Novel LIPA-Targeted Therapy for Treating Ovarian Cancer

Ovarian cancer (OCa) is the most lethal form of gynecologic cancer, and the tumor heterogeneities at the molecular, cellular, and tissue levels fuel tumor resistance to standard therapies and pose a substantial clinical challenge. Here, we tested the hypothesis that the heightened basal endoplasmic reticulum stress (ERS) observed in OCa represents an exploitable vulnerability and may overcome tumor heterogeneity. Our recent studies identified LIPA as a novel target to induce ERS in cancer cells using the small molecule ERX-41. However, the role of LIPA and theutility of ERX-41 to treat OCa remain unknown. Expression analysis using the TNMplot web tool, TCGA data sets, and immunohistochemistry analysis using a tumor tissue array showed that LIPA is highly expressed in OCa tissues, compared to normal tissues. ERX-41 treatment significantly reduced the cell viability and colony formation ability and promoted the apoptosis of OCa cells. Mechanistic studies revealed a robust and consistent induction of ERS markers, including CHOP, elF2α, PERK, and ATF4, upon ERX-41 treatment. In xenograft and PDX studies, ERX-41 treatment resulted in a significant reduction in tumor growth. Collectively, our results suggest that ERX-41 is a novel therapeutic agent that targets the LIPA with a unique mechanism of ERS induction, which could be exploited to treat heterogeneity in OCa.

Upper airway resistance syndrome 2018: non-hypoxic sleep-disordered breathing

INTRODUCTION

Upper airway resistance syndrome (UARS) as obstructive sleep apnea syndrome (OSAS) has been described as abnormal breathing during sleep, based on the recording technologies and knowledge of the time. These terms have advanced the field, but are they still useful? Area Covered: Historically, the definition of UARS syndrome was aimed at recognizing pathology not covered by 'OSAS' and to prompt specialists to go further than the obvious. It aimed at pushing specialists to recognize pathologies earlier and to elicit research in the developmental features of sleep-disordered-breathing (SDB). The technology used to monitor SDB changed over-time, allowing recognition of SDB differently but not necessarily better. Expert Commentary: Currently, we have a better understanding of the development of SDB, and its evolution with aging, leading to co-morbid-OSA. However, the real issue is to recognize the problems much earlier, and to understand what can be done to prevent its development. The notions of OSA, UARS, apnea hypopnea index are only historical. There is enough knowledge to date to go beyond these definitions, to recognize problems differently and to lead to the prevention of the factors leading to SDB. The recognition of non-hypoxic sleep-disordered breathing is a step in this direction.

Chronic Low Dose Growth Hormone Treatment Stimulates Both Hypertrophy and Hyperplasia of Remnant Kidneys in Uraemic Rats

CONCLUSION

In conclusion, low doses of exogenous rhGH, when administered in a manner similar to clinical practice, are associated with glomerular enlargement and stimulation of hypertrophy and hyperplasia of remnant kidneys from uraemic rats. Increased GV was also seen after short term, high dose rhGH therapy in our previous study.([4]) The time interval required before increased GV develops with low dose rhGH therapy and whether or not further rhGH exposure subsequently leads to worsening glomerular hypertrophy, glomerulosclerosis([7]) and renal failure cannot be determined from the current study. Although we observed no significant changes in renal function with rhGH therapy, we recommend that children with CRI be carefully monitored to ensure that long term rhGH treatment has no such deleterious effects.

T-lymphocyte subsets in nephrotic syndrome

T-lymphocyte subsets when measured in steroid responsive nephrotic syndrome (SRNS) have demonstrated significant variance from normal values. T-cell subsets were studied by using two-color flow cytometric analysis in 32 children (9.2 +/- 5 years of age) with SRNS. The children were divided into four groups: a) SRNS in acute relapse, on prednisone; b) SRNS in acute relapse, off prednisone; c) SRNS in long-term remission, off prednisone (nephrotic controls); d) patients in remission on long-term prednisone therapy; and e) 15 age-matched normal controls. Children suffering an acute relapse of SRNS showed an increase in Leu2a+/DR+ (CD8) activated lymphocytes (P less than 0.05), a decrease in Leu4a+ total T-lymphocytes (P = 0.01) and a decrease in Leu3a+ (CD4) helper T-cells (P less than 0.05) when compared to normal controls and nephrotic controls. Though some subset changes may represent a prednisone effect and the functional role of these lymphocytes in the disease process is unknown, this study provides additional evidence to support a role for abnormal T-cell subsets in the etiology of SRNS.

