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1.
ESMO Open ; 9(5): 103461, 2024 May.
Article in English | MEDLINE | ID: mdl-38744102

ABSTRACT

BACKGROUND: Results from the JAVELIN Merkel 200 study led to the approval of avelumab [an anti-programmed death-ligand 1 (PD-L1) antibody] for the treatment of metastatic Merkel cell carcinoma (mMCC) in multiple countries and its inclusion in the treatment guidelines as a preferred or recommended therapy in this setting. Here, we report 4-year follow-up results from the cohort of patients with mMCC who received avelumab as first-line treatment. PATIENTS AND METHODS: In part B of JAVELIN Merkel 200, a single-arm, open-label, phase II study, patients with mMCC who had not received prior systemic therapy for metastatic disease received avelumab 10 mg/kg via intravenous infusion every 2 weeks until confirmed disease progression, unacceptable toxicity, or withdrawal. In this analysis, long-term overall survival (OS), patient disposition, and subsequent treatment were analyzed. RESULTS: In total, 116 patients received first-line avelumab. At the data cutoff (2 February 2022), the median follow-up was 54.3 months (range 48.0-69.7 months). Seven patients (6.0%) remained on treatment and an additional 21 patients remained in follow-up (18.1%); 72 patients (62.1%) had died. The median OS was 20.3 months [95% confidence interval (CI) 12.4-42.0 months], with a 4-year OS rate of 38% (95% CI 29% to 47%). In patients with PD-L1+ or PD-L1- tumors, the 4-year OS rate was 48% (95% CI 26% to 67%) and 35% (95% CI 25% to 45%), respectively. In total, 48 patients (41.4%) received poststudy anticancer drug therapy, most commonly etoposide (20.7%), carboplatin (19.0%), and avelumab (12.1%). CONCLUSIONS: Avelumab first-line monotherapy in patients with mMCC resulted in meaningful long-term OS, which compared favorably with historical studies of first-line chemotherapy. These results further support the role of avelumab as a standard of care for patients with mMCC.


Subject(s)
Antibodies, Monoclonal, Humanized , Carcinoma, Merkel Cell , Skin Neoplasms , Humans , Carcinoma, Merkel Cell/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal, Humanized/pharmacology , Male , Female , Aged , Follow-Up Studies , Middle Aged , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Aged, 80 and over , Antineoplastic Agents, Immunological/therapeutic use , Antineoplastic Agents, Immunological/pharmacology , Neoplasm Metastasis , Adult , B7-H1 Antigen/antagonists & inhibitors , B7-H1 Antigen/metabolism
2.
ESMO Open ; 6(6): 100290, 2021 12.
Article in English | MEDLINE | ID: mdl-34715570

ABSTRACT

BACKGROUND: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer that has a poor prognosis in patients with advanced disease. Avelumab [anti-programmed death-ligand 1 (PD-L1)] became the first approved treatment for patients with metastatic MCC (mMCC), based on efficacy and safety data observed in the JAVELIN Merkel 200 trial. We report long-term overall survival (OS) data after >5 years of follow-up from the cohort of patients with mMCC whose disease had progressed after one or more prior lines of chemotherapy. PATIENTS AND METHODS: In Part A of the single-arm, open-label, phase II JAVELIN Merkel 200 trial, patients with mMCC that had progressed following one or more prior lines of chemotherapy received avelumab 10 mg/kg by intravenous infusion every 2 weeks until confirmed disease progression, unacceptable toxicity, or withdrawal. In this analysis, long-term OS was analyzed. RESULTS: In total, 88 patients were treated with avelumab. At data cut-off (25 September 2020), median follow-up was 65.1 months (range 60.8-74.1 months). One patient (1.1%) remained on treatment, and an additional patient (1.1%) had reinitiated avelumab after previously discontinuing treatment. Median OS was 12.6 months [95% confidence interval (CI) 7.5-17.1 months], with a 5-year OS rate of 26% (95% CI 17% to 36%). In patients with PD-L1+ versus PD-L1- tumors, median OS was 12.9 months (95% CI 8.7-29.6 months) versus 7.3 months (95% CI 3.4-14.0 months), and the 5-year OS rate was 28% (95% CI 17% to 40%) versus 19% (95% CI 5% to 40%), respectively (HR 0.67; 95% CI 0.36-1.25). CONCLUSION: Avelumab monotherapy resulted in meaningful long-term OS in patients with mMCC whose disease had progressed following chemotherapy. These results further support the role of avelumab as a standard of care for patients with mMCC.


