Serum total testosterone is associated with phosphate and calcium excretion in response to oral phosphate loading in healthy middle-aged males.

Androgen receptors are expressed in the kidney and serum testosterone is negatively associated with serum phosphate in males, suggesting a role of testosterone in renal phosphate handling. In this cross-sectional study, we examined the association of serum total and free testosterone with acute phosphate and calcium excretion in males in response to an oral phosphate challenge. Thirty-five healthy adult males with normal baseline testosterone levels consumed a 500 mg phosphorus drink and the urinary excretion of minerals, as well as levels of relevant circulating parameters, were assessed at baseline and hourly for 4 h. Serum total testosterone was positively associated with overall phosphate excretion (r = 0.35, p = 0.04) and calcium excretion (r = 0.44, p = 0.00) in response to the challenge. Serum free testosterone was positively associated with post-challenge calcium excretion (r = 0.34, p = 0.048), but significance was not reached for phosphate excretion (r = 0.31, p = 0.07). Serum total and free testosterone were not associated with parathyroid hormone, fibroblast growth factor-23, or vitamin D-key factors implicated in phosphate and calcium regulation. Overall, higher serum total testosterone levels in healthy middle-aged males are associated with a greater capacity to acutely excrete phosphate and calcium after a single oral phosphate challenge, suggesting potential ramifications of testosterone deficiency related to mineral homeostasis.

Are There Any Pleiotropic Benefits of Vitamin D in Patients With Diabetic Kidney Disease? A Systematic Review of Randomized Controlled Trials.

Background: Type 2 diabetes (T2D) and kidney disease are risk factors for vitamin D deficiency. Native forms of vitamin D have a lower risk of hypercalcemia than calcitriol, the active hormone. The enzyme responsible for activating native vitamin D is now known to be expressed throughout the body; therefore, native vitamin D may have clinically relevant effects in many body systems. Objective: The objective of this systematic review was to examine the effect of native vitamin D supplementation on clinical outcomes and surrogate laboratory measures in patients with T2D and diabetic kidney disease (DKD). Design: Systematic review. Setting: Randomized controlled trials (RCTs) conducted in any country. Patients: Adults with T2D and DKD receiving supplementation with any form of native vitamin D (eg, ergocalciferol, cholecalciferol, calcifediol). Measurements: Clinical outcomes and surrogate clinical and laboratory measures reported in each of the trials were included in this review. Methods: The following databases were searched from inception to January 31, 2023: Embase, MEDLINE, Cochrane CENTRAL, Web of Science, ProQuest Dissertations and Theses, and medRxiv. Only RCTs examining supplementation with a native vitamin D form with a control or placebo comparison group were included. We excluded studies reporting only vitamin D status or mineral metabolism parameters, without any other outcomes of clinical relevance or surrogate laboratory measures. Study quality was evaluated using the Cochrane risk-of-bias tool (RoB2). Results were synthesized in summary tables for each type of outcome with the P values from the original studies displayed. Results: Nine publications were included, corresponding to 5 separate RCTs (377 participants total). Mean age ranged from 40 to 63. All trials administered vitamin D3. Intervention groups experienced improvements in vitamin D status and a reduction in proteinuria in 4 of the 5 included RCTs. There was a decrease in low-density lipoprotein and total cholesterol in the 2 trials in which they were measured. Improvements in bone mass, flow-mediated dilation, and inflammation were also reported, but each was only measured in 1 RCT. Effects on glucose metabolism, high-density lipoprotein, triglycerides, blood pressure, oxidative stress, and kidney function were mixed. No serious adverse effects were reported. Limitations: Limitations include the small number of RCTs and lack of information on the use of drugs that affect measured outcomes (eg, proteinuria-lowering renin-angiotensin-aldosterone system inhibitors and lipid-lowering medication) in most studies. Our study is also limited by the absence of a prestudy protocol and registration. Conclusions: Native vitamin D is a safe treatment that improves vitamin D status in patients with DKD. Vitamin D may modify proteinuria and lipid metabolism in DKD, but further well-designed trials that include well-established treatments are necessary. Overall, there is limited evidence for beneficial pleiotropic effects of vitamin D in patients with DKD.

