Bioavailability study of oral and intravenous OGT 719, a novel nucleoside analogue with preferential activity in the liver

Purpose: Although oral fluoropyrimidine pro-drugs are increasingly being administered in preference to intravenous nucleoside analogues in cancer chemotherapy, their activation in malignant liver tissue may be insufficient. OGT 719 (1-galactopyranosyl-5-fluorouracil) is a novel nucleoside analogue, preferentially localized in hepatocytes and hepatoma cells via the asialoglycoprotein receptor. The aim of this study was to assess the systemic bioavailability of this rationally designed drug in 16 patients with advanced solid cancers. Method: Crossover pharmacokinetic study of oral (400 or 800 mg) and intravenous (250 mg/m 2) OGT 719. Results: Linear pharmacokinetics and oral bioavailability of approximately 25% were observed at the dose levels used in this study. Like other 5-FU prodrugs, considerable interpatient variability was observed in bioavailability following oral dosing. The mean half-life for oral doses was 4 h. OGT 719 was well tolerated. No objective tumour responses were demonstrated. Conclusion: The systemic bioavailability and half-life of oral OGT 719 are sufficient to merit dose escalation studies with frequent daily dosing. Subsequent efficacy studies should be performed in patients with primary and secondary liver malignancies.

Investigation of structural requirements of anticancer activity at the paclitaxel/tubulin binding site using CoMFA and CoMSIA

CoMFA and CoMSIA analysis were utilized in this investigation to define the important interacting regions in paclitaxel/tubulin binding site and to develop selective paclitaxel-like active compounds. The starting geometry of paclitaxel analogs was taken from the crystal structure of docetaxel. A total of 28 derivatives of paclitaxel were divided into two groups—a training set comprising of 19 compounds and a test set comprising of nine compounds. They were constructed and geometrically optimized using SYBYL v6.6. CoMFA studies provided a good predictability (q2 = 0.699, r2 = 0.991, PC = 6, S.E.E. = 0.343 and F = 185.910). They showed the steric and electrostatic properties as the major interacting forces whilst the lipophilic property contribution was a minor factor for recognition forces of the binding site. These results were in agreement with the experimental data of the binding activities of these compounds. Five fields in CoMSIA analysis (steric, electrostatic, hydrophobic, hydrogen-bond acceptor and donor properties) were considered contributors in the ligand–receptor interactions. The results obtained from the CoMSIA studies were: q2 = 0.535, r2 = 0.983, PC = 5, S.E.E. = 0.452 and F = 127.884. The data obtained from both CoMFA and CoMSIA studies were interpreted with respect to the paclitaxel/tubulin binding site. This intuitively suggested where the most significant anchoring points for binding affinity are located. This information could be used for the development of new compounds having paclitaxel-like activity with new chemical entities to overcome the existing pharmaceutical barriers and the economical problem associated with the synthesis of the paclitaxel analogs. These will boost the wide use of this useful class of compounds, i.e. in brain tumors as the most of the present active compounds have poor blood–brain barrier crossing ratios and also, various tubulin isotypes has shown resistance to taxanes and other antimitotic agents.

Decision-theoretic designs for dose-finding clinical trials with multiple outcomes

A decision-theoretic framework is proposed for designing sequential dose-finding trials with multiple outcomes. The optimal strategy is solvable theoretically via backward induction. However, for dose-finding studies involving k doses, the computational complexity is the same as the bandit problem with k-dependent arms, which is computationally prohibitive. We therefore provide two computationally compromised strategies, which is of practical interest as the computational complexity is greatly reduced: one is closely related to the continual reassessment method (CRM), and the other improves CRM and approximates to the optimal strategy better. In particular, we present the framework for phase I/II trials with multiple outcomes. Applications to a pediatric HIV trial and a cancer chemotherapy trial are given to illustrate the proposed approach. Simulation results for the two trials show that the computationally compromised strategy can perform well and appear to be ethical for allocating patients. The proposed framework can provide better approximation to the optimal strategy if more extensive computing is available.

