1 alpha(OH)D3 (ETALPHA) treatment and receptor studies in 16 patients with chronic and myeloproliferative disorders

10 patients with CLL and 2 with CML were treated with gradually increasing doses of 1 alpha(OH)D3, up to 4 micrograms daily during 6 wk. 3 patients with preleukemia and 1 with myelofibrosis were treated with 2 micrograms daily of 1 alpha(OH)D3 for a prolonged period up to 17 wk. The treatment with 1 alpha (OH)D3 did not result in changes of disease parameters in any of the patients under study. Receptor studies for 1,25(OH)2D3 were performed in 8 CLL patients and revealed only 1 patient with increased specific receptor binding capacity. The maximum tolerable dose of 1 alpha(OH)D3 varied individually, but was in the range of 2-4 micrograms daily.     

The effect of 1alpha(OH)D3 and 1alpha,25(OH)2D3 on the bone in patients with renal osteodystrophy

Six patients with chronic renal disease and variable degrees of renal osteodystrophy were treated for three weeks with either 1alpha,25-dihydroxyvitamin D3 (1alpha25(OH)D3) or 1alpha,hydroxyvitamin D3 (1alpha(OH)D3) and both the biochemical and osseous responses measured. The most consistent changes seen were an increase in serum calcium concentration to normal, a decrease in immunoreactive parathyroid hormone toward normal, an increase in the extent of the calcification front and a decrease in the extent of fibrous dysplasia in the marrow cavity. Two important parameters which did not change significantly were serum alkaline phosphatase activity and the osteoid volume. These data, in conjunction with that from previous studies, indicate that therapy with 1alpha,25(OH)2D3 or 1alpha(OH)D3 does not heal the osteomalacia of renal osteodystrophy, but that it does suppress the secondary hyperparathyroidism, and ameliorate the osteitis fibrosa seen in patients with chronic renal disease. They raise the likelihood that additional factors, such as metabolites of vitamin D other than 1alpha,25(OH)2D3, play a role in regulating bone formation and/or mineralization.     

1 alpha(OH)D3 treatment and procollagen III (PC III) studies in idiopathic myelofibrosis

Eight patients with idiopathic myelofibrosis (IMF) were treated with escalating doses (0.5 microgram/day to 4.0 micrograms/day) of 1 alpha(OH)D3 for periods up to 6 months. The treatment did not improve the disease parameters in any of the patients under study. No patient demonstrated a decrease in bone marrow fibrosis as determined by serial procollagen (PC III) serum level analysis. Although 1 alpha(OH)D3 was well tolerated at the administered doses, the therapeutic value of this treatment for IMF requires further evaluation.     

1 alpha,25-Dihydroxyvitamin D3[1 alpha,25-(OH)2D3]-26,23-lactone inhibits 1,25-(OH)2D3-mediated fusion of mouse bone marrow mononuclear cells

Vitamin D3 and its hormonally active metabolite 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] can be metabolized to a number of daughter metabolites, including 1 alpha,25-(OH)2D3-26,23-lactone; this latter compound has four diastereoisomers. The 23(S),25(R)-lactone (naturally occurring) and the 23(R),25(S)-1 alpha,25-(OH)2D3-26,23-lactone are both known to be able to inhibit bone resorption induced by 1 alpha,25-(OH)2D3 under in vivo or in vitro conditions. To understand the mechanism of the inhibitory action of these two isomers on bone resorption we investigated the effects of 1 alpha,25-(OH)2D3-26,23-lactone on unfractionated mouse bone marrow cells in vitro. The addition of 1 alpha,25-(OH)2D3 to these cultures dose-dependently stimulated the formation of multinucleated cells over a range of 10(-9) - 10(-7) M. The 23(S),25(S)- and 23(R),25(R)-1 alpha,25-(OH)2D3-26,23-lactones also increased the number of multinucleated cells, whereas the 23(S),25(R)- and 23(R),25(S)-1 alpha,25-(OH)2D3-26,23-lactones failed to do so. In addition, these latter two diastereomers inhibited the 1 alpha,25-(OH)2D3 stimulation of multinucleated cell formation, although the 23(S),25(S)- and 23(R),25(R)-1 alpha,25-(OH)2D3-26,23-lactones and 24R,25-(OH)2D3 did not. These multinucleated cells responded to calcitonin and contained tartrate-resistant acid phosphatase, both of which are characteristic of osteoclasts. The present data suggest that inhibition of multinucleated cell formation is the mechanism by which the 23(S),25(R)- or 23(R),25(S)-1 alpha,25-(OH)2D3-26,23-lactone inhibits bone resorption induced by 1 alpha,25-(OH)2D3.     

