Pharmacogenomics of Anti-TNF Treatment Response Marks a New Era of Tailored Rheumatoid Arthritis Therapy.

Rheumatoid arthritis (RA) is the most commonly occurring chronic inflammatory arthritis, the exact mechanism of which is not fully understood. Tumor Necrosis Factor (TNF)-targeting drugs has been shown to exert high effectiveness for RA, which indicates the key importance of this cytokine in this disease. Nevertheless, the response to TNF inhibitors varies, and approximately one third of RA patients are non-responders, which is explained by the influence of genetic factors. Knowledge in the field of pharmacogenomics of anti-TNF drugs is growing, but has not been applied in the clinical practice so far. Different genome-wide association studies identified a few single nucleotide polymorphisms associated with anti-TNF treatment response, which largely map genes involved in T cell function. Studies of the gene expression profile of RA patients have also indicated specific gene signatures that may be useful to develop novel prognostic tools. In this article, we discuss the significance of TNF in RA and present the current knowledge in pharmacogenomics related to anti-TNF treatment response.

AHR-dependent genes and response to MTX therapy in rheumatoid arthritis patients.

Methotrexate (MTX) is the first-line therapy for rheumatoid arthritis. Nevertheless, MTX resistance is quite a common issue in clinical practice. There are some premises that aryl hydrocarbon receptor (AhR) gene battery may take part in MTX metabolism. In the present retrospective study, we analyzed genes expression of AHR genes battery associated with MTX metabolism in whole blood of RA patients with good and poor response to MTX treatment. Additionally, sequencing, genotyping and bioinformatics analysis of AHR repressor gene (AHRR) c.565C > G (rs2292596) and c.1933G > C (rs34453673) have been performed. Theoretically, both changes may have an impact on H3K36me3 and H3K27me3. Evolutionary analysis revealed that rs2292596 may be possibly damaging. Allele G in rs2292596 and DAS28 seems to be associated with a higher risk of poor response to MTX treatment in RA. RA patients with poor response to MTX treatment revealed upregulated AhR and SLC19A1 mRNA level. Treatment with IL-6 inhibitor may be helpful to overcome the low-dose MTX resistance. Analysis of gene expression revealed possible another cause of poor response to MTX treatment which is different from that observed in the case of acute lymphoblastic leukemia.

Reduced periprocedural mortality and bleeding rates of radial approach in ST-segment elevation myocardial infarction. Propensity score analysis of data from the ORPKI Polish National Registry.

AIMS: We sought to evaluate bleeding complications and periprocedural outcomes of the radial approach (RA) as compared to the femoral approach (FA) during percutaneous coronary intervention (PCI) in "real-world" patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: The study group consisted of 22,812 consecutive patients with STEMI treated with PCI and stent implantation between January 2014 and June 2015 in 151 tertiary invasive cardiology centres in Poland (the ORPKI Polish National Registry). Patients treated using the RA and FA were compared using a propensity score analysis to avoid possible selection bias. The analysis was carried out in an "as-treated" manner. The FA was used in 9,334 (40.9%) and the RA in 13,478 (59.1%) patients. After propensity score matching, a higher total amount of contrast (191.8±8.0 vs. 174.8±68.8 ml; p=0.001) and lower radiation doses (1,279.5±1,346.3 vs. 1,182.6±887 mGy; p=0.02) were reported in FA. More access-site-related bleeding complications after both angiography (0.17% vs. 0.02%; p=0.004) and PCI (0.23% vs. 0.09%; p=0.049) were reported in the FA group. Periprocedural death (1.94% vs. 0.93%; p=0.001) was more common after PCI performed with the FA. CONCLUSIONS: The radial approach was associated with a lower incidence of periprocedural death in STEMI patients as well as a significant reduction of bleeding complications at the access site.

Calcifiying fibrous pseudotumor of the small bowel mesentery - case report.

Calcifiyng fibrous pseudotumor (CFPT) is a benign mesenchymal tumor diagnosed in children and young adults, located in the subcutaneous tissue of the trunk and limbs. Its intraabdominal localization is a unique rarity. The Authors of the study presented a case of a 48-year old female patient with an accidentally diagnosed small bowel mesentery tumor during surgery.