Subject(s)
Carcinoma, Merkel Cell , Skin Neoplasms , Antibodies, Monoclonal, Humanized/pharmacology , Antibodies, Monoclonal, Humanized/therapeutic use , Carcinoma, Merkel Cell/drug therapy , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/secondary , Follow-Up Studies , Humans , Skin Neoplasms/drug therapy
3.
Skin Health Dis ; 1(1)2021 Mar.
Article in English | MEDLINE | ID: mdl-34541577

ABSTRACT

BACKGROUNDS: Folate Hydrolase-1 (FOLH1; PSMA) is a type II transmembrane protein, luminally expressed by solid tumour neo-vasculature. Monoclonal antibody (mAb), J591, is a vehicle for mAb-based brachytherapy in FOLH1+ cancers. Brachytherapy is a form of radiotherapy that involves placing a radioactive material a short distance from the target tissue (e.g., on the skin or internally); brachytherapy is commonly accomplished with the use of catheters, needles, metal seeds and antibody or small peptide conjugates. Herein, FOLH1 expression in primary (p) and metastatic (m) Merkel cell carcinoma (MCC) is characterized to determine its targeting potential for J591-brachytherapy. MATERIALS & METHODS: Paraffin sections from pMCC and mMCC were evaluated by immunohistochemistry for FOLH1. Monte Carlo simulation was performed using the physical properties of conjugated radioisotope lutetium-177. Kaplan-Meier survival curves were calculated based on patient outcome data and FOLH1 expression. RESULTS: Eighty-one MCC tumours were evaluated. 67% (54/81) of all cases, 77% (24/31) pMCC and 60% (30/50) mMCC tumours were FOLH1+. Monte Carlo simulation showed highly localized ionizing tracks of electrons emitted from the targeted neo-vessel. 42% (34/81) of patients with FOLH1+/- MCC had available survival data f or analysis. No significant differences in our limited data set were detected based on FOLH1 status (p = 0.4718; p = 0.6470), staining intensity score (p = 0.6966; p = 0.9841) or by grouping staining intensity scores (- and + vs. ++, +++, +++) (p = 0.8022; p = 0.8496) for MCC-specific survival or recurrence free survival, respectively. CONCLUSIONS: We report the first evidence of prevalent FOLH1 expression within MCC-associated neo-vessels, in 60-77% of patients in a large MCC cohort. Given this data, and the need for alternatives to immune therapies it is appropriate to explore the safety and efficacy o f FOLH1-targeted brachytherapy for MCC.

4.
Br J Dermatol ; 184(2): 319-327, 2021 02.
Article in English | MEDLINE | ID: mdl-32320473

ABSTRACT

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive, high-grade, cutaneous neuroendocrine tumour (NET). Agents blocking programmed death 1/programmed death ligand 1 have efficacy in metastatic MCC (mMCC), but half of patients do not derive durable benefit. Somatostatin analogues (SSAs) are commonly used to treat low- and moderate-grade NETs that express somatostatin receptors (SSTRs). OBJECTIVES: To assess SSTR expression and the efficacy of SSAs in mMCC, a high-grade NET. Methods In this retrospective study of 40 patients with mMCC, SSTR expression was assessed radiologically by somatostatin receptor scintigraphy (SRS; n = 39) and/or immunohistochemically when feasible (n = 9). Nineteen patients (18 had SRS uptake in MCC tumours) were treated with SSA. Disease control was defined as progression-free survival (PFS) of ≥ 120 days after initiation of SSA. RESULTS: Thirty-three of 39 patients (85%) had some degree (low 52%, moderate 23%, high 10%) of SRS uptake. Of 19 patients treated with SSA, seven had a response-evaluable target lesion; three of these seven patients (43%) experienced disease control, with a median PFS of 237 days (range 152-358). Twelve of 19 patients did not have a response-evaluable lesion due to antecedent radiation; five of these 12 (42%) experienced disease control (median PFS of 429 days, range 143-1757). The degree of SSTR expression (determined by SRS and/or immunohistochemistry) did not correlate significantly with the efficacy endpoints. CONCLUSIONS: In contrast to other high-grade NETs, mMCC tumours appear frequently to express SSTRs. SSAs can lead to clinically meaningful disease control with minimal side-effects. Targeting of SSTRs using SSA or other novel approaches should be explored further for mMCC.