DNA intercalative 4-butylaminopyrimido4',5':4,5]thieno(2,3-b)quinoline induces cell cycle arrest and apoptosis in leukemia cells

DNA intercalators are one of the interesting groups in cancer chemotherapy. The development of novel anticancer small molecule has gained remarkable interest over the last decade. In this study, we synthesized and investigated the ability of a tetracyclic-condensed quinoline compound, 4-butylaminopyrimido4',5':4,5]thieno(2,3-b)quinoline (BPTQ), to interact with double-stranded DNA and inhibit cancer cell proliferation. Circular dichroism, topological studies, molecular docking, absorbance, and fluorescence spectral titrations were employed to study the interaction of BPTQ with DNA. Cytotoxicity was studied by performing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase (LDH) assay. Further, cell cycle analysis by flow cytometry, annexin V staining, mitochondrial membrane potential assay, DNA fragmentation, and western blot analysis were used to elucidate the mechanism of action of BPTQ at the cellular level. Spectral, topological, and docking studies confirmed that BPTQ is a typical intercalator of DNA. BPTQ induces dose-dependent inhibitory effect on the proliferation of cancer cells by arresting cells at S and G2/M phase. Further, BPTQ activates the mitochondria-mediated apoptosis pathway, as explicated by a decrease in mitochondrial membrane potential, increase in the Bax:Bcl-2 ratio, and activation of caspases. These results confirmed that BPTQ is a DNA intercalative anticancer molecule, which could aid in the development of future cancer therapeutic agents.

Representações sociais do câncer para o familiar do paciente oncológico em tratamento quimioterápico

Considerando-se que a família vivencia e partilha junto com o doente todos os sentimentos, emoções e angústias que envolve o diagnóstico e o tratamento do câncer, o presente estudo teve como objetivos descrever as dimensões das representações sociais acerca do câncer para familiares do cliente oncológico em tratamento quimioterápico ambulatorial em uma unidade de referência para o seu tratamento; analisar a representação social do câncer elaborada por familiares do cliente oncológico em tratamento quimioterápico ambulatorial; e discutir as contribuições do enfermeiro junto à família do cliente oncológico em tratamento quimioterápico ambulatorial a partir da construção representacional do câncer para os sujeitos do estudo. De caráter qualitativo, o caminho metodológico foi construído com base na Teoria das Representações Sociais. Os sujeitos foram 30 familiares que estavam acompanhando o doente durante o tratamento quimioterápico. Os dados foram coletados a partir da realização de entrevistas semi-estruturadas e analisados através da análise de conteúdo de Bardin (1979), sistematizada por Oliveira (2008), com o auxílio do software QRS Nvivo 2.0. Da análise dos dados emergiram seis categorias que compõem o campo representacional e se expressa através das dimensões representacionais concretizadas nas seguintes categorias: sentimentos compartilhados por familiares de clientes oncológicos em tratamento quimioterápico, que mostra que, ao se depararem com a doença e sua dura realidade, os familiares são acometidos por diversos tipos de sentimentos; imagens, metáforas e conceitos no existir da família que enfrenta a doença, onde os familiares revelaram que o câncer é percebido, entre outras coisas, como um monstro que invade a vida das pessoas e dela passa a tomar conta e a dominá-la; preconceitos e estigmas na vivência do câncer, que revelou que ainda hoje existem representações e estigmas presentes na sociedade e em suas construções culturais acerca do câncer; diferentes práticas desenvolvidas no contexto da doença e do processo de adoecimento pelo câncer, que evidenciou as diferentes práticas presentes no discurso dos sujeitos, quais sejam, a de religiosidade no contexto do câncer, a de enfrentamento da doença, a de comunicação-ocultamento e de atitudes da família ao estar no mundo frente ao câncer; o processo de ancoragem e o conhecimento adquirido após a experiência do câncer, onde surgiram os conhecimentos que os sujeitos adquiriram acerca do câncer e alguns elementos do processo de ancoragem do câncer; as vivências do enfermeiro que trabalha em oncologia e suas contribuições junto à família que alerta os enfermeiros para a necessidade de intervenções efetivas direcionadas à assistência integral do indivíduo, levando em consideração a importância da família. Conclui-se que ao se descobrir acompanhando um familiar que tem câncer, a família passa a viver um outro mundo, no qual a possibilidade de morte se mostra de forma inevitável e iminente. Diante disso, a família passa a valorizar não apenas o cuidado dispensado ao doente, mas também anseia por uma atenção profissional que contemple seu existir e seu modo de viver.

Development of a Cationic Mucic Acid Polymer-Based Nanoparticle siRNA Delivery System

Cancer chemotherapy has advanced from highly toxic drugs to more targeted treatments in the last 70 years. Chapter 1 opens with an introduction to targeted therapy for cancer. The benefits of using a nanoparticle to deliver therapeutics are discussed. We move on to siRNA in particular, and why it would be advantageous as a therapy. Specific to siRNA delivery are some challenges, such as nuclease degradation, quick clearance from circulation, needing to enter cells, and getting to the cytosol. We propose the development of a nanoparticle delivery system to tackle these challenges so that siRNA can be effective.

