Sleep quality and architecture in Idiopathic generalized epilepsy: A systematic review and meta-analysis.

Idiopathic generalized epilepsies are a group of sleep related epilepsy syndromes with sleep deprivation as a strong trigger for seizures and increased spike-wave activity during sleep and transition to sleep. Neuropsychological deficits are common in Idiopathic generalized epilepsy patients. Learning and memory processes are closely linked to sleep. Therefore, this systematic review and meta-analysis investigates the evidence of sleep disturbances in Idiopathic generalized epilepsy patients. A search of the databases EMBASE, Medline and Scopus identified 22 studies comparing polysomnographic parameters and scores of sleep questionnaires between Idiopathic generalized epilepsy patients and healthy controls. Random effect univariate meta-analyses revealed reduced sleep efficiency, total sleep time, proportion of N2 stage and prolonged REM onset latency in Idiopathic generalized epilepsy patients. Self-assessed sleep quality of patients measured by the Pittsburgh sleep quality index was lower in two thirds of reporting studies. Considering the influence on behavioral issues, cognitive performance and quality of life, the revealed alteration in sleep architecture and lower subjective sleep quality emphasizes the importance of screening for sleep disturbances in the medical care of patients with Idiopathic generalized epilepsy.

Synthesis and evaluation of antitumor activity of 9-methoxy-1H-benzo[f]chromene derivatives.

Herein, a series of aryl-substituted derivatives of 3-amino-1-aryl-9-methoxy-1H-benzo[f]chromene-2-carbonitriles (4a-4q) were designed and synthesized via reaction of 7-methoxy-2-naphthol with a mixture of appropriate aromatic aldehydes and malononitrile under microwave conditions. Among the tested benzochromene, the known compound 4e and four novel compounds 4f, 4j, 4k, 4m exhibited the highest cytotoxicity towards a panel of six human cancer cell lines MDA-MB-231, A549, HeLa, MIA PaCa-2, RPMI 7951, and PC-3. Compound 4j with 2,4-dichloro substitution on the pendant phenyl ring exhibited the highest broad-spectrum cytotoxicity towards all tested cancer cell lines. Compounds 4e, 4f, 4j, 4k, 4m were further selected to study the mechanism of cellular toxicity using the triple-negative breast cancer cells MDA-MB-231. Compounds 4e, 4f, 4j, 4k, 4m induced accumulation of the treated MDA-MB-231 cells in the S phase and 4k additionally in the G2/M phase of the cell cycle. Compounds 4e, 4f, 4j, 4k, 4m induced dissipation of mitochondrial transmembrane potential and activation of caspase 3/7 in MDA-MB-231 cells with 4j being one of the most active. In an in vivo model, compound 4j and less efficiently 4e and 4f inhibited growth and proliferation and triggered DNA fragmentation in MDA-MB-231 xenografts grown on chick chorioallantoic membranes. SAR study confirmed that the 2,4-dichloro substitution pattern on the pendant phenyl ring enhanced the cytotoxic activity of benzochromene.

Increased DNA integrity in colorectal cancer.

BACKGROUND: Blood-based DNA integrity, defined as the relation of long to small fragments of cell-free circulating DNA, is known to be increased in various types of cancers. Since different DNA fragments and formulae are used by different researchers, conflicting results on the relevance of this marker for cancer diagnosis have been reported. PATIENTS AND METHODS: Sera from 24 patients with colorectal cancer, 11 patients with benign gastrointestinal diseases, and 24 healthy individuals were investigated. After DNA isolation, ALU repeats with 115 bp and 247 bp length were measured using quantitative polymerase chain reaction and resulting DNA integrities were calculated by the two formulae of Umetani et al. (DNA Int 1) and Wang et al. (DNA Int 2) RESULTS: DNA integrity by both formulae correlated strongly with each other. DNA integrity was significantly higher in patients with colorectal cancer when compared with healthy controls (p=0.005 and p=0.006, respectively), while there was no significant difference from those with benign colorectal diseases. In receiver operating characteristic curve analysis, areas under the curve of 0.74 and 0.73 and sensitivities of 71% at 75% specificity (DNA Int 1 and 2, respectively) were achieved for the discrimination between patients with colorectal cancer and healthy controls. CONCLUSION: DNA integrity is significantly increased in patients with colorectal cancer and may be useful in prospective trials.

Diagnostic relevance of plasma DNA and DNA integrity for breast cancer.

Levels of ALU 115, ALU 247, DNA integrity ([1, 2]) and of the tumour markers CA 15-3 and CEA were analysed in the blood of 152 patients. Plasma levels of ALU 115 and ALU 247 were significantly higher in patients with locally confined (LBC; N = 65), metastatic breast cancer (MBC; N = 47), and benign diseases (N = 12) than in healthy controls (p < 0.001 for all comparisons). DNA integrity, CEA, and CA 15-3 were significantly higher in MBC than in benign controls and LBC but could not identify LBCs. The best discrimination of LBC from healthy controls was achieved by ALU 115 and ALU 247 (AUC 95.4 and 95.5 %) and of MBC from all control groups by CA 15-3 and CEA (AUC 83.2 and 79.1 %). Plasma DNA is valuable for the detection of LBC, while established tumour markers are most informative in MBC.

Circulating plasma DNA and DNA integrity in breast cancer patients undergoing neoadjuvant chemotherapy.