Syncytial giant cell hepatitis associated with chronic lymphocytic leukemia: a case report

ABSTRACT: BACKGROUND: Syncytial giant cell hepatitis (GCH) is an uncommon and an underreported disease entity. In two previously reported cases of GCH in patients with Chronic Lymphocytic Leukemia (CLL) liver failure ensued. Autoimmune and infective causes have been implicated but its etiology remains unclear. Case Presentation A 60-year-old female with CLL presented with acute hepatitis with negative viral and autoimmune serologies and without any prior toxic exposure. Liver biopsy showed typical histological features of GCH. The patient was successfully treated with corticosteroids and intravenous immunoglobulin (IVIG). Her liver enzymes returned to baseline and have remained normal as of the last follow up almost 4 years later. CONCLUSIONS: Association of GCH with CLL may be under recognized. Clinical suspicion of GCH in CLL patients with serology-negative hepatitis, early liver biopsy and therapeutic intervention may influence outcome. This is the first case report of successful treatment of GCH in CLL patients. Moreover, our case also demonstrates the ability to resume effective CLL therapy post-GCH diagnosis without detriment to the liver.     

Vitamin D analogs, 20-Epi-22-oxa-24a,26a,27a,-trihomo-1alpha,25(OH)2-vitamin D3, 1,24(OH)2-22-ene-24-cyclopropyl-vitamin D3 and 1alpha,25(OH)2-lumisterol3 prime NB4 leukemia cells for monocytic differentiation via nongenomic signaling pathways, involving calcium and calpain.

Side-chain modified vitamin D analogs including 20-Epi-22-oxa-24a,26a,27a-trihomo-1alpha,2 5-dihydroxyvitamin D3 (KH1060), and 1,24-dihydroxy-22-ene-24-cyclopropyl-vitamin D3 (MC903) were originally designed to aid in the treatment of hyperproliferative disorders including psoriasis and cancer. Here we demonstrate that these analogs, as well as the 6-cis-locked conformer, 1alpha,25-dihydroxy-lumisterol3 (JN) prime NB4 cells for monocytic differentiation. Previously, the action of MC903 and KH1060 was presumed to be mediated by the nuclear vitamin D receptor (VDRnuc). Differentiation in response to all analogs was shown to be inhibited by 1beta,25-dihydroxyvitamin D3 (HL), the antagonist to the nongenomic activities of 1,25D3. These data suggest that although MC903 and KH1060 may bind the VDRnuc, that the differentiative activities of these agents requires nongenomic signaling pathways. Here we show that 1alpha,25(OH)2-d5-previtamin D3 (HF), JN, KH1060, and MC903 induce expression of PKC alpha and PKC delta and translocation of both isoforms to the particulate fraction, and PKC alpha to the nuclear fraction. The full differentiation response with combinations of analogs and TPA was inhibited 50% by the membrane permeable Ca2+ chelator, 1,2-bis(o-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid (BAPTA-AM) or calpain inhibitor I. These data demonstrate that intracellular free calcium and the calcium-dependent protease, calpain play critical roles in monocytic differentiation. Intracellular calcium appears to be most critical in the 1,25D3-priming stage of differentiation, while calpain is essential in the TPA maturation response.     

Vitamin D3 treatment for locally advanced thyroid cancer: a case report

There are many intricacies in the surgical treatment of locally advanced thyroid cancer, including the medical management of the remaining functional organ and any cosmetic impairments, which are sometimes very difficult to manage and eventually carry a relatively high morbidity and mortality. Here, we report on a case of a 65-year-old female with an extremely locally-advanced thyroid cancer involving both lobes of the thyroid, blood vessels, trachea and esophagus. Despite the severity of her condition, oral administration of vitamin D3 (alphacalcido) has stalled both the tumor growth and further increases of serum thyroglobulin (Tg) level, and has led to a good preservation of quality of life for the last two years. Several reports have previously demonstrated the efficacy of vitamin D3 to inhibit the proliferation of thyroid cancer cell lines in vitro, but clinical evidence has been limited so far. Therefore, this case report provides important evidence for the effectiveness of vitamin D3 therapy against advanced thyroid cancers.     

