CHEK again: revisiting the development of CHK1 inhibitors for cancer therapy.

CHEK1 encodes the serine/threonine kinase CHK1, a central component of the DNA damage response. CHK1 regulates cell cycle checkpoints following genotoxic stress to prevent the entry of cells with damaged DNA into mitosis and coordinates various aspects of DNA repair. Accordingly, CHK1 has become a target of considerable interest in oncology. CHK1 inhibitors potentiate the efficacy of DNA-damaging chemotherapeutics by abrogating CHK1-mediated cell cycle arrest and preventing repair of damaged DNA. In addition, CHK1 inhibitors interfere with the biological role of CHK1 as a principal regulator of the cell cycle that controls the initiation of DNA replication, stabilizes replication forks, and coordinates mitosis. Since these functions of CHK1 facilitate progression through an unperturbed cell cycle, CHK1 inhibitors are being developed not only as chemopotentiators, but also as single-agent therapies. This review is intended to provide information on the current progress of CHK1 inhibitors in pre-clinical and clinical development and will focus on mechanisms of single-agent activity and potential strategies for patient tailoring and combinations with non-genotoxic agents.

Daily CT localization for correcting portal errors in the treatment of prostate cancer.

INTRODUCTION: Improved prostate localization techniques should allow the reduction of margins around the target to facilitate dose escalation in high-risk patients while minimizing the risk of normal tissue morbidity. A daily CT simulation technique is presented to assess setup variations in portal placement and organ motion for the treatment of localized prostate cancer. METHODS AND MATERIALS: Six patients who consented to this study underwent supine position CT simulation with an alpha cradle cast, intravenous contrast, and urethrogram. Patients received 46 Gy to the initial Planning Treatment Volume (PTV1) in a four-field conformal technique that included the prostate, seminal vesicles, and lymph nodes as the Gross Tumor Volume (GTV1). The prostate or prostate and seminal vesicles (GTV2) then received 56 Gy to PTV2. All doses were delivered in 2-Gy fractions. After 5 weeks of treatment (50 Gy), a second CT simulation was performed. The alpha cradle was secured to a specially designed rigid sliding board. The prostate was contoured and a new isocenter was generated with appropriate surface markers. Prostate-only treatment portals for the final conedown (GTV3) were created with a 0.25-cm margin from the GTV to PTV. On each subsequent treatment day, the patient was placed in his cast on the sliding board for a repeat CT simulation. The daily isocenter was recalculated in the anterior/posterior (A/P) and lateral dimension and compared to the 50-Gy CT simulation isocenter. Couch and surface marker shifts were calculated to produce portal alignment. To maintain proper positioning, the patients were transferred to a stretcher while on the sliding board in the cast and transported to the treatment room where they were then transferred to the treatment couch. The patients were then treated to the corrected isocenter. Portal films and electronic portal images were obtained for each field. RESULTS: Utilizing CT-CT image registration (fusion) of the daily and 50-Gy baseline CT scans, the isocenter changes were quantified to reflect the contribution of positional (surface marker shifts) error and absolute prostate motion relative to the bony pelvis. The maximum daily A/P shift was 7.3 mm. Motion was less than 5 mm in the remaining patients and the overall mean magnitude change was 2.9 mm. The overall variability was quantified by a pooled standard deviation of 1.7 mm. The maximum lateral shifts were less than 3 mm for all patients. With careful attention to patient positioning, maximal portal placement error was reduced to 3 mm. CONCLUSION: In our experience, prostate motion after 50 Gy was significantly less than previously reported. This may reflect early physiologic changes due to radiation, which restrict prostate motion. This observation is being tested in a separate study. Intrapatient and overall population variance was minimal. With daily isocenter correction of setup and organ motion errors by CT imaging, PTV margins can be significantly reduced or eliminated. We believe this will facilitate further dose escalation in high-risk patients with minimal risk of increased morbidity. This technique may also be beneficial in low-risk patients by sparing more normal surrounding tissue.

Stress and coping strategies in nurses from palliative, psychiatric and general nursing areas.

Briefly looks at the stress and coping strategies in nurses from palliative, psychiatric and general nursing areas. Examines the results of a recent study where 308 nurses completed questionnaires on sources of stress and coping strategies. Identifies five major sources of stress, concluding that, if patients are to receive quality care, then the needs of nurses must also be taken into consideration.

Benefits of a multidisciplinary approach to breast care.

