Monitoring of somatic mutations in circulating cell-free DNA by digital PCR and next-generation sequencing during afatinib treatment in patients with lung adenocarcinoma positive for EGFR activating mutations.

Background: Analysis of circulating cell-free DNA (cfDNA) is under intensive investigation for its potential to identify tumor somatic mutations. We have now explored the usefulness of such liquid biopsy testing with both the digital polymerase chain reaction (dPCR) and next-generation sequencing (NGS) during treatment of patients with the epidermal growth factor receptor (EGFR) inhibitor afatinib. Patients and methods: Eligible patients had advanced lung adenocarcinoma with EGFR activating mutations and were treated with afatinib. Plasma samples were collected before and during (4 and 24 weeks) afatinib treatment as well as at disease progression. Tumor and plasma DNA were analyzed by dPCR and NGS. Results: Thirty-five patients were enrolled. The objective response rate and median progression-free survival (PFS) were 77.1% and 13.8 months, respectively. Tumor and plasma DNA were available for 32 patients. dPCR and NGS detected EGFR activating mutations in 81.3% and 71.9% of baseline cfDNA samples, respectively. In 19 patients treated with afatinib for ≥24 weeks, the number of EGFR mutant alleles detected in cfDNA by dPCR declined rapidly and markedly after treatment onset, becoming undetectable or detectable at only a low copy number (<10 copies per milliliter) at 4 weeks. Median PFS was slightly longer for patients with undetectable EGFR mutant alleles in cfDNA at 4 weeks than for those in whom such alleles were detectable (14.3 versus 10.0 months). A total of 45 somatic mutations was identified in baseline tumor DNA, and 30 (66.7%) of these mutations were identified in cfDNA by NGS. Allele frequency for somatic mutations in cfDNA determined by NGS changed concordantly during afatinib treatment with the number of EGFR mutant alleles determined by dPCR. Conclusions: Monitoring of cfDNA by dPCR is informative for prediction of afatinib efficacy, whereas that by NGS is reliable and has the potential to identify mechanisms of treatment resistance.

Gefitinib induction followed by chemoradiotherapy in EGFR-mutant, locally advanced non-small-cell lung cancer: LOGIK0902/OLCSG0905 phase II study.

BACKGROUND: The role of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) induction coupled with standard concurrent chemoradiotherapy (CRT) is unclear in unresectable, stage III, EGFR-mutant non-small-cell lung cancer (NSCLC). Therefore, a phase II trial was conducted to evaluate the efficacy and safety of gefitinib induction followed by CRT in this disease setting. PATIENTS AND METHODS: Patients with unresectable, EGFR-mutant, stage III NSCLC were administered gefitinib monotherapy (250 mg/day) for 8 weeks. Subsequently, patients without disease progression during induction therapy were administered cisplatin and docetaxel (40 mg/m2 each) on days 1, 8, 29, and 36 with concurrent radiotherapy at a total dose of 60 Gy. The primary endpoint was the 2-year overall survival (OS) rate, which was hypothesized to reach 85%, with a threshold of the lower limit of 60%. RESULTS: Twenty patients (median age: 66 years; male/female: 9/11; histology: 20 adenocarcinoma; stage IIIA/IIIB: 9/11; and exon 19/21: 10/10) were enrolled. The 2-year OS rate was 90% (90% confidence interval: 71.4% to 96.8%), indicating that this trial met the primary objective. The overall response rate and 1- and 2-year progression-free survival rates were 85.0%, 58.1%, and 36.9%, respectively. Grade ≥3 adverse events (>10%) included hepatic toxicity during the induction phase and neutropenia and febrile neutropenia in the CRT phase. Radiation pneumonitis grade ≥3 or treatment-related death did not occur. CONCLUSIONS: This is the first prospective study to demonstrate the favorable efficacy and safety of EGFR-TKI induction followed by standard CRT in EGFR-mutant, stage III NSCLC. Further confirmatory studies are needed.

Metabolic and cellular analysis of alopecia in vitamin D receptor knockout mice.