BACKGROUND: In breast cancer patients undergoing neoadjuvant chemotherapy before surgery, biomarkers for predicting response to therapy are urgently required. PATIENTS AND METHODS: In 65 patients with locally confined breast cancer who had completed the course of chemotherapy until surgery, plasma DNA biomarkers obtained before and during therapy were evaluated concerning (early) estimation of therapy response. Levels of repetitive ALU 115 and ALU 247 elements as well as DNA integrity calculated according the formulas of Umetani (1) and Wang (2) were correlated with changes in histopathological staging at surgery and compared with conventional tumor markers CEA and CA 15-3. RESULTS: At surgery, 13 patients presented complete remission (CR), 32 partial remission (PR) and 20 no change of disease (NC). Pretherapeutic Her2/neu status was positively correlated with therapy response (p=0.019). DNA biomarkers before onset of therapy cycles 1, 2 and 6 did not indicate outcome after therapy. However, kinetics of ALU 115 from cycle 1 to 6 showed decreases in CR patients, while in NC patients, an increase was observed (p=0.033). Similar tendencies were found for ALU 247 fragments. DNA integrity index as well as CEA and CA 15-3 were not informative for therapy outcome. CONCLUSION: Kinetics of plasma DNA (ALU 115) is associated with response to neoadjuvant chemotherapy in patients with locally confined breast cancer.

Circulating nucleosomes and biomarkers of immunogenic cell death as predictive and prognostic markers in cancer patients undergoing cytotoxic therapy.

INTRODUCTION: Immunogenic cell death markers are released from apoptotic and necrotic cells upon pathologic or therapeutic causes and stimulate the innate and adaptive immune system. Cell death products such as nucleosomes, damage-associated molecular pattern (DAMP) molecules such as the high-mobility group box 1 protein (HMGB1) and its receptor of advanced glycation end products (sRAGE) are supposed to play an essential role in driving this process. However, this immunogenic activation may have dual effects, either by sensitizing the immune system for more efficient tumor cell removal or by creating a favorable tumor microenvironment that facilitates tumor growth, proliferation and invasiveness. AREAS COVERED: Here, we review recent findings on the relevance of serum nucleosomes, DNAse activity, HMGB1 and sRAGE as biomarkers for the diagnosis, prognosis and therapy prediction in cancer disease. EXPERT OPINION: In comparison with healthy controls, cancer patients demonstrated elevated serum levels of nucleosomes and HMGB1 while sRAGE levels were decreased. During locoregional and systemic cytotoxic therapies, a high release of nucleosomes and HMGB1 as well as low release of sRAGE before and during the initial phase of the treatment was found to be associated with poor response to the therapy and patient survival. Therefore, immunogenic cell death markers are promising tools for the prognosis, therapy prediction and monitoring in cancer patients.

Methodological and preanalytical evaluation of an HMGB1 immunoassay.

BACKGROUND: Soluble high-mobility group box 1 (sHMGB1) is a promising biomarker for the prognosis and the monitoring of cancer and of acute diseases such as trauma and sepsis. MATERIALS AND METHODS: We investigated the methodological characteristics of an ELISA for sHMGB1 (Shino-Test, Tokyo, Japan and IBL, Hamburg, Germany) including intra- and inter-assay imprecision, dilution linearity and differences in serum and plasma materials. Furthermore, the influence of various preanalytical factors such as time and storage temperature before and after centrifugation prior to definite deep freezing, as well as multiple freeze-thaw cycles were tested. By the use of sera from 28 healthy individuals, a reference range and the dependency on patient characteristics were established. RESULTS: Intra-assay imprecision (coefficients of variation (CV)=1.2-4.8%) and inter-assay imprecision (10.3-14.0%) were in an acceptable range of manual assays. HMGB1 levels were found to be considerably lower in EDTA plasma as compared to serum samples. Linearity testing yielded satisfying results with dilution recoveries of 100-121% (mean=112.3%). sHMGB1 results were the same when samples were kept at 4°C and 25°C after centrifugation, for up to 7 days (recoveries 87-128%). Delay before centrifugation led to a considerable increase in some samples. The median values for healthy individuals was 1.3 ng/ml, and the 95th percentile was 4.1 ng/ml. HMGB1 levels correlated inversely with age (R=0.33). CONCLUSION: The sHMGB1 ELISA is a robust and safe assay producing reliable quantitative results in sera.

Methodological and preanalytical evaluation of a RAGE immunoassay.

BACKGROUND: Soluble receptor of advanced glycation end products (sRAGE) is a promising biomarker for the prognosis and the monitoring of cancer and of acute diseases such as trauma and sepsis. MATERIALS AND METHODS: We investigated the methodological characteristics of an ELISA for sRAGE (R&D Diagnostics) including intra- and inter-assay imprecision, dilution linearity and differences in various serum and plasma materials. Furthermore, the influence of various preanalytical factors such as time and storage temperature before and after centrifugation prior to definite deep freezing, as well as multiple freeze-thaw cycles, were tested. By the use of sera from 30 healthy individuals, a reference range and the dependency on patient characteristics was established. RESULTS: Intra-assay imprecision (coefficients of variation (CV): 6.0-11.5%) and inter-assay imprecision (5.9-7.8%) were in an acceptable range of manual assays. Linearity testing yielded satisfying results with dilution recoveries of 99-131%. Results of serum, EDTA-plasma (recovery of 85.9-114.7%), and heparin-plasma samples (88-102%) were quite comparable, while results from citrate-plasma were slightly lower (78-96%). There was no influence of the time to centrifugation after 6 and 24 hours (recoveries 87-102%) at storage temperatures of 4°C and 25°C. Similarly, results were the same when samples were kept at 4°C and 25°C after centrifugation for up to 7 days (recoveries 88-109%). Repeated freeze-thawing of samples did not affect the results obtained for the RAGE protein (recoveries 92-104%). The median value of healthy individuals was 1.10 ng/ml, with 90% limits of 0.52 to 1.49 ng/ml. CONCLUSION: sRAGE ELISA is a very robust and safe assay which produces reliable quantitative results for sera and plasma measurements.