N-acetyl cysteine in prevention of amphotericin- induced electrolytes imbalances: a randomized, double-blinded, placebo-controlled, clinical trial.

PURPOSE: The aim of this study was to evaluate the effectiveness of oral n-acetyl cysteine, as a potential nephroprotective agent, in preventing and/or attenuating amphotericin B-induced electrolytes imbalances. METHODS: During a one year period, patients were to receive conventional amphotericin b for any indication for at least one week and were randomly allocated to receive either placebo or 600 mg oral n-acetyl cysteine twice daily during the treatment course of amphotericin b. Demographic and clinical data of the study population were gathered. Different aspects of amphotericin b nephrotoxicity including decrease of glomerular filtration rate, hypokalemia, hypomagnesemia, renal magnesium and potassium wasting were assessed. Each patient was monitored for any adverse reaction to n-acetyl cysteine. Sixteen and 14 patients in the n-acetyl cysteine and placebo groups completed the study, 3incidences of hypokalemia (75 % versus 70 %; P = 0.724) and hypomagnesemia (30 % versus 20 %; P = 0.468) did not differ significantly between placebo and NAC groups, respectively. Although the rate of AmB nephrotoxicity was higher in the placebo than in the NAC group (60 % versus 40 %), this difference was not statistically significant (P = 0.209) even after adjusting for probable associated factors of amphotericin b nephrotoxicity (P = 0.206). The incidence as well as time of onset of electrolyte abnormalities also did not differ significantly between placebo and n-acetyl cysteine groups. About 44 % of n-acetyl cysteine recipients experienced new onset nausea and a mild unpleasant taste during the study. CONCLUSION: Oral n-acetyl cysteine during the amphotericin B treatment course was not significantly effective in preventing or mitigating different features of its nephrotoxicity including decrease of glomerular filtration rate, hypokalemia, hypomagnesemia, and renal potassium as well as magnesium wasting.

Preclinical Assessment of Immunogenicity and Protectivity of Novel ROR1 Fusion Proteins in a Mouse Tumor Model.

The receptor tyrosine kinase-like orphan receptor 1 (ROR1) is a new tumor associated antigen (TAA) which is overexpressed in several hematopoietic and solid malignancies. The present study aimed to produce and evaluate different fusion proteins of mouse ROR1 (mROR1) to enhance immunogenicity and protective efficacy of ROR1. Four ROR1 fusion proteins composed of extracellular region of mROR1, immunogenic fragments of TT as well as Fc region of mouse IgG2a were produced and employed to immunize Balb/C mice. Humoral and cellular immune responses and anti-tumor effects of these fusion proteins were evaluated using two different syngeneic murine ROR1+ tumor models. ROR1-specific antibodies were induced in all groups of mice. The levels of IFN-γ, IL-17 and IL-22 cytokines in culture supernatants of stimulated splenocytes were increased in all groups of immunized mice, particularly mice immunized with TT-mROR1-Fc fusion proteins. The frequency of ROR1-specific CTLs was higher in mice immunized with TT-mROR1-Fc fusion proteins. Finally, results of tumor challenge in immunized mice showed that immunization with TT-mROR1-Fc fusion proteins completely inhibited ROR1+ tumor cells growth in two different syngeneic tumor models until day 120 post tumor challenge. Our preclinical findings, for the first time, showed that our fusion proteins could be considered as a potential candidate vaccine for active immunotherapy of ROR1-expressing malignancies.

Down-regulation of immune checkpoints by doxorubicin and carboplatin-containing neoadjuvant regimens in a murine breast cancer model.