Subject(s)
Carcinoma, Merkel Cell , Skin Neoplasms , Carcinoma, Merkel Cell/drug therapy , Humans , Receptors, Somatostatin , Retrospective Studies , Skin Neoplasms/drug therapy , Somatostatin/therapeutic use
5.
Nat Commun ; 9(1): 3868, 2018 09 24.
Article in English | MEDLINE | ID: mdl-30250229

ABSTRACT

Understanding mechanisms of late/acquired cancer immunotherapy resistance is critical to improve outcomes; cellular immunotherapy trials offer a means to probe complex tumor-immune interfaces through defined T cell/antigen interactions. We treated two patients with metastatic Merkel cell carcinoma with autologous Merkel cell polyomavirus specific CD8+ T cells and immune-checkpoint inhibitors. In both cases, dramatic remissions were associated with dense infiltration of activated CD8+s into the regressing tumors. However, late relapses developed at 22 and 18 months, respectively. Here we report single cell RNA sequencing identified dynamic transcriptional suppression of the specific HLA genes presenting the targeted viral epitope in the resistant tumor as a consequence of intense CD8-mediated immunologic pressure; this is distinguished from genetic HLA-loss by its reversibility with drugs. Transcriptional suppression of Class I loci may underlie resistance to other immunotherapies, including checkpoint inhibitors, and have implications for the design of improved immunotherapy treatments.


Subject(s)
Carcinoma, Merkel Cell/therapy , Genes, MHC Class I/genetics , Immunotherapy, Adoptive/methods , Neoplasm Recurrence, Local/genetics , Polyomavirus Infections/therapy , Skin Neoplasms/therapy , Tumor Escape/genetics , Tumor Virus Infections/therapy , Antineoplastic Agents, Immunological/therapeutic use , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/transplantation , Carcinoma, Merkel Cell/genetics , Carcinoma, Merkel Cell/immunology , Carcinoma, Merkel Cell/virology , Costimulatory and Inhibitory T-Cell Receptors/antagonists & inhibitors , Gene Expression Regulation, Neoplastic , Genes, MHC Class I/immunology , Humans , Lymphocytes, Tumor-Infiltrating/immunology , Lymphocytes, Tumor-Infiltrating/transplantation , Male , Merkel cell polyomavirus/immunology , Merkel cell polyomavirus/isolation & purification , Middle Aged , Neoplasm Recurrence, Local/immunology , Polyomavirus Infections/genetics , Polyomavirus Infections/immunology , Polyomavirus Infections/virology , Sequence Analysis, RNA/methods , Single-Cell Analysis/methods , Skin Neoplasms/genetics , Skin Neoplasms/immunology , Skin Neoplasms/virology , Testicular Neoplasms/immunology , Testicular Neoplasms/secondary , Testicular Neoplasms/virology , Transcription, Genetic/immunology , Transplantation, Autologous/methods , Tumor Virus Infections/genetics , Tumor Virus Infections/immunology , Tumor Virus Infections/virology
6.
Rev Sci Instrum ; 83(2): 02B320, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22380299

ABSTRACT

Over the last few years, the interest of the international scientific community for high power accelerators in the megawatt range has been increasing. For such machines, the ion source has to deliver a beam intensity that ranges from several tens up to a hundred of mA. One of the major challenges is to extract and transport the beam while minimizing the emittance growth and optimizing its injection into the radio frequency quadrupole. Consequently, it is crucial to perform precise simulations and cautious design of the low energy beam transport (LEBT) line. In particular, the beam dynamics calculations have to take into account not only the space charge effects but also the space charge compensation of the beam induced by ionization of the residual gas. The physical phenomena occurring in a high intensity LEBT and their possible effects on the beam are presented, with a particular emphasis on space charge compensation. Then, beam transport issues in different kind of LEBTs are briefly reviewed. The SOLMAXP particle-in-cell code dedicated to the modeling of the transport of charge particles under a space charge compensation regime is described. Finally, beam dynamics simulations results obtained with SOLMAXP are presented in the case of international fusion materials irradiation facility injector.