Contexte: Le diabète de type 2 (DT2) et l'insuffisance rénale sont des facteurs de risque pour une carence en vitamine D. Les formes natives de la vitamine D représentent un risque plus faible d'hypercalcémie que le calcitriol, la forme active sur le plan hormonal de la vitamine D. On sait maintenant que l'enzyme responsable de l'activation de la vitamine D peut être exprimée dans tout le corps et donc, que la vitamine D native peut avoir des effets cliniquement significatifs dans de nombreux systèmes de l'organisme. Objectif: Examiner l'effet d'une supplémentation en vitamine D native sur les résultats cliniques et les mesures de laboratoire de substitution de patients atteints de DT2 et de maladie rénale diabétique (MRD). Conception: Revue systématique. Sources: Les essais contrôlés randomisés (ECR) pertinents, sans égard au pays où ils ont été menés. Sujets: Des adultes atteints de DT2 et de MRD recevant une supplémentation de toute forme de vitamine D native (ergocalciférol, cholécalciférol, calcifédiol). Mesures: Les mesures biologiques et cliniques de substitution ainsi que les résultats cliniques rapportés dans chacun des essais inclus. Méthodologie: Une recherche des articles pertinents a été effectuée dans les bases de données Embase, MEDLINE, Cochrane CENTRAL, Web of Science, ProQuest Dissertations and Theses et medRxiv depuis leur création jusqu'au 31 janvier 2023. Seuls les ECR examinant la supplémentation avec une forme native de vitamine D contre un groupe témoin ou un placebo ont été inclus. Nous avons exclu les études ne rapportant que le statut en vitamine D ou les paramètres du métabolisme minéral, sans aucun autre résultat significatif sur le plan clinique ou mesure de laboratoire de substitution. La qualité des études a été évaluée à l'aide de l'outil Cochrane sur le risque de biais (RoB2). Les résultats ont été résumés dans des tableaux récapitulatifs pour chaque type de résultat avec les valeurs de p tirées des essais originaux. Résultats: Neuf publications ont été incluses, lesquelles portaient sur cinq ECR distincts (377 participants au total). L'âge moyen des sujets variait de 40 à 63 ans. De la vitamine D3 avait été administrée dans tous les essais. Dans quatre des cinq ECR inclus, le groupe d'intervention avait connu une amélioration du statut en vitamine D et une réduction de la protéinurie. Une diminution des LDL et du cholestérol total avait été observée dans les deux essais où ces paramètres avaient été mesurés. Des améliorations de la masse osseuse, de la dilatation médiée par le débit et de l'inflammation avaient également été rapportées, mais chacun de ces paramètres n'avait été mesuré que dans un seul ECR. Lorsque rapportés, les effets sur le métabolisme du glucose, les HDL, les triglycérides, la pression artérielle, le stress oxydatif et la fonction rénale étaient mitigés. Aucun effet indésirable grave à la supplémentation n'a été signalé. Limites: Les résultats sont limités par le faible nombre d'ECR inclus et par le manque d'information dans la plupart des études sur l'utilisation de médicaments qui affectent les résultats mesurés (par exemple, les inhibiteurs du SRAA abaissant la protéinurie et les médicaments abaissant le taux de lipides). Aussi, notre étude n'est pas enregistrée et ne comportait pas de protocole pré-étude. Conclusion: La supplémentation en vitamine D native est sûre et elle améliore le statut en vitamine D des patients atteints de MRD. La vitamine D semble modifier la protéinurie et le métabolisme lipidique en contexte de MRD, mais d'autres essais bien conçus et intégrant des traitements bien établis sont nécessaires. Globalement, il existe peu de données probantes sur les effets pléiotropiques bénéfiques de la vitamine D chez les patients atteints de MRD.

Does Native Vitamin D Supplementation Have Pleiotropic Effects in Patients with End-Stage Kidney Disease? A Systematic Review of Randomized Trials.

Vitamin D has been shown to have multiple pleiotropic effects beyond bone and mineral metabolism, with purported roles in cardiovascular disease, cancer, and host immunity. Vitamin D deficiency is common in patients with end-stage kidney disease (ESKD); however, current clinical practice has favored the use of the active hormone. Whether vitamin D deficiency should be corrected in patients with ESKD remains unclear, as few randomized trials have been conducted. In this systematic review, we summarize the current evidence examining whether vitamin D supplementation improves outcomes, beyond mineral metabolism, in patients with ESKD. Data from randomized controlled trials of adults with ESKD were obtained by searching Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection from inception to February 2023. Twenty-three trials composed of 2489 participants were identified for inclusion. Data were synthesized by two independent reviewers and summarized in tables organized by outcome. Outcomes included measures of mortality, cardiovascular disease, inflammation, muscle strength/function, nutrition, patient well-being, and outcomes specific to ESKD including erythropoietin usage, pruritus, and dialysis access maturation. The Cochrane risk of Bias Tool (RoB 2, 2019) was used to assess study quality. Overall, our findings indicate a minimal and varied benefit of native vitamin D supplementation. From the largest studies included, we determine that vitamin D has no demonstrated effect on patient-reported measures of well-being or utilization of erythropoietin, nor does it change levels of the inflammation biomarker C-reactive protein. Included trials were heterogeneous with regards to outcomes, and the majority studied small participant populations with a relatively short follow-up. We conclude that vitamin D supplementation corrects vitamin D deficiency and is safe and well-tolerated in humans with ESKD. However, it is not clear from clinical trials conducted to date that a causal pathway exists between 25(OH)D and pleiotropic effects that is responsive to vitamin D treatment.