Targeted ablation of the vitamin D receptor (VDR) results in hypocalcemia, hypophosphatemia, hyperparathyroidism, rickets, osteomalacia, and alopecia--the last a consequence of defective anagen initiation. To investigate whether the markedly elevated levels of 1,25-dihydroxyvitamin D led to the alopecia, we raised VDR-null mice in a ultraviolet light-free environment and fed them chow lacking vitamin D for five generations. Despite undetectable circulating levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, alopecia persisted in the VDR-null mice, demonstrating that the alopecia was not secondary to toxic levels of 1,25-dihydroxyvitamin D interacting with an alternative receptor. Furthermore, alopecia was not seen in control littermates, suggesting that absence of ligand and absence of receptor cause different phenotypes. To identify the cell population responsible for the alopecia, we performed hair-reconstitution assays in nude mice and observed normal hair follicle morphogenesis, regardless of the VDR status of the keratinocytes and dermal papilla cells. However, follicles reconstituted with VDR-null keratinocytes demonstrated a defective response to anagen initiation. Hence, alopecia in the VDR-null mice is due to a defect in epithelial-mesenchymal communication that is required for normal hair cycling. Our results also identify the keratinocyte as the cell of origin of the defect and suggest that this form of alopecia is due to absence of ligand-independent receptor function.

Up-regulation of nitric oxide synthase (NOS) gene expression together with NOS activity in the rat hypothalamo-hypophysial system after chronic salt loading: evidence of a neuromodulatory role of nitric oxide in arginine vasopressin and oxytocin secretion.

Chronic salt loading up-regulated the expression of neuronal nitric oxide synthase (NOS) mRNA in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) of the hypothalamus with a concomitant increase in NOS activity in the posterior pituitary. Once daily ip injection of N-omega-nitroarginine (N-Arg), a NOS inhibitor, significantly inhibited NOS activity in the posterior pituitary in a dose-dependent manner, but did not influence NOS mRNA levels. Two percent salt loading for 3 or 4 days significantly depleted the contents of both arginine vasopressin (AVP) and oxytocin (OT) in the posterior pituitary, and simultaneous treatment with daily injections of N-Arg at a dose of 10 mg/kg significantly enhanced the depletion of both AVP and OT. This effect was dose dependent and paralleled the inhibition of NOS activity in the posterior pituitary. N-Arg treatment had no effect on the levels of both AVP and OT transcripts in PVN or SON. These results suggest that NOS gene expression in the SON and PVN of the rat hypothalamus is increased during hyperosmotic stimulation and suggest a neuromodulatory role for NO in the rat hypothalamo-hypophysial system as an inhibitory regulator of AVP and OT secretion.

Age-related changes of calbindin-D28k, calretinin, and parvalbumin mRNAs in the hamster brain.

Changes of three different cytosolic Ca2+ binding proteins, calbindin-D28k, calretinin, and parvalbumin mRNA expression in the brain of the hamster during aging were investigated by in situ hybridization using brains from hamsters aged 4, 9, 13, 19, to 24 months old. In cerebellum area, calbindin-D28k transcripts showed about 50% to 68% decrease in content in aged-hamster (19 and 24 months old) compared with young (4 months) and adult (9 months), whereas calretinin and parvalbumin mRNA expression remain unchanged throughout the ages examined. Calbindin-D28k gene expression was decreased during aging also in the hippocampus (approximately 60% reduction) and striatum (approximately 25%). In the same areas, striatum and hippocampus, calretinin and parvalbumin mRNA expression in the equivalent sections were not significantly changed with age. These data raise the possibility that CNS calbindin-D28k expression may be selectively down-regulated during aging. The statistically significant decrease of calbindin-D28k mRNA in the normal aging process also suggests and provides further support for the hypothesis that this calcium binding protein may have an important role in neuronal degeneration.

Marked increases in neuronal nitric oxide synthase (nNOS) mRNA and NADPH-diaphorase histostaining in adrenal cortex after immobilization stress in rats.

