade the extracellular matrix conferring metastatic potential to tumor cells. The mechanisms whereby growth factors and oncogenes control the expression of stromelysin are beginning to be characterized. In the study shown here we also identify a region in the stromelysin promoter which is involved in the induction of stromelysin in response to platelet-derived growth factor, phosphatidylcholine-hydrolyzing phospholipase C, and ras oncogene. Our results are consistent with the notion that platelet-derived growth factor/phosphatidylcholine-hydrolyzing phospholipase C induces stromelysin gene expression through a phorbol myristate acetate/protein kinase C-independent mechanism by acting through elements in the stromelysin promoter distinct from the 12-O-tetradecanoylphorbol-13-acetate-responsive element.

Early clinical effect of cladribine in patients with highly active multiple sclerosis in Mexico

Background

Cladribine shows efficacy in multiple sclerosis (MS), but Latin American (LATAM) real-world data is limited, despite potential sociodemographic variations.

Objective

Investigate baseline characteristics and clinical response in highly active MS patients in Mexico, identifying predictors of early treatment response.

Method

A multicenter cohort study analyzed retrospective data from individuals with "highly active" MS in the Cladribine Patient Support Program across 11 Mexican clinics. Criteria included one-year prior treatment with another disease-modifying treatment and recent relapse with specific MRI findings. Primary outcomes focused on achieving NEDA-3 status after 12 months.

Results

In the follow-up, 67.5% maintained NEDA-3 status. Baseline EDSS scores decreased significantly from 1.50 to 1.00 (p = 0.011), with no confirmed disability worsening. No significant differences were observed between NEDA-3 achievers and non-achievers in demographic and clinical variables. No severe adverse events were reported.

Conclusion

Cladribine showed early and effective control of active MS in Mexican patients, demonstrating a secure profile with minimal adverse events. This study provides valuable real-world evidence in the LATAM context.

[Adequacy of the pharmacologic treatment to the recommendations of a performance protocol in hypercholesterolemia in primary care]

OBJECTIVE

To evaluate whether hypolipaemiant treatment in patients with hypercholesterolaemia (HC) corresponds to the recommendations in a primary care diagnosis and treatment protocol.

DESIGN

Descriptive observational study.

SETTING

Primary care centre.

PATIENTS

304 patients whose long-term prescription records recorded hypolipaemiant drugs.

RESULTS

Average age was 62.7 and 198 were women. 176 presented simple HC and 125 mixed dyslipaemia. 46 had a history of ischaemic cardiopathy. Pre-treatment LDL-cholesterol (LDL-c) was recorded for 224; 168 of them had 2 or more cardiovascular risk factors. Of the 202 who had a record of post-treatment LDL-c, 163 were at level III of risk, which went down to 47 at 6 months. The values before and after medication were as follows: total cholesterol (TC) 290.3 mg/dl and 246.2 mg/dl; LDL-c 207.8 mg/dl and 166.0 mg/dl; HDL-cholesterol 50.5 mg/dl and 53.1 mg/dl; and triglycerides (TG) 156.1 mg/dl and 133.6 mg/dl. Mean reduction of TC and LDL-c was greater in the patients treated with statins that in those treated with fibrates. Decrease in TG was greater with fibrates.

CONCLUSIONS

Treatment was initiated when LDL-c figures were over the limit specified in the protocol. In most cases this was because of the accumulation of cardiovascular risk factors.