OBJECTIVES: Immune checkpoint expression on tumor-infiltrating lymphocytes (TILs) has a correlation with the outcome of neoadjuvant chemotherapy (NAC) in breast cancer. However, the reciprocal effect of these regimens on the quality and quantity of immune checkpoints has hitherto not been addressed. We aimed to evaluate the impact of three NAC regimens on TILs and immune checkpoints in a murine triple-negative breast cancer model. MATERIALS AND METHODS: Syngeneic model of locally-advanced breast cancer was established in immunocompetent mice using a 4T1 cell line. Tumor-bearing animals were treated with human-equivalent dosages of doxorubicin, paclitaxel, paclitaxel and carboplatin combination, and placebo. Infiltration of CD3+, CD8+, and FoxP3+ cells into the tumor was assessed by immunohistochemistry. Expression of immune checkpoints, including PD-1, CTLA-4, and TIM-3, was evaluated by real-time PCR. RESULTS: Doxorubicin led to a significant (P<0.01) increase in the percentage of the stromal infiltrating CD3+ and CD8+ lymphocytes. Doxorubicin also suppressed significantly (P<0.05) the relative expression of PD-1 compared with the placebo. PD-1 expression was significantly (P<0.05) lower in the group treated with paclitaxel and carboplatin combination as compared with the placebo. The relative expression of TIM-3 was significantly (P<0.05) suppressed in doxorubicin-treated mice in comparison with other interventions. CONCLUSION: Our findings hypothesize that NAC with doxorubicin may potentiate antitumor immunity not merely by recruitment of TILs, but via down-regulation of PD-1 and TIM-3 checkpoints. Carboplatin-containing NAC may suppress PD-1 as well.

Inhibition of tumor growth by mouse ROR1 specific antibody in a syngeneic mouse tumor model.

INTRODUCTION: Immunotherapy with tumor-associated antigens (TAAs) is a potentially powerful approach to eradicate tumor cells. The receptor tyrosine kinase-like orphan receptor 1 (ROR1) plays a crucial role for survival of tumor cells and is overexpressed in various malignancies. In the present study, we developed a syngeneic mouse tumor model to assess anti-tumor effect of mouse ROR1 specific polyclonal antibody (pAb) in vivo. MATERIALS AND METHODS: Mouse ROR1 specific antibody was produced in rabbit using recombinant ROR1 protein. Tow mouse tumor cell lines, (4T1 and CT26), were transfected with full length mouse ROR1 construct and stable clones were selected and characterized by immunocytochemistry, Western blot and flow cytometry. In vitro and in vivo anti-tumor activities of anti-ROR1 antibody were assessed by XTT and syngeneic BALB/c mouse model, respectively. RESULTS: We successfully established two mouse ROR1-overexpressing tumor cell lines. The in vitro results indicate that the ROR1pAb did not significantly inhibit growth of ROR1+ cell lines. One of these cell lines (CT26-ROR1) was implanted in syngeneic BALB/c mice to assess anti-ROR1 tumor inhibitory activity in vivo. The tumor size was significantly reduced in mice treated with ROR1 specific pAb. CONCLUSION: Our results demonstrated for the first time tumor inhibitory effect of mouse ROR1 specific antibody in a syngeneic mouse tumor model. This model is a promising tool for preclinical assessment of ROR1 therapeutics and investigation of the underling molecular mechanisms.

Expression of the testis-specific gene, TSGA10, in Iranian patients with acute lymphoblastic leukemia (ALL).

Testis-specific gene antigen (TSGA10) is expressed in fetus, testis and frequently in human solid cancers and acute leukemias, making it a candidate for immunotherapy and for detection of minimal residual disease (MRD). This gene is considered as a member of cancer-testis (CT) genes. We previously demonstrated TSGA10 expression during spermatogenesis. There is also evidence for potential TSGA10 involvement in cell proliferation. TSGA10 expression has been observed in a wide spectrum of cancers but not in hematopoietic neoplasm. Here we demonstrated expression of TSGA10 by semi-quantitative RT-PCR in 44 (84.6%) out of 52 bone marrow samples and all peripheral blood samples from patients with acute lymphoblastic leukemia (ALL). Twenty-seven (52%) cases had high level of gene expression and 16 (30.7%) cases had a lower expression level of the gene in the patients bone marrow. Presence of TSGA10 expression in ALL may open a window to functional study of mitotic checkpoint proteins in leukemia. RT-PCR of TSGA10 may help in detection of residual clonal cells leading to early diagnosis and better prognostic qualification of the disease.

The relation of bone marrow scintigraphy and unilateral bone marrow biopsy in malignant lymphoma.