The changes of neuronal nitric oxide synthase (nNOS) mRNA expression in the rat adrenal gland following immobilization-induced stress were examined by the in situ hybridization technique. To introduce immobilization stress, the animals were wrapped with flexible wire gauze for 6 h. In the adrenal medulla and cortex, signals for nNOS mRNA were detected. In the adrenal medulla, the difference between non-stressed and stressed animals was not clear. In the adrenal cortex, the expression of nNOS mRNA markedly increased (2.5-fold) in the stressed animals. Nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-diaphorase) histochemistry also showed an increase of staining in adrenal cortex after stress. This suggests that nitric oxide (NO) is involved in stress-induced activation in adrenal cortex function.

Cellular localization of putative odorant receptor mRNAs in olfactory and chemosensory neurons: a non radioactive in situ hybridization study.

The precise cellular localization of mRNAs for putative odorant receptors was investigated in the mouse chemosensory system (olfactory epithelium, septal organ and vomeronasal organ). Four additional members of the odorant receptor family were cloned from mouse olfactory mucosa and in situ hybridization was performed with paraffin-embedded tissue using digoxigenin labelled, non-radioactive antisense RNA probes for these individual receptor genes. The results clearly demonstrated expression of odorant receptors within single individual receptor neurons and there was no receptor expression either in the basal cells (stem cells) or supporting cells (sustentacular cells). In contrast to the uniform expression of olfactory marker protein mRNA within the layer of mature neurons, odorant receptor expression was localized in scattered individual cells but with a bilateral symmetry. The number of positive cells was far less than the number detected with the olfactory marker protein probe. Interestingly, rostro-caudal and dorso-ventral sites of expression were specific to each receptor probe. Under the highly stringent hybridization and washing conditions used here, even mixed RNA probes prepared from 4 different odorant receptor genes were only expressed in a maximum of 20-60 neurons per section (i.e. less than 0.1% of the population of total receptor neurons) suggesting the size of odorant receptor superfamilies to be larger than previously estimated. Some chemoreceptor neurons in the septal organ and vomeronasal organ also expressed odorant receptor mRNAs suggesting that these two additional non-olfactory chemosensory systems share the same chemoreceptive pathway as the olfactory system.

Isolation of mouse vomeronasal receptor genes and their co-localization with specific G-protein messenger RNAs.

Four mouse vomeronasal receptors (mV1Rs) have been isolated by similarity to rat vomeronasal receptor (V1R) motifs. The four mV1Rs identified in this study are members of two distinct subfamilies. Specific in situ hybridization probes (ISH) derived from the 3' non-coding regions of the mV1R genes, were used to detect expression of a single receptor and probes from the homologous coding regions were used to detect expression of subfamily members. The ISH results showed that the mV1Rs expressing neurons were scattered in the middle/upper layer of the vomeronasal organ (VNO) sensory epithelium in serial VNO sections but were excluded from the deeper layers of the VNO sensory epithelium and these neurons were found to co-express the mRNA for the G-protein Galphai2, and were distinct from the deeper layers of the VNO sensory epithelium where the mRNA for Galphao positive neurons was located.

Gastrointestinal mucoadhesive patch system (GI-MAPS) for oral administration of G-CSF, a model protein.

A new gastrointestinal mucoadhesive patch system (GI-MAPS) has been designed for the oral delivery of protein drugs. The system consists of four layered films, 3.0 x 3.0 mm2, contained in an enteric capsule. The 40 microm backing layer is made of a water-insoluble polymer, ethyl cellulose (EC). The surface layer is made of an enteric pH-sensitive polymer such as hydroxypropylmethylcellulose phthalate (HP-55), Eudragit L100 or S100 and was coated with an adhesive layer. The middle layer, drug-containing layer. made of cellulose membrane is attached to the EC backing layer by a heating press method. Both drug and pharmaceutical additives including an organic acid, citric acid, and a non-ionic surfactant, polyoxyethylated castor oil derivative (HCO-60), were formulated in the middle layer. The surface layer was attached to the middle layer by an adhesive layer made of carboxyvinyl polymer (Hiviswako 103). Fluorescein (FL), 30mg, was first used as a model drug for oral administration of GI-MAPS having different surface layers in beagle dogs. The plasma FL concentration vs. time profiles demonstrated that the targeting of the systems was obtained, because the Tmax, the time when plasma FL concentrations reaches to its maximum lelev, was 2.33+/-0.82 h for HP-55 system, 3.33+/-0.41 h for Eudragit L100 system and 5.00+/-0.00 h for Eudragit S100 system. The same three kinds of GI-MAPSs containing 125 microg of recombinant human granulocyte colony-stimulating factor (G-CSF) were prepared and orally administered to dogs and the increase in total white blood cell (WBC) counts were measured as the pharmacological index for G-CSF. Comparison with the total increase of WBCs after iv injection of the same amount of G-CSF (125 microg) indicated the pharmacological availabilities (PA) of G-CSF were 23%, 5.5% and 6.0% for Eudragit L100, HP-55 and Eudragit S100 systems. By decreasing the amount of HCO-60 and citric acid, the PA of G-CSF decreased. These results suggest the usefulness of GI-MAPS for the oral administration of proteins.

