Intravenous ibandronate does not affect time to renal function deterioration in patients with skeletal metastases from breast cancer: phase III trial results

As patients with metastatic bone disease typically receive long-term treatment with bisphosphonates, and often antineoplastic compounds, drug-related safety is of considerable importance. Clinical trial data for intravenous (i.v.) ibandronate suggest that its nephrotoxic potential is comparable with placebo. We conducted a post hoc Kaplan-Meier analysis of time to serum creatinine increase with i.v. ibandronate throughout 2 years of treatment. After 96 weeks, 12% of patients in the placebo group and 6% in the ibandronate 6 mg group (ns, P = 0.22) had defined serum creatinine increases. After 12 treatment months (48 weeks), 4% of patients receiving placebo and 2% of patients receiving ibandronate 6 mg showed increased serum creatinine. These results suggest that there is no clinically relevant change in serum creatinine levels with i.v. ibandronate 6 mg infused every 3-4 weeks for 2 years. Comparative trials to examine the renal safety of ibandronate and other i.v. bisphosphonates are warranted.     

Differences in nephrotoxicity of intravenous bisphosphonates for the treatment of malignancy-related bone disease

Renal dysfunction is a particularly problematic adverse event that requires additional management and can prohibit the use of certain medications. Due to their renal uptake and elimination, some bisphosphonates can cause nephrotoxicity when used for the treatment of skeletal-related events in patients with bone metastases. However, clinical studies and post-marketing experience indicate that renal effects do not appear to be the same for all bisphosphonates. Zoledronic acid and pamidronate appear to be associated with a greater risk of renal toxicity, especially when given in high doses or over short infusion times. In contrast, high loading doses of intravenous ibandronate (3 x 6 mg given on days 1-3) have shown no additional renal safety concerns, and intravenous ibandronate 6 mg appears to have a renal safety profile comparable to placebo. This paper reviews the renal safety of intravenously administered bisphosphonates and makes some suggestions, based on preclinical and clinical data, as to why renal safety profiles may differ.     

Tetrahydrogestrinone is a potent but unselective binding steroid and affects glucocorticoid signalling in the liver

Tetrahydrogestrinone (THG) is a steroid recently identified to be misused as doping agent. However, the knowledge on functions of this substance in humans or animal models is rather limited. Therefore, it was our aim to further characterize the pharmacological profile of THG and identify potential adverse side effects. THG was synthesized, the purity was confirmed and its biological activity was tested. The potency of THG to transactivate AR dependent reporter gene expression was two orders of magnitude lower compared to dihydrotestosterone. THG binds with high affinity but unselective to the androgen (AR), progesterone (PR), glucocorticoid (GR) and mineralocorticoid (MR) receptor. Treatment of orchiectomised rats with THG resulted in a stimulation of prostate, seminal vesicle and levator ani muscle, indicating androgenic and anabolic properties. In the liver THG, in contrast to testosteronepropionate (TP), down regulates the expression of the GR dependent tyrosine aminotransferase gene (TAT). In summary, our results demonstrate that THG is not a specific AR agonist. THG exhibits a high binding affinity to all tested steroid hormone receptors and binds with highest affinity to the GR. Our in vivo data are indicative of an anabolic and androgenic potency of THG, but the repression of TAT demonstrates that THG also interferes with the glucocorticoid hormone system. Therefore, it is conceivable that an intake will result in adverse side effects.     

Ibandronate: efficacy in the treatment of metastatic bone disease

Ibandronate is a bisphosphonate treatment for metastatic bone disease. In Phase III trials in breast cancer patients, intravenous and oral formulations of ibandronate lowered the incidence of skeletal-related events, reduced metastatic bone pain scores throughout 2 years of treatment, and had significant positive effects on patient quality of life, demonstrating its efficacy in this condition. Recent pilot studies in other primary cancers suggest that a loading dose of ibandronate may relieve severe or opioid-resistant metastatic bone pain. In safety analyses, ibandronate was well tolerated with a safety profile comparable to placebo. Ibandronate therefore represents a treatment choice with documented efficacy and safety in metastatic bone disease from breast cancer.     