Effect of growth hormone on kidney growth and glomerular structure

The effect of growth hormones (GH) on renal growth was measured in growing uremic rats using a five-sixths nephrectomy model and GH, 5 mg/kg per day. At the end of 8 weeks, somatic size was significantly smaller in the untreated uremic rats. The uremic rats given GH were the same size as the non-uremic control animals. Organ size (heart, liver and kidney) differed in that only untreated uremic animals had a significantly smaller kidney weight. Despite a five-sixths nephrectomy, the uremic animals receiving GH had kidneys the same size as sham-operated control animals. Renal function was not changed by GH therapy in either control or uremic animals. DNA content expressed as milligrams per kilogram kidney tissue was low only in the untreated uremic rats. Glomerular volume and proximal tubular area were elevated in both groups of uremic animals but were elevated to a significantly greater degree in those receiving GH. GH given in large doses to growing animals appears to induce both somatic and renal growth.

Increased circulating concentration of the N-terminus of the atrial natriuretic factor prohormone in persons with pheochromocytomas

To investigate the possible relationship of hypertension and the N-terminus of the atrial natriuretic factor (ANF) prohormone which contains two peptides [i.e. pro ANF-(1-30) and pro-ANF-(31-67)] with blood pressure-lowering effects, we examined the circulating levels of the N-terminus of the ANF prohormone in three patients with pheochromocytomas before surgery, during an increase in their blood pressure with surgical manipulation of their tumors, and after surgery when their blood pressures returned to normal. The circulating levels of the whole N-terminus [amino acids 1-98; pro-ANF-(1-98)] and pro-ANF-(31-67) from the midportion of the N-terminus of the ANF prohormone were increased 2-fold in patients with both extraadrenal and intraadrenal pheochromocytomas. In both the intraadrenal and extraadrenal patients N-terminus [pro-ANF-(1-98)] and pro-ANF-(31-67) circulating levels increased further during surgical manipulation and returned to normal after surgical removal of their respective tumors. Each of these pheochromocytomas was found to have pro-ANF-(1-30) and -(31-67)-binding sites that were functional, since they could enhance the guanylate cyclase-cGMP system 2-fold in these pheochromocytomas. The entire 126 amino acids of the prohormone were present within each of the pheochromocytomas, since both the whole N-terminus and C-terminus (i.e. ANF) of the prohormone were present. Examination of the pheochromocytomas by electron microscopy revealed electron-dense granules similar to those in the heart, which have been associated with the synthesis and storage of the ANF prohormone. We conclude that 1) the whole N-terminus [pro-ANF-(1-98)] and pro-ANF-(31-67) of the ANF prohormone circulate at higher concentrations in persons with pheochromocytomas and return to normal with removal of the tumors; 2) pheochromocytomas contain specific binding sites for pro-ANF-(1-30) and -(31-67); 3) these binding sites are functional, since pro-ANF-(1-30) and -(31-67) could enhance the enzyme guanylate cyclase within these tumors; and 4) the entire 126 amino acids of the ANF prohormone are present within these tumors, which have electron-dense granules associated with polypeptide hormone synthesis, suggesting that the ANF prohormone is being synthesized within the pheochromocytomas.

Parenteral nutrition, and fluid and electrolyte therapy

The provision of fluid and electrolytes during parenteral nutrition can be a challenge in the malnourished child or the child with complicating illnesses. The practitioner using the basic concepts of maintenance and deficit therapy--in this case for calories--must adapt his or her therapy to the expansion of the intracellular as well as the extracellular fluid compartment. Impairment of other organ systems further complicates the ability to deliver therapy. Careful monitoring and individually tailored solution will provide adequate caloric fluid and electrolyte therapy during parenteral nutrition in children.

