Mithramycin delivery systems to develop effective therapies in sarcomas.

BACKGROUND: Sarcomas comprise a group of aggressive malignancies with very little treatment options beyond standard chemotherapy. Reposition of approved drugs represents an attractive approach to identify effective therapeutic compounds. One example is mithramycin (MTM), a natural antibiotic which has demonstrated a strong antitumour activity in several tumour types, including sarcomas. However, its widespread use in the clinic was limited by its poor toxicity profile. RESULTS: In order to improve the therapeutic index of MTM, we have loaded MTM into newly developed nanocarrier formulations. First, polylactide (PLA) polymeric nanoparticles (NPs) were generated by nanoprecipitation. Also, liposomes (LIP) were prepared by ethanol injection and evaporation solvent method. Finally, MTM-loaded hydrogels (HG) were obtained by passive loading using a urea derivative non-peptidic hydrogelator. MTM-loaded NPs and LIP display optimal hydrodynamic radii between 80 and 105 nm with a very low polydispersity index (PdI) and encapsulation efficiencies (EE) of 92 and 30%, respectively. All formulations show a high stability and different release rates ranging from a fast release in HG (100% after 30 min) to more sustained release from NPs (100% after 24 h) and LIP (40% after 48 h). In vitro assays confirmed that all assayed MTM formulations retain the cytotoxic, anti-invasive and anti-stemness potential of free MTM in models of myxoid liposarcoma, undifferentiated pleomorphic sarcoma and chondrosarcoma. In addition, whole genome transcriptomic analysis evidenced the ability of MTM, both free and encapsulated, to act as a multi-repressor of several tumour-promoting pathways at once. Importantly, the treatment of mice bearing sarcoma xenografts showed that encapsulated MTM exhibited enhanced therapeutic effects and was better tolerated than free MTM. CONCLUSIONS: Overall, these novel formulations may represent an efficient and safer MTM-delivering alternative for sarcoma treatment.

SOX2 Expression and Transcriptional Activity Identifies a Subpopulation of Cancer Stem Cells in Sarcoma with Prognostic Implications.

Stemness in sarcomas is coordinated by the expression of pluripotency factors, like SOX2, in cancer stem cells (CSC). The role of SOX2 in tumor initiation and progression has been well characterized in osteosarcoma. However, the pro-tumorigenic features of SOX2 have been scarcely investigated in other sarcoma subtypes. Here, we show that SOX2 depletion dramatically reduced the ability of undifferentiated pleomorphic sarcoma (UPS) cells to form tumorspheres and to initiate tumor growth. Conversely, SOX2 overexpression resulted in increased in vivo tumorigenicity. Moreover, using a reporter system (SORE6) which allows to monitor viable cells expressing SOX2 and/or OCT4, we found that SORE6+ cells were significantly more tumorigenic than the SORE6- subpopulation. In agreement with this findings, SOX2 expression in sarcoma patients was associated to tumor grade, differentiation, invasive potential and lower patient survival. Finally, we studied the effect of a panel of anti-tumor drugs on the SORE6+ cells of the UPS model and patient-derived chondrosarcoma lines. We found that the mithramycin analogue EC-8042 was the most efficient in reducing SORE6+ cells in vitro and in vivo. Overall, this study demonstrates that SOX2 is a pro-tumorigenic factor with prognostic potential in sarcoma. Moreover, SORE6 transcriptional activity is a bona fide CSC marker in sarcoma and constitutes an excellent biomarker for evaluating the efficacy of anti-tumor treatments on CSC subpopulations.

FUS-CHOP Promotes Invasion in Myxoid Liposarcoma through a SRC/FAK/RHO/ROCK-Dependent Pathway.

Deregulated SRC/FAK signaling leads to enhanced migration and invasion in many types of tumors. In myxoid and round cell liposarcoma (MRCLS), an adipocytic tumor characterized by the expression of the fusion oncogene FUS-CHOP, SRC have been found as one of the most activated kinases. Here we used a cell-of-origin model of MRCLS and an MRCLS cell line to thoroughly characterize the mechanisms of cell invasion induced by FUS-CHOP using in vitro (3D spheroid invasion assays) and in vivo (chicken chorioallantoic membrane model) approaches. FUS-CHOP expression activated SRC-FAK signaling and increased the invasive ability of MRCLS cells. In addition, FAK expression was found to significantly correlate with tumor aggressiveness in sarcoma patient samples. The involvement of SRC/FAK activation in FUS-CHOP-mediated invasion was further confirmed using the SRC inhibitor dasatinib, the specific FAK inhibitor PF-573228, and FAK siRNA. Notably, dasatinib and PF573228 could also efficiently block the invasion of cancer stem cell subpopulations. Downstream of SRC/FAK signaling, we found that FUS-CHOP expression increases the levels of the RHO/ROCK downstream effector phospho-MLC2 (T18/S19) and that this activation was prevented by dasatinib or PF573228. Moreover, the ROCK inhibitor RKI-1447 was able to completely abolish invasion in FUS-CHOP-expressing cells. These data uncover the involvement of SRC/FAK/RHO/ROCK signaling axis in FUS-CHOP-mediated invasion, thus providing a rationale for testing inhibitors of this pathway as potential novel antimetastatic agents for MRCLS treatment.

