Familial lung cancer and aggregation of smoking habits: a simulation of the effect of shared environmental factors on the familial risk of cancer.

BACKGROUND: Tobacco smoking is the principal cause of lung cancer. The risk of lung cancer in the offspring of lung cancer patients is about twice higher than the risk in the general population. The present study investigated the contribution of shared smoking habits to the familial clustering of lung cancer. METHODS: We estimated the relative risk of lung cancer attributable to smoking according to the extent to which smokers transmit their smoking habits to the offspring (heritability of smoking), the prevalence of smoking in the general population, and the risk of lung cancer for smokers compared with nonsmokers. FINDINGS: The relative risk of lung cancer for the offspring of lung cancer patients attributable to smoking was 1.19 when published data on smoking practice were modeled (i.e., assuming that the heritability of smoking was 0.5, the smoking prevalence 40%, and the odds ratio of lung cancer for smokers versus nonsmokers was 20). INTERPRETATION: Most familial cases of lung cancer cannot be attributed to shared smoking habits. The example of smoking can be used for other familial cancers, for which no strong environmental risk factors are usually known, to infer the primary role for heritable genes.     

A phase IB dose-finding trial of liposomal doxorubicin in combination with capecitabine in patients with pretreated metastatic breast cancer

Purpose

Anthracyclines and fluoropyrimidines are very active in breast cancer, while liposomal doxorubicin has low cardiotoxicity. We conducted a dose-finding study of the combination of liposomal doxorubicin and capecitabine in patients with pretreated metastatic breast cancer.

Patients and methods

Patients received liposomal doxorubicin 60 mg/m² on day 1 plus capecitabine 825 mg/m² bid (level 0) or 1,000 mg/m² bid (level 1) on days 1–14 of each 21-day cycle to establish the maximum tolerated dose (MTD) and cardiac safety.

Results

Nine patients were enrolled and a total of 52 courses were delivered (median 6 cycles per patient [range 4–7]). Grade 4 neutropenia occurred in 15% of cycles, with one episode of febrile neutropenia; most nonhematological toxicities were mild or moderate. No formal MTD was established, and the study was closed because two cardiac events were observed at dose level 1 and another at dose level 0 in patients pretreated with epirubicin ≥ 560 mg/m².

Conclusions

The recommended dose for phase II studies is liposomal doxorubicin 60 mg/m² on day 1 plus capecitabine 825 mg/m²/bid on days 1–14 of each 21-day cycle. Despite the lower cardiotoxicity of liposomal doxorubicin, the risk of cardiac damage persists in anthracycline-pretreated individuals and mandates close cardiac monitoring and careful evaluation of the overall cumulative dose.     

Acupuncture for Symptom Management in Cancer Care: an Update

In a previous systematic review of the worldwide literature of randomized controlled trials (RCTs) involving needle insertion into acupuncture points for symptom management in cancer patients, we identified only one high-quality RCT that was deemed to have a low risk of bias. Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 with no language limits applied. A total of 41 RCTs met all inclusion criteria and were rated. In the current review, we examined 18 trials published since our last report. The purpose of this update was to emphasize important recent findings and discuss how concerns such as blinding, separating non-specific placebo effects from specific needling effects, determining biologic mechanisms and dosing parameters, evaluating determinants of response such as expectation, controlling for sources of bias, and the lack of standardization in treatment and study methods may affect the interpretation of study results.     

O6-methylguanine DNA-methyltransferase methylation status can change between first surgery for newly diagnosed glioblastoma and second surgery for recurrence: clinical implications

O⁶-methylguanine DNA-methyltransferase (MGMT) promoter methylation status is a prognostic factor in newly diagnosed glioblastoma patients. However, it is not yet clear whether, and if so how, MGMT methylation status may change. Moreover, it is unknown whether the prognostic role of this epigenetic feature is retained during the disease course. A retrospective analysis was made using a database of 614 glioblastoma patients treated prospectively from January 2000 to August 2008. We evaluated only patients who met the following inclusion criteria: age ≥18 years; performance status 0-2; histological diagnosis of glioblastoma at both first and second surgery for recurrence; postoperative treatment consisting of: (i) radiotherapy (RT) followed by adjuvant temozolomide (TMZ) until 2005 and (ii) TMZ concurrent with and adjuvant to RT after 2005; a time interval ≥3 months between first and second surgery. MGMT status was evaluated at first and second surgery in all 44 patients (M:F 32:12, median age: 49 years, range: 27–67 years). In 38 patients (86.4%), MGMT promoter status was assessable at both first and second surgery. MGMT methylation status, changed in 14 patients (37%) of second surgery samples and more frequently in methylated than in unmethylated patients (61.5% vs 24%, P = .03). The median survival was significantly influenced only by MGMT methylation status determined at first surgery (P = .04). Significant changes in MGMT methylation status during the course of GBM occur more frequently in MGMT methylated than unmethylated cases. MGMT methylation status determined at first surgery appears to be of prognostic value; however, it is not predictive of outcome following second surgery.     