7.
J Vet Intern Med ; 24(2): 372-8, 2010.
Article in English | MEDLINE | ID: mdl-20102497

ABSTRACT

BACKGROUND: Vector-transmitted microorganisms in the genera Ehrlichia, Anaplasma, Rickettsia, Bartonella, and Borrelia are commonly suspected in dogs with meningoencephalomyelitis (MEM), but the prevalence of these pathogens in brain tissue and cerebrospinal fluid (CSF) of dogs with MEM is unknown. HYPOTHESIS/OBJECTIVES: To determine if DNA from these genera is present in brain tissue and CSF of dogs with MEM, including those with meningoencephalitis of unknown etiology (MUE) and histopathologically confirmed cases of granulomatous (GME) and necrotizing meningoencephalomyelitis (NME). ANIMALS: Hundred and nine dogs examined for neurological signs at 3 university referral hospitals. METHODS: Brain tissue and CSF were collected prospectively from dogs with neurological disease and evaluated by broadly reactive polymerase chain reaction (PCR) for Ehrlichia, Anaplasma, Spotted Fever Group Rickettsia, Bartonella, and Borrelia species. Medical records were evaluated retrospectively to identify MEM and control cases. RESULTS: Seventy-five cases of MUE, GME, or NME, including brain tissue from 31 and CSF from 44 cases, were evaluated. Brain tissue from 4 cases and inflammatory CSF from 30 cases with infectious, neoplastic, compressive, vascular, or malformative disease were evaluated as controls. Pathogen nucleic acids were detected in 1 of 109 cases evaluated. Specifically, Bartonella vinsonii subsp. berkhoffii DNA was amplified from 1/6 dogs with histopathologically confirmed GME. CONCLUSION AND CLINICAL IMPORTANCE: The results of this investigation suggest that microorganisms in the genera Ehrlichia, Anaplasma, Rickettsia, and Borrelia are unlikely to be directly associated with canine MEM in the geographic regions evaluated. The role of Bartonella in the pathogenesis of GME warrants further investigation.


Subject(s)
Brain/microbiology , Dog Diseases/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/veterinary , Meningoencephalitis/veterinary , Polymerase Chain Reaction/veterinary , Animals , DNA, Bacterial/classification , DNA, Bacterial/isolation & purification , Dog Diseases/cerebrospinal fluid , Dogs , Female , Gram-Negative Bacterial Infections/cerebrospinal fluid , Gram-Negative Bacterial Infections/microbiology , Male , Meningoencephalitis/microbiology
8.
Actas dermo-sifiliogr. (Ed. impr.) ; 100(supl.2): 49-54, dic. 2009. ilus, tab
Article in English | IBECS | ID: ibc-78815

ABSTRACT

Merkel cell carcinoma (MCC) is a neuroendocrine skin cancer with a higher propensity for recurrence and metastasis than melanoma or squamous cell carcinoma. Despite aggressive behavior and the tripling of its reported incidence in the past 20 years, there is extensive confusion about how MCC should be managed. Here we address two issues that have impeded optimal MCC management: lack of a consensus staging system and lack of unique diagnostic codes for MCC. Five conflicting systems currently used to stage MCC will be replaced by one system in 2010 that will diminish confusion about prognosis and management among physicians and patients. The diagnostic bundling of MCC with numerous less aggressive skin cancers leads to care refusals by insurance and an inability to track MCC care costs. Worldwide adoption in 2009 of specific diagnostic codes for MCC will also improve understanding and management of this often-lethal skin cancer (AU)