Identification and expression analysis of photoreceptor genes in kiwifruit leaves under natural daylength conditions and their relationship with other genes that regulate photoperiodic flowering.

Kiwifruit (Actinidia chinensis var. deliciosa (A. Chev) A. Chev.) is a dioecious vine highly dependent on pollination, which is limited by a lack of synchrony of flowering time between male and female plants. In many plant species, the regulation of the timing of flowering depends largely on seasonal cues such as photoperiod, which is detected by photoreceptors. In this report, we determined the full sequences of the PHYB (AcPHYB) and PHYA (AcPHYA) genes and a partial sequence of the CRY2 (AcCRY2) gene in kiwifruit. Next, we monitored the expression patterns of these photoreceptor genes (AcPHYA, AcPHYB and AcCRY2) as well as other genes involved in flowering regulation (AcCO-like and AcFT) in the leaves of kiwifruit plants grown under natural photoperiods in the field. The annual expression patterns of AcPHYB, AcPHYA and AcCRY2 genes showed that they were significantly highly expressed from late flower development until full bloom and fitting with floral evocation, closely matching the peaks of expression detected for the AcFT and AcCO-like genes. In addition, the daily expression patterns of AcPHYB, AcPHYA and AcCRY2 were analyzed in leaves collected under different daylength conditions. Under long-day (LD) conditions, maximum expression levels were detected in the middle of the day in April (before full bloom), while their expression lost their daily rhythmic patterns in June (after full bloom) and were consistently expressed at low levels. Under short-day (SD) conditions, AcPHYB, AcPHYA and AcCRY2 gene expression patterns were the opposite of those observed in April. With respect to AcFT, no expression was detected in SD conditions. In contrast, the AcCO-like gene oscillated for all daylength conditions with the same daily rhythm. Our results seem to indicate the involvement of photoreceptor genes in kiwifruit flowering regulation. The different daily expression patterns detected for AcPHYA, AcPHYB, AcCRY2 and AcFT under different daylength conditions suggest that photoperiod regulates their expression, while the uniform expression of the AcCO-like gene is in agreement with its reported regulation by the circadian clock.

Osteosarcoma: Cells-of-Origin, Cancer Stem Cells, and Targeted Therapies.

Osteosarcoma (OS) is the most common type of primary solid tumor that develops in bone. Although standard chemotherapy has significantly improved long-term survival over the past few decades, the outcome for those patients with metastatic or recurrent OS remains dismally poor and, therefore, novel agents and treatment regimens are urgently required. A hypothesis to explain the resistance of OS to chemotherapy is the existence of drug resistant CSCs with progenitor properties that are responsible of tumor relapses and metastasis. These subpopulations of CSCs commonly emerge during tumor evolution from the cell-of-origin, which are the normal cells that acquire the first cancer-promoting mutations to initiate tumor formation. In OS, several cell types along the osteogenic lineage have been proposed as cell-of-origin. Both the cell-of-origin and their derived CSC subpopulations are highly influenced by environmental and epigenetic factors and, therefore, targeting the OS-CSC environment and niche is the rationale for many recently postulated therapies. Likewise, some strategies for targeting CSC-associated signaling pathways have already been tested in both preclinical and clinical settings. This review recapitulates current OS cell-of-origin models, the properties of the OS-CSC and its niche, and potential new therapies able to target OS-CSCs.

