Pharmacokinetics and pharmacodynamics of daptomycin in a clinical setting

We investigated achievement of a target 24-h area under the concentration-time curve to minimum inhibitory concentration ratio (AUC/MIC) ≥666 and the factors influencing this ratio in patients who received daptomycin (DAP) for infectious disease treatment in a clinical setting. The target AUC/MIC was obtained in 6 patients (35.3%) at a 4–6 mg/kg dose (Group_{_4–6 mg/kg}) and in 4 (18.2%) at a >6 mg/kg dose (Group_{_>6 mg/kg}). There was a significant difference in clearance of DAP (CL_{_DAP}) between these groups, but no other difference in characteristics. Multiple linear regression analysis was performed for prediction of AUC ≥666 based on patient factors and the presence or absence of sepsis. In a stepwise analysis, serum creatinine (SCr) was a significant predictor of AUC, but this parameter explained only 13% of the variance in achievement of the target AUC. These results show that the target AUC/MIC may or may not be achieved at the doses used in Group_{_4–6 mg/kg} and Group_{_>6 mg/kg}. Receiver operating characteristic analysis suggested that a CL_{_DAP} >0.450 L/hr may lead to failure to reach the target AUC/MIC. Therefore, regardless of dose, the efficacy of DAP should be monitored closely to prevent failure of infectious disease treatment, particularly because therapeutic drug monitoring of DAP is limited by difficulty measuring the DAP serum concentration at many medical facilities. Our findings are preliminary, and a further study is required to identify factors that increase CL_{_DAP} and to enable dose adjustment of DAP.     

The diverse oncogenic and tumor suppressor roles of salt-inducible kinase (SIK) in cancer

Introduction: The salt-inducible kinases originally cloned in adrenal glands of high salt diet-fed rats, generally named as SIKs, are highly evolutionarily conserved serine/threonine protein kinases belonging to a family of AMP-activated protein kinase (AMPK). Overexpression of SIK2 and SIK3 is discovered in many tumors. Whereas, SIK1 expression was significantly lower in tumors than in normal tissues. Areas covered: The main aim of our review is to introduce the signaling pathways as well as its mechanisms underlying their activity regulation, and especially the roles they play in cancer, which may shed light on the prospects of the cancer prevention and therapeutic targeting of SIKs in the future. Expert opinion: It is conceivable that SIKs, mainly stimulated by ACTH, LKB1, TGF-β, and autophosphorylation, play crucial roles in regulating multiple signal pathways in cancer cells and controlling a series of cellular processes including cell proliferation and cell apoptosis. More recent studies about SIKs are emerging, and their overexpression is found in a few specific types of cancers. However, correlations between SIKs and carcinogenesis remain to be fully elucidated.     

TP53突变对非小细胞肺癌表皮生长因子受体突变患者酪氨酸激酶抑制剂的治疗效果和预后影响

基因突变能够影响肺癌细胞对靶向药物的敏感性,导致个体化临床治疗效果出现差异。表皮生长因子受体(EGFR)的突变状态在内科药物治疗决策中具有重要意义。此外,其他并存的基因突变均可影响疾病的治疗效果和患者的远期临床预后。EGFR突变合并TP53突变是否可改变肺癌细胞对酪氨酸激酶抑制剂治疗的敏感性和对远期预后的影响一直受到人们的关注。目前在临床实践中,TP53的突变状态并不是临床治疗决策中的参考依据,因此需要进一步的证据阐明TP53(包括各亚型)突变状态对EGFR靶向治疗潜在获益的影响,以指导非小细胞肺癌的治疗。     

FLT3 Inhibition in Acute Myeloid Leukemia

Mutations in the FLT3 receptor tyrosine kinase are the most frequently found mutations in acute myeloid leukemia (AML). Patients with FLT3 internal tandem duplication (ITD) mutations have poor prognoses. The approved FLT3 tyrosine kinase inhibitors (TKIs) midostaurin and gilteritinib improve survival in AML with FLT3 mutations. Multiple other FLT3 inhibitors are in clinical development. Patients frequently relapse after response to FLT3 inhibitors and the optimal use of FLT3 inhibitors in the upfront, relapse, and maintenance settings remain to be established. We will discuss the biology of FLT3, approved and investigational FLT3 inhibitors, resistance mechanisms, and emerging FLT3 TKI combination clinical trials.     

Decoding signaling pathways involved in prolactin-induced neuroprotection: A review

It has been well recognized that prolactin (PRL), a pleiotropic hormone, has many functions in the brain, such as maternal behavior, neurogenesis, and neuronal plasticity, among others. Recently, it has been reported to have a significant role in neuroprotection against excitotoxicity. Glutamate excitotoxicity is a common alteration in many neurological and neurodegenerative diseases, leading to neuronal death. In this sense, several efforts have been made to decrease the progression of these pathologies. Despite various reports of PRL’s neuroprotective effect against excitotoxicity, the signaling pathways that underlie this mechanism remain unclear. This review aims to describe the most recent and relevant studies on the molecular signaling pathways, particularly, PI3K/AKT, NF-κB, and JAK2/STAT5, which are currently under investigation and might be implicated in the molecular mechanisms that explain the PRL effects against excitotoxicity and neuroprotection. Remarkable neuroprotective effects of PRL might be useful in the treatment of some neurological diseases.     

