Irinotecan and temozolomide chemotherapy in paediatric and adult populations with relapsed Ewing Sarcoma.

BACKGROUND: Irinotecan and temozolomide (IT) is a widely used regimen for relapsed Ewing sarcoma (ES), although studies are largely limited to paediatric populations. METHODS: We retrospectively reviewed paediatric (< 18 years) and adult patients (≥ 18 years) treated with salvage IT at two institutions. Haematologic toxicities were graded according to common terminology criteria of adverse events. Survival was estimated by the Kaplan-Meier method and compared by the Log Rank test. RESULTS: Fifty-three patients were treated with IT from Jan, 2010 to Dec, 2018 (n = 16 paediatric; n = 37 adult). IT was given as second-line (n = 34; 64%) or ≥ third-line (n = 19; 36%). There was no difference in ≥ grade 3/4 haematologic toxicity between paediatrics and adults (31% vs. 35% respectively; p = 0.76). The frequency of diarrhoea of any grade was similar (38% in each group). Of 43 patients assessable for response, 12 (28%) had objective response (1 CR, 11 PR), 12 (28%) stable disease and 19 (44%) disease progression. Objective response rate did not differ between the two groups (36% in paediatrics vs. 25% in adults; p = 0.47). Median PFS was superior in paediatrics vs. adults (7.4 vs. 2.2 months, p = 0.039). CONCLUSION: Irinotecan and temozolomide (IT) chemotherapy has activity for relapsed ES, with favourable toxicity and equally observed objective responses in the paediatric and adult populations. The observed superior PFS for the paediatric cohort requires further confirmation in future studies.

Adrenomedullin increased the short-circuit current in the pig oviduct through chloride channels via the CGRP receptor: mediation by cAMP and calcium ions but not by nitric oxide.

The oviduct serves as a site for the fertilization of the ovum and the transport of the conceptus down to the uterus for implantation. In this study, we investigated the presence of adrenomedullin (ADM) and its receptor component proteins in the pig oviduct. The effect of ADM on oviductal secretion, the specific receptor, and the mechanisms involved were also investigated. The presence of ADM and its receptor component proteins in the pig oviduct were confirmed using immunostaining. Short-circuit current (I(sc)) technique was employed to study chloride ion secretion in the oviductal epithelium. ADM increased I(sc) through cAMP- and calcium-activated chloride channels, and this effect could be inhibited by the CGRP receptor antagonist, hCGRP8-37. In contrast, the nitric oxide synthase inhibitor, L-NG-nitroarginine methyl ester (L-NAME), could not block the effect of ADM on I(sc). In summary, ADM may increase oviductal fluid secretion via chloride secretion independent of the nitric oxide pathway for the transport of sperm and the conceptus.

Corticosteroid insensitivity is reversed by formoterol via phosphoinositide-3-kinase inhibition.

BACKGROUND AND PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) show a poor response to corticosteroids, which has been linked to oxidative stress. Here we show that the long-acting ß(2) -agonist formoterol (FM) reversed corticosteroid insensitivity under oxidative stress via inhibition of phosphoinositide-3-kinase (PI3K) signalling. EXPERIMENTAL APPROACH: Responsiveness to corticosteroids dexamethasone (Dex), budesonide (Bud) and fluticasone propionate (FP) was determined, as IC(50) values on TNF-α-induced interleukin 8 release, in U937 monocytic cell line treated with hydrogen peroxide (H(2) O(2) ) or peripheral blood mononuclear cells (PBMCs) from patients with COPD or severe asthma. KEY RESULTS: PBMCs from severe asthma and COPD were less sensitive to Dex compared with those from healthy subjects. Both FM (10(-9) M) and salmeterol (SM, 10(-8) M) reversed Dex insensitivity in severe asthma, but only FM restored Dex sensitivity in COPD. Although H(2) O(2) exposure decreased steroid sensitivity in U937 cells, FM restored responsiveness to Bud and FP while the effects of SM were weaker. Additionally, FM, but not SM, partially inhibited H(2) O(2) -induced PI3Kδ-dependent (PKB) phosphorylation. H(2) O(2) decreased SM-induced cAMP production in U937 cells, but did not significantly affect the response to FM. The reduction of SM effects by H(2) O(2) was reversed by pretreatment with LY294002, a PI3K inhibitor, or IC87114, a PI3Kδ inhibitor. CONCLUSION AND IMPLICATIONS: FM reversed oxidative stress-induced corticosteroid insensitivity and decreased ß(2) adrenoceptor-dependent cAMP production via inhibition of PI3Kδ signalling. FM will be more effective than SM, when combined with corticosteroids, for the treatment of respiratory diseases under conditions of high oxidative stress, such as in COPD.

