Avaliação de diferentes protocolos de aplicação da terapia fotodinâmica antimicrobiana (aPDT) no tratamento da periodontite induzida em ratos imunossuprimidos com droga quimioterápica: estudo histomorfométrico, imunoistoquímico, imunológico e microbiológico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Metformin and soybean-derived bioactive molecules attenuate the expansion of stem cell-like epithelial subpopulation and confer apoptotic sensitivity in human colon cancer cells

Colorectal cancer (CRC) is a disease whose genesis may include metabolic dysregulation. Cancer stem cells are attractive targets for therapeutic interventions since their aberrant expansion may underlie tumor initiation, progression, and recurrence. To investigate the actions of metabolic regulators on cancer stem cell-like cells (CSC) in CRC, we determined the effects of soybean-derived bioactive molecules and the anti-diabetes drug metformin (MET), alone and together, on the growth, survival, and frequency of CSC in human HCT116 cells. Effects of MET (60 μM) and soybean components genistein (Gen, 2 μM), lunasin (Lun, 2 μM), β-conglycinin (β-con, 3 μM), and glycinin (Gly, 3 μM) on HCT116 cell proliferation, apoptosis, and mRNA/protein expression and on the frequency of the CSC CD133(+)CD44(+) subpopulation by colonosphere assay and fluorescence-activated cell sorting/flow cytometry were evaluated. MET, Gen, and Lun, individually and together, inhibited HCT116 viability and colonosphere formation and, conversely, enhanced HCT116 apoptosis. Reductions in frequency of the CSC CD133(+)CD44(+) subpopulation with MET, Gen, and Lun were found to be associated with increased PTEN and reduced FASN expression. In cells under a hyperinsulinemic state mimicking metabolic dysregulation and without and with added PTEN-specific inhibitor SF1670, colonosphere formation and frequency of the CD133(+)CD44(+) subpopulation were decreased by MET, Lun and Gen, alone and when combined. Moreover, MET + Lun + Gen co-treatment increased the pro-apoptotic and CD133(+)CD44(+)-inhibitory efficacy of 5-fluorouracil under hyperinsulinemic conditions. Results identify molecular networks shared by MET and bioavailable soy food components, which potentially may be harnessed to increase drug efficacy in diabetic and non-diabetic patients with CRC.

Footprints of a trypanosomatid RNA world: pre-small subunit rRNA processing by spliced leader addition trans-splicing

The addition of a capped mini-exon [spliced leader (SL)] through trans-splicing is essential for the maturation of RNA polymerase (pol) II-transcribed polycistronic pre-mRNAs in all members of the Trypanosomatidae family. This process is an inter-molecular splicing reaction that follows the same basic rules of cis-splicing reactions. In this study, we demonstrated that mini-exons were added to precursor ribosomal RNA (pre-rRNA) are transcribed by RNA pol I, including the 5' external transcribed spacer (ETS) region. Additionally, we detected the SL-5' ETS molecule using three distinct methods and located the acceptor site between two known 5' ETS rRNA processing sites (A' and A1) in four different trypanosomatids. Moreover, we detected a polyadenylated 5' ETS upstream of the trans-splicing acceptor site, which also occurs in pre-mRNA trans-splicing. After treatment with an indirect trans-splicing inhibitor (sinefungin), we observed SL-5' ETS decay. However, treatment with 5-fluorouracil (a precursor of RNA synthesis that inhibits the degradation of pre-rRNA) led to the accumulation of SL-5' ETS, suggesting that the molecule may play a role in rRNA degradation. The detection of trans-splicing in these molecules may indicate broad RNA-joining properties, regardless of the polymerase used for transcription.

Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation Long-Term Results of a Prospective Trial (National Clinical Trial 00254683)

BACKGROUND: Neoadjuvant chemoradiation (CRT) therapy may result in significant tumor regression in patients with rectal cancer. Patients who develop complete tumor regression have been managed by treatment strategies that are alternatives to standard total mesorectal excision. Therefore, assessment of tumor response with positron emission tomography/computed tomography (PET/CT) after neoadjuvant treatment may offer relevant information for the selection of patients to receive alternative treatment strategies. METHODS: Patients with clinical T2 (cT2) through cT4NxM0 rectal adenocarcinoma were included prospectively. Neoadjuvant therapy consisted of 54 grays of radiation and 5-fluorouracil-based chemotherapy. Baseline PET/CT studies were obtained before CRT followed by PET/CT studies at 6 weeks and 12 weeks after the completion of CRT. Clinical assessment was performed at 12 weeks after CRT completion. PET/CT results were compared with clinical and pathologic data. RESULTS: In total, 99 patients were included in the study. Twenty-three patients were complete responders (16 had a complete clinical response, and 7 had a complete pathologic response). The PET/CT response evaluation at 12 weeks indicated that 18 patients had a complete response, and 81 patients had an incomplete response. There were 5 false-negative and 10 false-positive PET/CT results. PET/CT for the detection of residual cancer had 93% sensitivity, 53% specificity, a 73% negative predictive value, an 87% positive predictive value, and 85% accuracy. Clinical assessment alone resulted in an accuracy of 91%. PET/CT information may have detected misdiagnoses made by clinical assessment alone, improving overall accuracy to 96%. CONCLUSIONS: Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2012;35013511. (C) 2011 American Cancer Society.

Endogene DNA-Schädigung als Ursache genetischer Instabilität

Zusammenfassung Diese Arbeit beschreibt Untersuchungen über die zellulären Mechanismen, die zur Bildung dieser DNA-Schäden führen, sowie über die biologischen Auswirkungen dieser Schäden. Die Untersuchungen zu Uracil in der DNA wurden in ung-knockout-MEFs und Mäusen durchgeführt, die es erlauben, die Konsequenzen eines Ausfalls der wichtigsten Reparaturglykosylase für Uracil zu beleuchten. Die Ergebnisse zeigen eine deutliche Akkumulation von Uracil in den ung-/--Mausfibroblasten im Vergleich zum Wildtyp. In frisch isolierten Leber- und Milzzellen der Mäuse konnte dieser genotypspezifische Unterschied, wenn auch weniger ausgeprägt, ebenso beobachtet werden, nicht jedoch in reifen Spermien. Dieser gewebespezifische Unterschied und die quantitativ stärker ausgeprägte Akkumulation in ung-/--Mausfibroblasten im Vergleich zu den Mäusegeweben gab Anlass zur Vermutung, dass die Proliferation der Zellen für den Haupteintrag an Uracil in die DNA verantwortlich ist. Erstmals konnte in Versuche mit konfluenten (nicht mehr proliferierenden) ung-/--Mausfibroblasten gezeigt werden, dass nicht die spontane hydrolytische Desaminierung von Cytosin, sondern der Fehleinbau von dUMP während der DNA-Replikation die Hauptquelle für Uracil in der DNA von Säugerzellen darstellt. Da der Uracilmetabolismus ein wichtiges Target in der Chemotherapie ist, lag es nahe, das zur Verfügung stehende ung-knockout-Modell der MEFs zur Untersuchung mit Fluorpyrimidinen, die als Zytostatika verwendet werden, einzusetzen. Da bisher die Ursachen der beobachteten Apoptose der Tumorzellen und aller anderen metabolisch hochaktiven Zellen eines behandelten Organismus noch nicht vollständig verstanden ist, wurden diese Zellen mit verschiedenen Fluorpyrimidinen behandelt, die als Thymidylatsynthasehemmer die de novo Synthese von Thymidin unterbinden. Es konnte gezeigt werden, dass ung-/- Mausfibroblasten, im Gegensatz zu ung+/+ Mausfibroblasten, verstärkt Uracil in der DNA akkumulieren. Obwohl die ung+/+ Mausfibroblasten keine erhöhten Uracil-Spiegel in der DNA aufwiesen, zeigten sie bei Inkubation mit einem der beiden Thymidylatsynthasehemmern, 5-Fluoruracil (5-FU), die gleiche Sensitivität in einem nachfolgenden Proliferationsversuch wie die ung-/- Mausfibroblasten. Dies lässt darauf schließen, dass weder Reparatur noch Einbau von Uracil in die DNA für die beobachtete Toxizität dieser Zytostatika notwendig sind. Ein weiterer Schwerpunkt dieser Arbeit war die Untersuchung des DNA-schädigenden Potenzials endogener ROS, die aus dem Fremdstoffmetabolismus stammen. Dazu wurden V79-Zellen verwendet, die mit dem humanen Enzym Cytochrom 2E1 (CYP2E1) transfiziert wurden (V79 CYP2E1) sowie Zellen, die ebenfalls durch Transfektion das humane Enzym Cytochromreduktase (auch Oxidoreduktase genannt) überexprimieren (V79 hOR). Beide Enzyme sind zusammen an der Hydroxylierung von Fremdstoffen beteiligt, bei der die Reduktion von molekularem Sauerstoff durch Übertragung von zwei Elektronen notwendig ist. Wird anstatt zweier Elektronen in Folge nur eines auf den Sauerstoff übertragen, so führt dieser von der Substratoxygenierung enkoppelte Vorgang zur Bildung von Superoxid. Daher galt es zu klären, ob das so erzeugte Superoxid und daraus gebildete ROS in der Lage sind, die DNA zu schädigen. Es konnte gezeigt werden, dass die Überexpression von CYP2E1 nicht zu einem erhöhten basalen Gleichgewichtsspiegel oxidativer DNA-Schäden führt und die Metabolisierung von Ethanol durch dieses Enzym ebenfalls keine DNA-Modifikationen verursacht. Die Überexpression der Cytochromreduktase hingegen führte gegenüber dem Wildtyp zu einem erhöhten basalen Gleichgewichtsspiegel oxidativer Basenmodifikationen nach Depletion von Glutathion, einem wichtigen zellulären Antioxidans. Im Mikrokerntest, der gentoxische Ereignisse wie Chromosomenbrüche in Zellen aufzeigt, zeigte sich schon ohne Glutathion-Depletion eine doppelt so hohe Mikrokernrate im Vergleich zum Wildtyp. In weiteren Versuchen wurden die V79-hOR-Zellen mit dem chinoiden Redoxcycler Durochinon inkubiert, um zu untersuchen, ob das vermutlich durch die Reduktase vermittelte Redoxcycling über Generierung von ROS in der Lage ist, einen oxidativen DNA-Schaden und Toxizität zu verursachen. Hier zeigte sich, dass die Überexpression der Reduktase Voraussetzung für Toxizität und den beobachteten DNA-Schaden ist. Die Wildtyp-Zellen zeigten weder einen DNA-Schaden noch Zytotoxizität, auch eine zusätzliche Glutathion-Depletion änderte nichts an dem Befund. Die V79-hOR-Zellen hingegen reagierten auf die Inkubation mit Durochinon mit einer konzentrationsabhängigen Zunahme der Einzelstrangbrüche und oxidativen Basenmodifikationen, wobei sich der DNA-Schaden durch vorherige Glutathion-Depletion verdoppeln ließ.