Rectovaginal fistula after gastrointestinal tract continuity restoration using a stapler--case report.

The authors presented a case of rectovaginal fistula in a 40-year old female patient after gastrointestinal tract continuity restoration (Hartmann's operation) performed because of iatrogenic rectal damage. The most likely cause of rectovaginal fistula development was the erroneous introduction of the stapler into the vagina and sigmoidovaginostomy during an attempt to reconstruct the continuity of the gastrointestinal tract. In order to reconstruct the continuity of the gastrointestinal tract the patient was subject to anterior rectal resection, sigmoidorectostomy, and closure of the fistula inside the vaginal wall by its duplication. Additionally, a double protective ileostomy was performed, which was subject to closure after three months.

Thymosin beta4 regulates migration of colon cancer cells by a pathway involving interaction with Ku80.

Aberrant expression of thymosin beta4 (Tbeta4) has recently been found to be associated with colorectal carcinoma (CRC) progression evidently due to an increase of the motility and invasion of tumor cells and the induction of a proangiogenic phenotype of endothelial cells. Both mechanisms depend upon matrix-degrading proteases, particularly plasmin and matrix metalloproteinases (MMPs) that are responsible for extensive tissue remodeling. Cleavage of ECM macromolecules weakens the structural integrity of tissues and exposes cryptic domains of extracellular components, which elicit biological responses distinct from intact molecules. Interestingly, signaling via integrins (alphaVbeta3, alpha5beta1) in CRC cells (HT29, CX1.1) is induced by Tbeta4 and VEGF-A only when they grow in 3D fibrin gels but not in 2D ones. The cells growing in 3D fibrin gels release upon Tbeta4 significant amounts of active MMPs (MMP-2, MMP-9, and MMP-7) that cause extensive proteolysis in their close vicinity. As evidenced by a variety of approaches (transfection experiments, coimmunoprecipitation, gene silencing with siRNA), we found that this involves interaction of Tbeta4 with Ku80, which has recently been described by us to mediate Tbeta4 intracellular activity.

[Mechanisms of cancer angiogenesis]. / Mechanizmy angiogenezy nowotworowej.

The early stages of tumor growth are independent of blood vessels. When a tumor reaches a volume of approximately 2 mm3, it requires an oxygen and nutrient supply, like other tissues. Satisfaction of the metabolic demands of tumor tissue occurs through neovascularization, which is also called tumor angiogenesis. The best-characterized mechanism of new vessel formation is endothelial cell sprouting. This three-step process involves dilation of a preexisting vessel and basement membrane degradation as well as endothelial cell proliferation and migration, which lead to the restoration of vessel continuity. Eventually, a new vascular basement membrane is deposited and proliferating pericytes are recruited to stabilize the newly formed vessels. Other examples of tumor neovascularization are intussusceptive and glomerular angiogenesis. Since endothelial cell recruitment, proliferation, and migration is not required, they proceed faster and at lower energetic costs. These types of angiogenesis predominate in the colon, stomach, thymus, and skin cancers as well as gliosarcomas mulitiforme. Moreover, tumors can also be fed by co-opting host vessels or by forming "pseudovessels" in angiogenesis mimicry. All the processes mentioned in this review are not mutually exclusive; on the contrary, they are closely connected in many cases.Therefore, effective anticancer therapies should not only focus on diminishing the activity of proangiogenic factors targeted during vessel sprouting, but include the great variety of vessel factors.

An association between vascular endothelial growth factor gene promoter polymorphisms and diabetic retinopathy.

