Lymphangiogenesis does not occur in breast cancer

Breast cancer metastasis predominantly occurs via lymphatic vessels. However, the study of lymphatic vessels and lymphangiogenesis has been hampered by lack of specific markers. Recently, antibodies directed against M2A (D2-40), Podoplanin, and Prox-1 that specifically mark lymphatic vessels in paraffin-embedded sections have become available. These were used to study lymphangiogenesis in archival paraffin sections of normal breast (n = 23), fibrocystic disease (n = 7), ductal carcinoma in situ (n = 32), invasive ductal carcinoma (n = 50), and invasive lobular carcinoma (n = 5). In addition, endothelial proliferation in lymphatic vessels was analyzed by dual-color immunohistochemistry with D2-40 and proliferating cell nuclear antigen (PCNA). Expression of D2-40, Prox-1, and Podoplanin was seen in lymphatic vessels but not in blood vessels. Lymphatic vessels were seen in the peritumoral area and as "entrapped" intratumoral vessels adjacent to preexisting normal lobules and ducts. Unlike angiogenesis, there was no increase of lymphatic vessel density in association with neoplastic transformation. On the contrary, a marked reduction in intratumoral lymphatic vessel density was seen in comparison to normal breast tissue, fibrocystic disease, and ductal carcinoma in situ (P = 0.0001). There was an increase in peritumoral lymphatic vessel density as compared with normal breast (P = 0.0001). However, the endothelial cells in the "entrapped" or the peritumoral lymphatic vessels did not show any expression of PCNA indicating minimal or no proliferative activity. This was in contrast to the strong expression seen in adjacent tumor cells and blood vessel endothelial cells. Thus, lymphangiogenesis was not evident when studied by lymphatic vessel density or by lymph vessel endothelial proliferation.     

Peritoneal Phosphate Clearance is Influenced by Peritoneal Dialysis Modality,Independent of Peritoneal Transport Characteristics

Background and objectives: Hyperphosphatemia is an independent risk factor for mortality in ESRD, but factors regulating phosphate clearance on peritoneal dialysis (PD) are incompletely understood. The objective of this study was to test the hypothesis that peritoneal phosphate clearance is better with continuous ambulatory PD (CAPD) as compared with continuous cyclic PD (CCPD) after adjusting for membrane transport status.Design, setting, participants, & measurements: In this cross-sectional and retrospective study, measurements of peritoneal phosphate clearance of 129 prevalent PD patients were reviewed. Patients were divided according to membrane transport status (high, high average, low average-low categories) and PD modality (CAPD or CCPD).Results: Among high transporters, peritoneal phosphate clearances were comparable in both modalities. However, treatment with CAPD was associated with increased peritoneal phosphate clearance compared with CCPD among high-average transporters (42.4 ± 11.4 versus 36.4 ± 8.3 L/wk/1.73 m², P = 0.01), and low-average-low transporters (35.6 ± 5.9 versus 28.9 ± 11 L/wk/1.73 m², P = 0.034). On multivariate linear regression, PD modality, membrane transport category, and peritoneal creatinine clearance, but not Kt/V urea, were independently associated with peritoneal phosphate clearance.Conclusions: Peritoneal phosphate clearance is determined by PD modality and membrane transport category, suggesting that PD regimes with longer dwell times may help control hyperphosphatemia in lower transporters.Hyperphosphatemia is a strong predictor of overall and cardiovascular mortality in ESRD patients treated with peritoneal dialysis (PD) therapy (1,2). Despite this well established risk, approximately 40% of PD patients have serum phosphate concentrations above levels recommended by current guidelines (2). Control of hyperphosphatemia is difficult to achieve for several reasons. First, dietary phosphate restriction is characterized by poor adherence and if achieved can result in protein malnutrition (3). Second, the use of phosphate binders, although effective, is associated with secondary effects, including hypercalcemia, gastrointestinal disturbances, and poor adherence (4,5). Finally, in PD patients phosphate control is known to deteriorate as residual renal function declines, which may contribute to sustained hyperphosphatemia (6). In addition to these factors, peritoneal phosphate clearance plays a role in achieving adequate phosphate homeostasis, although this component of phosphate balance has not been well studied.In PD patients, diffusive and convective transport of phosphate across the peritoneal membrane contributes to overall phosphate homeostasis. Phosphate is surrounded by an aqueous layer because of its hydrophilic properties and may behave like a larger molecule with respect to solute clearance (7). Because peritoneal phosphate clearance is time-dependent, it may be altered with different peritoneal dialysis modalities and across different peritoneal membrane transport categories (8). These clearance properties have not been well characterized because previous studies were limited by small sample size and no adjustment for peritoneal membrane transport category (9–11). Accordingly, the objective of this study was to determine the effect of membrane transport characteristics and PD modality on peritoneal phosphate clearance in a prevalent PD population. We hypothesized that peritoneal phosphate clearance would be inferior in patients with lower transport membranes when treated with PD modalities with shorter dwell times such as continuous cyclic PD (CCPD) compared with those treated with continuous ambulatory PD (CAPD).     