Quantitative analysis of cutaneous calcitonin gene-related peptide content in response to acute cutaneous mechanical or thermal stimuli and immobilization-induced stress in rats.

The effects of various stimuli on restricted skin areas or immobilization-induced stress on the calcitonin gene-related peptide (CGRP) content in rat skin were examined by radioimmunoassay (RIA) and immunohistochemistry. Various stimuli were delivered to the shaven skin of the medial thigh by pinching, brushing, or contact with a glass tube containing hot (50 degrees C) or ice-water for 2 min. To induce immobilization stress, animals were placed in the prone position and wrapped with flexible wire gauze at room temperature. The cutaneous CGRP content determined by RIA as well as the number of CGRP-immunoreactive nerve fibers of the skin were significantly higher at sites stimulated by pinching or ice-water compared to non-stimulated areas within the same animals. However, after brushing, hot water stimulation or any period (2 min, 30 min, 2 h, 6 h, or 3 days x 6 h) of immobilization stress, no differences in cutaneous CGRP content were observed. Plasma corticosterone levels increased after immobilization stress of 30 min or greater, but plasma CGRP level did not change after any period of immobilization stress. These data suggest that some forms of cutaneous stimulation cause a rapid rise in CGRP content in the skin, while emotional stress does not influence the cutaneous CGRP content.

Local inhibition of nitric oxide synthase activity in the accessory olfactory bulb does not prevent the formation of an olfactory memory in mice.

The putative intercellular transmitter nitric oxide has been suggested to play a role in synaptic plasticity in several models of learning and memory. We have investigated the cellular localisation of nitric oxide synthase in the accessory olfactory bulb of the mouse, using immunohistochemistry and NADPH diaphorase histochemistry. The strikingly high levels of nitric oxide synthase observed in the accessory olfactory bulb were found to be due almost exclusively to its localisation in granule cell interneurons. In mice the accessory olfactory bulb has been proposed as the site of synaptic changes occurring during the formation of an olfactory memory to male pheromones. In an attempt to disrupt the formation of this olfactory memory, we used local infusions of the nitric oxide synthase inhibitor L-NG-nitroarginine, into the olfactory bulb over the critical period for memory formation. Infusions of L-NG-nitroarginine at doses that effectively inhibited nitric oxide synthase activity did not prevent memory formation. The apparent resistance of this memory to inhibition of nitric oxide synthase activity may reflect the special nature of the mitral cell to granule cell reciprocal synapse in the accessory olfactory bulb.

Calretinin, calbindin-D28k and parvalbumin-like immunoreactivity in mouse chemoreceptor neurons.

Calretinin immunoreactivity was demonstrated in adult mouse olfactory receptor neurons and in the vomeronasal and septal chemoreceptor neurons, whereas parvalbumin expression was restricted to the vomeronasal receptor neurons. Calbindin-D28k-like immunoreactivity was primarily localized in the vomeronasal and septal chemoreceptor neurons although an occasional neuronal staining with calbindin-D28k was also found in restricted areas of the main olfactory epithelium.