Abundance & distribution of aquatic benthic macro-invertebrate families of river Ganga and correlation with environmental parameters.

Bio-monitoring freshwater bodies using macro-invertebrates is an excellent way to detect biological water quality. Organic contamination in aquatic settings is well indicated by benthic macro-invertebrates. The use of macro-invertebrates to bio-monitor freshwater bodies is an effective method for determining biological water quality. Benthic macro-invertebrates are excellent indicators of organic pollution in aquatic environments. In the present study, the distribution of pollution-sensitive and pollution-tolerant families of benthic macro-invertebrates from 33 different locations along the Ganga River in Uttarakhand, Uttar Pradesh, Bihar, and West Bengal was studied. Benthic macro-invertebrates collected from different studied locations were identified up to family level and it was observed that a total of 15 pollution-sensitive families belong to four taxonomic orders, while eight pollution-tolerant families come from two taxonomic orders. Several moderately tolerant families have also been observed, but in this paper the distribution of only pollution-sensitive and pollution-tolerant families is presented as they reflect the extreme states of organic pollution. In the majority of locations, the pollution-sensitive Ephemeroptera family Ameletidae predominated. Likewise, the pollution-tolerant families Chironomidae (order-Diptera) and Naididae (order-Oligochaeta) dominated the Ganga River locations. Besides, the relationship between macro-invertebrate diversity and physicochemical factors (pH, water temperature, and dissolved oxygen) was investigated, and 3D surface distribution maps were displayed for qualitative interpretation. The correlation coefficients for all parameters were found to be positive. Macro-invertebrate pollution indices for bio-monitoring are based on community impacts and assist in evaluating the success of action plans to prevent industrial and anthropogenic pollution that contributes to the Ganga.

Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein IgG associated disorder: A comprehensive neuro-ophthalmic review.

Neuromyelitis optica spectrum disorder (NMOSD) is an antibody-mediated inflammatory disease of the central nervous system that involves the optic nerves, spinal cord, and often other specific brain regions such as area postrema of the medulla. NMOSD was formerly classified as a variant of multiple sclerosis (MS), given the similar symptomatology and relapsing course but is now considered to have distinct clinical, paraclinical, immunological and prognostic features. The discovery of aquaporin 4 (AQP4) immunoglobulin G (IgG) has improved the ability to diagnose NMOSD. AQP4-IgG targets the astrocytic AQP4 water channel leading to complement activation and increased blood-brain barrier permeability. Accurate and early diagnosis is crucial as timely treatment may result in mitigation of long-term disability. Myelin oligodendrocyte glycoprotein (MOG)-IgG associated disorder (MOGAD) is a distinct nosologic entity, which has been more recently described. Its clinical spectrum partly overlaps that of seronegative NMOSD and MS. Although it is considered to have fewer relapses and better prognosis than NMOSD, the clinical course and outcome of MOGAD has not been fully characterized.

Phosphatase mediated bioprecipitation of lead as pyromorphite by Achromobacter xylosoxidans.