To assess the diagnostic role of bone marrow scintigraphy (BMS) for detecting bone marrow infiltration by malignant lymphomas, 47 patients, 14 with malignant Hodgkin's and 33 with non-Hodgkin's lymphoma underwent BMS with 99mTc-sulphur-colloid and also unilateral iliac crest bone marrow biopsy (BMB). BM involvement in BMB was observed in 11 of the 47 patients. Four of these patients also had BMS lesions. Eight patients had BMS lesions not detected by BMB. There was poor agreement between the two modalities (kappa=0.137). Considering BMB as the gold standard, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BMS were 36%, 77%, 33%, 80%, and 68% respectively. In conclusion, BMS has a high negative predictive value and may be used as a complementary screening test for lymphoma to assess the extent of BM involvement, especially if magnetic resonance imaging-guided biopsy or positron emission tomography studies are not available, as is the case in developing countries.

The quality of life of hematological malignancy patients with major depressive disorder or subsyndromal depression.

OBJECTIVE: The purpose of the present study was to compare the quality of life of hematological malignancy patients with major depressive disorder or subsyndromal depression. METHOD: Sample consisted of 93 hematological malignancy patients recruited from oncology ward of Valieasr hospital for Imam Khomeini complex hospital at Tehran through purposeful sampling. Participants were divided into three groups through diagnostic interview based on DSM-IV-TR criteria and the Beck Depression Inventory-2 (BDI-II): Major depressive disorder (MDD) (n = 41; 44.1%); subsyndromal depression (SSD) (n = 23; 24.7%), and without depression (WD) (n = 29; 31.2%). Participants completed the short-form health survey (SF-36) as a measure of the quality of life. We carried out an analysis of covariance to examine the collected data. RESULTS: Findings showed that there was not a significant difference between patients with MDD and SSD based on measure of quality of life. But patients with MDD and SSD showed significantly worse quality of life than patients with WD. This finding highlights the clinical importance of subsyndromal depressive symptoms and casts doubt on the clinical utility of separation between MDD and subsyndromal depression in terms of important clinical outcomes.

Combination of cyclophosphamide, etoposide, carboplatin and dexamethasone as a salvage regimen for refractory multiple myeloma patients: a comparison with a historical control group.

The aim of this study was to design a regimen for refractory multiple myeloma with minimum complications to achieve a reasonable response. Fifteen patients with active multiple myeloma after at least two lines of conventional treatment underwent therapy with our regimen for two cycles. Disease activity was evaluated after the last cycle. Another 15 patients with refractory multiple myelomas that had previously received only supportive therapy and pain management formed a historical control group. The follow-up period was 12 months for each study group. Of the patients receiving therapy, 6.7% achieved a complete response and 26.7% a partial response; overall response rate was 33.3%. Stable disease was achieved in 46.7% and 20% of the patients had progressive disease. There was no treatment related mortality. The hazard rate of death was 0.73 lower in the intervention group than in the historical control group. In the historical control group, 60% had progressive disease and 40% had stable disease; approximately 40% of patients died during the 12-month follow up. Also, the severity of pain was significantly reduced in the intervention group (P=0.033). Our chemotherapy regimen showed a reasonable response in end stage patients with multiple myeloma in terms of disease control, reducing bone pain and improving survival, in addition to reducing toxicity.

A study of Bernard-Soulier syndrome in Tehran, Iran.

BACKGROUND: Bernard-Soulier Syndrome (BSS) is a hemorrhagic disorder with an autosomal recessive pattern of inheritance. We describe the demographic and clinical characteristics of Iranian patients with BSS followed in a major teaching and tertiary care hospital in Tehran, Iran. METHODS: We performed a retrospective medical record review of 97 patients with BSS who received care at the Imam Khomeini Hospital between 1969 and 2001. We collected data on the family history, clinical presentation, bleeding episodes, and lab profiles of these patients. RESULTS: Among all patients, 78 (81%) had a family history of consanguinity. The most common presenting symptom was epistaxis, seen in 62 (63.9%) patients. Peripheral blood smears demonstrated giant platelets on 67 (68.7%) of patients. Complete blood count demonstrated decreased platelets in 85 (87.4%) of patients ranging from 20,000/µL to 130,000/µL. Anemia was seen in 62 (64%) and 91 (93.8%) had prolonged bleeding time. The majority of patients (60%) had mild bleeding episodes, but 39 (40%) had at least one episode of severe bleeding in their past history. CONCLUSION: Our data are consistent with other reports regarding clinical presentation of BSS, but consanguinity seems to be more common.