Switching from Tacrolimus to Sirolimus Halts the Appearance of New Sebaceous Neoplasms in Muir-Torre Syndrome

Little is known about the effects of immunosuppression on patients with hereditary nonpolyposis colorectal cancer (HNPCC). We describe a kidney transplant recipient with unrecognized Muir-Torre syndrome in whom the administration of a tacrolimus-based regimen led to the eruption of multiple sebaceous tumors. The patient was later found to harbor an MSH2 mutation. Switching to a sirolimus-based regimen resulted in arrest of the disease. When the patient was switched back to tacrolimus, new facial lesions rapidly appeared. Switching again to sirolimus resulted again in halting the appearance of new lesions. This finding is in line with the known antiangiogenic activity of sirolimus and reports on the regression of cutaneous Kaposi's sarcoma in kidney transplant recipients switched from another immunosuppressive regimen to sirolimus. Further studies on the potential use of sirolimus for the treatment of de novo tumors in immunosuppressed kidney transplant recipients with HNPCC are warranted.     

Testicular amplificaion and impaired transmission of human butyrylcholinesterase cDNA in transgenic mice

Gene amplification occurs frequently in tumour tissues yet is,in general, non-inheritable. To study the molecular mechanismsconferring this restraint, we created transgenic mice carryinga human butyrylcholinesterase (BCHE) coding sequence, previouslyfound to be amplified in a father and son. Blot hybridizationof tail DNA samples revealed somatic transgene amplificationswith variable restriction patterns and intensities, suggestingthe occurrence of independent amplification events, in 31% (11/35)of mice from the FII generation but in only 3.5% (2/58) of theFII and FIV generations. In contrast, >10-fold amplificationsof the BCHE transgene and the endogenous acetylcholinesteraseand c-raf genes appeared in both testis and epididymis DNA from>80% of FIII mice. Drastic, selective reductions in testisBCHEmRNA but not in actin mRNA were detected by the PCR amplificationof testis cDNA from the transgenic mice, and apparently resultedin the limited transmission of amplified genes. The testicularamplification of the BCHE transgene may potentially representa general phenomenon with clinical implications in human infertility.     

Computed tomographic (CT) demonstration of calcification of the ligamenta flava of the lumbosacral spine associated with protrusion of the intervertebral disc

Axial computed tomographic (CT) scan of the lumbosacral region was performed in 220 patients. The patient population was divided into three groups. The control group included 40 elderly patients without calcification of the ligamenta flava. The second group included 150 patients with posterior protrusion of the intervertebral discs. The third group included 30 patients with spinal stenosis. More than 80% of the patients of the second and the third group had calcification of the ligamenta flava. The diagnostic and practical importance of these findings is discussed.     

Association between pancreatic cystadenocarcinoma, malignant liver cysts, and polycystic disease of the kidney

Polycystic kidney disease is an autosomal dominant disease that may be associated with cystic disease of the liver. In women, the cysts may develop early and be more troublesome than in men. Cystadenocarcinoma of the pancreas is uncommon, comprising 1% of primary pancreatic malignancies. This case report is the first to describe a familial association between polycystic kidney disease and cystadenocarcinoma of the pancreas and liver in the English medical literature. A patient with autosomal dominant polycystic kidney disease (ADPKD) and multiple hepatic cysts developed cystadenocarcinoma of the pancreas with multiple malignant liver cysts. The patient's mother, sister, and niece had ADPKD, and the patient's sister also died of pancreatic cystadenocarcinoma. We believe that the development of these two disease entities in which the primary pathology is cyst formation has a genetic association. (Gastroenterology 1997 Jun;112(6):2104-7)     

Gonadotropin secretion from perifused tilapia pituitary in relation to gonadotropin-releasing hormone, extracellular calcium, and activation of protein kinase C

Gonadotropin (taGTH) secretion from perifused fragments of tilapia pituitaries was stimulated in a dose-dependent manner by an analog of gonadotropin-releasing hormone ([D-Ala6] des Gly10 ethylamide LHRH; GnRHa) in a dose range of 1.28 to 128 pM. The baseline secretion rate and taGTH secretion in response to GnRHa were both reduced when the perifusion medium lacked Ca2+. Calcium ionophore (A23187; 0.1 mM) mimicked the effect of GnRHa but only in the presence of Ca2+. The addition of cobalt chloride to the medium at 0.6 mM initially caused an increase in taGTH secretion which was followed by its decrease. At a CoCl2 concentration of 1.3 mM, the baseline secretion rate remained low and the effect of GnRHa on taGTH secretion was attenuated. Withdrawal of CoCl2 from the medium was followed by an elevated basal secretion rate. Five-minute pulses of the protein kinase C activator, 1 oleyl-2-acetyl-rac-glycerol (OAG; 0.25 to 10.4 mM) stimulated taGTH secretion in the presence of Ca2+. With the reservation that the experiments were performed on fragments containing more than one pituitary cell type, the results indicate that the stimulation of GTH secretion in this fish is dependent, as in mammals, on extracellular Ca2+ and probably involves the activation of protein kinase C. However, the fact that taGTH may be stimulated to some extent in the absence of extracellular calcium or in the presence of 1.3 mM Co2+ may point to the possibility that Ca2+ is mobilized from intracellular stores as a result of GnRH stimulation or to the involvement of an additional mechanism of GnRH action in fish independent of calcium.