El carcinoma de células de Merkel (CCM) es una neoplasia cutánea neuroendocrina con una mayor propensión para desarrollar recurrencias y metástasis que el melanoma o el carcinoma epidermoide. A pesar de su comportamiento agresivo, y el hecho de que su incidencia se haya triplicado en los últimos 20 años, aún existe una gran confusión respecto al tratamiento del CCM. En esta revisión abordaremos dos cuestiones que han dificultado el tratamiento óptimo del CCM: la carencia de un sistema de estadificación consensuado y la falta de códigos diagnósticos exclusivos para el CCM. Los 5 sistemas contradictorios que actualmente se utilizan para estadificar el CCM serán reemplazados solamente por uno en 2010, lo que disminuirá la confusión sobre el pronóstico y el tratamiento entre los médicos y pacientes. La codificación diagnóstica del CCM, junto con numerosas neoplasias cutáneas menos agresivas, ha condicionado la denegación de atención por parte de las compañías aseguradoras y la incapacidad para evaluar los costes de la atención sanitaria por CCM. La adopción, que se ha efectuado en 2009, de códigos diagnósticos específicos para el CCM también mejorará la comprensión y el tratamiento de esta neoplasia cutánea frecuentemente letal( AU)


Subject(s)
Humans , Carcinoma, Merkel Cell/diagnosis , Skin Neoplasms/diagnosis , Carcinoma, Merkel Cell/therapy , Skin Neoplasms/therapy , Prognosis , Neoplasm Staging , Polyomavirus/pathogenicity
9.
J Vet Intern Med ; 23(6): 1220-6, 2009.
Article in English | MEDLINE | ID: mdl-19780928

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) is a correlate to physical examination in various myelopathies and a predictor of functional outcome. OBJECTIVES: To describe associations among MRI features, neurological dysfunction before MRI, and functional outcome in dogs with disk herniation. ANIMALS: One hundred and fifty-nine dogs with acute thoracolumbar disk herniation. METHODS: Retrospective case series. Signalment, initial neurological function as assessed by a modified Frankel score (MFS), and ambulatory outcome at hospital discharge and >3 months (long-term) follow-up were recorded from medical records and telephone interview of owners. Associations were estimated between these parameters and MRI signal and morphometric data. RESULTS: Dogs with intramedullary T2W hyperintensity had more severe pre-MRI MFS (median 2, range 0-4) and lower ambulatory proportion at long-term follow-up (0.76) than those dogs lacking hyperintensity (median MFS 3, range 0-5; ambulatory proportion, 0.93) (P=.001 and .013, respectively). Each unit of T2W length ratio was associated with a 1.9 times lower odds of long-term ambulation when adjusted for pre-MRI MFS (95% confidence interval 1.0-3.52, P=.05). Dogs with a compressive length ratio >1.31 (which was the median ratio within this population) had more severe pre-MRI MFS (median 3, range 0-5) compared with those with ratios < or =1.31 (median MFS 3, range 0-4; P=.006). CONCLUSIONS AND CLINICAL IMPORTANCE: MRI features were associated with initial injury severity in dogs with thoracolumbar disk herniation. Based on results of this study, the T2W length ratio and presence of T2W intramedullary hyperintensity appear to be predictive of long-term ambulatory status.


Subject(s)
Dog Diseases/pathology , Intervertebral Disc Displacement/veterinary , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging/veterinary , Animals , Dog Diseases/etiology , Dog Diseases/surgery , Dogs , Female , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/pathology , Intervertebral Disc Displacement/surgery , Male , Spinal Cord Compression/pathology , Spinal Cord Compression/surgery , Spinal Cord Compression/veterinary , Thoracic Vertebrae
10.
Actas Dermosifiliogr ; 100 Suppl 2: 49-54, 2009 Dec.
Article in English | MEDLINE | ID: mdl-20096162

ABSTRACT

Merkel cell carcinoma (MCC) is a neuroendocrine skin cancer with a higher propensity for recurrence and metastasis than melanoma or squamous cell carcinoma. Despite aggressive behavior and the tripling of its reported incidence in the past 20 years, there is extensive confusion about how MCC should be managed. Here we address two issues that have impeded optimal MCC management: lack of a consensus staging system and lack of unique diagnostic codes for MCC. Five conflicting systems currently used to stage MCC will be replaced by one system in 2010 that will diminish confusion about prognosis and management among physicians and patients. The diagnostic bundling of MCC with numerous less aggressive skin cancers leads to care refusals by insurance and an inability to track MCC care costs. Worldwide adoption in 2009 of specific diagnostic codes for MCC will also improve understanding and management of this often-lethal skin cancer.