Epidemiologic evidence of slow growing,nonprogressive or regressive breast cancer: A systematic review

The general aim of this systematic review is to mitigate breast cancer (BC) overdiagnosis and overtreatment. The specific aim is to summarize available data on the occurrence and features of indolent invasive or in situ (DCIS) BC, and precisely survival of untreated cases, prevalence of occult cancers found in autopsies, frequency of regressive BC. PubMed, Embase and Cochrane Library were systematically searched up to 3/31/2014. Eligibility criteria were: cohort studies, case‐control studies, uncontrolled case series assessing survival in women with a diagnosis of BC who did not receive treatment compared to treated women; case series of autopsies estimating the prevalence of undiagnosed BC; cohort studies, case‐control studies, uncontrolled case series, case reports assessing the occurrence of spontaneous regression of BC in women with a confirmed histology diagnosis. Untreated BC: 8 cohort studies and 12 case series (3593 BC) were included. In three controlled cohort studies (diagnoses 1978–2006), the 5‐years overall survival was 19–43%. Occult BC: 8 case series (2279 autopsies) were included. The prevalence of invasive BC undiagnosed during lifetime range was 0–1.5%, while for DCIS the range was 0.2–14.7%. Spontaneous regression: 2 cohort studies, 3 case reports, 1 case series included. In the cohort studies the relative risk of regression for screen detected compared with nonscreened BC was estimated as 1.2 and 1.1. It seems plausible that around 10% of invasive BC are not symptomatic during life, and that one fith of BC patients if untreated would be alive after 5 years. Around 1 of 10 screen‐detected BC may regress according two studies.     

Biosynthesis of iridoid sex pheromones in aphids

Iridoid monoterpenes, widely distributed in plants and insects, have many ecological functions. While the biosynthesis of iridoids has been extensively studied in plants, little is known about how insects synthesize these natural products. Here, we elucidated the biosynthesis of the iridoids cis-trans-nepetalactol and cis-trans-nepetalactone in the pea aphid Acyrthosiphon pisum (Harris), where they act as sex pheromones. The exclusive production of iridoids in hind legs of sexual female aphids allowed us to identify iridoid genes by searching for genes specifically expressed in this tissue. Biochemical characterization of candidate enzymes revealed that the iridoid pathway in aphids proceeds through the same sequence of intermediates as described for plants. The six identified aphid enzymes are unrelated to their counterparts in plants, conclusively demonstrating an independent evolution of the entire iridoid pathway in plants and insects. In contrast to the plant pathway, at least three of the aphid iridoid enzymes are likely membrane bound. We demonstrated that a lipid environment facilitates the cyclization of a reactive enol intermediate to the iridoid cyclopentanoid-pyran scaffold in vitro, suggesting that membranes are an essential component of the aphid iridoid pathway. Altogether, our discovery of this complex insect metabolic pathway establishes the genetic and biochemical basis for the formation of iridoid sex pheromones in aphids, and this discovery also serves as a foundation for understanding the convergent evolution of complex metabolic pathways between kingdoms.