Telemedicina y su aplicación en Dermatología Laboral / Teledermatology and Ocupational Health

INTRODUCCIÓN: La importancia y el impacto de la telemedicina han provocado que se aplique a todas las áreas posibles del conocimiento médico y que los tipos de telemedicina hayan crecido de forma paralela al desarrollo de las nuevas tecnologías. La dermatología fue una de las primeras especialidades en la que se aplicaron tecnologías de telemedicina. Las enfermedades de la piel suponen la segunda causa de notificación de enfermedad profesional por lo que aplicar la teledermatología a nivel del ámbito laboral podría ayudar a llevar a cabo un mejor y precoz diagnóstico, al mismo tiempo que podría tener un significativo impacto en ahorro de costes económicos. OBJETIVO: Conocer el estado actual de la evidencia en Teledermatología y su potencial traslación al campo de la Medicina del Trabajo, así como identificar el conocimiento y evidencia existentes en los siguientes aspectos críticos que marcan el interés de esta potencial traslación: exactitud diagnóstica, coste-beneficio y coste-efectividad, aceptabilidad y satisfacción del paciente, satisfacción del profesional y reducción del tiempo para realizar el diagnóstico. Material y MÉTODOS: Se realiza una revisión bibliográfica de la literatura científica publicada entre 2006-2013. Se consultaron las bases de datos MEDLINE, OSH UPDATE, IBSST, CISDOC, LILACS,WOK, Clinicalkey, Scielo, SCOPUS,OVIDSP, Biblioteca Cochrane e IBECS. RESULTADOS: Se seleccionaron 13 artículos que incluyen 2 revisiones sistemáticas, 6 ensayos clínicos y 5 estudios transversales. La Teledermatología presenta una exactitud diagnóstica comparable a la consulta convencional, siendo ésta entre un 5%-11% más exacta, mostrándose coste-efectiva (1,78 veces más barata) si tenemos en cuenta desplazamientos y pérdida de productividad, con disminución en el tiempo de espera. CONCLUSIONES: Existen pocas referencias sobre teledermatologia aplicada al ámbito laboral. Teniendo en cuenta la evidencia recogida sobre exactitud diagnóstica, coste-beneficio, aceptabilidad, satisfacción y reducción de tiempos de espera; ésta podría ser una herramienta útil para el Médico del Trabajo que permitiría el acceso a un servicio especializado facilitando un diagnóstico y tratamiento precoz, promoviendo la adopción de medidas preventivas, mejorando el seguimiento y evitando ausencias prolongadas del puesto de trabajo, bien por tiempos de consulta o por incapacidad laboral por estudio de enfermedad profesional

INTRODUCTION: The importance and impact of telemedicine has caused to be applied to all possible areas and the types of telemedicine have grown in parallel to the development of new technologies. The dermatology was one of the first specialties to adopt the telemedicine. The skin diseases pose a very important issue within the occupational pathology. So applying the teledermatology at workplace level could help to perform better and earlier diagnosis, at the same time that could have a significant impact on economic cost savings. OBJECTIVE: Knowing the current state of the evidence in Teledermatology and its potential translation to the field of Occupational Medicine, and to identify existing knowledge and evidence on the following critical issues that set the potential interest of this translation: Diagnostic Accuracy; Cost-benefit and cost-effectiveness; Acceptability and patient satisfaction; Professional satisfaction; Reduction of time for diagnosis. MATERIAL AND METHODS: A literature review of the scientific literature published between 2006-2013 was performed. The MEDLINE, OSH UPDATE, IBSST, CISDOC, LILACS, WOK, ClinicalKey, SciELO, SCOPUS, OVIDSP, IBECS and Cochrane Library were searched. RESULTS: 13 items including 2 systematic reviews, 6 clinical trials, and 5 cross-sectional studies were selected. The results show that Teledermatology has a diagnostic accuracy comparable to conventional query, this being between 5% -11% more accurate. Results also show that Teledermatology is cost-effective (1.78 times cheaper) when you consider displacement and loss of productivity, and decreasing average waiting time for consultancy. CONCLUSIONS: There are few references on Teledermatology applied to the workplace. Given the evidence collected on diagnostic accuracy, cost-effectiveness, acceptability, satisfaction, and reduced waiting times, this could be a useful tool for the Occupational Health because it would allow access to a specialized service providing early diagnosis and treatment, promoting the adoption of preventive measures, improving monitoring, and avoiding prolonged absences from work, due to consultation times or to prolonged labor incapacity while the occupational disease is examined

Oncogene amplification pattern in adenoid cystic carcinoma of the salivary glands.

The aim of the present study was the search of molecular alterations (oncogene amplification or protein overexpression) that could have an impact on the outcome of ACC patients. For this purpose, paraffin-embedded tissue samples of primary ACC of 24 patients were collected. Oncogenic amplification status of six targets previously described to be involved in human carcinogenesis (ERBB1, KIT, PIK3CA, CCND1, MYC and MDM2) were studied by a PCR-based semiquantitative approach. C-Kit, cyclin D1 and EGFR protein levels were immunohistochemically assessed. ERBB1, CCND1 and PIK3CA were frequent targets of oncogene amplification (67, 46 and 38%, respectively). C-Kit and cyclin D1 were overexpressed in 57 and 82%, respectively. CCND1 amplification was associated with advanced tumour stage and ERBB1 amplification to distant metastasis. ERBB1/CCND1/PIK3CA coamplification was the most consistently observed pattern (29%). The cases with this amplification pattern presented a reduced survival. This study points to the importance of ERBB1, CCND1 and PIK3CA oncogenic amplification status in ACC carcinogenesis.