Axonal neuropathy and hearing loss associated with alpha interferon treatment in chronic hepatitis B: a case report.

The effect of interferon alpha in chronic viral hepatitis and common side effects are well known, but axonal polyneuropathy and hearing loss have been rarely reported. A 58-year-old woman was administered interferon alpha-2a (9 MU/3 times a week) and lamividin (100 mg daily) with the diagnosis of chronic hepatitis B. At the fifth month of the treatment gait disturbance and tinnitus developed. In her neurological examination tandem gait was ataxic on the right side. Cerebral magnetic resonance imaging performed to elucidate a probable cerebral pathology revealed nonspecific millimetric hyperintense lesions thought to be related with her hypertension anamnesis. Electroneuromyography demonstrated mild axonal polyneuropathy. The finding of pure-tone audiometry was sensorineural hearing loss in her left ear. Our diagnosis was axonal polyneuropathy and sensorineural type hearing loss as a side effect of interferon. In conclusion, the development of polyneuropathy and sensorineural hearing loss in the same patient may suggest autoimmunity as the cause of these side effects.     

The monoclonal antibodies alpha S-HCL 1 (alpha Leu-14) and alpha S-HCL 3 (alpha Leu-M5) allow the diagnosis of hairy cell leukemia

To define cell surface antigens associated with hairy cell leukemia (HCL), and to gain better insight into the origin of this disease, we developed monoclonal antibodies against spleen cells of a patient with this disease. Although none of these antibodies alone proved specific for the leukemic cells, two of them, designated alpha S-HCL 1 (alpha Leu-14) and alpha S-HCL 3 (alpha Leu-M5) were found to be valuable in the diagnosis of HCL when used in combination. alpha S-HCL 1 recognizes an antigen associated with greater than 95% of B cells in the peripheral blood. Biochemical analysis identified this antigen as a single polypeptide chain with a molecular weight of 150,000 daltons (150 kilodaltons). alpha S-HCL 1 expression on hairy cells is markedly increased when compared with normal B lymphocytes isolated from peripheral blood, tonsils, and spleens. alpha S-HCL 3 reacts with an antigen present on hairy cells but also on monocytes, macrophages, in a lower density on neutrophils, and a small percentage (less than 2%) of lymphocytes. The antigen recognized by alpha S-HCL 3 is composed of a non-covalently linked biomolecular complex of 90 and 150 kilodaltons. Since the HCL 3 antigen was not detectable on other lymphomas of either T or B cell type, the co-expression of S-HCL 1 and S-HCL 3 on hairy cells is a unique marker for this disease.     

Occurrence of a pulmonary carcinoid following allogeneic stem cell transplantation for chronic myelogenous leukemia: a case report

Carcinoid tumors are relatively rare neuroendocrine malignancies with an indolent clinical behavior. The majority of cases arise within the gastrointestinal tract, but they may also be encountered in other organs such as the bronchial system. While occurrence of carcinoid tumors has been reported in association with the multiple endocrine neoplasia (MEN) type I syndrome, no clear-cut risk factors have been established for the development of these malignancies. We report the case of a 50-year-old woman who was diagnosed with a pulmonary carcinoid in 2001 after having undergone allogeneic stem cell transplantation for chronic myeloid leukemia (CML) in 1997. This is the first case report of a carcinoid tumor following allogeneic bone marrow transplantation. At the moment, however, an association with CML as well as a causative role of transplantation and intake of immunosuppressants remains speculative. Apart from highlighting the occurrence of a carcinoid in this setting, our case again underscores the importance of nuclear medicine methods, i.e., somatostatin receptor scintigraphy, in staging and follow-up of patients with carcinoid tumors.     

Low-dose ARA-C and 1(OH) D3 administration in acute non lymphoid leukemia: pilot study.

BACKGROUND AND METHODS. Vitamin D3 metabolites have been shown to be able to induce monocytic differentiation both in vitro and in vivo. In this paper we report the preliminary results of an uncontrolled clinical trial where low doses of ARA-C and 1(OH)D3 were administered to patients affected by acute non lymphoid leukemia. The achievement of complete or partial remission was recorded. Morphological and cytochemical studies were performed in order to control the blastic populations under therapy. Immunocytochemical studies were also performed in some patients in order to detect the presence of 1,25(OH)2D3 receptors in the blast population. Seventeen percent reached complete remission and 45% reached only a partial remission. RESULTS AND CONCLUSIONS. The results are in line with those showing that low doses of ARA-C are an effective treatment in this type of leukemia. In some cases (7/11), a monocytic/monoblastic shift was detected. The demonstration of 1,25(OH)2D3 receptors in some blasts is also reported. Thus it is possible to suggest that the vitamin D metabolite displays "in vivo" the differentiating activity already shown "in vitro".     