Iridoids are a class of atypical bicyclic monoterpenoids that are widely distributed in flowering plants, but, notably, are also found in several insect orders, including Coleoptera, Hymenoptera, and Hemiptera (1). Iridoids therefore present an opportunity to compare and contrast the chemical logic of natural product biosynthesis between plants and insects.In plants, iridoids largely act as defensive metabolites or biosynthetic intermediates for other natural products (e.g., monoterpenoid indole alkaloids and isoquinoline alkaloids). The pathway leading to the cyclopentanoid-pyran (iridoid) scaffold was first elucidated in the plant Madagascar periwinkle (Catharanthus roseus) (2–6) and more recently in the two mint species Nepeta mussinii and Nepeta cataria (7–9). Iridoid biosynthesis in plants starts with the condensation of the universal terpene precursors isopentenyl diphosphate (IPP) and dimethylallyl diphosphate (DMAPP) to form geranyl diphosphate (GPP), followed by hydrolysis to geraniol (Fig. 1A). Both reactions take place in the plastids and are catalyzed by trans-isoprenyl diphosphate synthase (IDS) and geraniol synthase (GES), respectively. Hydroxylation of geraniol by geraniol-8-hydroxylase (G8H) leads to 8-hydroxygeraniol, which is further oxidized in two consecutive reaction steps by 8-hydroxygeraniol oxidase (HGO) to 8-oxogeranial. This dialdehyde is then converted to the iridoid nepetalactol by a two-step reduction–cyclization sequence that involves the formation of a highly reactive 8-oxocitronellyl enol/enolate intermediate. Initially, reduction and cyclization of 8-oxogeranial were thought to be controlled by a single enzyme, iridoid synthase (ISY) (3), though later studies showed that ISY likely catalyzes only the NADPH-dependent reduction of 8-oxogeranial to the 8-oxocitronellyl enol/enolate intermediate (8). This intermediate can nonenzymatically cyclize, or, alternatively, the stereoselective cyclization of this intermediate to nepetalactol is enzymatically mediated by nepetalactol-related short-chain dehydrogenase (NEPS) or by major latex protein-like (MLPL) enzymes (8, 9). In C. roseus, nepetalactol is further metabolized to secologanin, which serves as a precursor for the formation of monoterpene indole alkaloids in this plant (10). In Nepeta, a NEPS protein oxidizes nepetalactol to nepetalactone (8), with both the alcohol and lactone released as volatiles.Open in a separate windowFig. 1.The formation of iridoids in plants and aphids. (A) Labeling studies suggest that the biosynthesis of iridoids in the pea aphid A. pisum mimics the biosynthetic pathway in iridoid-producing plants. IPP, isopentenyl diphosphate; DMAPP, dimethylallyl diphosphate; GPP, geranyl diphosphate; IDS, isoprenyl diphosphate synthase; GES, geranyl diphosphate synthase; G8H, geraniol 8-hydroxylase; HGO, 8-hydroxygeraniol oxidoreductase; ISY, iridoid synthase; NEPO, nepetalactol oxidase. (B) Relative expression of mevalonate and putative nepetalactone pathway genes in hind legs and front legs of different sexual stages of A. pisum. Relative expression data are based on RPKM values obtained by RNAseq. f-hl, hind legs of sexual females; f-fl, front legs of sexual females; af-hl, hind legs of asexual females; m-hl, hind legs of males.Insects utilize iridoids as both defense compounds and volatile pheromones, but in terms of biosynthesis, comparatively little is understood about insect-derived iridoids. Biosynthetic insights have been obtained from studies on larvae of chrysomelid leaf beetles, which accumulate the iridoid-related monocyclic dialdehydes chrysomelidial and plagiodial (11). Feeding experiments with isotopically labeled precursors and the discovery of some of the enzymes involved in chrysomelidial formation demonstrated that leaf beetles produce these compounds by a series of chemical reactions similar to those that occur in plants (12–15). Although the enzymatic basis for this pathway has not been completely established, the fact that the known enzymes are unrelated to their counterparts in plants suggests independent evolution of the pathway occurred (14).Cis-trans-nepetalactol and cis-trans-nepetalactone are the major iridoids produced by catnip (N. mussinii) and catmint (N. cataria) (16). These molecules are responsible for the euphoric effect these plants have on cats, but their ecological function is unclear, though they may play roles in mediating interactions with insects (17). Interestingly, cis-trans-nepetalactol and cis-trans-nepetalactone occur also in aphids, which produce these compounds as volatile sex pheromones (18, 19). The pea aphid Acyrthosiphon pisum, for example, has been reported to biosynthesize (1R,4aS,7S,7aR)-cis-trans-nepetalactol and (4aS,7S,7aR)-cis-trans-nepetalactone in glandular structures on the hind legs of sexual female aphids, from where they are released to attract male conspecifics (18, 20). Recent studies with isotopically labeled iridoid precursors suggest that the iridoid pathway in aphids follows the reaction sequence described for plants (21). However, the underlying enzymatic machinery of this pathway is completely unknown.Here, we report the elucidation of the entire iridoid pathway in the pea aphid A. pisum. By searching for genes expressed exclusively in hind legs of sexual female aphids, the site of iridoid production, we could rapidly identify all six biosynthetic genes/enzymes responsible for the conversion of IPP and DMAPP to cis-trans-nepetalactone. The discovery of the insect nepetalactone pathway in its entirety now allows a comparison of the chemical solutions that have evolved for nepetalactone biosynthesis in plants and animals. Although the chemical steps from GPP to nepetalactone are the same in both Nepeta and pea aphids, the enzymes of these pathways have clearly evolved independently.