Modulatory effect of L-NAME, a specific nitric oxide synthase (NOS) inhibitor, on stress-induced changes in plasma adrenocorticotropic hormone (ACTH) and corticosterone levels in rats: physiological significance of stress-induced NOS activation in hypothalamic-pituitary-adrenal axis.

We investigated whether NG-nitro-L-arginine methyl ester (L-NAME), a specific inhibitor of nitric oxide synthase (NOS), can modify the stress-induced adrenocorticotropic hormone (ACTH) and corticosterone responses, because we found that immobilization-induced stress increases NOS mRNA and protein levels and enzyme activity in the adrenal cortex. The physiological significance of these phenomena, however, remains unknown. Plasma ACTH and corticosterone levels were determined by radioimmunoassay (RIA) of systemic blood samples and NOS enzyme activity was measured as the rate of [3H]arginine conversion to [3H]citrulline in the presence of tissue homogenate of adrenal cortex separated from the adrenal gland. The NOS enzyme activity in the adrenal cortex of rats pre-injected with saline at 2 h after the 2-h immobilization was significantly higher (P < 0.01) than that in the non-stressed controls. Pre-injection of L-NAME (100 mg/kg, s.c.) almost completely abolished the activity. This dose of L-NAME maintained a significantly elevated plasma corticosterone level (P < 0.05, compared with basal level) even 2 h after the 2-h stress, whereas the plasma corticosterone level in rats pre-injected with saline returned to the basal level at the same time point. Plasma ACTH level in L-NAME-pre-treated rats was higher than that in those pre-treated with saline 2 h after the stress, but the difference was not significant. This dose of L-NAME did not influence plasma ACTH or corticosterone levels under resting conditions without stress. These findings suggest that the stress-induced increase in NO synthesis in the adrenal cortex can modify the stress-induced corticosterone response to facilitate the recovery from the elevated corticosterone secretion by stress in the adrenal cortex to the resting basal level.

Immobilization-induced stress activates neuronal nitric oxide synthase (nNOS) mRNA and protein in hypothalamic-pituitary-adrenal axis in rats.

The purpose of this study was to determine whether immobilization stress can cause changes in the enzyme activity and gene expression of neuronal nitric oxide synthase (nNOS) in the hypothalamus, pituitary, and adrenal gland in rats. NOS enzyme activity was measured as the rate of [3H]arginine conversion to citrulline, and the level of nNOS mRNA signal was determined using in situ hybridization and image analysis. NOS-positive cells were also visualized using nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-diaphorase) histochemistry and by immunohistochemistry using an anti-nNOS antibody. A significant increase of NOS enzyme activity in the anterior pituitary, adrenal cortex, and adrenal medulla (1.5-, 3.5-, and 2.5-fold) was observed in the stressed animals (immobilization of 6 h) as compared to non-stressed control rats. Up-regulation of nNOS mRNA expression in anterior pituitary and adrenal cortex was already detectable after stress for 2 h with 1.5- and 2-fold increase, respectively. The nNOS mRNA signals in hypothalamic paraventricular nucleus (PVN) significantly increased after the stress for 6 h. This increase in NOS enzyme activity was confirmed using NADPH-diaphorase staining and immunostaining in the PVN and adrenal cortex. An increase of NOS enzyme activity in adrenal medulla after immobilization for 6 h posited by far longer than in the adrenal cortex and anterior pituitary. The present findings suggest that psychological and/or physiological stress causes NO release in hypothalamic-pituitary-adrenal (HPA) axis and in sympatho-adrenal system. It is suggested that NO may modulate a stress-induced activation of the HPA axis and the sympatho-adrenal medullary system. The different duration of stress-induced NOS activity in HPA axis and the adrenal medulla may suggest NO synthesis is controlled by separate mechanism in the two HPA and the sympatho-adrenal systems.

Expression of olfactory receptors, G-proteins and AxCAMs during the development and maturation of olfactory sensory neurons in the mouse.