Doxorubicin eluting beads-2: methods for evaluating drug elution and in-vitro:in-vivo correlation.

DC Bead is a sulfonate-modified, PVA-based microspherical embolisation agent approved for the treatment of hypervascular tumours and arterio-venous malformations. The beads have previously been shown to actively sequester oppositely charged drugs, such as doxorubicin hydrochloride (dox) by an ion-exchange mechanism. In order to characterise the release kinetics and predict the in vivo behaviour of drug eluting beads (DEB), two elution methods were utilised. The first, an application of the USP dissolution method Type II - Apparatus, enables study of the complete elution of loaded DC Bead in less than 4 h, allowing relatively rapid comparison to be made between different products and formulations. Release data obtained using this method were fitted to first order kinetics (R (2) > 0.998) and the elution constants shown to increase with the total surface area of the beads exposed to the elution medium. Diffusion coefficients were calculated adopting the Fickian diffusion model, which predicted slow elution rates under physiological conditions. The second method involved the use of a T-Apparatus where the drug experiences an element of diffusion through a static environment. This method was developed to resemble the in vivo situation in embolisation procedures more closely. Slow release of dox from DC Bead with half-lives over 1,500 h were predicted for all size ranges using a slow release model. A strong linear relationship was found between the release data from T-Apparatus and pharmacokinetic data obtained from patients treated with DC Bead loaded with dox in transarterial chemoembolisation (TACE) procedures. These data indicated a Level A in vitro-in vivo correlation (IVIVC) for the first 24 h post embolisation. Both systems developed were automated and good reproducibility was obtained for all samples, demonstrating the usefulness of these elution techniques for product development and comparative testing.

Doxorubicin eluting beads - 1: effects of drug loading on bead characteristics and drug distribution.

DC Bead is a FDA cleared embolisation device for the treatment of hypervascular tumours and arteriovenous malformations. This product is currently evaluated in a number of centres in Europe as an embolic device for transarterial chemoembolisation (TACE). The beads consist of poly(vinyl alcohol) microspheres modified with sulfonic acid groups and are available at different size ranges varying from 100 to 900 microm in diameter. The beads were shown to actively sequester doxorubicin hydrochloride (dox) from solution in a time dependent upon the dose of the drug and size of the beads. Drug uptake was by an ion-exchange mechanism, and in the absence of other ions in solution, the beads could load a maximum of around 40 mg dox/mL hydrated beads, with >99% of drug being sequestered from the solution. A loading of 25 mg dox/mL beads was recommended as providing a practical therapeutic dose and optimum handling characteristics. There was a decrease in equilibrium water content of the beads with increasing dox loading, which resulted in a decrease in the average diameter of the beads and an increase in the compressive modulus. The deliverability properties, however, were not affected after drug loading. Using a variety of microscopic methods, the drug was shown to be distributed throughout the bead structure, but concentrated in the outer 20 microm surface layer, a feature related to the method of synthesis. This study characterises the properties of DC Bead loaded with dox with respect to important characteristics in embolisation and demonstrates the potential of this drug device combination for the treatment of hypervascular tumours such as hepatocellular carcinoma.

Irinotecan drug eluting beads for use in chemoembolization: in vitro and in vivo evaluation of drug release properties.

Drug eluting beads that release irinotecan in a controlled manner may be useful for application in the chemoembolization of colorectal cancer metastases to the liver. In this study, irinotecan drug eluting beads were prepared with loadings up to 50 mg drug/mL hydrated beads. Drug loading was via an ion-exchange mechanism with sulfonate binding sites in the bead. Release in vitro was shown to be sustained and dependent upon the presence of ions in the elution medium, drug loading and bead size. Drug elution in PBS was controlled by solute diffusion within the beads and gave rise to values for the diffusion coefficient, D, of between 2.4x10(-9) and 1.4x10(-7) cm(2)s(-1). The beads were shown to decrease in size (by a maximum 25-30%), and concomitantly their modulus of compression increased (from approximately 27 kPa to a maximum of about 49 kPa), with increasing drug loading. This did not however, influence their ability to be suspended homogeneously in contrast agent or delivered through a microcatheter. Following porcine hepatic artery embolization, maximum plasma levels were 70-75% lower for both irinotecan and SN-38 compared to intraarterial bolus administration, with peak levels observed at 2 and 5 min after completion of the embolization procedure. The in vivo data were shown to correlate well with the in vitro release measured using a T-apparatus model of embolization.

Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization.

PURPOSE: To present the pathologic and pharmacokinetic findings from hepatic embolization in a porcine model comparing doxorubicin-eluting beads with bland embolization and to correlate these findings with in vitro release kinetics. MATERIALS AND METHODS: Drug-eluting beads (DEB; 100-300 microm and 700-900 microm) loaded with 37.5 mg doxorubicin per milliliter hydrated beads were used to embolize the hepatic artery feeding the left lobe of the liver in young adult Yucatan pigs (n = 5 per group). Control animals underwent embolization with bland beads (100-300 microm; n = 5). Systemic plasma levels of doxorubicin were measured and correlated to in vitro drug release. Blood sampling and histopathologic examination were performed during the 90-day follow-up. RESULTS: All animals underwent successful embolization, and the treatment was well tolerated. Mean volumes of beads administered were 2.0-3.4 mL, with mean doses of 127.5 mg and 78.7 mg of doxorubicin for the 100- to 300-microm and 700- to 900-microm DEB groups, respectively. Gross pathologic examination revealed no effects on organs other than the liver. There was a transient increase in liver enzyme levels, particularly in the groups of animals who underwent embolization with 100- to 300-microm DEB. Histopathologic study showed mostly nonnecrotic changes with bland beads, whereas the effects of DEB were more severe, with large areas of pannecrosis evident with the 100- to 300-microm DEB. Maximum plasma concentrations were 651 ng/mL and 42.8 ng/mL for the 100- to 300-microm and 700- to 900-microm DEB groups, respectively, observed at 1 minute for both groups. Correlation with in vitro data showed a strong linear relationship. CONCLUSIONS: Hepatic arterial embolization with DEB was shown to be safe and well tolerated. The locoregional delivery of doxorubicin from DEB caused targeted tissue damage with minimal systemic impact and could be a promising new approach to transarterial chemoembolization of solid tumors.

DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization.

PURPOSE: The purpose of this investigation is to present the in vitro characterization and detailed drug-loading procedure for DC Bead, a microsphere product that can be loaded with chemotherapeutic agents for embolization. MATERIALS AND METHODS: DC Bead is an embolic microsphere product that is capable of being loaded with anthracycline drugs such as doxorubicin just before administration in a transarterial chemoembolization (TACE) procedure. Beads can be loaded from solutions prepared from doxorubicin powder or the doxorubicin HCl formulation. In this evaluation, bead sizes were measured by optical microscopy with video imaging. Gravimetric analysis demonstrated the effect of drug loading on bead water content, and its consequent impact on bead compressibility was determined. The subsequent deliverability of the beads was assessed by mixing the beads with contrast medium and saline solution and passing the beads through an appropriately sized microcatheter. A T-cell apparatus was used to monitor the in vitro elution of the drug from the beads over a period of 24 hours in various elution media. RESULTS: DC Bead spheres could be easily loaded with doxorubicin to a recommended level of 25 mg/mL of hydrated beads by immersion of the beads in the drug solution for 10-120 minutes depending on microsphere size. Other commercial embolic microspheres were shown not to load doxorubicin to the same extent or release it in the same fashion and were considered unsuitable for local drug delivery. Maximum theoretic capacity for DC Bead was approximately 45 mg/mL. Increase in doxorubicin loading resulted in a concomitant decrease in water content and consequential increase in bead resistance to compression force. Drug loading also resulted in a decrease in the average size of the beads, which was dependent on bead size and drug dose. This did not impact bead delivery at any drug loading level to a maximum of 37.5 mg/mL. Beads 100-700 microm in size could be delivered through 2.7-F microcatheters, whereas the 700-900-microm range required 3-F catheters. Modeling of the kinetics of drug elution from the beads in vitro at a loading dose of 25 mg/mL yielded calculated half-lives of 150 hours for the 100-300-microm range to a maximum of 1,730 hours for the 700-900-microm size range, which was dependent on the ionic strength of the elution medium. For comparison, there was a rapid loss of drug from an unstable Lipiodol emulsion with a half-life of approximately 1 hour. CONCLUSIONS: DC Bead can be loaded with doxorubicin to provide an accurate dosage of drug per unit volume of beads. Drug elution is dependent on ion exchange with the surrounding environment and is controlled and sustained, unlike the rapid separation of the drug from Lipiodol. Drug loading has no impact on the handling and deliverability of the beads, making them suitable for superselective TACE.