Localization of adrenal and extra-adrenal pheochromocytomas by magnetic resonance imaging

We found magnetic resonance imaging helpful in the localization of both an adrenal and an extra-adrenal pheochromocytoma, since these tumors produced a high-intensity "light bulb" image. MRI is an excellent method for localizing pheochromocytomas because it detects adrenal and extra-adrenal pheochromocytomas missed by computerized tomography and adrenal-renal ultrasonography, and because the high-intensity MRI signal generated by pheochromocytomas is useful in differentiating them from nonfunctioning adrenal masses in hypertensive patients.

Increased circulating concentration of atrial natriuretic factor in persons with pheochromocytomas

To investigate the possible relationship of atrial natriuretic factor (ANF) to hypertension, we examined the circulating levels of ANF in 3 patients with pheochromocytomas before surgery, during increase of their blood pressure with surgical manipulation of their tumors, and after surgery when their blood pressures returned to normal. The circulating levels of ANF were increased 2-fold in patients with both extra-adrenal and intra-adrenal pheochromocytomas. In both the intra-adrenal and extra-adrenal patients their ANF levels increased further during surgical manipulation and returned to normal after surgical removal of their respective tumors. Each of these pheochromocytomas was examined and found to have atrial natriuretic receptors that were functional since ANF could enhance the guanylate cyclase - cyclic GMP system two-fold in these pheochromocytomas. We conclude that ANF circulates at higher concentrations in persons with pheochromocytomas and returns to normal with removal of the tumor. In addition, pheochromocytomas contain specific ANF receptors and ANF itself within these tumors.

Cryptococcal peritonitis in patients on peritoneal dialysis

Peritonitis is an unusual complication of infections caused by Cryptococcus neoformans and has rarely been reported in patients with end-stage renal disease who are maintained on peritoneal dialysis. We report two patients on chronic peritoneal dialysis in whom the first known manifestation of cryptococcal infection was dialysate cultures positive for Cryptococcus neoformans. One patient was on prednisone for systemic lupus erythematosis. The other patient was severely malnourished with type I diabetes mellitus. Both patients were found to have cryptococcal meningitis. Both patients were treated with intravenous (IV) amphotericin B and removal of the dialysis catheter. Evaluation and care of peritoneal dialysis patients with cryptococcal peritonitis include serial cryptococcal cultures and antigen titers, investigation for cryptococcal meningitis, removal of the peritoneal dialysis catheter, and IV amphotericin B.

Identifying psychiatric disorders in children with renal disease

We gave a structured diagnostic interview to determine what psychiatric disorders were present in 15 children aged 8 to 16 years who had renal disease; eight of the children had end-stage renal disease, and the seven children in the control group had mild renal disease. We calculated the psychiatric disorders diagnosed, and compared the results between the two groups. Depression was the most common psychiatric disorder in the children with end-stage renal disease (N = 5), while anxiety disorders were the most common psychiatric problem in the group having mild renal disease (N = 4). We discuss possible explanations for the psychiatric disorders in each group, as well as future research directions.

Thrombotic thrombocytopenic purpura in an asplenic patient with hereditary spherocytosis: failure of plasmapheresis, antiplatelet therapy, and corticosteroids

Thrombotic thrombocytopenic purpura (TTP) is a severe multisystem disorder characterized by microangiopathic hemolysis, central nervous system and renal dysfunction, and a very poor prognosis. Recently, however, plasma exchange or infusion therapy has proven effective in the majority of patients with TTP. We report a patient who developed TTP several years after splenectomy for hereditary spherocytosis. Despite aggressive therapy with plasmapheresis (PP), plasma infusion, antiplatelet drugs, and corticosteroids, the patient had progression of TTP that eventually resulted in his death. The occurrence of TTP in an asplenic patient with an intrinsic red cell disorder, a previously unreported association, may predict a poor prognosis.

The effect of Medicaid criteria on pediatric emergency department visits

The use of the emergency department by children on Medicaid was documented, and the effect of new adult Medicaid criteria on a pediatric emergency department was investigated. Eight percent of daytime visits by all patients were nonemergencies, compared to 15% by Medicaid patients. More Medicaid patients required admission than other children (16% v 10%) seen in the emergency department. Emergency department use by Medicaid patients was not decreased by the new criteria. Documentation of inappropriate denials of emergency care when criteria designed for adults were applied to pediatric patients was presented to state health officials and resulted in a change in the state Medicaid criteria for emergency care of children.