Mikrometastatische Zellen im Knochenmark von Patientinnen mit Mammakarzinom

BACKGROUND: The immunocytological detection of disseminated epithelial cells in bone marrow in patients with breast cancer has been performed at many hospitals and institutes since the early 1980s. Despite numerous publications in this field, it has not been possible to standardize the method and establish the ideal antibody, either nationally or internationally. Molecular biological methods using PCR technology could extend the diagnostic spectrum. However, one of the major problems in breast cancer is the lack of a disease-specific marker gene. As a result, immunocytology is still the standard procedure for tumour cell detection. METHODS: The detection of disseminated single cells in bone marrow in primary breast cancer (also known as minimal residual disease) is a new prognostic factor for disease-free and overall survival. This has been demonstrated in three large (N > 300) groups and several small to medium groups (N = 50-300). As a marker of dissemination in a target organ for metastasis this prognostic factor corresponds much more closely to the tendency of breast cancer to early haematogenic spread. Tumour cell detection may predict the course of the disease better than the axillary lymph node status. Bone marrow aspiration and detection of disseminated cells might replace lymph node dissection, at least in those patients with small tumours and no clinical signs of lymph node involvement. This strategy will soon be investigated in appropriate studies. Another possible clinical use might be deciding on whether or not to give adjuvant systemic therapy to node-negative patients. Patients with positive tumour cell detection are at a higher risk of subsequent metastasis, even if the axillary nodes are histologically normal. APPLICATION OF METHODS: The immunohistological or molecular biological detection of tumour cells in axillary lymph nodes might also be very useful, now that is has been shown that a considerable subset of patients determined to be node-negative by means of conventional methods, are positive according to these new techniques. These methods could be a useful supplement to sentinel node biopsy. A further potential use of this method is in monitoring therapy with new treatment modalities such as gene therapy and immunotherapy. Repeated bone marrow aspiration can provide information on the success of therapy in minimal residual disease (cytoreduction). Immunocytochemical investigation of individual cells may be useful in studying the pathogenesis of metastasis, in particular in the skeleton. Phenotyping of cells might allow statements to be made in the metastatic potential of cells and the question of cell dormancy. It remains to be hoped that this aspect of minimal residual disease will be granted more attention in future.     

Bloodspot cortisol in mild asthma: the effect of inhaled corticosteroids

Bloodspot cortisol, where finger pricked blood is applied to blotting paper, is suitable for repeated measurements in the home environment. The use of bloodspot cortisol measurements in children with asthma and the effect of inhaled corticosteroids on daytime cortisol concentrations were assessed. Twenty children with mild asthma were randomised to receive double blind either placebo or beclomethasone dipropionate 200 micrograms twice daily. Blood was taken by finger prick at home on waking, and treatment administered. Blood was then taken one hour after treatment, at lunchtime, and in the evening. The area under the curve (AUC) for the four time points was calculated as a composite index of daytime cortisol. Mean (SEM) bloodspot cortisols fell progressively over the day from 199.2 (15.6) nmol/l to 58.4 (8.9) nmol/l. Cortisol in the group treated with beclomethasone dipropionate was lower at all time points, but was significant only after treatment (mean (SEM) 120.9 (14.3) v 177.5 (21.0) nmol/l) and at lunchtime (mean (SEM) 82.7 (12.4) v 128.9 (12.6) nmol/l). AUC for the beclomethasone dipropionate treated group was also significantly decreased (mean (SEM) 317 (31.4) v 446 (29.7)). Beclomethasone dipropionate at a dose of 400 micrograms/day significantly suppresses the daytime cortisol profile.     

组成型αB晶体蛋白在热休克蛋白核转录因子1敲除小鼠心肌中的表达

目的:了解热休克蛋白核转录因子1(HSF1)对小鼠心肌组成型αB晶体蛋白(αB-Crystallin,αBC)表达的影响.方法:用western blot和免疫组织化学的方法,测定组成型αBC在HSF1基因野生型(hsf1+/+)和HSF1基因敲除型(hsf1-/-)小鼠心肌中的表达.结果:αBC在hsf1-/-和hsf1+/+小鼠心肌表达量分别为68.42±4.16和100.00±7.58(心肌可溶性组分,P＜0.05),20.35±1.01和37.55±1.91(心肌不可溶性组分,P＜0.05);免疫组化显示αBC在hsf1-/-心肌细胞内的表达信号较hsf1+/+明显减弱.结论:HSF1基因是介导组成型αBC基因表达重要的、但不是惟一的因子.