BACKGROUND: Diabetic retinopathy is a highly prevalent cause of visual loss in Western countries. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor implicated in the development of the proliferative stage of this disease. Reports have suggested that polymorphisms at positions -460 and -634 of the 5' untranslated region of the VEGF gene increase its basal promoter activity. METHODS: To investigate whether polymorphisms are associated with diabetic retinopathy, 215 patients with type 2 diabetes mellitus (T2DM) were enrolled. Among them, 82 subjects had proliferative diabetic retinopathy (PDR), 72 had non-proliferative diabetic retinopathy (NPDR), and 61 individuals without retinopathy served as controls. Two polymorphisms of the VEGF gene, a G-->C transversion at -634 (the G/C polymorphism) and a C-->T transition at -460 (the C/T polymorphism), were investigated by restriction fragment length polymorphism PCR and allele-specific PCR respectively. RESULTS: We did not find any association between the C/T polymorphism and diabetic retinopathy. However, the G/C polymorphism genotype distribution and the frequency of the C allele were significantly higher in the NPDR group than in control patients (OR = 1.69, 95% CI = 1.03-2.79). Analysis of the distribution of combined genotypes of the VEGF gene revealed the prevalence of the C/C-C/C genotype in NPDR patients (OR = 8.26, 95% CI = 1.79-37.99) and C/G-CC in PDR patients (OR = 3.36, 95% CI = 1.39-8.12). CONCLUSIONS: Occurrence of the -634C allele appears to be associated with increased VEGF gene promoter activity, and the G/C polymorphism might serve as a predictive factor for the development of diabetic retinopathy.

[Atelocollagen as a potential carrier of therapeutics]. / Atelokolagen jako potencjalny nosnik terapeutyków.

Collagen is a very abundant protein that makes up about 25% of the total protein in animal organisms. Of the 28 types of collagen described so far, type I is the most common. Applying collagen in medical treatment is dangerous and may be harmful to patients due to its high immunoreactivity and the risk of contamination with viruses or prions. The immunogenicity of collagen I can be significantly reduced by digestion with pepsin, resulting in the release of telopeptides containing mostly antigenic epitopes. The major product of the digestion is called atelocollagen, which was used for the first time in tissue engineering already in the 1970s. Recent data indicate that due to its rare properties, such as low immunogenicity, liquid state at 4 degrees C, and solid state at 37 degrees C as well as its strong positive charge (pI 9), it may be used as a carrier of negatively charged proteins and nucleic acids. In addition, such complexes of atecollagen/therapeutics are easy to obtain and, depending upon the concentration of atelocollagen, they may be used to provide therapeutics to the organism locally or in a systemic manner. In this review the practical application of atelocollagen used as a carrier of proteins and nucleic acids (plasmids, antisense oligodeoxynucleotides, and siRNA) to treat inherited diseases and cancers is critically discussed. The observations described indicate that it is an optimal vehicle to transport medication which may be used in vivo with very limited risk. Therefore, atelocollagen has the potential to contribute significantly to the further development of gene therapy.

Comparative study of DNA damage, cell cycle and apoptosis in human K562 and CCRF-CEM leukemia cells: role of BCR/ABL in therapeutic resistance.

The Philadelphia translocation t(9;22) resulting in the bcr/abl fusion gene is the pathogenic principle of almost 95% of human chronic myelogenous leukemia (CML). Imatinib mesylate (STI571) is a specific inhibitor of the BCR/ABL fusion tyrosine kinase that exhibits potent antileukemic effects in CML. BCR/ABL-positive K562 and -negative CCRF-CEM human leukemia cells were investigated. MTT survival assay and clonogenic test of the cell proliferation ability were used to estimate resistance against idarubicin. DNA damage after cell treatment with the drug at the concentrations from 0.001 to 3 microM with or without STI571 pre-treatment were examined by the alkaline comet assay. We found that the level of DNA damages was lower in K562 cells after STI571 pre-treatment. It is suggested that BCR/ABL activity may promote genomic instability, moreover K562 cells were found to be resistant to the drug treatment. Further, we provided evidence of apoptosis inhibition in BCR/ABL-positive cells using caspase-3 activity colorimetric assay and DAPI nuclear staining for chromatin condensation. We suggest that these processes associated with cell cycle arrest in G2/M checkpoint detected in K562 BCR/ABL-positive compared to CCRF-CEM cells without BCR/ABL expression might promote clone selection resistance to drug treatment.