Myocardial Infarction after Long-Term Treatment with a Tyrosine Kinase Inhibitor (TKI) with Anti-VEGF Receptor Activity.

TKIs including anti-VEGF receptor activity have been approved for the treatment of patients with radioiodine resistant thyroid carcinomas. For lenvatinib arterial thromboembolic events are listed as adverse events of special interest with lenvatinib. In the phase III study, arterial thromboembolic events were reported in 3% of lenvatinib-treated patients and 1% in the placebo group. Most of the patients had predisposing factors. Only one myocardial infarct was reported in the lenvatinib phase III study. We report a 73-year-old female patient with metastatic thyroid papillary carcinoma who was treated with total thyroidectomy. The operation was followed by four radioiodine therapies over a period of 6 years. At 6 years she developed lung metastasis without radioiodine uptake, one solitary liver metastasis and one solitary right renal metastasis. One year after the first diagnosis of radioiodine resistant lung metastasis the lung metastasis showed progression according to RECIST criteria. This treatment was resulting in prolonged partial response with disappearance of a hepatic and renal metastasis. A myocardial infarction occurred after 39 months of lenvatinib treatment resulting in implantation of 3 stents and a two chamber pacemaker. The treatment was discontinued. Except for well controlled hypertension there were neither predisposing diseases like diabetes nor symptoms of cardiac ischemia on exertion. However, the family history for cardiovascular diseases was positive for cardiac infarction reported for one brother. Another brother was treated for hypertension and the patient's mother suffered from a cerebral infarction at the age of 60. While only one myocardial infarct was reported in the lenvatinib phase III study with 392 patients this case suggests that long-term treatment with lenvatinib may be associated with an increased risk for myocardial infarct also in patients with no predisposing diseases except well controlled hypertension and positive family history for cardiovascular diseases.

[Urea plus ceramides and vitamins: improving the efficacy of a topical urea preparation by addition of ceramides and vitamins]. / Harnstoff plus Ceramide und Vitamine: Untersuchungen zur Verbesserung eines harnstoffhaltigen Externums durch Zusatz von Ceramiden und Vitaminen.

Topical urea preparations containing urea have been used successfully to improve the barrier function of the skin. We investigated whether the efficacy of an urea-containing topical preparation could be improved by the addition of vitamins and ceramides. For this an intra-individual comparative study was conducted on 10 subjects with healthy skin. The application of the combination preparation containing urea, vitamins and ceramides for 2 weeks was significantly superior to the urea-only preparation in respect to reduction of transepidermal water loss and skin hydration levels. This improved efficacy was associated with a stronger up-regulation of the transcriptional expression of differentiation genes in keratinocytes in the treated skin areas. While both preparations caused an increased expression of the genes encoding transglutaminase-1, involucrin, loricrin and filaggrin, this increase was significantly greater in those skin areas treated with the combination preparation. This study indicates that the efficacy of topical preparations containing urea can be enhanced by the incorporation of ceramides and vitamins.

[Topical application of vitamins, phytosterols and ceramides. Protection against increased expression of interstital collagenase and reduced collagen-I expression after single exposure to UVA irradiation]. / Topische Applikation von Vitaminen, Phytosterolen und Ceramiden. Schutz vor vermehrter Expression der interstitiellen Kollagenase und verminderter Kollagen-I-Expression nach 1-maliger UVA-Bestrahlung.

Photoaged skin is characterized by a decrease of dermal collagen fibers, resulting from an increased breakdown and a diminished de novo synthesis. The increased breakdown results from an increased expression of matrix metalloproteinases (MMPs). The main building blocks involved in de novo synthesis of collagen fibers are collagen 1A1 and 1A2, the expression of which is reduced in photoaged skin. We studied the effect of topical application of vitamins, phytosterols and ceramides on UV-induced up-regulation of the expression of MMP-1 and on UV-induced down-regulation of COL1A1 and COL1A2. The study was conducted with 10 subjects with healthy skin who were comparatively treated for 10 days with (i) a basic preparation containing jojoba oil, (ii) the basic preparation supplemented with vitamins, (iii) the basic preparation supplemented with phytosterols and ceramides, and (iv) the basic preparation supplemented with vitamins, phytosterols and ceramides. All four preparations inhibited the UV induced up-regulation of MMP-1. Neither the basic product nor that supplemented with vitamins inhibited down-regulation of COL1A1 and COL1A2, but addition of phytosterols and ceramides caused a decreased down-regulation of the expression of these genes. Our results indicate that phytosterols and ceramides are effective in blocking the reduced collagen synthesis after UV irradiation and even stimulating synthesis. They may be useful additions to anti-aging products.

