Metformin and thiazolidinediones are associated with improved breast cancer-specific survival of diabetic women with HER2+ breast cancer

BackgroundInsulin/insulin-like growth factor-I (IGF-I) signaling is a mechanism mediating the promoting effect of type 2 diabetes (DM2) on cancer. Human epidermal growth factor receptor (HER2), insulin receptor and IGF-I receptor involve the same PI3K/AKT/mTOR signaling, and different antidiabetic pharmacotherapy may differentially affect this pathway, leading to different prognoses of HER2+ breast cancer.MethodsWe reviewed 1983 consecutive patients with HER2+ breast cancer treated between 1 January 1998 and 30 September 2010. The overall survival, breast cancer-specific death rate, age, race, nuclear grade, stage, menopausal status, estrogen and progesterone receptor status, body mass index and classes of antidiabetic pharmacotherapy were analyzed.ResultsA Cox regression analysis showed that DM2 [P = 0.026, hazard ratio (HR) = 1.42, 95 % confidence interval (95 % CI) 1.04–1.94] predicted poor survival of stage ≥2 HER2+ breast cancer. In Kaplan–Meier analysis, metformin predicted lengthened survival and so did thiazolidinediones. Analyzing only the diabetics, Cox regression showed that metformin (P = 0.041, HR = 0.52, 95 % CI 0.28–0.97) and thiazolidinediones (P = 0.036; HR = 0.41, 95 % CI 0.18–0.93) predicted lengthened survival, and competing risk analysis showed that metformin and thiazolidinediones were associated with decreased breast cancer-specific mortality (P = 0.023, HR = 0.47, 95 % CI 0.24–0.90 and P = 0.044, HR = 0.42, 95 % CI 0.18–0.98, respectively).ConclusionsThiazolidinediones and metformin users are associated with better clinical outcomes than nonusers in diabetics with stage ≥2 HER2+ breast cancer. The choice of antidiabetic pharmacotherapy may influence prognosis of this group.     

Raf kinase inhibitor protein (RKIP) in cancer

Raf kinase inhibitory protein (RKIP) was initially identified as phosphatidylethanolamine binding protein in bovine brain. It was later identified as a protein that inhibits Raf kinase activation of MEK. Further exploration has revealed that RKIP modulates several other signaling pathways including NF–κB and G-protein signaling. A gene array screen revealed that RKIP expression was low in a metastatic compared with non-metastatic prostate cancer cell line. Further experiments revealed that RKIP fits the criteria for a metastasis suppressor gene. RKIP expression has been shown to be downregulated in metastatic tissues, compared with non-metastatic tissue in multiple cancers, suggesting that loss of RKIP metastasis suppressor activity is a broad mechanism leading to metastasis. Additionally, loss of RKIP has been shown to impact therapy through conferring radioresistance and chemoresistance. Taken together, these data indicate understanding RKIP’s contributions to cancer may lead to important therapeutic strategies to prevent metastasis and promote therapeutic efficacy.     

An Unusual Case of Gastric Cancer Presenting with Breast Metastasis with Pleomorphic Microcalcifications

Breast metastasis from gastric carcinoma is rare. We present a case of right breast mass with microcalcification in which the diagnosis of poorly differentiated adenocarcinoma from the stomach was made after a biopsy. Pleomorphic microcalcification was noted in the ill-defined breast mass, which is a rare feature in breast metastasis. Since breast metastasis usually signifies advanced metastatic disease, differentiating primary breast cancer from metastasis is important for appropriate treatment.     

Attenuation of proliferation in oligodendrocyte precursor cells by activated microglia

Activated microglia can influence the survival of neural cells through the release of cytotoxic factors. Here, we investigated the interaction between Toll‐like receptor 4 (TLR4)‐activated microglia and oligodendrocytes or their precursor cells (OPC). Primary rat or N9 microglial cells were activated by exposure to TLR4‐specifc lipopolysaccharide (LPS), resulting in mitogen‐activated protein kinase activation, increased CD68 and inducible nitric oxide synthase expression, and release of the proinflammatory cytokines tumor necrosis factor (TNF) and interleukin‐6 (IL‐6). Microglial conditioned medium (MGCM) from LPS‐activated microglia attenuated primary OPC proliferation without inducing cell death. The microglial‐induced inhibition of OPC proliferation was reversed by stimulating group III metabotropic glutamate receptors in microglia with the agonist L‐AP4. In contrast to OPC, LPS‐activated MGCM enhanced the survival of mature oligodendrocytes. Further investigation suggested that TNF and IL‐6 released from TLR4‐activated microglia might contribute to the effect of MGCM on OPC proliferation, insofar as TNF depletion of LPS‐activated MGCM reduced the inhibition of OPC proliferation, and direct addition of TNF or IL‐6 attenuated or increased proliferation, respectively. OPC themselves were also found to express proteins involved in TLR4 signalling, including TLR4, MyD88, and MAL. Although LPS stimulation of OPC did not induce proinflammatory cytokine release or affect their survival, it did trigger JNK phosphorylation, suggesting that TLR4 signalling in these cells is active. These findings suggest that OPC survival may be influenced not only by factors released from endotoxin‐activated microglia but also through a direct response to endotoxins. This may have consequences for myelination under conditions in which microglial activation and cerebral infection are both implicated. © 2010 Wiley‐Liss, Inc.     

Assessment of maxillary position: Implant vs cephalometric methods

Objective:To compare changes in maxillary position assessed from a maxillary implant and three cephalometric methods based on linear measurements.Methods:Series of tracings of the maxilla obtained around puberty from an implant study were analyzed. The displacement of the implant was used to determine the direction and amount of “actual” maxillary growth. Displacement of point A was measured according to three cephalometric methods. The values obtained from absolute, horizontal, and vertical displacement of point A by three cephalometric methods and by the implant method were compared.Results:Results showed that estimation of displacement of the maxilla by three cephalometric methods (point A) was significantly larger than that of the implant method in all directions. The average difference in the horizontal plane was 0.7 mm, 1.2 mm, and 1.6 mm, respectively; the average difference in the vertical plane was 2.2 mm, 2.5 mm, and 3.6 mm, respectively.Conclusions:Estimations of changes in maxillary position by the implant method and by cephalometric methods were not proportional. All three cephalometric methods overestimated changes in the position of the maxilla.