Chapter 2 of this thesis discusses the synthesis and analysis of a cationic mucic acid polymer (cMAP) which condenses siRNA to form a nanoparticle. Various methods to add polyethylene glycol (PEG) for stabilizing the nanoparticle in physiologic solutions, including using a boronic acid binding to diols on mucic acid, forming a copolymer of cMAP with PEG, and creating a triblock with mPEG on both ends of cMAP. The goal of these various pegylation strategies was to increase the circulation time of the siRNA nanoparticle in the bloodstream to allow more of the nanoparticle to reach tumor tissue by the enhanced permeation and retention effect. We found that the triblock mPEG-cMAP-PEGm polymer condensed siRNA to form very stable 30-40 nm particles that circulated for the longest time – almost 10% of the formulation remained in the bloodstream of mice 1 h after intravenous injection.

Chapter 3 explores the use of an antibody as a targeting agent for nanoparticles. Some antibodies of the IgG1 subtype are able to recruit natural killer cells that effect antibody dependent cellular cytotoxicity (ADCC) to kill the targeted cell to which the antibody is bound. There is evidence that the ADCC effect remains in antibody-drug conjugates, so we wanted to know whether the ADCC effect is preserved when the antibody is bound to a nanoparticle, which is a much larger and complex entity. We utilized antibodies against epidermal growth factor receptor with similar binding and pharmacokinetics, cetuximab and panitumumab, which differ in that cetuximab is an IgG1 and panitumumab is an IgG2 (which does not cause ADCC). Although a natural killer cell culture model showed that gold nanoparticles with a full antibody targeting agent can elicit target cell lysis, we found that this effect was not preserved in vivo. Whether this is due to the antibody not being accessible to immune cells or whether the natural killer cells are inactivated in a tumor xenograft remains unknown. It is possible that using a full antibody still has value if there are immune functions which are altered in a complex in vivo environment that are intact in an in vitro system, so the value of using a full antibody as a targeting agent versus using an antibody fragment or a protein such as transferrin is still open to further exploration.

In chapter 4, nanoparticle targeting and endosomal escape are further discussed with respect to the cMAP nanoparticle system. A diboronic acid entity, which gives an order of magnitude greater binding (than boronic acid) to cMAP due to the vicinal diols in mucic acid, was synthesized, attached to 5kD or 10kD PEG, and conjugated to either transferrin or cetuximab. A histidine was incorporated into the triblock polymer between cMAP and the PEG blocks to allow for siRNA endosomal escape. Nanoparticle size remained 30-40 nm with a slightly negative ca. -3 mV zeta potential with the triblock polymer containing histidine and when targeting agents were added. Greater mRNA knockdown was seen with the endosomal escape mechanism than without. The nanoparticle formulations were able to knock down the targeted mRNA in vitro. Mixed effects suggesting function were seen in vivo.

Chapter 5 summarizes the project and provides an outlook on siRNA delivery as well as targeted combination therapies for the future of personalized medicine in cancer treatment.

Efeitos tardios no tecido ovariano de ratas Wistar após tratamento com Docetaxel e Ciclofosfamida

O câncer de mama (CM) é o segundo tipo de câncer mais comum no mundo. Sabe-se que a maior incidência de CM ocorre nas mulheres pós-menopausa, entretanto é crescente o número de mulheres jovens acometidas por esta doença. O tratamento do CM pode incluir: quimioterapia, radioterapia e/ou hormonioterapia. A quimioterapia, por se ser um tratamento sistêmico, pode causar importantes efeitos colaterais, entre eles a falência ovariana induzida por quimioterapia (FOIQ). As principais consequências da FOIQ são a infertilidade, além de complicações tardias relacionadas à diminuição do estrogênio, como a osteoporose e doenças cardiovasculares. O regime quimioterápico TC, adota a associação do docetaxel com a ciclofosfamida, como uma opção por fármacos que resultem numa taxa de sobrevida livre do câncer, e menores efeitos colaterais. Este trabalho teve como objetivo estudar os efeitos tardios no ovário causados pelo tratamento com a associação dos quimioterápicos docetaxel e ciclofosfamida (TC), em modelo animal com ratos Wistar. Para verificar o sinergismo desses quimioterápicos e assim analisar o efeito da administração conjunta, ratos Wistar fêmeas foram divididos em dois grupos: um grupo controle e um grupo que recebeu quimioterapia (TC). Os animais foram submetidos a eutanasia cinco meses após o fim do tratamento, e foram recolhidos o plasma e os ovários. Foram observadas alterações importantes. O nível de estradiol no plasma foi significativamente reduzido no grupo de TC em comparação com o grupo controle. Além disso, o número de núcleos apoptóticos foi maior no grupo TC. O papel da resposta inflamatória no desenvolvimento da lesão ovariana foi também investigado, e notou-se um aumento do número de mastócitos, e aumento da expressão de Fator de Necrose Tumoral-α (TNF-α) no grupo TC. O envolvimento de fibrose nesse processo, foi também investigado. Os resultados mostraram que níveis de expressão de Fator de Crescimento Tumoral-β1 (TGF-β1), Colágeno Tipo I (Col-I) e Colágeno Tipo III (Col-III) estavam maiores no grupo TC em comparação com o grupo de controle. A análise ultraestrutural revelou a presença de feixes de colágeno no grupo tratado, e mostrou que a arquitetura do tecido do ovário estava mais desorganizada neste grupo comparado ao grupo controle. Os resultados obtidos neste trabalho indicam que a combinação de ciclofosfamida e docetaxel, um recente regime quimioterápico proposto para o tratamento do CM, pode levar a importantes alterações no ovário. O processo inflamatório, desencadeado pela administração dos quimioterápicos, estimula a apoptose e liberação de TGF-β no estroma ovariano, que induz a produção de matriz extracelular e subsequente, substituição do tecido sadio por tecido fibrótico. A principal consequência deste processo é a diminuição, ou perda, da função ovariana, levando à menopausa precoce e possível infertilidade. É importante compreender os mecanismos envolvidos na infertilidade provocada pelo regime TC, a fim de estudar novos métodos que evitem este efeito indesejável em mulheres submetidas a tratamento do CM.