成人慢性乙型肝炎合并急性淋巴细胞白血病1例报告

<正>机体对HBV特异性细胞免疫反应的活力、多样性及效应功能是HBV感染后转归的关键,因此,HBV在体内持续存在及复制是引起机体免疫功能紊乱和肝炎慢性化的主要原因。近年来,有关乙型肝炎并发血液病的报道逐渐增多,现将临床工作中遇到的1例成人慢性乙型肝炎合并急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的病例报告如下。1临床资料患者男性,46岁,因"反复腹胀、乏力、纳差1年,加重1个     

血清25羟维生素D3或1,25二羟维生素D3水平与慢性阻塞性肺疾病关系的Meta分析

目的：系统评价血清25(OH)D3或1,25(OH)2 D3与 COPD 相关病例对照研究,进一步明确血清维生素 D 水平与 COPD 之间的关系。方法计算机检索 PubMed、EMBASE、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)数据库、万方数据库、维普数据库,并辅以文献追溯的方法,收集国内外发表的相关病例对照研究,检索时间均从建库至2015年11月。2位研究者按纳入排除标准筛选文献并评价纳入研究质量,应用 RevMan 5.2软件进行 Meta 分析。结果共纳入15篇病例对照研究,包含1948例 COPD患者及1549例健康对照者。25(OH)D3浓度水平结果：Meta分析结果表明无论是急性加重期 COPD还是稳定期 COPD,与健康对照组相比,其25(OH)D3浓度水平差异均有统计学意义,COPD组25(OH)D3浓度低于健康对照组。急性加重期组vs对照组,WMD=-14.28,95%CI =(-23.82~-4.73),Z=2.93,P <0.01;稳定期组vs对照组 WMD=-4.46,95%CI =(-7.36~-1.57),Z=3.02,P <0.01;急性加重期与稳定期相比,25(OH)D3浓度水平差异亦有统计学意义[WMD=-2.66,95%CI =(-4.19~-1.12), Z=3.38,P<0.01,见图2];1,25(OH)2 D3浓度水平结果：Meta分析结果表明无论是急性加重期COPD还是稳定期 COPD,与健康对照组相比,其1,25(OH)2 D3浓度水平差异均有统计学意义, COPD组1,25(OH)2 D3浓度低于健康对照组。急性加重期组vs对照组,WMD=-15.09,95%CI =(-17.97~-12.22),Z =10.3,P <0.01;稳定期组 vs 对照组,WMD=-9.62,95%CI =(-12.55~-6.70),Z=3.02,P<0.01。结论 COPD患者体内25(OH)D3与1,25(OH)2 D3浓度水平均显著降低,维生素D缺乏可能参与COPD的发生、发展,并影响COPD患者的预后。     

Monocytic crisis in chronic myeloid leukemia: a case report

We report a 17-year-old female with chronic myeloid leukemia (CML) who developed monocytic crisis. She was diagnosed as chronic phase of Ph1-chromosome positive CML at 14 years old. Three years after the diagnosis of the disease, she was admitted to the hospital because of low grade fever, lethargy and marked splenomegaly. Small dose of Ara-C relieved her symptoms and splenomegaly. Six months later, however, a marked leukocytosis over 70,000/microliters were observed, and the peripheral blood smear disclosed that about 80% of the leukocytes were relatively mature monocytoid cells. Chromosomal analysis revealed additional abnormalities (double Ph1, +8, +9, +19). Lysozyme levels in serum and urine were high and NAP score was elevated. These monocytoid cells expressed receptors for IgG-Fc and C3, phagocytic activity, and monocytoid antigens which were determined by monoclonal antibodies (MY4, Mo2, OKM5). Cytochemically, almost all of monocytoid cells were positive for peroxidase and naphthol-ASD-chloroacetate esterase (CAE), but the monocytoid cells positive for non-specific esterase were limited. These data suggested that this case was monocytic crisis in CML with proliferation of CAE positive monocytoid cells. Among several types of blast crisis, monocytic crisis is extremely rare condition. The definite monocytic crisis demonstrated by this case may support the hypothesis that target cells of CML are pluripotent hematopoietic precursors.