Serum mannose-binding lectin levels and mbl2 gene polymorphisms in different age and gender groups of southern Chinese adults.

Mannose-binding lectin (MBL) is an acute-phase serum protein, and its inherited deficiency has been shown to predispose to infections. The developmental profile of serum MBL in preterm infants has been demonstrated previously. To determine the profiles of serum MBL levels and mbl2 polymorphisms over age and genders in an adult population, samples from 689 southern Chinese (age range 16-57 years; 382 males and 307 females) were studied using enzyme-linked immunosorbent assay and high-throughput genotyping of mbl2. Serum MBL levels maintained within a narrow range from age groups of 16-20 years old to 31-40 years old (mean of 2050-2160 micro g/l) and declined to a mean of 1466 micro g/l in the last age group 41-57 years old. No significant differences were found in the distributions of mbl2 haplotypes (YA, XA and YB) among all these age groups. Between gender groups, no significant imbalance of MBL profile in terms of serum MBL levels and distribution of mbl2 haplotypes was found. Results suggest an important role of circulating MBL in first-line host defence because MBL maintains at fairly constant levels after childhood and no gender influence on the MBL profile.

ARP-1/COUP-TF II determines hepatoma phenotype by acting as both a transcriptional repressor of microsomal triglyceride transfer protein and an inducer of CYP7A1.

L35 and FAO cells were derived as single cell isolates from H35 cells. Whereas L35 cells do not express microsomal triglyceride transfer protein (MTP), which regulates lipoprotein secretion, they express CYP7A1, which regulates bile acid synthesis from cholesterol. FAO cells display the opposite phenotype (i.e. expression of MTP but not CYP7A1). We examined the molecular basis of the transcriptional inactivation of the MTP gene in L35 cells. Nested deletion and mutagenesis studies show that a conserved DR1 element within the 135-bp proximal MTP promoter is responsible for differential expression by L35 and FAO cells. Yeast one-hybrid screening identified apolipoprotein A1 regulatory protein-1/chicken ovalbumin upstream promoter transcription factor II (ARP-1/COUP-TFII) and retinoid X receptor (RXRalpha) as the protein factors that can bind to the conserved DR1 element. Nuclear extracts from L35 cells contained 2-fold more ARP-1/COUP-TFII and 50% less RXRalpha than those from FAO cells. Immunologic studies show that in L35 cells, ARP-1/COUP-TFII is bound to the DR1 element, whereas in FAO cells, a complex containing RXRalpha is bound to the DR1 element. Co-transfection studies show that ARP-1/COUP-TFII repressed MTP promoter activity by approximately 70% in FAO hepatoma cells, whereas RXRalpha and its ligand 9-cis-retinoic acid increased MTP promoter activity by 6-fold in L35 cells. The combined data suggest that in the context of the MTP promoter, ARP-1/COUP-TFII (repressor) and a complex containing RXRalpha (inducer) compete for the DR1 element. Analysis of the CYP7A1 promoter revealed that it is approximately 5-fold more active in L35 cells than in FAO cells. Co-transfection of an ARP-1/COUP-TFII expression vector showed that it enhances CYP7A1 promoter activity by 6-fold in FAO cells. These combined findings indicate that ARP-1/COUP-TFII acts as both a transcriptional repressor (of MTP) and as a transcription activator (of CYP7A1). This dual function of ARP-1/COUP-TFII may play an important role in determining the metabolic phenotype of individual liver cells.

The application of a multisensory Snoezelen room for people with learning disabilities-Hong Kong experience.

