Loss of breast cancer metastasis suppressor 1 protein expression predicts reduced disease-free survival in subsets of breast cancer patients.

PURPOSE: This study aims to determine the effect of loss of breast cancer metastasis suppressor 1 (BRMS1) protein expression on disease-free survival in breast cancer patients stratified by estrogen receptor (ER), progesterone receptor (PR), or HER2 status, and to determine whether loss of BRMS1 protein expression correlated with genomic copy number changes. EXPERIMENTAL DESIGN: A tissue microarray immunohistochemical analysis was done on tumors of 238 newly diagnosed breast cancer patients who underwent surgery at the Cleveland Clinic between January 1, 1995 and December 31, 1996, and a comparison was made with 5-year clinical follow-up data. Genomic copy number changes were determined by array-based comparative genomic hybridization in 47 breast cancer cases from this population and compared with BRMS1 staining. RESULTS: BRMS1 protein expression was lost in nearly 25% of cases. Patients with tumors that were PR negative (P=0.006) or HER2 positive (P=0.039) and <50 years old at diagnosis (P=0.02) were more likely to be BRMS1 negative. No overall correlation between BRMS1 staining and disease-free survival was observed. A significant correlation, however, was seen between loss of BRMS1 protein expression and reduced disease-free survival when stratified by either loss of ER (P=0.008) or PR (P=0.029) or HER2 overexpression (P=0.026). Overall, there was poor correlation between BRMS1 protein staining and copy number status. CONCLUSIONS: These data suggest a mechanistic relationship between BRMS1 expression, hormone receptor status, and HER2 growth factor. BRMS1 staining could potentially be used in patient stratification in conjunction with other prognostic markers. Further, mechanisms other than genomic deletion account for loss of BRMS1 gene expression in breast tumors.     

Methazolamide-Induced Delirium

A 74-year-old man became delirious 2 days after beginning oral therapy with methazolamide. The delirium was manifested by intermittent psychosis, incontinence of bowel and bladder, lethargy, and disorientation. These symptoms continued for 25 days despite many changes in his drug regimen, and complete laboratory, urologic, and neurologic work-ups. The symptoms resolved completely within 1 week of discontinuing methazolamide. This is the first case reported of delirium associated with methazolamide not accompanied by a metabolic imbalance.     

Effect of chronic ethanol administration on the uptake and degradation of asialoglycoproteins by the perfused rat liver

We have shown previously reduced binding, internalization, degradation and receptor-ligand dissociation during receptor-mediated endocytosis (RME) of 125I-asialoorosomucoid (ASOR) by hepatocytes isolated from rats fed ethanol for 4-6 weeks. In the present study, we investigated the effect of ethanol feeding on RME by using the intact perfused liver as a model. Male, Sprague-Dawley rats were fed a liquid diet containing either ethanol (36% of calories) or isocaloric carbohydrate. Receptor-mediated endocytosis of 125I-ASOR was then examined over a time course of perfusion. In all cases, clearance of the labeled glycoprotein was followed by a slower but steady appearance of acid-soluble products in the medium. Ethanol-fed animals had a significantly (P less than 0.01) slower rate of clearance of the labeled ligand from the circulating perfusate than did control animals. Impairment of ASOR surface binding and degradation in ethanol-fed animals was also demonstrated in this model. When we examined the subcellular distribution of labeled ligand after various times of perfusion, we found that in control livers, a shift of radiolabeled ligand from the subcellular fractions containing endosomes and plasma membranes to fractions containing lysosomes occurred, while significantly less ligand was shifted to the lysosomes of ethanol-treated rats. These results show that ethanol administration inhibits RME of ASOR in the isolated perfused liver model, thus confirming our earlier reported defects in isolated hepatocytes. In addition, transport of ligand along the intracellular RME pathway was also shown to be altered by ethanol treatment as indicated by the impaired movement of ASOR from the endosomal to the lysosomal compartment.     

Experimental rabies in skunks and foxes. Pathogenesis of the spongiform lesions

The pathogenesis of rabies spongiform lesions in striped skunks (Mephitis mephitis) and red foxes (Vulpes vulpes) was studied by light and electron microscopy and peroxidase-antiperoxidase immunocytochemistry. Studies in skunks included use of several street virus variants (different antigenic profiles as tested by monoclonal antibodies) different routes of inoculation (intranasal, intracerebral and intramuscular), immunosuppression of infected skunks, different preparations of virus (brain and salivary gland suspensions and infective tissue culture fluids), and sequential development of the lesions. Foxes (Vulpes vulpes) were infected intramuscularly with a street virus isolate. Except for the group of immunosuppressed skunks, all animals that developed clinical signs of rabies had encephalitis characterized by varying degrees of mononuclear perivascular cuffing, focal gliosis, and Negri bodies. Spongiform change occurred in the neuropil of the grey matter (especially thalamus and cerebral cortex) in rabid animals from all groups, but not in controls or exposed animals that did not develop rabies. Rabies antigen (detected by peroxidase-antiperoxidase immunocytochemistry) occurred only in small amounts in many thalami; some vacuolated areas were devoid of antigen. Ultrastructurally, there was a gradation in lesions from small to large membrane-bound vacuoles in cellular processes (mainly dendrites, less frequently axons) and to large tissue spaces containing granular and/or membranous material. These studies indicate that rabies spongiform change occurs in skunks given street virus of several different antigenic profiles and challenge virus standard rabies virus and that the distribution of the lesions has remarkable similarities to those of the traditional spongiform encephalopathies. The occurrence of the lesion is not affected by the immune response, the route of inoculation of virus, the preparation (suspension of salivary gland or brain, or tissue culture fluid), or the incubation period. The paucity of antigen in many thalami suggests that incorporation of viral components into vacuolar membranes is not necessary for development of the spongiform change. The development of the lesions includes formation of small membrane-bound vacuoles in cellular processes, rapid enlargement (less than 3 days) with compression of adjacent neural tissue, and rupture resulting in the large tissue spaces readily visible by light microscopy.