Paroxysmal nocturnal hemoglobinuria presenting as recurrent hemolytic uremic syndrome

Paroxysmal nocturnal hemoglobinuria (PNH) may present with acute anemia, thrombocytopenia and, if hemoglobin nephropathy or dehydration is present, azotemia. Thus PNH may be confused with the hemolytic uremic syndrome (HUS). Recurrent episodes, though common in PNH, are unusual in HUS. A positive acid hemolysis test can be used to differentiate between the two diseases.

Analysis of peritoneal fluid in urinary ascites

Urinary ascites may be the most common cause of ascites in the neonate, and should be suspected in an infant with abdominal distention, oliguria, hyponatremia, and hyperkalemia. The diagnosis is confirmed when analysis of the peritoneal fluid shows creatinine, urea, and potassium concentrations higher than corresponding serum concentrations. The establishment of adequate urinary drainage by catheterization of the bladder or nephrostomy rapidly corrects electrolyte abnormalities.

Fanconi syndrome in a patient with a variant of isovaleric acidemia

Fanconi syndrome with proximal renal tubular acidosis is caused by a variety of anatomic, functional and metabolic disorders. We report a patient with a variant of isovaleric acidosis who developed proximal tubular acidosis. This patient was able to acidify the urine during metabolic acidosis, developed a hyperchloremic metabolic acidosis, and needed 24 mEq/kg/day of bicarbonate to maintain normal serum bicarbonate. She had a FE Bicarbonate of 12 +/- 4% during bicarbonate infusion. Isovaleric acidosis may be another toxic cause of proximal RTA.

Ureteropelvic junction obstruction presenting with recurrent abdominal pain: diagnosis by ultrasound

Three cases of ureteropelvic junction obstruction are presented in which the only symptom was recurrent abdominal pain. Results of physical examination and urinalysis were normal. Ultrasound established the correct diagnosis in the two patients in whom it was performed. Because it is safe, involves no radiation exposure, and is useful in evaluating the gallbladder, pancrease, and liver, as well as both kidneys, abdominal ultrasound should be performed prior to contrast radiography in the evaluation of children with recurrent abdominal pain.

Compensatory growth in infants with severe failure to thrive

We studied compensatory growth and caloric intake during an accelerated growth period of ten infants with severe failure to thrive (FTT). The mean age at diagnosis was 7.1 months (range 1.5 to 16.0 months). The average percentage of normal weight for age in this group was 54.9%, mean length was 58 cm (86% normal for age), and the mean head circumference was 39.7 cm (92% normal for age). Compensatory growth rebound was completed after 6.2 months (range 3.5 to 9.0 months). Minimal calorie counts during peak rate of growth averaged 187 kcal/kg/day (range 147 to 213). The final group average percentage of normal weight for age was 95.5%, an increase of 40%. The group of rebounding infants gained 31 gm/day. The group's length increased to 94% of that expected for age and head circumference to 98% of that expected for age. Like malnourished infants, these with FTT had compensatory growth when managed with ad libitum caloric intake equal to twice the expected intake.

Response to pneumococcal vaccine in renal allograft recipients

Pneumococcal vaccine, 14-valent, was administered to 75 stable adult renal transplant patients on maintenance immunosuppression. 32 had undergone splenectomy prior to transplantation and 43 had not. Functional opsonizing antibody was measured by chemiluminescence methodology for types 12F and 14, contained in the vaccine, and for type 5, a control strain. Serum was examined prior to and at 1 and 6 months after vaccine injection. 33, 71, and 35% of transplant patients had preexisting antibody to types 5, 12F, and 14, respectively, as compared to 58, 87, and 68% of controls. No differences were observed in nonsplenectomized versus splenectomized patients. Following immunization, 59 and 76% of antibody-negative patients converted to positive for pneumococcus type 12F and 14. These included 70 and 70% for nonsplenectomized patients as compared to 50 and 84% for those splenectomized. Vaccination did not result in the production of opsonizing antibody for the related type 5 pneumococcus. Pneumococcal vaccine generates functional antibody and is safe in renal transplant patients.