心理干预对癌症病人生活质量和免疫功能作用的研究

A set of tools of clinical psychological intervention for cancer patients had been composed for the first time in the form of a manual with three tapes and some pictures. The cancer patients during chemotherapy were treated by psychological intervention via the tools in group and individual therapy. QLQ-C30, POMS-SF and DWI-CI were first recommended and used as indicators for measuring the results of QoL, emotion and coping method in cancer patients in Chinese mainland. NK cell activity and IgG、IgM, IgA were used to measure the immune function. 120 cancer chemotherapy patients were randomly assigned to one of four conditions formed by a 2 (pre-chemotherapy and post-chemotherapy) *2 (experimental and control group) factorial design. The effect of psychological intervention on quality of life and immune function for cancer patients was investigated as well as the mediate role of coping method and personality and their factors. The efficiency of the tools was verified. The major conclusive results drawn out from the study were: 1. After treated by psychological intervention for three months, the status of quality of life and the symptoms of the patients during the chemotherapy was improved accompanying with the increase of immune parameters, especially the NK cell activity. The influential way of the factors, which effected on the effect of psychological intervention on the quality of life, immune parameters and coping methods, was synthetic. There was obvious mutual effects among the factors. 2. The patients of experimental group used more the active behavior, more the active cognition and less the avoidance coping method than those in control group. 3. The results of measurement showed that the personality of the caner patients was of obvious concealing and hiding. 4. Quality of Life Questionnaire-Core 30(QLQ-C30) was suitable for the cancer patients with great efficiency in Chinese mainland although the scale of SF needed to be revised in the light of Chinese culture.

Targeting aberrant kinase activity in myeloid leukaemias

Acute myeloid leukaemia (AML) is the most common form of acute leukaemia in adults. Its treatment has remained largely unchanged for the past 30 years. Chronic myeloid leukaemia (CML) represents a tremendous success story in the era of targeted therapy but significant challenges remain including the development of drug resistance and disease persistence due to presence of CML stem cells. The Aurora family of kinases is essential for cell cycle regulation and their aberrant expression in cancer prompted the development of small molecules that selectively inhibit their activity. Chapter 2 of this thesis outlines the efficacy and mechanism of action of alisertib, a novel inhibitor of Aurora A kinase, in preclinical models of CML. Alisertib possessed equipotent activity against CML cells expressing unmutated and mutated forms of BCR-ABL. Notably, this agent retained high activity against the T315I and E255K BCR-ABL mutations, which confer the greatest degree of resistance to standard CML therapy. Chapter 3 explores the activity of alisertib in preclinical models of AML. Alisertib disrupted cell viability, diminished clonogenic survival, induced expression of the forkhead box O3 (FOXO3a) targets p27 and BCL-2 interacting mediator (BIM), and triggered apoptosis. A link between Aurora A expression and sensitivity to ara-C was established. Chapter 4 outlines the role of the proto-oncogene serine/threonine-protein (PIM) kinases in resistance to ara-C in AML. We report that the novel small molecule PIM kinase inhibitor SGI-1776 disrupted cell viability and induced apoptosis in AML. We establish a link between ara-C resistance and PIM over-expression. Finally, chapter 5 explores how the preclinical work outlined in this thesis may be translated into clinical studies that may lead to novel therapeutic approaches for patients with refractory myeloid leukaemia.

Antibiotic resistance-the need for global solutions.

The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.