Subject(s)
Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/virology , Skin Neoplasms/pathology , Skin Neoplasms/virology , Consensus , Humans , Neoplasm Staging , Prognosis
11.
Br J Dermatol ; 156(5): 957-64, 2007 May.
Article in English | MEDLINE | ID: mdl-17388926

ABSTRACT

BACKGROUND: Characterization of mechanisms that can reverse residual damage from prior skin exposure to ultraviolet (UV) would be of considerable biological and therapeutic interest. Topical caffeine application to mouse skin that had previously been treated with UV has been shown to inhibit the subsequent development of squamous cell carcinomas. OBJECTIVES: We used an established mouse photodamage model to investigate other possible effects of topical caffeine application after UV. METHODS: SKH-1 hairless mice were treated with ultraviolet B (UVB) followed immediately by topical application of caffeine or vehicle three times weekly for 11 weeks. RESULTS: Caffeine applied topically after UV treatment resulted in a significant decrease in UV-induced skin roughness/transverse rhytides as assessed by treatment-blinded examiners. Histologically, topical caffeine application after a single dose of UVB more than doubled the number of apoptotic keratinocytes as evaluated by sunburn cell formation, caspase 3 cleavage and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labelling (TUNEL) staining. A trend towards decreased solar elastosis was noted in the caffeine-treated group although this was not statistically significant. Other histological parameters including epidermal hyperplasia, solar elastosis and angiogenesis were increased in mice treated with UV but topical application of caffeine did not alter these particular UV effects. CONCLUSIONS: These findings support the concept that topical application of caffeine to mouse skin after UV irradiation promotes the deletion of DNA-damaged keratinocytes and may partially diminish photodamage as well as photocarcinogenesis.


Subject(s)
Apoptosis/drug effects , Caffeine/pharmacology , Dermatologic Agents/pharmacology , Keratinocytes/drug effects , Radiation Injuries, Experimental/drug therapy , Skin/drug effects , Administration, Topical , Animals , Apoptosis/radiation effects , Keratinocytes/radiation effects , Mice , Mice, Hairless , Models, Animal , Skin/radiation effects , Ultraviolet Rays
12.
Phys Rev Lett ; 93(21): 211102, 2004 Nov 19.
Article in English | MEDLINE | ID: mdl-15600989

ABSTRACT

Important revisions of the solar model ingredients have appeared recently. We first show that the updated CNO composition suppresses the anomalous position of the Sun in the known galactic enrichment. The following law, He/H = 0.075 + 44.6 O/H in number fraction, is now compatible with all the indicators. We then suggest some directions of investigation to solve the discrepancies between the standard model and solar seismic observations. We finally update our predicted neutrino fluxes using a seismic model and all the recent progress. We get 5.31 +/- 0.6 x 10(6)/cm2/s for the total 8B neutrinos, 66.5 +/- 4.4 SNU and 2.76 +/- 0.4 SNU for the gallium and chlorine detectors, all in remarkable agreement with the detected values including neutrino oscillations for the last two. So, the acoustic modes and detected neutrinos see the same Sun, but the standard model fails to reproduce them.