Efficacy of metolazone and furosemide in children with furosemide-resistant edema

The effect of a combination of metolazone (0.2 to 0.4 mg/kg/d) and furosemide (2 to 4 mg/kg/d) in achieving a natriuresis and diuresis was measured in 14 children during 22 episodes of edema resistant to furosemide alone. Urinary volume increased from 24 +/- 14 mL/kg/d for patients receiving furosemide to 51 mL/kg/d with combined diuretic therapy (P less than .01), and sodium excretion increased from 34 +/- 5 mEq/d to 155 +/- 176 mEq/d (P less than .01). Two children with severe hypoalbuminemia (serum albumin level less than 1.5 g/dL) and normal renal function, and five children with chronic renal insufficiency (71%) did not respond to combined diuretic therapy. The combination of furosemide and metolazone offers a useful and effective oral therapy in most children with edema resistant to furosemide. Children with chronic renal insufficiency and furosemide-resistant edema did not respond to combination diuretic therapy.

Effects of caloric supplementation on growth in children with uremia

Growth and nutritional status were evaluated in 12 children with chronic renal insufficiency over a 2-year period. During 1 year the children received nutritional counseling but no caloric supplement; during year 2, they received both nutritional counseling and caloric supplementation. With caloric supplementation, food intake as a percent of normal increased from 73 to 103% and the rate of growth increased from 59 to 90% of expected. The deviation from normal for height, as measured by SD scores, did not improve during the period of supplementation, that is, there was no accelerated or compensatory growth. During the unsupplemented period growth rate, as percent normal, correlated with energy intake as percent normal (r = 0.68). Growth rate and energy intake did not correlate during the period of caloric supplementation. Anthropometric measurements and plasma albumin increased during the period of supplementation, but other indices of body protein mass did not change. Plasma lipid levels also rose with caloric supplementation. We interpret these findings as evidence that dietary energy deficiency exists in many children with chronic renal insufficiency and contributes to their poor growth. Caloric supplementation in children improves total energy intake, growth rate, and skinfold thickness, but it does not lead to accelerated or compensatory growth.

Renovascular hypertension in an infant with segmental renal artery stenosis and hypoplasia of the abdominal aorta

Hypoplasia of the abdominal aorta is a rare cause of renovascular hypertension. Arteriographic studies of the renal vasculature are presented from an infant with hypoplasia of the abdominal aorta and segmental renal artery stenosis. The renovascular hypertension was cured by partial nephrectomy. There was no difference in the parenchymal histology in the tissue from the congenitally ischemic lower pole of the kidney and the vascularized upper pole. In this unique case with decreased renal blood flow during fetal development there was no evidence that parenchymal ischemia can cause renal parenchymal hypoplasia.

Somatomedin in children with chronic renal insufficiency - relationship to growth rate and energy intake

The relationship of energy intake, growth rate and serum concentration of somatomedin-A was evaluated in eighteen children with chronic renal insufficiency. Serum concentrations of somatomedin-A were found to be 0.84 micro/ml in normal children and were elevated to 3.06 micro/ml in children with chronic renal insufficiency prior to dialysis (p less than 0.01). Somatomedin-A concentrations increased during chronic hemodialysis to 5.81 micro/ml and decreased to 1.59 micro/ml following successful renal transplantation (p less than 0.01). Serum concentrations of somatomedin-A correlated with residual glomerular filtration rates (r = -0.5), serum creatinine concentration (r = 0.59), and blood urea nitrogen (r = 0.6). Growth rates correlated with energy intake (r = 0.58) and somatomedin-A concentrations (r = 0.4) in the children with chronic renal insufficiency. Both energy intake and somatomedin-A increased significantly after one year of nutritional supplementation. Our findings are consistent with the hypothesis that somatomedin, like other polypeptide hormones, is elevated in uremia and that increased energy intake may affect the growth of children with chronic renal insufficiency by increasing somatomedin levels.

Chronic camphor ingestion mimicking Reye's syndrome

Camphor is a potentially dangerous drug which nevertheless remains popular as a home remedy. Because of its hepatoneurotoxic effects, camphor toxicity may clinically mimic Reye's syndrome. The differentiation between the two requires histologic examination of liver tissue, further emphasizing the need for a liver biopsy to establish the diagnosis of Reye's syndrome.