A novel radiolytic rotenone derivative,rotenoisin A,displays potent anticarcinogenic activity in breast cancer cells

Chemotherapy for cancer treatment has therapeutic limitations, such as drug resistance, excessive toxic effects and undesirable adverse effects. Therefore, efforts to improve the safety and efficacy of chemotherapeutic agents are essential. Ionizing radiation can improve physiological and pharmacological properties by transforming structural modifications of the drug. In this study, in order to reduce the adverse effects of rotenone and increase anticancer activity, a new radiolytic rotenone derivative called rotenoisin A was generated through radiolytic transformation. Our findings showed that rotenoisin A inhibited the proliferation of breast cancer cells and increased the rate of apoptosis, whereas it had no inhibitory effect on primary epidermal keratinocytes compared with rotenone. Moreover, rotenoisin A-induced DNA damage by increasing reactive oxygen species (ROS) accumulation. It was also confirmed not only to alter the composition ratio of mitochondrial proteins, but also to result in structural and functional changes. The anticancer effect and molecular signalling mechanisms of rotenoisin A were consistent with those of rotenone, as previously reported. Our study suggests that radiolytic transformation of highly toxic compounds may be an alternative strategy for maintaining anticancer effects and reducing the toxicity of the parent compound.     

Current status of first-line therapy,anti-angiogenic therapy and its combinations of other agents for unresectable hepatocellular carcinoma

Globally, hepatocellular carcinoma (HCC) is a frequently diagnosed malignancy with rapidly increasing incidence and mortality rates. Unfortunately, many of these patients are diagnosed in the advanced stages when locoregional treatments are not appropriate. Before 2008, no effective drug treatments existed to prolong survival, until the breakthrough multi-tyrosine kinase inhibitor (TKI) sorafenib was developed. It remained the standard treatment option for advanced HCC for 10 years, with a battery of other candidate drugs in clinical trials failing to produce similar efficacy results. In 2018, the REFLECT trial introduced another multi-TKI, lenvatinib, which has non-inferior overall survival compared with sorafenib. Thus, offering patients and their treating physicians two effective treatment options. Recently, immunotherapy-based drugs, such as atezolizumab and bevacizumab, have shown promising results in patients with unresectable HCC. This review summarizes clinical trial and real-world data studies of sorafenib and lenvatinib in patients with unresectable HCC. We offer guidance on the optimal choice between the two treatments and discuss the potential of immunotherapy-based combination; when more data become available, this will likely make the choice between sorafenib and lenvatinib somewhat obsolete.     

Targeting Aurora B kinase prevents and overcomes resistance to EGFR inhibitors in lung cancer by enhancing BIM- and PUMA-mediated apoptosis

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葛根芩连汤调控MMP-9/p38 MARK途径修复溃疡性结肠炎小鼠肠黏膜上皮屏障功能

目的 探讨葛根芩连汤对溃疡性结肠炎（UC）小鼠肠黏膜上皮屏障功能的保护作用，并通过基质金属蛋白酶-9（MMP-9）/p38丝裂原活化蛋白激酶（p38 MAPK）信号通路探究其治疗UC的作用机制。方法 48只雌性C57BL/6小鼠随机分为正常组、模型组、柳氮磺吡啶组（0.3 g·kg^-1）及葛根芩连汤高、中、低剂量组（2.84，1.42，0.71 g·kg^-1）。采用3%葡聚糖硫酸钠（DSS）溶液构建UC小鼠模型，葛根芩连汤和柳氮磺吡啶于造模后第8天灌胃给药，连续7 d，正常组给予等量生理盐水处理。末次给药后取结肠组织，苏木素-伊红（HE）染色观察结肠组织病理变化，免疫组化（IHC）观察结肠组织紧密连接（TJ）蛋白，如闭合蛋白（Occludin），闭锁连接蛋白-1（ZO-1）的表达，实时荧光定量聚合酶链式反应（Real-time PCR）检测结肠组织中肿瘤坏死因子-α（TNF-α），白细胞介素-1β（IL-1β），MMP-9 mRNA表达，蛋白免疫印迹法（Western blot）检测结肠组织中磷酸化（p）-p38 MAPK，p38 MAPK和MMP-9蛋白的表达。结果 与正常组比较，模型组小鼠体质量显著下降（P<0.01），疾病活动指数（DAI）评分显著升高（P<0.01），结肠黏膜上皮破损并可见黏膜和黏膜下层炎细胞浸润明显，Occludin，ZO-1蛋白表达显著降低（P<0.01），TNF-α，IL-1β，MMP-9 mRNA相对表达量显著升高（P<0.01），p-p38 MAPK和MMP-9蛋白表达显著升高（P<0.01）；与模型组比较，柳氮磺吡啶组、葛根芩连汤各剂量组小鼠体质量和DAI评分均有明显改善（P<0.05，P<0.01），结肠组织损坏明显改善，Occludin，ZO-1蛋白明显增多（P<0.05，P<0.01），TNF-α，IL-1β，MMP-9 mRNA相对表达量显著下降（P<0.01），p-p38 MAPK和MMP-9蛋白表达显著下降（P<0.01），其中葛根芩连汤各组中以中剂量组的变化最为明显。结论 葛根芩连汤能够通过抑制MMP-9和炎性细胞因子TNF-α，IL-1β的表达，阻断p38 MAPK信号通路的激活，增加TJ蛋白的表达，从而修复肠道黏膜屏障功能。