Development of hollow/porous calcium pectinate beads for floating-pulsatile drug delivery.

The purpose of this work was to develop hollow calcium pectinate beads for floating-pulsatile release of diclofenac sodium intended for chronopharmacotherapy. Floating pulsatile concept was applied to increase the gastric residence of the dosage form having lag phase followed by a burst release. To overcome limitations of various approaches for imparting buoyancy, hollow/porous beads were prepared by simple process of acid-base reaction during ionotropic crosslinking. The floating beads obtained were porous (34% porosity), hollow with bulk density<1 and had Ft50% of 14-24 h. In vivo studies by gamma scintigraphy determined on rabbits showed gastroretention of beads up to 5 h. The floating beads provided expected two-phase release pattern with initial lag time during floating in acidic medium followed by rapid pulse release in phosphate buffer. This approach suggested the use of hollow calcium pectinate microparticles as promising floating-pulsatile drug delivery system for site- and time-specific release of drugs acting as per chronotherapy of diseases.     

Effects of HIV protease inhibitor ritonavir on Akt-regulated cell proliferation in breast cancer.

PURPOSE: These studies were designed to determine whether ritonavir inhibits breast cancer in vitro and in vivo and, if so, how. EXPERIMENTAL DESIGN: Ritonavir effects on breast cancer cell growth were studied in the estrogen receptor (ER)-positive lines MCF7 and T47D and in the ER-negative lines MDA-MB-436 and MDA-MB-231. Effects of ritonavir on Rb-regulated and Akt-mediated cell proliferation were studied. Ritonavir was tested for inhibition of a mammary carcinoma xenograft. RESULTS: ER-positive estradiol-dependent lines (IC50, 12-24 micromol/L) and ER-negative (IC50, 45 micromol/L) lines exhibit ritonavir sensitivity. Ritonavir depletes ER-alpha levels notably in ER-positive lines. Ritonavir causes G1 arrest, depletes cyclin-dependent kinases 2, 4, and 6 and cyclin D1 but not cyclin E, and depletes phosphorylated Rb and Ser473 Akt. Ritonavir induces apoptosis independent of G1 arrest, inhibiting growth of cells that have passed the G1 checkpoint. Myristoyl-Akt, but not activated K-Ras, rescues ritonavir inhibition. Ritonavir inhibited a MDA-MB-231 xenograft and intratumoral Akt activity at a clinically attainable serum Cmax of 22 +/- 8 micromol/L. Because heat shock protein 90 (Hsp90) substrates are depleted by ritonavir, ritonavir effects on Hsp90 were tested. Ritonavir binds Hsp90 (K(D), 7.8 micromol/L) and partially inhibits its chaperone function. Ritonavir blocks association of Hsp90 with Akt and, with sustained exposure, notably depletes Hsp90. Stably expressed Hsp90alpha short hairpin RNA also depletes Hsp90, inhibiting proliferation and sensitizing breast cancer cells to low ritonavir concentrations. CONCLUSIONS: Ritonavir inhibits breast cancer growth in part by inhibiting Hsp90 substrates, including Akt. Ritonavir may be of interest for breast cancer therapeutics and its efficacy may be increased by sustained exposure or Hsp90 RNA interference.     

Bone formation is not coupled to bone resorption in site-specific manner in adult rats

The trabecular bone of the secondary spongiosa of mature rats shows a coupling of bone formation to resorption. It has been clearly shown that in adult man the coupling of formation and resorption involves a site-specific sequence of events, in which bone resorption is normally followed, at the same site, by bone formation. Whether the coupled processes of bone resorption and formation also occur at the same site in the rat is controversial. To elucidate the spatial relationship between bone formation and resorption in the rat, we compared the percentage of crenated and non-crenated cement lines with the percentage of crenated and non-crenated bone surfaces in the proximal tibia of adult rats aged 16 weeks to 2 years. A similar comparison was also made using bone from adult human iliac crest. We found that the trabecular bones of 16-week-old and 7-month-old rats exhibited a low percentage (7–11%) of crenated cement lines, which is opposite to the proportion (88%) we observed in human trabecular bone. In contrast, the surfaces of rat bone trabeculae showed a similar low proportion of crenated surface to human bone (rat 1.1–1.4% vs. 5% in humans). In older (2 years) rats, in which bones have ceased to grow in length, the percentage of cement lines that were crenated increased to 45%. These results imply that the major proportion of bone formation in the trabecular bone of growing rats occurs on non-resorbed surfaces. Thus, although there is substantial evidence that bone formation is coupled to resorption in the rat, such that increased resorption is associated with increased formation, and suppression of resorption suppresses bone formation, bone formation does not necessarily occur on a previously resorbed site. This suggests that in the rat, the processes are not coupled by local release of cytokines or local cell interactions but by some other signal, such as mechanical stimulation. Since site-specificity appears not to be crucial to the coupling of formation to resorption, the greater site-specificity of coupling in man, and in older rats, may be attributable to a more static skeleton, which engenders a closer spatial correlation between bone formation and the resorption that induced it. © 1993 Wiley-Liss, Inc.