In recent years there has been a considerable increase in the use of complementary therapies in the field of learning disabilities. This paper describes the use of a Snoezelen (multisensory) room for adults with learning disabilities in a psychiatric setting in Hong Kong. Theoretical and operational issues are discussed. The demographic and clinical data of a cohort of 96 patients who had used the room were reviewed. Rating forms were completed by their carers or staff at the end of the course to provide a subjective evaluation of the effectiveness of treatment. This is followed by three case reports. In view of the rising popularity of the multisensory room for people with learning disabilities, more research of the impact and therapeutic values is recommended.

Blocking microsomal triglyceride transfer protein interferes with apoB secretion without causing retention or stress in the ER.

Microsomal triglyceride transfer protein (MTP) is an intraluminal protein in the endoplasmic reticulum (ER) that is essential for the assembly of apolipoprotein B (apoB)-containing lipoproteins. In this study, we examine how the livers of mice respond to two distinct methods of blocking MTP function: Cre-mediated disruption of the gene for MTP and chemical inhibition of MTP activity. Blocking MTP significantly reduced plasma levels of triglycerides, cholesterol, and apoB-containing lipoproteins in both wild-type C57BL/6 and LDL receptor-deficient mice. While treating LDL receptor-deficient mice with an MTP inhibitor for 7 days lowered plasma lipids to control levels, liver triglyceride levels were increased by only 4-fold. Plasma levels of apoB-100 and apoB-48 fell by >90% and 65%, respectively, but neither apoB isoform accumulated in hepatic microsomes. Surprisingly, loss of MTP expression was associated with a nearly complete absence of apoB-100 in hepatic microsomes. Levels of microsomal luminal chaperone proteins [e.g., protein disulfide isomerase, glucose-regulated protein 78 (GRP78), and GRP94] and cytosolic heat shock proteins (HSPs) (e.g., HSP60, HSC, HSP70, and HSP90) were unaffected by MTP inhibition. These findings show that the liver responds rapidly to inhibition of MTP by degrading apoB and preventing its accumulation in the ER. The rapid degradation of secretion-incompetent apoB in the ER may block the induction of proteins associated with unfolded protein and heat shock responses.

Early interleukin 4-dependent response can induce airway hyperreactivity before development of airway inflammation in a mouse model of asthma.

In experimental models of bronchial asthma with mice, airway inflammation and increase in airway hyperreactivity (AHR) are induced by a combination of systemic sensitization and airway challenge with allergens. In this report, we present another possibility: that systemic antigen-specific sensitization alone can induce AHR before the development of inflammation in the airway. Male BALB/c mice were sensitized with ovalbumin (OVA) by a combination of intraperitoneal injection and aerosol inhalation, and various parameters for airway inflammation and hyperreactivity were sequentially analyzed. Bronchial response measured by a noninvasive method (enhanced pause) and the eosinophil count and interleukin (IL)-5 concentration in bronchoalveolar lavage fluid (BALF) gradually increased following the sensitization, and significant increase was achieved after repeated OVA aerosol inhalation along with development of histologic changes of the airway. In contrast, AHR was already significantly increased by systemic sensitization alone, although airway inflammation hardly developed at that time point. BALF IL-4 concentration and the expression of IL-4 mRNA in the lung reached maximal values after the systemic sensitization, then subsequently decreased. Treatment of mice with anti-IL-4 neutralizing antibody during systemic sensitization significantly suppressed this early increase in AHR. In addition, IL-4 gene-targeted mice did not reveal this early increase in AHR by systemic sensitization. These results suggest that an immune response in the lung in an early stage of sensitization can induce airway hyperreactivity before development of an eosinophilic airway inflammation in BALB/c mice and that IL-4 plays an essential role in this process. If this early increase in AHR does occur in sensitized human infants, it could be another therapeutic target for early prevention of the future onset of asthma.

[Successful therapy of cyclosporin A in a case with idiopathic interstitial pneumonia].