Tumori primitivi multipli del polmone. Profilo clinico e biologico in pazienti affetti da neoplasie polmonari multiple. Analisi di elementi clinici e marcatori biologici come possibili fattori di differenziazione dei tumori polmonari multipli

Background: MPLC represents a diagnostic challenge. Topic of the discussion is how to distinguish these patients as a metastatic or a multifocal disease. While in case of the different histology there are less doubt on the opposite in case of same histology is mandatory to investigate on other clinical features to rule out this question. Matherials and Methods: A retrospective review identified all patients treated surgically for a presumed diagnosis of SPLC. Pre-operative staging was obtained with Total CT scan and fluoro-deoxy positron emission tomography and mediastinoscopy. Patients with nodes interest or extra-thoracic location were excluded from this study. Epidermal growth factor receptor (EGFR) expression with complete immunohistochemical analisis was evaluated. Survival was estimated using Kaplan-Meyer method, and clinical features were estimated using a long-rank test or Cox proportional hazards model for categorical and continuous variable, respectively. Results: According to American College Chest Physician, 18 patients underwent to surgical resection for a diagnosis of MPLC. Of these, 8 patients had 3 or more nodules while 10 patients had less than 3 nodules. Pathologic examination demonstrated that 13/18(70%) of patients with multiple histological types was Adenocarcinoma, 2/18(10%) Squamous carcinoma, 2/18(10%) large cell carcinoma and 1/18(5%) Adenosquamosu carcinoma. Expression of EGFR has been evaluated in all nodules: in 7 patients of 18 (38%) the percentage of expression of each nodule resulted different. Conclusions: MPLC represent a multifocal disease where interactions of clinical informations with biological studies reinforce the diagnosis. EGFR could contribute to differentiate the nodules. However, further researches are necessary to validate this hypothesis.

