Sustained compensatory p38 MAPK signaling following treatment with MAPK inhibitors induces the immunosuppressive protein CD73 in cancer: combined targeting could improve outcomes

RAS‐MAPK signaling promotes immune evasion and cancer cell survival, and MAPK inhibitors (MAPKis) are frequently used as cancer therapies. Despite progress elucidating the direct effects of MAPKi on immune cells, their indirect effect on the tumor microenvironment (TME) through changes in tumor cells remains incompletely understood. Here, we present evidence of a rapid compensatory response to MAPKi that is driven by sustained p38 MAPK signaling and by which cancer cells can upregulate the immunosuppressive protein CD73 to reduce the antitumor immune response. This compensatory response also results in decreased sensitivity toward MAPKi, and, accordingly, combining anti‐CD73 antibodies and MAPKi significantly enhances the antitumor effect compared to single‐agent treatment in vivo. Combining MAPKi and anti‐CD73 was accompanied by significant alterations in intratumor immune cell composition, supporting the effect of MAPKi‐induced CD73 expression on the TME. We show that high CD73 expression significantly correlates with worse outcome in MAPKi‐treated colorectal cancer patients, highlighting the potential clinical importance of increased CD73 expression following MAPKi treatment. Our findings may explain the diminished effect of MAPKi in cancer patients and provides further rationale for combined anti‐CD73 and MAPKi treatment.     

Enteroendocrine,Musashi 1 and neurogenin 3 cells in the large intestine of Thai and Norwegian patients with irritable bowel syndrome

Objectives: The prevalence, gender distribution and clinical presentation of IBS differ between Asian and Western countries. This study aimed at studying and comparing enteroendocrine, Musashi 1 (Msi 1) and neurogenin 3 (neurog 3) cells in Thai and Norwegian IBS patients.

Material and methods: Thirty Thai and 61 Norwegian IBS patients as well as 20 Thai and 24 Norwegian controls were included. Biopsy samples were taken from each of the sigmoid colon and the rectum during a standard colonoscopy. The samples were immunostained for serotonin, peptide YY, oxyntomodulin, pancreatic polypeptide, somatostatin, Msi 1 and neurog 3. The densities of immunoreactive cells were determined with computerized image analysis.

Results: The densities of several enteroendocrine cell types were altered in both the colon and rectum of both Thai and Norwegian IBS patients. Some of these changes were similar in Thai and Norwegian IBS patients, while others differed.

Conclusions: The findings of abnormal densities of the enteroendocrine cells in Thai patients support the notion that enteroendocrine cells are involved in the pathophysiology of IBS. The present observations highlight that IBS differs in Asian and Western countries, and show that the changes in large-intestine enteroendocrine cells in Thai and Norwegian IBS patients might be caused by different mechanisms.     

雄黄砷的蓄积性研究

目的 研究大鼠长期给予雄黄后砷在血液、肝脏、肾脏和脑组织中的蓄积性,以探讨雄黄的毒性机制,为临床安全用药提供科学依据.方法 ①将禁食16 h后的雄性SD大鼠随机分为对照组(4只)和雄黄0.16g·kg-1组(28只).雄黄组灌胃给药1次,于给药后0.5,1,2,4,8,16,36 h时间点各取4只大鼠,取全血、心脏、肝脏、肾脏、肺和脑组织,测定砷含量.②将SD大鼠随机分为对照组和雄黄0.16,0.08,0.02g·kg-1剂量组,每组10只(雌雄各5只).各剂量组每日灌胃给药1次,共给药3个月.于末次给药后16 h取血、肝、肾、脑,测定砷含量.结果 单次给予雄黄0.16 g· kg-1后,一定量的砷能吸收进入体内,分布于血液和心、肝、肺、肾、脑等主要脏器,达峰时砷含量从高至低依次为血液＞肾＞肺＞肝＞心＞脑.血液中砷水平远高于其他脏器中砷水平,这一分布特点可能为雄黄治疗白血病的基础.雄黄反复给药3个月后,血液、肝脏、肾脏和脑组织均有一定程度的砷蓄积.在相同的雄黄剂量组,肾脏的砷蓄积倍数最高,其次是肝脏.然而在砷含量方面,血液中的砷含量远高于其他脏器的砷含量,砷含量由高至低的顺序为血液＞肾脏＞肝脏＞脑.雄黄长期用药时可造成肝、肾组织轻度病理变化,可能与肝、肾组织的砷蓄积相关.但未见血液与肝肾毒性相关的生化指标变化,说明肝脏与肾脏毒性较轻.结论 雄黄的可溶性砷可吸收入体内,广泛分布于主要脏器中.长期用药后,砷可在血液、肾脏、肝脏、脑组织蓄积,其中肾脏、肝脏砷蓄积与肝、肾毒性有关.血液是砷分布水平最高的部位,可能是雄黄治疗白血病的基础.     

Good outcome in every fourth resuscitation attempt is achievable--an Utstein template report from the Stavanger region

Aim of the study

Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the western world. We wanted to study changes in survival over time and factors linked to this in a region which have already reported high survival rates.

Methods

We used a prospectively collected Utstein template database to identify all resuscitation attempts in adult patients with OHCA of presumed cardiac origin. We included 846 resuscitation attempts and compared survival to discharge with good outcome in two time periods (2001-2005 vs. 2006-2008).

Results

We found no significant differences between the two time periods for mean age (71 and 70 years (p = 0.309)), sex distribution (males 70% and 71% (p = 0.708)), location of the OHCA (home 64% and 63% (p = 0.732)), proportion of shockable rhythms (44% and 47% (p = 0.261)) and rate of return of spontaneous circulation (38% and 43% (p = 0.136)), respectively. Bystander cardiopulmonary resuscitation (CPR), however, increased significantly from 60% to 73% (p < 0.0001), as did the overall rate of survival to discharge from 18% to 25% (p = 0.018). In patients with a shockable first rhythm, rate of survival to discharge increased significantly from 37% to 48% (p = 0.036). In witnessed arrest with shockable rhythm survival to discharge increased from 37% to 52% (p = 0.0105).

Conclusion

Overall, good outcome is now achievable in every fourth resuscitation attempt and in every second resuscitation attempt when patients have a shockable rhythm. The reason for the better outcomes is most likely multi-factorial and linked to improvements in the local chain of survival.