Subchronic alpha- and beta-adrenergic regulation of cardiac gap junction protein expression.

Gap junction channels are essential for intercellular electrical communication in the heart. The most important cardiac gap junction proteins are connexin43 (predominantly) (Cx43), connexin40 (Cx40), and in early developmental stages connexin45. Since catecholamines play an important role in cardiac (patho)physiology, we wanted to elucidate whether catecholamines may affect expression of Cx43 and Cx40. Cultured neonatal rat cardiomyocytes were exposed for 24 h to increasing concentrations of noradrenaline (1-10000 nM) (physiological agonist at alpha and beta-adrenoceptors), resulting in significantly increased Cx43-expression, while Cx40 was unaffected. In further experiments cells were incubated with either phenylephrine (alpha-adrenergic agonist) or isoproterenol (beta-adrenergic agonist) (0.1-1000 nM) for 24 h. Both catecholamines lead to a concentration-dependent increase in Cx43 protein and mRNA expression (EC50: 10-20 nM). Inhibition experiments showed that the phenylephrine effect was transduced via PKC, while the isoproterenol effect was mediated by PKA. Dual whole-cell voltage clamp demonstrated that increased Cx43-expression was accompanied by significant increases in gap junction current. In additional in vivo experiments, adult rats were subjected to 24-h infusion of isoproterenol or phenylephrine showing again significant increase in Cx43 but not Cx40. Adrenergic stimulation of cardiomyocytes can enhance Cx43 expression thereby increasing cellular coupling, indicating a possible role for catecholamines in the regulation of cardiac gap junction expression in cardiac disease.

Neuroreceptors and ion channels as targets of alcohol.

This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Toshio Narahashi and Kinya Kuriyama. The presentations were (1) Modulation of neuroreceptors and ion channels by alcohol, by T. Narahashi; (2) Inhibition by ethanol of NMDA and AMPA receptor-channels, by P. Illes, K. Wirkner, W. Fischer, K. Mühlberg, P. Scheibler, and C. Allgaier; (3) Effects of ethanol on metabotropic glutamate receptors, by K. Minami; (4) Acute alcohol actions on the 5-HT3 ligand-gated ion channel, by D. Lovinger; (5) Inhibition of NMDA receptors by MK801 attenuates ethanol-induced taurine release from the hippocampus, by F. Lallemand, R.J. Ward, and P. DeWitte; and (6) Effect of ethanol on voltage-operated Ca2+ channels in hepatic stellate cells, by T. Itatsu, Y. Takei, H. Oide, M. Hirose, X. E. Wang, S. Watanabe, M. Tateyama, R. Ochi, and N. Sato.

Ethanol-induced inhibition of NMDA receptor channels.

Ethanol is a potent inhibitor of the N-methyl-D-aspartate (NMDA)-receptor subtype of glutamate receptor in a number of brain areas. The mechanism of ethanol action has been investigated by means of patch-clamp recording of ionic currents and fura-2 measurement of intracellular Ca2+ concentration in cell culture systems; the subunit composition of NMDA receptors and their influence on the effect of ethanol was determined by molecular biology methods. Ethanol does not appear to interact with NMDA either at the glutamate recognition site of the receptor, or at any of the hitherto known multiple modulatory sites, such as the glycine or polyamine site. Moreover, ethanol does not cause an open channel block by itself and fails to interact with Mg2+ at the site where it causes open channel block. The ability of ethanol to inhibit responses to NMDA is dependent on the subunit combination of NMDA receptors. The NR1/NR2A and NR1/NR2B combinations are preferentially sensitive to ethanol inhibition. Chronic treatment with ethanol leads to an increase of the NMDA receptor number at the transcriptional and posttranscriptional level; the receptor function is also facilitated. This causes withdrawal-type seizures after termination of chronic treatment with ethanol. The inhibition of NMDA receptors by ethanol leads to the depression of excitatory synaptic potentials mediated by this type of excitatory amino acid receptor. Ethanol-induced disturbances in certain regions of the brain, i.e. hippocampus, nucleus accumbens or locus coeruleus may lead to cognitive disorders or drug dependence. Brain slices containing the locus coeruleus may be used as an in vitro test system to investigate the addictive properties of ethanol.