Modulation der Strahlen- und Chemosensitivität menschlicher Tumorzellen durch Interferon

Pankreaskarzinome und maligne Melanome weisen eine hohe Resistenz gegenüber Zytostatika und Bestrahlung in der Therapie auf. Die Behandlung eines metastasierenden Pankreaskarzinoms besteht aus einer Kombination aus 5-FU, CDDP und IR. Für die Behandlung des malignen Melanoms ist das methylierende Agenz DTIC das Mittel erster Wahl. Das ebenfalls methylierende Agenz TMZ, welches jedoch in Deutschland noch nicht für die Behandlung von malignen Melanomen zugelassen ist, erlangt immer größere Bedeutung. Die Ansprechrate der Tumore kann durch Kombination mit IFNs erhöht werden. In der vorliegenden Arbeit wurde an Pankreaskarzinom- bzw. Melanomzelllinien untersucht, ob IFNs einen radio- bzw. chemosensibilisierender Effekt ausüben und, wenn ja, welcher Mechanismus hierfür verantwortlich ist. Es wurden zehn Pankreaskarzinom-Zelllinien (Panc-1, Su8686, Capan-1, Capan-2, Bxpc-3, PA-TU 8988T, Aspc-1, HS 766T, Mia-PaCa-2 und PA-TU 8902) untersucht. Diese zeigten eine hohe Variabilität in ihrer intrinsischen Radiosensitivität sowie in ihrer Sensitivität gegenüber IFN-alpha und IFN-beta. IFN-beta erwies sich als toxischer im Vergleich zu IFN-alpha. Die radiosensibilisierende Wirkung der IFNs an Pankreaskarzinom-Zelllinien war moderat, wobei IFN-beta im Vergleich zu IFN-alpha effektiver war. Der radiosensibilisierende Effekt ging mit einer deutlichen Erhöhung der alpha-Komponente, der Überlebenskurven einher und kam durch eine IFN-beta vermittelte Verstärkung der IR-induzierten Apoptoserate zustande. Dies wurde sowohl durch SubG1 als auch durch Annexin V / PI Messungen gezeigt. Einen Einfluss von IFN-beta auf den Zellzyklus und die DSB-Reparatur konnte durch funktionelle Untersuchungen sowie durch PCR bzw. Western-Blot-Analysen als Grund für den sensibilisierdenen Effekt ausgeschlossen werden. Ein sensibilisierender Effekt von IFN-beta auf die durch TMZ-induzierte Zytotoxizität war für die Pankreaskarzinom-Zelllinien weder in MGMT-profizientem noch –depletiertem Zustand zu beobachten. Zur Untersuchung der sensibilisierenden Eigenschaften von IFNs gegenüber TMZ in malignen Melanomzelllinien wurden p53-Wildtyp (D05 und A375) und mutierte Zelllinien (D14 und RPMI 7951) untersucht. Gegenüber alleiniger TMZ-Behandlung reagierten die untersuchten p53-Wildtyp Melanomzelllinien nicht sensitiver auf eine Behandlung mit TMZ als p53-mutierte Zelllinien. Der Nachweis des Spaltprodukts der Caspase-9 lieferte einen Hinweis darauf, dass in den Melanomzelllinien unabhängig vom p53-Status nach alleiniger TMZ-Behandlung der mitochondriale Apoptoseweg aktiviert wird. Durch eine Vorbehandlung der Zellen mit IFN-alpha oder IFN-beta konnte die TMZ-induzierte Apoptoserate in malignen Melanomzellen deutlich gesteigert werden. In p53-Wildtyp Melanomzellen war der chemosensibilisierende Effekt der IFNs besonders ausgeprägt. IFN-beta erwies sich hierbei als effektiver, weshalb es für die folgenden Versuche verwendet wurde. Durch stabile Transfektion der Zelllinie D05 mit MGMT konnte das durch TMZ-induzierte Addukt O6MeG als für den sensibilisieredenen Effekt ausschlaggebende DNA-Schädigung charakterisiert werden. Western-Blot-Analysen und gamma-H2AX-Immunfluoreszenz Untersuchungen konnten einen Einfluss von IFN-beta auf die Prozessierung der Läsion O6MeG sowie einen Einfluss von IFN-beta auf die Induktion und Reparatur von TMZ verursachten DSBs ausschließen. Durch Experimente mit einem Fas-aktivierenden Antikörper und durch eine stabile Transfektion der Zelllinien D05 und A375 mit DN-FADD konnte gezeigt werden, dass p53-Wildtyp Melanomzellen nicht oder nur eingeschränkt in der Lage sind, nach TMZ-Behandlung über den Fas-Rezeptor Signalweg Apoptose zu induzieren. Ausschlaggebend hierfür ist die geringe Pro-Caspase-8 Expression dieser Zelllinien. Eine IFN-beta Vorbehandlung bewirkte eine Reaktivierung des Fas-Rezeptor Signalweges, was mit einer verstärkten Expression der Pro-Caspase-8 einherging. Durch Experimente mit Caspase-8 siRNA konnte diese IFN-beta induzierte Verstärkung der Pro-Caspase-8 Expression als entscheidender Faktor für den sensibilisierenden Effekt ausgemacht werden. Zum ersten Mal konnte damit in dieser Arbeit gezeigt werden, dass p53-Wildtyp Melanomzellen durch eine IFN-beta vermittelte Hochregulation der Pro-Caspase-8 ihre Fähigkeit wiedererlangen, nach TMZ-Behandlung über den Fas-Rezeptor Signalweg Apoptose auszulösen. Diese Arbeiten weisen einen Weg, auf welchem die hohe Resistenz von malignen Melanomzellen, welche zu 80 % das nicht mutierte p53 Gen beherbergen, über eine IFN-beta induzierte Reaktivierung der Fas-Rezeptor vermittelten Apoptosekaskade überwunden werden kann.