Achromobacter xylosoxidans strain SJ11, tolerating up to 4.0 mM lead nitrate, in a defined minimal medium was isolated from the waste of a battery manufacturing industry, Goa, India. Interestingly, it formed white precipitate on exposure to lead nitrate which was also evident from scanning electron micrograph (SEM). Energy dispersive X-ray spectroscopic analysis revealed the presence of lead (48.5% by weight) along with phosphorus and chlorine in the precipitate. Transmission electron microscopy (TEM) of bacterial cells clearly refuted the possibility of intracellular lead uptake confirming extracellular precipitation as a predominant mechanism of lead resistance in this bacterium. The extracellular precipitate was further identified as pyromorphite [Pb5(PO4)3Cl] by X-ray diffraction analysis. This was also corroborated by fourier transformed infrared spectroscopy (FTIR) indicating a significant involvement of phosphate groups. Atomic absorption spectroscopic analysis clearly demonstrated that 465.8 mg g-1 lead was precipitated by the bacterial cells. There was remarkable increase of 160% in phosphatase activity suggesting it's important role in lead precipitation. This was further substantiated by significant up-regulation of phosphatase, CheZ using LC-MS/MS. Therefore phosphatase mediated extracellular precipitation of lead as pyromorphite by A. xylosoxidans strain SJ11 clearly demonstrated it's potential in bioremediation of lead contaminated environmental sites.

Two Cases of Myiasis Associated with Malignancies in Patients Living in the Continental United States.

Myiasis is the infestation of humans with dipterous larvae. Traditionally, myiasis was thought to affect individuals living in tropical regions, however, several cases in temperate zones have been reported. We encountered two patients with histories of malignancies that presented with complaints of myiasis, in Chicago, in the spring and summer of 2016. The first patient, a 54-year-old female with a history of breast cancer, presented with complaints of maggots infesting her postsurgical chest wounds. She was diagnosed with sepsis, cellulitis, and wound myiasis. The second patient, a 63-year-old female with a history of recurrent ovarian cancer, presented with complaints of passing maggots vaginally and seeing worms mixed with her stools. She was diagnosed with internal urogenital myiasis. The first lesson that we learned from these cases is that myiasis can occur in individuals living in any part of the world. Second of all, for patients with accidental myiasis, a sample of the larvae should be sent for analysis to help guide the treatment. Third of all, myiasis has been associated with new or recurrent malignancies, and therefore a biopsy of the affected tissue should be sent for analysis. Finally, we learned that myiasis can serve as a form of tissue debridement; this coinciding benefit should not prevent the treatment of accidental myiasis.

Retraction Note: Development and In Vitro-In Vivo Characterization of Chronomodulated Pulsatile Delivery Formulation of Terbutaline Sulphate by Box-Behnken Statistical Design.

This article has been retracted by the journal because the editors have clear evidence that the scientific findings in this article are unreliable.

Toxicity and infectivity: insights from de novo prion formation.

Prions are infectious misfolded proteins that assemble into oligomers and large aggregates, and are associated with neurodegeneration. It is believed that the oligomers contribute to cytotoxicity, although genetic and environmental factors have also been shown to have additional roles. The study of the yeast prion [PSI +] has provided valuable insights into how prions form and why they are toxic. Our recent work suggests that SDS-resistant oligomers arise and remodel early during the prion formation process, and lysates containing these newly formed oligomers are infectious. Previous work shows that toxicity is associated with prion formation and this toxicity is exacerbated by deletion of the VPS5 gene. Here, we show that newly made oligomer formation and infectivity of vps5∆ lysates are similar to wild-type strains. However using green fluorescent protein fusions, we observe that the assembly of fluorescent cytoplasmic aggregates during prion formation is different in vps5∆ strains. Instead of large immobile aggregates, vps5∆ strains have an additional population of small mobile foci. We speculate that changes in the cellular milieu in vps5∆ strains may reduce the cell's ability to efficiently recruit and sequester newly formed prion particles into central deposition sites, resulting in toxicity.

Formulation and ex vivo-in vivo evaluation of pH-triggered brimonidine tartrate in situ gel for the glaucoma treatment using application of 32 factorial design.

CONTEXT: Short residence time, poor bioavailability and poor permeability are the major problems for conventional eye drops treatment. OBJECTIVE: The aim of this article is to develop, optimize and ex vivo-in vivo investigation of brimonidine tartrate in situ gel as compared to marketed eye drops for the treatment of glaucoma. MATERIALS AND METHODS: The effect of independent variables, namely concentrations of polymers, on various dependent variables like viscosity at physiological pH and in vitro drug release were studied by using 32 factorial design. Further the optimized formulation was characterized for ex vivo and in vivo study. RESULTS AND DISCUSSION: Experimental data demonstrated that optimized in situ gel formulation (F8) showed in vitro-ex vivo sustained release profile with polymer composites carbopol 974P and HPMC K4M. After 5 h of ex vivo transcorneal permeation study, the amount recovered from the corneal surface on the donor chamber 12.40% (124 ug) and the amount collected from the receptor chamber 76.8% (760 ug) of the initial dose 1 mg. The total amount recovered from the permeation experiment was 89.2%. Bioadhesive carbopol 974P and viscosity HPMC K4M composites optimized formulation (F 8) produce greater influence on the duration of drug action and improved intraocular pressure reduction activity as compared to marketed eye drop solution in in vivo study. CONCLUSION: The developed in situ gelling system as a promising ophthalmic formulation to prolong the drug lowering effect on the intraocular pressure.

