Dasatinib-Triggered Severe Hypocalcemia in a Patient with Chronic Kidney Disease and Osteoporosis.

Given the increasing prevalence of chronic myeloid leukemia (CML) in older individuals, careful selection of tyrosine kinase inhibitors (TKIs) is required. The case of an 84-year-old woman with chronic-phase CML and chronic kidney disease undergoing osteoporosis, in whom dasatinib triggered severe hypocalcemia, is reported. She was intolerant to both imatinib and nilotinib. Initiation of low-dose dasatinib treatment led to severe hypocalcemia and long QT syndrome, compounded by vitamin D deficiency and denosumab use. We stopped dasatinib, and her hypocalcemia was improved after calcium administration. This case highlights the potential of TKIs in triggering hypocalcemia, emphasizing the need to assess mineral disorders before initiating TKI therapy.

Intestinal Mineralocorticoid Receptor Contributes to Epithelial Sodium Channel-Mediated Intestinal Sodium Absorption and Blood Pressure Regulation.

BACKGROUND: Mineralocorticoid receptor (MR) has pathological roles in various cell types, including renal tubule cells, myocytes, and smooth muscle cells; however, the role of MR in intestinal epithelial cells (IECs) has not been sufficiently evaluated. The intestine is the sensing organ of ingested sodium; accordingly, intestinal MR is expected to have essential roles in blood pressure (BP) regulation. METHODS AND RESULTS: We generated IEC-specific MR knockout (IEC-MR-KO) mice. With a standard diet, fecal sodium excretion was 1.5-fold higher in IEC-MR-KO mice, with markedly decreased colonic expression of ß- and γ-epithelial sodium channel, than in control mice. Urinary sodium excretion in IEC-MR-KO mice decreased by 30%, maintaining sodium balance; however, a low-salt diet caused significant reductions in body weight and BP in IEC-MR-KO mice, and plasma aldosterone exhibited a compensatory increase. With a high-salt diet, intestinal sodium absorption markedly increased to similar levels in both genotypes, without an elevation in BP. Deoxycorticosterone/salt treatment elevated BP and increased intestinal sodium absorption in both genotypes. Notably, the increase in BP was significantly smaller in IEC-MR-KO mice than in control mice. The addition of the MR antagonist spironolactone to deoxycorticosterone/salt treatment eliminated the differences in BP and intestinal sodium absorption between genotypes. CONCLUSIONS: Intestinal MR regulates intestinal sodium absorption in the colon and contributes to BP regulation. These regulatory effects are associated with variation in epithelial sodium channel expression. These findings suggest that intestinal MR is a new target for studying the molecular mechanism of hypertension and cardiovascular diseases.

Busulfan-induced pathological changes of the cerebellar development in infant rats.

Busulfan, an antineoplastic bifunctional-alkylating agent, is known to induce developmental anomalies and fetal neurotoxicity. We previously reported that busulfan induced p53-dependent neural progenitor cell apoptosis in fetal rat brain (Ohira et al., 2012). The present study was carried out to clarify the characteristics and sequence of busulfan-induced pathological changes in infant rat brain. Six-day-old male infant rats were treated with 10, 20, 30 or 50 mg/kg of busulfan, and their brains were examined at 1, 2, 4, 7, and 14 days after treatment (DAT). As a result, histopathological changes were selectively detected in the external granular layer (EGL), deep cerebellar nuclei (DCN) and cerebellar white matter (CWM) in the cerebellum with dose-dependent severity but not in the cerebrum. In the normal infant rat cerebellum, granular cells in the EGL were proliferating and moving to the internal granular layer during the normal developmental process. In the EGL of the busulfan group, apoptotic granular cells increased at 2 DAT simultaneously with increased numbers of p53- and p21-positive cells while mitotic granular cells decreased, suggesting an occurrence of p53-related apoptosis and depression of proliferative activity in granular cells. In the DCN, apoptotic glial cells increased at 2 DAT and glial cells showing abnormal mitosis increased at 4 DAT. In the CWN, edematous change accompanying a few apoptotic cells was found in the CWN, especially in the parafolliculus (PFL), from 2 to 7 DAT. The present study demonstrated for the first time the characteristics and sequence of busulfan-induced pathological changes in infant rat cerebellum.

Monocyte chemoattractant protein-1 contributes to gut homeostasis and intestinal inflammation by composition of IL-10-producing regulatory macrophage subset.

Lamina propria macrophages (LPMs) spontaneously produce large amounts of anti-inflammatory IL-10 and play a central role in regulation of immune responses against commensal bacteria. MCP-1 is a chemokine that plays an important role in recruitment of monocytes and macrophages to inflamed tissues. We demonstrated that, in addition to IL-10, LPMs produced large amounts of MCP-1, even in a steady state. MCP-1 deficiency caused impaired IL-10 production by LPMs and led to exacerbation of dextran sulfate sodium-induced acute colitis. As an explanation of this impaired IL-10 production by LPMs, we found that LPMs could be separated into two subsets with distinct side-scattered properties, namely LPM1 (CD11b(+)F4/80(+)CD11c(-)SSC(hi)) and LPM2 (CD11b(+)F4/80(+)CD11c(-)SSC(lo)). Unlike LPM1, the LPM2 subset migrated in response to MCP-1 and produced a larger amount of IL-10 in response to commensal bacteria. LPMs isolated from MCP-1-deficient mice produced less IL-10 as a consequence of the lack of the MCP-1-dependent LPM2 population. This imbalanced composition in LPM population may be involved in the susceptibility to DSS-induced colitis in MCP-1-deficient mice. Our results suggest that endogenous MCP-1 contributes to the composition of resident LPM subsets in the intestine. Moreover, MCP-1-dependent LPM2 subset may play an important role in maintenance of gut homeostasis in the steady state, and in the termination of excess inflammatory responses in the intestine, by producing IL-10.