Photodynamic therapy in the treatment of actinic keratosis

The efficacy of photodynamic therapy (PDT) with 5-aminolevulinate and methyl aminolevulinate in the treatment of actinic keratosis has been demonstrated in a large number of clinical studies over the last several years. Here, we recapitulate the major findings, comparing the various photosensitizers, light sources and therapeutic regimens, and present a retrospective analysis of 142 own cases treated with 259 PDTs. In addition, we also discuss the value of PDT in comparison with cryotherapy or 5-fluorouracil. The efficacy and the low risk of side effects of PDT have resulted in a high patient preference in clinical trials.

Predictors of inflammation in response to anthracycline-based chemotherapy for breast cancer

Although chemotherapy for breast cancer can increase inflammation, few studies have examined predictors of this phenomenon. This study examined potential contributions of demographics, disease characteristics, and treatment regimens to markers of inflammation in response to chemotherapy for breast cancer. Thirty-five women with stage I-III-A breast cancer (mean age 50 years) were studied prior to cycle 1 and prior to cycle 4 of anthracycline-based chemotherapy. Circulating levels of inflammatory markers with high relevance to breast cancer were examined, including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), Interleukin-1 receptor antagonist (IL1-RA), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), Interleukin- (IL-6), soluble P-selectin (sP-selectin), and von Willebrand factor (vWf). Chemotherapy was associated with elevations in VEGF (p < or = 0.01), sICAM-1 (p < or = 0.01), sP-selectin (p < or = 0.02) and vWf (p < or = 0.05). Multiple regression analysis controlling for age and body mass index (BMI) showed that higher post-chemotherapy levels of inflammation were consistently related to higher pre-chemotherapy levels of inflammation (ps < or =0.05) as well as to certain disease characteristics. Post-chemotherapy IL-6 levels were higher in patients who had larger tumors (p < or = 0.05) while post-chemotherapy VEGF levels were higher in patients who had smaller tumors (p < or = 0.05). Post-chemotherapy sP-selectin levels were highest in women who had received epirubicin, cytoxan, 5-fluorouracil chemotherapy (p < or = 0.01). These findings indicate that chemotherapy treatment can be associated with elevations in certain markers of inflammation, particularly markers of endothelial and platelet activation. Inflammation in response to chemotherapy is most significantly related to inflammation that existed prior to chemotherapy but also potentially to treatment regimen and to certain disease characteristics.