Three mouse olfactory receptors have been cloned and sequenced and were found to be expressed in different zones of the olfactory epithelium. In situ hybridisation (ISH) results showed that each olfactory receptor was expressed at an early stage in development (E12), was not dependent on the maturation of the receptor neurons, and was present long before the onset of odour detection. Cells positive for these same olfactory receptors and the G-protein (Gbeta) were also found in non-neural regions of the nasal epithelium in the earlier stages of development (E12-16). Ncam, and Big-2 expression were, however, restricted to the region of developing olfactory neurons. Ncam expression appeared in advance of the olfactory receptor expression, while Big-2 appeared after olfactory receptor expression and neither were expressed in cells outside the olfactory epithelium. Both showed the highest number of positive cells in the early post-partum period when olfactory detection is functional. Ncam is known to be involved in guidance of the developing olfactory axons and was expressed earlier than any of the olfactory receptors, while Big-2 appears somewhat later (E14) at a time when developing axons reach the olfactory bulb. Moreover the highest periods of expression occur at post-natal day 7 when a proliferation of bulbar glomeruli are observed, suggesting the role of Big-2 to be primarily concerned with synaptogenesis.

Retention and transit of intestinal mucoadhesive films in rat small intestine.

The retention and transit characteristics of intestinal mucoadhesive film systems have been studied after intraduodenal administration in rats. Small size four layered film preparations, 0.5x0.5 mm, were prepared, where the backing layer (45.1+/-2.9 microm thick) was made of a water-insoluble polymer, ethylcellulose (EC), the surface layer was made of enteric pH-sensitive polymers, Eudragit L100, S100 or HP-55 and the middle layer was made of cellulose membrane. The surface layer was attached to the middle layer with an adhesive layer composed of carboxyvinyl polymer (Hiviswako(R) 103). After administration of ten films to the duodenum, the rats were sacrificed hourly and the distribution of the films in the whole small intestine was directly observed after abdominal incision. The HP-55, Eudragit L100 and S100 film systems were found to adhere to the upper, middle and lower part of the small intestine after 1, 2 and 4 h, respectively, for 2-3 h. Direct inspection study suggests that intestinal mucoadhesive film system has functions of: (1) pH-dependent intestinal adhesion site specificity; (2) adhesion to the intestinal wall; and (3) retention in the small intestinal adhesion site for at least 2 h. Intestinal mucoadhesive film system has been suggested to be a targeting system for drugs to the gastrointestinal tract.

3D ultrasound system to investigate intraventricular hemorrhage in preterm neonates.

Intraventricular hemorrhage (IVH) is a common disorder among preterm neonates that is routinely diagnosed and monitored by 2D cranial ultrasound (US). The cerebral ventricles of patients with IVH often have a period of ventricular dilation (ventriculomegaly). This initial increase in ventricle size can either spontaneously resolve, which often shows clinically as a period of stabilization in ventricle size and eventual decline back towards a more normal size, or progressive ventricular dilation that does not stabilize and which may require interventional therapy to reduce symptoms relating to increased intracranial pressure. To improve the characterization of ventricle dilation, we developed a 3D US imaging system that can be used with a conventional clinical US scanner to image the ventricular system of preterm neonates at risk of ventriculomegaly. A motorized transducer housing was designed specifically for hand-held use inside an incubator using a transducer commonly used for cranial 2D US scans. This system was validated using geometric phantoms, US/MRI compatible ventricle volume phantoms, and patient images to determine 3D reconstruction accuracy and inter- and intra-observer volume estimation variability. 3D US geometric reconstruction was found to be accurate with an error of <0.2%. Measured volumes of a US/MRI compatible ventricle-like phantom were within 5% of gold standard water displacement measurements. Intra-class correlation for the three observers was 0.97, showing very high agreement between observers. The coefficient of variation was between 1.8-6.3% for repeated segmentations of the same patient. The minimum detectable difference was calculated to be 0.63 cm(3) for a single observer. Results from ANOVA for three observers segmenting three patients of IVH grade II did not show any significant differences (p > 0.05) for the measured ventricle volumes between observers. This 3D US system can reliably produce 3D US images of the neonatal ventricular system. There is the potential to use this system to monitor the progression of ventriculomegaly over time in patients with IVH.