Seventy-one-year-old woman was visited to our hospital because of dry cough and dyspnea on effort. Fine crackle was audible on both lower lung fields. Joints and skin were normal. Laboratory examination revealed elevation of serum LDH and CRP level. Both anti-nuclear antibody and Jo-1 antibody were negative. Blood gas analysis showed hypoxia after exercise. Chest X-ray film showed reticular shadow in both lower lung fields. Chest CT finding showed patchy area of ground glass attenuation, air-space consolidation, and reticular shadow. Scintigram showed diffuse uptake of Gallium-67 in both lung. Transbronchial biopsy specimen revealed alveolar wall thickness, lymphocyte infiltration and swelling of type II pneumocytes. Bronchoalveolar lavage fluid analysis revealed elevation of CD4/CD8 ratio. She was given a diagnosis of idiopathic interstitial pneumonia. Combination therapy of cyclosporin A and steroid was performed. After therapy, her chest CT findings and her data of pulmonary function test were improved. Then therapy of cyclosporin A was continued and dose of prednisolone was gradually decreased. After that, she was suffered from respiratory tract infection. After administration of antibiotics and cyclosporin A, she was getting well without acute exacerbation of interstitial pneumonia. Since then, she was treated with cyclosporin A only and her pulmonary function test data were gradually improved more. It suggests that cyclosporin A may be useful for the treatment of idiopathic interstitial pneumonia.

Transferrin-bound and transferrin free iron uptake by cultured rat astrocytes.

Previously we had demonstrated the presence of transferrin receptor (TfR) on the plasma membrane of cultured rat cortical astrocytes. In this study, we investigated the roles of TfR in transferrin-bound iron (Tf-Fe) as well as transferrin-free iron (Fe II) uptake by the cells. The cultured rat astrocytes were incubated with 1 microM of double-labelled transferrin (125I-Tf-59Fe) in serum- free DMEM F12 medium or 59Fe II in isotonic sucrose solution at 37 degrees C or 4 degrees C for varying times. The cellular Tf-Fe, Tf and Fe II uptake was analyzed by measuring the intracellular radioactivity with gamma counter. The result showed that Tf-Fe uptake kept increasing in a linear manner at least in the first 30-min. In contrast to Tf-Fe uptake, the internalization of Tf into the cells was rapid initially but then slowed to a plateau level after 10 min. of incubation. The addition of either NH4Cl or CH3NH2, the blockers of Tf-Fe uptake via inhibiting iron release from Tf within endosomes, decreased the cellular Tf-Fe uptake but had no significant effect on Tf uptake. Pre-treated cells with trypsin inhibited significantly the cellular uptake of Tf-Fe as well as Tf. These findings suggested that Tf-Fe transport across the membrane of astrocytes is mediated by Tf-TfR endocytosis. The results of transferrin-free iron uptake indicated that the cultured rat cortical astrocytes had the capacity to acquire Fe II. The highest uptake of Fe II occurred at pH 6.5. The Fe II uptake was time and temperature dependent, iron concentration saturable, inhibited by several divalent metal ions, such as Co2+, Zn2+, Mn2+ and Ni2+ and not significantly affected by phenylarsine oxide treatment. These characteristics of Fe II uptake by the cultured astrocytes suggested that Fe II uptake is not mediated by TfR and implied that a carrier-mediated iron transport system might be present on the membrane of the cultured cells.

[Immunohistochemical analysis of bronchial mucosa in severe asthmatics treated with long-term, high-dose inhaled BDP].

To analyze specific mucosal changes in asthmatic patients receiving long-term, high-dose beclomethazone dipropionate (BDP) inhalation therapy, we performed bronchial mucosal biopsies and immunohistochemical analysis of patients who had been treated with or without BDP-inhalation. Our study enrolled 6 chronic severe asthmatics who were treated with 1,800 micrograms/day or more of BDP with regular use for more than 3 years (HD-BDP group), 6 mild asthmatics who were not treated with BDP (non-BDP group), and 6 control subjects. Specimens of bronchial mucosa were stained with anti-EG 2 (eosinophils), anti-UCHLA-1 (T lymphocytes) and anti-tryptase (mast cells). Although limited eosinophil infiltration was observed in the HD-BDP and control groups, a significant increase was noted in the non-BDP group. The infiltration of both T lymphocytes and mast cells exhibited a statistically significant increase in the non-BDP group compared to the HD-BDP and control groups. In chronic severe asthmatics, airway mucosal cell infiltration was reduced by high-dose and long-term inhaled BDP therapy, and BDP also relieved their asthmatic symptoms. However, in mild asthmatics, bronchial mucosal cell infiltration remained high. For such patients, we concluded that initiating BDP therapy from an early stage may bring clinical improvement and help prevent cell infiltration.

[Successful treatment of steroid-resistant bronchiolitis obliterans-organizing pneumonia with orally administered cyclosporin and pirfenidone].