A specific expression profile of heat-shock proteins and glucose-regulated proteins is associated with response to neoadjuvant chemotherapy in oesophageal adenocarcinomas

BACKGROUND Oesophageal adenocarcinomas often show resistances to chemotherapy (CTX), therefore, it would be of high interest to better understand the mechanisms of resistance. We examined the expression of heat-shock proteins (HSPs) and glucose-regulated proteins (GRPs) in pretherapeutic biopsies of oesophageal adenocarcinomas to assess their potential role in CTX response. METHODS Ninety biopsies of locally advanced adenocarcinomas before platin/5-fluorouracil (FU)-based CTX were investigated by reverse phase protein arrays (RPPAs), immunohistochemistry (IHC) and quantitative RT-PCR. RESULTS CTX response strongly correlated with survival (P=0.001). Two groups of tumours with specific protein expression patterns were identified by RPPA: Group A was characterised by low expression of HSP90, HSP27 and p-HSP27((Ser15, Ser78, Ser82)) and high expression of GRP78, GRP94, HSP70 and HSP60; Group B exhibited the inverse pattern. Tumours of Group A were more likely to respond to CTX, resulting in histopathological tumour regression (P=0.041) and post-therapeutic down-categorisation from cT3 to ypT0-T2 (P=0.040). High HSP60 protein (IHC) and mRNA expression were also associated with tumour down-categorisation (P=0.016 and P=0.004). CONCLUSION Our findings may enhance the understanding of CTX response mechanisms, might be helpful to predict CTX response and might have translational relevance as they highlight the role of potentially targetable cellular stress proteins in the context of CTX response.

Dual Targeting of Tumor Angiogenesis and Chemotherapy by Endostatin- Cytosine Deaminase-Uracil PhosphoribosylTransferase

Antiangiogenesis is a promising anti-tumor strategy through inhibition tumor vascularformation to suppress tumor growth. Targeting specific VEGF/R has been showntherapeutic benefits in many cancer types and become a first approvedantiangiogenic modalities by Food and Drug Administration (FDA) in United States.However, interruption of homeostasis in normal tissues that is likely due to theinhibition of VEGF/R signaling pathway induces unfavorable side effects. Moreover,cytostatic nature of antiangiogenic drugs frequently causes less tumor cell specifickilling activity, and cancer cells escaped from cell death induced by these drugseven gain more malignant phenotypes, resulting in tumor invasion and metastasis.To overcome these issues, we developed a novel anti-tumor therapeutic EndoCDfusion protein which linked endostatin (Endo) to cytosine deaminase-uracilvphosphoribosyl transferase (CD). Endo targets unique tumor endothelial cells toprovide tumor-specific antiangiogenesis activity and also carries CD to the localtumor area, where it serves nontoxic prodrug 5-fluorocytosine (5-FC) enzymaticconversion reaction to anti-metabolite chemotherapy drug 5-fluorouracil (5-FU). Wedemonstrated that 5-FU concentration was highly increased in tumor sites, resultingin high level of endothelial cells and tumor cells cytotoxic efficacy. Furthermore,EndoCD/5-FC therapy decreased tumor growth and colorectal liver metastasisincident compared with bevacizumab/5-FU treatment in human breast and colorectalliver metastasis orthotropic animal models. In cardiotoxicity safety profile,EndoCD/5-FC is a contrast to bevacizumab/5-FU; lower risk of cardiotoxicityinduction or heart function failure was found in EndoCD/5-FC treatment thanbevacizumab/5-FU does in mice. EndoCD/5-FC showed more potent therapeuticefficacy with high safety profile and provided stronger tumor invasion or metastasisinhibition than antiangiogenic drugs. Together, EndoCD fusion protein with 5-FCshowed dual tumor targeting activities including antiangiogenesis and tumor localchemotherapy, and it could serve as an alternative option for antiangiogenic therapy.