The University of Michigan Breast Care Center (BCC) was established in 1985 to provide comprehensive, multidisciplinary diagnosis and treatment of benign and malignant breast disease. This work presents an overview of our experience in the BCC and assesses the clinical, academic, financial, and educational effectiveness of the program. A database was used to generate a list of all patients seen in the BCC between February 1, 1985 and December 31, 1991. Participating departments provided information regarding outpatient, inpatient, clinical and consultative activities, and referral patterns attributable to BCC endeavors. BCC educational and academic activities were reviewed and profiled. Clinical information was culled from the BCC database, hospital records, and the hospital tumor registry. The BCC has resulted in a fivefold increase in breast care related activity at the University of Michigan Medical Center. Over half of the patients treated in the BCC with primary operable breast cancer receive breast-conserving therapy. The BCC performs a unique educational function, providing the primary breast care experience for house staff as well as one third of the third year medical school class. The BCC supports over 20 clinical research protocols, and patient enrollment in clinical trials has increased dramatically since 1985. The BCC also provides support to basic science researchers receiving over 2.5 million dollars in peer reviewed direct cost support. These data suggest that a multidisciplinary approach to patient care as embodied by the BCC can be clinically, financially, and academically superior and productive. This model warrants further investigation not only in the field of breast care, but also in other clinical situations that require multidisciplinary input and therapy.

Multilayered vesicles prepared by reverse-phase evaporation: liposome structure and optimum solute entrapment.

Liposome structure and solute entrapment in multilayered vesicles (MLVs) prepared by reverse-phase evaporation (REV) were studied. MLV-REV vesicles prepared from ether/water emulsions have high entrapment. Entrapment depends on drug, drug concentration, lipid, lipid concentration, and the container used to prepare the vesicles. By use of 300 microL of aqueous phase and 100 mg of phosphatidylcholine (PC), vesicles prepared in a test tube 25 mm X 175 mm have higher entrapment than vesicles prepared in a 100-mL round-bottom or pear-shaped flask. By use of a test tube, 100 mg of PC, and 300 microL of aqueous phase containing sucrose (1-50 mg/mL), greater than 90% sucrose entrapment was obtained. Increasing lipid content to 150 mg of PC decreased entrapment to approximately 80%. Neutral PC MLV-REV vesicles have optimum entrapment. Mixing negatively charged lipids or cholesterol (CH) with PC to make MLV-REV vesicles results in decreased entrapment compared to using only PC. Preparing vesicles with the solid lipid dipalmitoylphosphatidylcholine (DPPC) or DPPC/CH mixtures (0 less than or equal to mol % CH less than or equal to 50) results in approximately 30-40% entrapment when diethyl ether is used to make the MLV-REV emulsion. Substituting diisopropyl ether for diethyl ether and heating the MLV-REV emulsion during vesicle formation generate DPPC/CH vesicles that entrap 60% of added solutes. The high entrapment found for MLV vesicles prepared from water/organic solvent emulsions depends on maintaining a core during the process of liposome formation. A method to calculate the fraction of water residing in the liposomes' core is presented and used to compare multilayered vesicles prepared by different processes. X-ray diffraction data demonstrate that a heterogeneous distribution of lipid may exist in multilayered vesicles prepared by the REV process.

Multilaboratory evaluation of an ultrafiltration procedure for high density lipoprotein cholesterol quantification in turbid heparin-manganese supernates.

High density lipoprotein (HDL) can be quantitated by measurement of cholesterol in supernates after precipitation of low and very low density lipoprotein (LDL and VLDL) with heparin and Mn(2+). Supernatant turbidity, often observed with hypertriglyceridemic specimens, indicates incomplete sedimentation of LDL/VLDL and precludes accurate quantitation of HDL. Ten Lipid Research Clinic Laboratories compared an ultrafiltration technique for clearing turbid heparin-Mn(2+) supernates to current methods involving repeat precipitation of either the original specimen after dilution or the d > 1.006 g/ml fraction after removal of VLDL from the initial specimen by ultracentrifugation. Results for ultrafiltration of 429 turbid supernates averaged only slightly higher (1.0-1.1 mg/dl) than results by the dilution or ultracentrifugation methods on the same specimens, but this difference was found to be significant (P < 0.005). The agreement of the ultrafiltration method with the other two methods is indicated by the following linear regression equations: a), ultrafiltration = (0.964 x ultracentrifugation) + 2.4 mg/dl, and correlation coefficient = 0.926; and b), ultrafiltration = (0.936 x dilution) + 3.3 mg/dl, and correlation coefficient = 0.933. We conclude that ultrafiltration of turbid heparin-Mn(2+) supernates is a convenient alternative to precipitation after either dilution or removal of VLDL.-Warnick, G. R., J. J. Albers, P. Bachorik, J. Turner, C. Garcia, C. Breckinridge, K. Kuba, S. McNeely, G. Hillerman, P. King, R. Muesing, B. Most, and K. Lippel. Multi-laboratory evaluation of an ultrafiltration procedure for high density lipoprotein cholesterol quantification in turbid heparin-manganese supernates.