Awake orotracheal fibre-optic intubation: Comparison of two different doses of dexmedetomidine on intubation conditions in patients undergoing cervical spine surgery.

BACKGROUND AND AIMS: Awake fibre-optic intubation (AFOI) is an integral part of anaesthetic management of difficult airways. Conscious sedation is essential to assist AFOI. This study compared two different doses of dexmedetomidine in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation in patients undergoing elective cervical spine surgery with rigid cervical collar in situ. METHODS: A randomized, prospective, comparative study design was conducted in sixty patients divided into two groups: Group (L) (n = 30) patients received low dose of dexmedetomidine (0.5 µg/kg) along with airway blocks and Group (H) (n = 30) patients received standard dose of dexmedetomidine (1 µg/kg) along with airway blocks. Both the groups received dexmedetomidine infusion over 10 min followed by airway block. Quantitative data were analysed by applying Student's t-test whereas qualitative data were analysed with Chi-square test. The objectives were to compare patients' Observer's Assessment of Alertness/Sedation scale (OAA/S) as primary outcome and other variables such as endoscopy, intubation condition, tolerance and haemodynamic stability among low and standard doses of dexmedetomidine. RESULTS: Group H had more favourable OAA/S score than that of Group L, but endoscopy and intubation time, patient tolerance, vocal cord and limb movement and satisfaction score did not differ significantly between the groups. There were no significant haemodynamic differences between the two groups. CONCLUSION: The 0.5 µg/kg dose of dexmedetomidine was found optimal and effective in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation for patients undergoing elective cervical spine surgery.

Rapid and efficient method to extract metagenomic DNA from estuarine sediments.

Metagenomic DNA from sediments of selective estuaries of Goa, India was extracted using a simple, fast, efficient and environment friendly method. The recovery of pure metagenomic DNA from our method was significantly high as compared to other well-known methods since the concentration of recovered metagenomic DNA ranged from 1185.1 to 4579.7 µg/g of sediment. The purity of metagenomic DNA was also considerably high as the ratio of absorbance at 260 and 280 nm ranged from 1.88 to 1.94. Therefore, the recovered metagenomic DNA was directly used to perform various molecular biology experiments viz. restriction digestion, PCR amplification, cloning and metagenomic library construction. This clearly proved that our protocol for metagenomic DNA extraction using silica gel efficiently removed the contaminants and prevented shearing of the metagenomic DNA. Thus, this modified method can be used to recover pure metagenomic DNA from various estuarine sediments in a rapid, efficient and eco-friendly manner.

De novo [PSI +] prion formation involves multiple pathways to form infectious oligomers.

Prion and other neurodegenerative diseases are associated with misfolded protein assemblies called amyloid. Research has begun to uncover common mechanisms underlying transmission of amyloids, yet how amyloids form in vivo is still unclear. Here, we take advantage of the yeast prion, [PSI +], to uncover the early steps of amyloid formation in vivo. [PSI +] is the prion form of the Sup35 protein. While [PSI +] formation is quite rare, the prion can be greatly induced by overexpression of the prion domain of the Sup35 protein. This de novo induction of [PSI +] shows the appearance of fluorescent cytoplasmic rings when the prion domain is fused with GFP. Our current work shows that de novo induction is more complex than previously thought. Using 4D live cell imaging, we observed that fluorescent structures are formed by four different pathways to yield [PSI +] cells. Biochemical analysis of de novo induced cultures indicates that newly formed SDS resistant oligomers change in size over time and lysates made from de novo induced cultures are able to convert [psi -] cells to [PSI +] cells. Taken together, our findings suggest that newly formed prion oligomers are infectious.

Metallothionein assisted periplasmic lead sequestration as lead sulfite by Providencia vermicola strain SJ2A.