Dihydropyrimidinase and β-ureidopropionase gene variation and severe fluoropyrimidine-related toxicity

AIMS To assess the association of DPYS and UPB1 genetic variation, encoding the catabolic enzymes downstream of dihydropyrimidine dehydrogenase, with early-onset toxicity from fluoropyrimidine-based chemotherapy. PATIENTS & METHODS The coding and exon-flanking regions of both genes were sequenced in a discovery subset (164 patients). Candidate variants were genotyped in the full cohort of 514 patients. RESULTS & CONCLUSIONS Novel rare deleterious variants in DPYS (c.253C > T and c.1217G > A) were detected once each in toxicity cases and may explain the occurrence of severe toxicity in individual patients, and associations of common variants in DPYS (c.1-1T > C: padjusted = 0.003; OR = 2.53; 95% CI: 1.39-4.62, and c.265-58T > C: padjusted = 0.039; OR = 0.61; 95% CI: 0.38-0.97) with 5-fluorouracil toxicity were replicated.

Influence of Different Neoadjuvant Chemotherapy Regimens on Response, Prognosis, and Complication Rate in Patients with Esophagogastric Adenocarcinoma.

BACKGROUND Perioperative chemotherapy improves survival in patients with advanced esophagogastric cancer, but the optimal treatment regimen remains unclear. More intensive chemotherapy may improve outcome, but also increase toxicity and complications. METHODS A total of 843 patients were included in this retrospective study and stratified in 4 groups: doublet therapy with cisplatin or oxaliplatin and 5-fluorouracil (groups A/B) or triplet therapy with additional epirubicin or taxane (groups C/D). The influence of the different neoadjuvant chemotherapy regimens on response, prognosis, and complications was assessed. RESULTS Clinical and pathological response were associated with longer overall survival (OS; p < 0.001). No significant differences regarding response or OS were found, but there was a trend toward better outcome in group D (taxane-containing triplet). In the subgroup of 669 patients with adenocarcinomas of the esophagogastric junction (AEG), patients who had received taxane-containing regimens had a significantly longer OS (p = 0.037), but taxane use was not an independent factor in multivariate analysis. Triple therapy with taxanes did not result in a higher complication rate or postoperative mortality. CONCLUSIONS Although no superior neoadjuvant chemotherapy regimen was identified for patients with esophagogastric adenocarcinoma, taxane-containing regimens should be further investigated in randomized trials, especially in patients with AEG tumors.

The impact of ABCC11 polymorphisms on the risk of early-onset fluoropyrimidine toxicity

A missense variant (c.1637C>T, T546M) in ABCC11 encoding the MRP8 (multidrug resistance protein 8), a transporter of 5-fluorodeoxyuridine monophosphate, has been associated with an increased risk of 5-fluorouracil-related severe leukopenia. To validate this association, we investigated the impact of the ABCC11 variants c.1637C>T, c.538G>A and c.395+1087C>T on the risk of early-onset fluoropyrimidine-related toxicity in 514 cancer patients. The ABCC11 variant c.1637C>T was strongly associated with severe leukopenia in patients carrying risk variants in DPYD, encoding the key fluoropyrimidine-metabolizing enzyme dihydropyrimidine dehydrogenase (odds ratio (OR): 71.0; 95% confidence interval (CI): 2.5-2004.8; Pc.1637C>T*DPYD=0.013). In contrast, in patients without DPYD risk variants, no association with leukopenia (OR: 0.95; 95% CI: 0.34-2.6) or overall fluoropyrimidine-related toxicity (OR: 1.02; 95% CI: 0.5-2.1) was observed. Our study thus suggests that c.1637C>T affects fluoropyrimidine toxicity to leukocytes particularly in patients with high drug exposure, for example, because of reduced fluoropyrimidine catabolism.

Managing Complications of Fillers: Rare and Not-So-Rare.

Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse effects. The main goal is to prevent them, however, this is not always possible. Utmost care has to be given to the prevention of infections and the injection technique has to be perfect. Treatment of adverse effects is often with hyaluronidase or steroid injections and in some cases together with 5-fluorouracil plus allopurinol orally. Histological examination of biopsy specimens often helps to identify the responsible filler allowing a specific treatment to be adapted.