The 16-hour-standing test and lipoprotein electrophoresis compared for detection of chylomicrons in plasma.

We compared the 16-hour-standing plasma test to lipoprotein electrophoresis on agarose gel for detection of chylomicrons in 129 patients' samples with triglyceride values greater than or equal to 4.00 g/L. Chylomicrons were observed in 12 samples (9.3%) by use of the standing-plasma test and in 58 samples (45.0%) by use of agarose-gel electrophoresis. Thus the standing-plasma test did not detect chylomicrons in 46 samples where they were observed by electrophoresis, or 79.3% of all cases where chylomicrons were present. Chylomicronemia was missed in the presence of lower triglyceride concentrations as well as at very high ones. We recommend that lipoprotein electrophoresis be routinely performed on plasma of patients with triglycerides concentrations greater than 4.00 g/L to distinguish between types IV and V hyperlipoproteinemia, as well as to detect failure of a patient to fast before sample collection.

beta-Lipoprotein quantitation in cord blood spotted on filter paper: a screening test.

We describe an electroimmunodiffusion technique for measuring beta-lipoprotein in cord blood spotted on filter paper. A series of cord-blood samples, taken from 916 consecutive live-birth infants, was spotted directly onto filter paper and assayed for beta-lipoprotein. Eleven had above-normal beta-lipoprotein. Of these 11, seven were tested two to six months later, along with their parents, for total cholesterol and triglyceride concentrations. Five infants had increased cholesterol values, and four parents of these infants had either increased cholesterol or triglyceride values. We also measured beta-lipoprotein concentrations in 63 paired samples of dried cord-blood and three-day post-delivery blood specimens, routinely collected for phenylketonuria screening. We saw a significant correlation between results for the specimens, but detected no cases of increased beta-lipoprotein. beta-Lipoprotein assay in dried specimens of cord blood is simple, inexpensive, and potentially is useful in mass screening of newborns for familial type II and combined hyperlipidemia.

Electrophoretic separation of high-density lipoprotein choelsterol evaluated and compared with the modified lipid research clinic procedure.

We evaluated a new agarose-gel-electrophoretic procedure (Corning) (I) for separating and quantitating of high-density lipoprotein cholesterol (HDLC), comparing it with the modified Lipid Research Clinics (LRC) procedure (heparin 183 kilounits/L, MnCl2 92 mmol/L) (II). Method I was insensitive to an HDLC concentration of 50 mg/L, but gave a linear dose-response curve between 130 and 1200 mg/L. Method II is sensitive to 50 mg/L and linear from 50--1200 mg/L. The within-plate CV for the Corning method varied from 26.2% for an HDLC of 168 mg/L to 6.8% for 580 mg/L. Within-day between-plate CV for the Corning method ranged from 22.1% at 155 mg/L to 8.0% at 651 mg/L, compared to 3.0 and 0.8% for the modified LRC procedure. Between-day CV for method I was 20, 12.6, 4.3, and 3.5% for HDLC concentrations of 175, 435, 542, and 678 mg/L, respectively; for method II it was 14, 5, 3.5, and 2.6%, respectively. Analysis of HDLC in 100 patients by both procedures showed mean HDLC values to be significantly lower (mean + SD, 27.8 +/- 1.7 mg/L; p less than 0.001) by method I. In 46 patients with HDLC less than 450 mg/L, this difference was accentuated (mean + SD = 40.5 +/- 2.6 mg/L) and clinically significant. Electrophoretic methods offer a promising further alternative method for HDLC separation and quantitation, but the negative bias, present limited sensitivity, and lack of precision at less than 450 mg/L indicate that they are not yet optimal for routine clinical use for patients with values less than 450 mg/L.