Lead resistant Providencia vermicola strain SJ2A was isolated from the waste of a battery manufacturing industry which could tolerate upto 3.0mM lead nitrate in the minimal medium. Interestingly, this isolate showed presence of a plasmid borne metallothionein gene, bmtA that matched significantly (96%) with that of Pseudomonas aeruginosa. Scanning electron micrographs of bacterial cells exposed to lead revealed a unique alteration in the cell morphology from rods to long inter-connected filaments. On the other hand, electron dispersive X-ray spectroscopy (EDX) clearly indicated no significant lead adsorption therefore, we speculated intracellular sequestration in this bacterial strain. Transmission electron micrographs of the bacterial cells exposed to lead evidently demonstrated periplasmic sequestration of lead which was also supported by Fourier transformed infrared spectroscopic (FTIR) analysis. The bacterium internalised 155.12mg Pb2+/g biomass as determined by atomic absorption spectroscopy. Subsequently, the accumulated lead was identified as lead sulfite by X-ray diffraction studies. Therefore P. vermicola strain SJ2A has potential to bioremediate lead contaminated environmental sites.

Proteasomal Inhibition by Ixazomib Induces CHK1 and MYC-Dependent Cell Death in T-cell and Hodgkin Lymphoma.

Proteasome-regulated NF-κB has been shown to be important for cell survival in T-cell lymphoma and Hodgkin lymphoma models. Several new small-molecule proteasome inhibitors are under various stages of active preclinical and clinical development. We completed a comprehensive preclinical examination of the efficacy and associated biologic effects of a second-generation proteasome inhibitor, ixazomib, in T-cell lymphoma and Hodgkin lymphoma cells and in vivo SCID mouse models. We demonstrated that ixazomib induced potent cell death in all cell lines at clinically achievable concentrations. In addition, it significantly inhibited tumor growth and improved survival in T-cell lymphoma and Hodgkin lymphoma human lymphoma xenograft models. Through global transcriptome analyses, proteasomal inhibition showed conserved overlap in downregulation of cell cycle, chromatin modification, and DNA repair processes in ixazomib-sensitive lymphoma cells. The predicted activity for tumor suppressors and oncogenes, the impact on "hallmarks of cancer," and the analysis of key significant genes from global transcriptome analysis for ixazomib strongly favored tumor inhibition via downregulation of MYC and CHK1, its target genes. Furthermore, in ixazomib-treated lymphoma cells, we identified that CHK1 was involved in the regulation of MYC expression through chromatin modification involving histone H3 acetylation via chromatin immunoprecipitation. Finally, using pharmacologic and RNA silencing of CHK1 or the associated MYC-related mechanism, we demonstrated synergistic cell death in combination with antiproteasome therapy. Altogether, ixazomib significantly downregulates MYC and induces potent cell death in T-cell lymphoma and Hodgkin lymphoma, and we identified that combinatorial therapy with anti-CHK1 treatment represents a rational and novel therapeutic approach. Cancer Res; 76(11); 3319-31. ©2016 AACR.

Lenalidomide in non-Hodgkin lymphoma: biological perspectives and therapeutic opportunities.

Lenalidomide is an immunomodulatory drug (IMiD) with activity in lymphoid malignancies occurring primarily through immune modulation (eg, T-cell immune synapse enhancement and NK-cell/T-cell effector augmentation) and antiproliferative effects. Food and Drug Administration-approved for bortezomib-resistant, relapsed/refractory mantle-cell lymphoma, lenalidomide has demonstrated efficacy in several additional lymphoma subtypes. There are many ongoing clinical trials examining the use of lenalidomide alone or in combinatorial therapy. It will be important in these studies to delineate reliable, predictive biomarkers to optimally integrate lenalidomide into lymphoma treatment paradigms.

Current therapeutic strategies and new treatment paradigms for follicular lymphoma.

Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma that remains an incurable disease for most patients. It is responsive to a variety of different treatments, however it follows a pattern of relapsing and remitting disease. Traditional therapeutic options for patients with untreated FL include expectant observation for asymptomatic and low tumor burden and multiagent cytotoxic chemotherapy for symptomatic and/or high tumor burden. Biologics have become an integral part of therapy with agents that target B lymphocytes, including monoclonal anti-CD20 antibodies and radiolabeled anti-CD20 antibodies. Treatment response to cytotoxic and biologic therapy is high initially; however, with subsequent treatments, response rate and remission duration typically decline and cumulative toxicities increase. The identification of novel targeted agents, use of stem cell transplantation, and new treatment combinations provide the opportunity to enhance patient outcomes. In this review, we critically examine standard treatment strategies for patients with newly diagnosed and relapsed or refractory FL and discuss established and emerging novel therapeutic approaches.