Use of urinary indexes in renal failure in the newborn

Causes of renal failure and urinary indexes were recorded in 45 neonates with oliguria and uremia. Twenty (44%) had ischemic renal damage; nine of these infants recovered and 11 died. Eight infants (18%) had various other causes of renal insufficiency. Determination of serum BUN or creatinine concentrations did not differentiate between these groups. Fractional excretion of sodium (FENa) and renal failure index (RFI) determined on serum and first-voided urine samples were statistically different between the neonates with prerenal uremia and the neonates with ischemic renal damage, although there was overlap between the groups. A neonate with an FENa less than 2.5% and an RFI less than 2.5 is said to have prerenal uremia. An FENa greater than 2.5% or an RFI greater than 2.5 in a neonate suggests ischemic renal disease; however, some neonates with prerenal uremia may have values in this range.

In vitro suppression of insulin-mediated amino acid uptake in uremic skeletal muscle

Resistance to insulin-mediated glucose uptake is well documented in uremia. We have previously reported that in vivo resistance to insulin mediated amino acid uptake is present in the skeletal muscle of acutely uremic rats. This report compares the effect of insulin on in vitro 14C alpha-amino isobutyric acid and cycloleucine uptake by skeletal muscle from uremic and control rats. Intracellular accumulation of 14C alpha-amino isobutyric acid were normal in the diaphragm and epitrochlear muscle of acutely uremic rats in the absence of insulin. However, insulin failed to further stimulate amino acid uptake in both tissues. Insulin also failed to stimulate cellular uptake of cycloleucine in skeletal muscle from acutely uremic animals. Resistance to insulin-mediated amino acid uptake was evident in rats with chronic uremia. This resistance to insulin mediated increases in intracellular amino acid concentration may contribute to the abnormal depression in protein synthesis or the exaggerated gluconeogenesis and alanine turnover seen in uremia.

Tissue resistance to insulin stimulation of amino acid uptake in acutely uremic rats

Peripheral tissue resistance to insulin-mediated glucose uptake occurs in uremia. A similar resistance also may exist to insulin-mediated amino acid uptake. The present study examined the effect of insulin on the uptake or distribution ratios (DR) of alpha-aminoisobutyric acid (AIBA) attained in the tissues of rats made acutely uremic by bilateral nephrectomy. Both uremic and control rats concentrated equally AIBA in the gastrocnemius muscle in the absence of insulin (DR = 2.82 +/- 0.39 in controls, 2.52 +/- 0.40 in uremics). Compared to control rats, the diaphragm and liver of uremic rats, in the absence of insulin, had higher concentrations of AIBA. Insulin had the expected effect of increasing the uptake in the gastrocnemius, diaphragm, and liver of control rats but had no effect on uptake in the gastrocnemius muscle of uremic rats (DR = 5.82 +/- 0.78 in controls, 3.07 +/- 0.60 in uremics). The effect of insulin on the distribution ratio of AIBA in diaphragm and liver or uremic rats was less than it was in control rats. Uremia is associated with inhibition of insulin-mediated amino acid uptake as well as peripheral resistance to glucose utilization.

Growth impairment with elevated somatomedin levels in children with chronic renal insufficiency

In children with chronic renal insufficiency serum levels of somatomedin measured by radioreceptor assay were found to be strikingly elevated and were in the same range as in acromegaly in spite of decreased growth. The serum somatomedin level was inversely correlated with renal function and children on haemodialysis had the highest values. The elevated somatomedin was most likely due to progressive destruction of the kidney, the primary catabolic site for somatomedin and other polypeptides. After successful transplantation the somatomedin values fell to slightly above normal even though growth was still impaired. Using a bioassay based on the mitogenic property of somatomedin, a lower than normal rather than an increased level was found in chronic renal insufficiency suggesting that in uraemia an inhibitor to somatomedin bioactivity was present. It is concluded that the cause of the growth failure in chronic renal insufficiency and after transplantation is not due to a lack of somatomedin, but an inhibitor to its action could be a factor. It would appear that a normal somatomedin may be necessary for normal growth, but it is not sufficient.