13.
Arch Dermatol ; 137(9): 1202-6, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11559218

ABSTRACT

BACKGROUND: Tacrolimus (formerly FK 506) is an immunosuppressive drug that works by inhibiting calcineurin, a calcium-dependent protein phosphatase required for immune function. Tacrolimus has been shown to be effective topically in atopic dermatitis and systemically in psoriasis and graft-vs-host disease (GVHD). However, its efficacy in treating cutaneous GVHD when applied topically has not been reported. OBJECTIVE: To assess the therapeutic efficacy of 0.1% tacrolimus ointment on chronic cutaneous GVHD in patients with symptoms refractory to systemic corticosteroid therapy. RESULTS: Tacrolimus ointment effectively treated pruritus and/or erythema in 13 (72%) of 18 patients with chronic GVHD. Responding patients had a rapid effect within several hours to days. Effectiveness was measured by means of patient report, results of physical examination, side-by-side comparisons of tacrolimus vs a vehicle control, and temporal flares of the cutaneous symptoms of the disease in the context of stopping tacrolimus ointment therapy. Because of the progression of GVHD and in 2 cases, loss of drug efficacy, all patients eventually went on to receive more aggressive treatment, including increases in steroid dosage, psoralen-UV-A therapy, and extracorporeal photopheresis. CONCLUSIONS: This case series suggests that tacrolimus ointment has efficacy in treating the erythema and pruritus of steroid-refractory, chronic cutaneous GVHD in most patients. The rapid response of tacrolimus ointment may provide a useful therapeutic bridge to systemic therapies that have slower onset, such as psoralen-UV-A therapy or extracorporeal photopheresis.


Subject(s)
Bone Marrow Transplantation , Graft vs Host Disease/drug therapy , Immunosuppressive Agents/administration & dosage , Skin Diseases/drug therapy , Tacrolimus/administration & dosage , Adult , Chronic Disease , Erythema/drug therapy , Female , Humans , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Ointments , Pruritus/drug therapy , Tacrolimus/adverse effects , Treatment Outcome
14.
Proc Natl Acad Sci U S A ; 98(16): 9092-7, 2001 Jul 31.
Article in English | MEDLINE | ID: mdl-11481475

ABSTRACT

Premature chromatin condensation (PCC) is a hallmark of mammalian cells that begin mitosis before completing DNA replication. This lethal event is prevented by a highly conserved checkpoint involving an unknown, caffeine-sensitive mediator. Here, we have examined the possible involvement of the caffeine-sensitive ATM and ATR protein kinases in this checkpoint. We show that caffeine's ability to inhibit ATR (but not ATM) causes PCC, that ATR (but not ATM) prevents PCC, and that ATR prevents PCC via Chk-1 regulation. Moreover, mimicking cancer cell phenotypes by disrupting normal G(1) checkpoints sensitizes cells to PCC by ATR inhibition plus low-dose DNA damage. Notably, loss of p53 function potently sensitizes cells to PCC caused by ATR inhibition by a small molecule. We present a molecular model for how ATR prevents PCC and suggest that ATR represents an attractive therapeutic target for selectively killing cancer cells by premature chromatin condensation.


Subject(s)
Cell Cycle Proteins/antagonists & inhibitors , Chromatin/metabolism , G1 Phase , Protein Serine-Threonine Kinases , Ataxia Telangiectasia Mutated Proteins , Caffeine/pharmacology , DNA Replication/drug effects , Humans , S Phase , Transfection , Tumor Cells, Cultured
18.
Adv Dent Res ; 11(1): 33-42, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9524440

ABSTRACT

Adhesion to adsorbed pellicles and interspecies co-adhesion to form plaque biofilms involve selective interactions of bacterial adhesins with specific receptors. Our laboratory has devised in vitro assays for co-adhesion between Actinomyces naeslundii and Streptococcus oralis or Porphyromonas gingivalis on saliva-coated mineral and hexadecane droplet substrata. P. gingivalis structures significant for co-adhesion with A. naeslundii include surface vesicles and fimbriae. A family of arginine-specific cysteine proteinases in vesicles may be involved in adherence to bacteria, to host cells, and to matrix proteins. New research from several laboratories has found that such proteinases are processed from genes encoding polyproteins containing both proteinase and hemagglutinin domains. In addition to enzyme-substrate recognition, bacterial adhesion is often determined by specific protein-peptide and lectincarbohydrate recognition. A. naeslundii--salivary prolinerich protein, S. gordonii--salivary alpha-amylase, and Treponema denticola--matrix protein recognition are examples of the former. Co-adhesion of A. naeslundii and S. oralis is an example of the latter. Lactose can selectively desorb A. naeslundii cells from mixed biofilms with S. oralis, a demonstration of the significance of specificity. Although non-specific forces are probably secondary to stereochemical fit in determining the selective range of surfaces that bacteria have evolved to recognize and bind, they probably help stabilize non-covalent bonds within aligned, complementary domains.