A 27-year-old man with fever and dyspnea was admitted to our hospital. Chest computed tomography and a lung biopsy were performed, and bronchiolitis obliterans-organizing pneumonia (BOOP) was diagnosed. The patient was treated with corticosteroid, and a marked improvement was noted. However, when the dosage was tapered, BOOP recurred. Although the dosage was increased again, the corticosteroid alone was no longer effective against BOOP. While continuing with corticosteroid therapy, we also put the patient on a daily regimen of cyclosporin and pirfenidone, a recently developed anti-fibrotic agent. Both drugs were administered orally, and were so effective that we gradually decreased the dosage of corticosteroid. Several journals have reported that cyclosporin may be effective in the treatment of interstitial pneumonitis associated with collagen disease. We concluded that cyclosporin may also be useful in the treatment of refractory BOOP.

Transferrin receptors on the plasma membrane of cultured rat astrocytes.

It is generally accepted that transferrin receptor is located in the endothelial cells of the brain, but its existence in other brain cell types is less established. In this study, a [(125)I]transferrin binding assay was used to determine whether there is transferrin receptor on the membrane of cultured rat cortical astrocytes (type 1) in vitro. The results demonstrated that cortical astrocytes (type 1) in suspension attracted [(125)I]transferrin with a saturable and specific binding. Scatchard and Hill plot analysis showed that the dissociation constant (K(D)) of the binding was about 3.5x10(-8) M and the number of receptors was about 7.1x10(4)/cell. The Hill coefficient was 0.99, approaching 1, indicating the absence of cooperativity. The receptor was specific both for rat and human transferrin. The binding of rat [(125)I]transferrin could be competitively and specifically inhibited by unlabeled iron-saturated rat and human transferrin, and no difference was found between interaction of rat or human transferrin with this receptor. The interaction of duck or camel transferrin with this receptor was found to be very weak. This study provides evidence for the presence of transferrin receptor on the plasma membrane of cultured rat brain astrocytes.

[A case of eosinophilic gastroenteritis complicated with ileus and ascites collection].

A 30-year-old woman was admitted to our hospital because of ileus and ascites. Laboratory data on admission demonstrated marked eosinophilia (42.5% of WBC) but negative CRP-value. Abdominal CT showed marked ascites and diffuse thickening of intestinal walls. Ascites examination revealed eosinophilic ascites. The level of IL-5 both in the serum and in the ascites were also high. No evidence of eosinophilic infiltration was noted both gastric and colonic mucosal biopsy specimens. Oral prednisolone treatment (50 mg/day) was effective for her. We diagnosed her as a case of sub-serosal type eosinophilic gastroenteritis. It is essential to obtain eosinophilic ascites for correct diagnosis of the disease. And it is possible that serum and ascites IL-5 value would be reliable indicator of the activity of this disease.

Noninvasive system for evaluating the allergen-specific airway response in a murine model of asthma.

In the present report, we show that the enhanced pause (Penh), a novel indicator of airway responsiveness to bronchoconstrictors, can also be a good marker of airway response to an allergen challenge in a murine model of asthma. Male BALB/c mice were sensitized with ovalbumin (OVA) through a combination of intraperitoneal injection and aerosol inhalation. After this immunization, the OVA-specific IgE titer in serum increased to a significantly higher level than in a saline/PBS-treated control group. After the final OVA aerosol challenge, Penh was repeatedly measured in conscious, unrestrained mice, according to the time schedule. Penh increased gradually after the challenge and reached a maximal value at 24 hours that was significantly higher than the control value (p < 0.01). Histologic examination of the lung revealed airway inflammation with an invasion by eosinophils and lymphocytes from vessels into the peribronchial interstitium and the mucosal and submucosal areas of the bronchus. There was a strong correlation between the Penh value and eosinophil number in bronchoalveolar lavage fluid (r = 0.699, p < 0.0001). Moreover, Penh also correlated strongly with the intensity score of histologic findings. These results suggest that the bronchial response to a specific allergen could be followed in a particular individual through the noninvasive Penh method, and that Penh accurately reflects the intensity of eosinophilic bronchial inflammation. This system would be applicable to a noninvasive, chronological evaluation of various experimental interventions in a murine model of asthma.