Subject(s)
Actinomyces viscosus/physiology , Bacterial Adhesion/physiology , Bacterial Proteins/physiology , Biofilms , Dental Plaque/microbiology , Porphyromonas gingivalis/physiology , Actinomyces viscosus/genetics , Actinomyces viscosus/metabolism , Adhesins, Bacterial/chemistry , Adhesins, Bacterial/physiology , Bacterial Proteins/chemistry , Biofilms/growth & development , Cysteine Endopeptidases/metabolism , Ecosystem , Fimbriae, Bacterial/physiology , Gingipain Cysteine Endopeptidases , Hemagglutinins/metabolism , Humans , Models, Biological , Porphyromonas gingivalis/genetics , Porphyromonas gingivalis/metabolism , Streptococcus/physiology , Substrate Specificity
19.
Nature ; 371(6495): 347-50, 1994 Sep 22.
Article in English | MEDLINE | ID: mdl-8090206

ABSTRACT

In the presence of costimulation, Ca2+ influx in T cells leads to activation (transcription of interleukin-2; ref. 2) via calcineurin. In the absence of costimulation, Ca2+ influx results in anergy (interleukin-2 transcriptional block) through an unknown mechanism. Specific attenuation of interleukin-2 transcriptional induction occurs in Jurkat T cells following pretreatment with a Ca2+ ionophore. A > 90% block of inducible interleukin-2 reporter gene activity was initiated by transfection of a constitutively active mutant of multifunctional Ca2+/calmodulin-dependent protein kinase (CaM kinase or CaM kinase II), but not by constitutive mutants of CaM kinase IV, calcineurin or protein kinase C. The block was complete six hours after kinase transfection and showed specificity for interleukin-2; there was no change in beta-actin transcription or in c-fos transcription induced by phorbol myristyl acetate, and a Rous sarcoma virus promoter was stimulated threefold. Multifunctional CaM kinase also attenuated interleukin-2 activation by calcineurin plus phorbol ester. T-cell receptor signalling activates multifunctional CaM kinase. These findings suggest that two Ca2+/calmodulin-responsive enzymes, multifunctional CaM kinase and calcineurin, could mediate the divergent effects of Ca2+ signals in T-lymphocyte regulation.


Subject(s)
Calcium-Calmodulin-Dependent Protein Kinases/metabolism , Calcium/metabolism , Gene Expression Regulation , Interleukin-2/genetics , Multienzyme Complexes/metabolism , T-Lymphocytes/metabolism , Amino Acid Sequence , Calcium-Calmodulin-Dependent Protein Kinase Type 2 , Cell Line , Clonal Anergy , Enhancer Elements, Genetic , Enzyme Activation , Genes, Reporter , Humans , Molecular Sequence Data , Receptors, Antigen, T-Cell/metabolism , T-Lymphocytes/enzymology , Transcription, Genetic , Transfection
20.
Cytogenet Cell Genet ; 66(2): 113-6, 1994.
Article in English | MEDLINE | ID: mdl-8287681

ABSTRACT

Multifunctional calcium/calmodulin-dependent protein kinase (CaM kinase) is an enzyme mediating calcium-dependent signal transduction pathways. CaM kinase exists in a variety of isoforms, each with a distinct tissue-specific expression pattern, that enables the kinase to regulate multiple functions in mammalian systems. Here we report the chromosomal localization of the previously cloned human gamma-CaM kinase gene (CAMKG). By using a mapping panel of human x Chinese hamster somatic cell hybrid lines and fluorescence in situ hybridization, we have assigned human CAMKG to chromosome 10q22. We have partially cloned the murine gamma-CaM kinase gene and mapped it Camkg to mouse chromosome 14 by analyzing a panel of mouse x rodent somatic cell hybrid lines. A recessive gene, asa, implicated in the control of autoimmune response, is located within the predicted region for Camkg.


Subject(s)
Calcium-Calmodulin-Dependent Protein Kinases/genetics , Chromosome Mapping , Chromosomes, Human, Pair 10 , Animals , Base Sequence , DNA , Humans , Mice , Molecular Sequence Data
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