Hexokinase 2-driven glycolysis in pericytes activates their contractility leading to tumor blood vessel abnormalities.

Defective pericyte-endothelial cell interaction in tumors leads to a chaotic, poorly organized and dysfunctional vasculature. However, the underlying mechanism behind this is poorly studied. Herein, we develop a method that combines magnetic beads and flow cytometry cell sorting to isolate pericytes from tumors and normal adjacent tissues from patients with non-small cell lung cancer (NSCLC) and hepatocellular carcinoma (HCC). Pericytes from tumors show defective blood vessel supporting functions when comparing to those obtained from normal tissues. Mechanistically, combined proteomics and metabolic flux analysis reveals elevated hexokinase 2(HK2)-driven glycolysis in tumor pericytes, which up-regulates their ROCK2-MLC2 mediated contractility leading to impaired blood vessel supporting function. Clinically, high percentage of HK2 positive pericytes in blood vessels correlates with poor patient overall survival in NSCLC and HCC. Administration of a HK2 inhibitor induces pericyte-MLC2 driven tumor vasculature remodeling leading to enhanced drug delivery and efficacy against tumor growth. Overall, these data suggest that glycolysis in tumor pericytes regulates their blood vessel supporting role.

Practical Genetic and Biologic Therapeutic Considerations in Vascular Anomalies.

Vascular anomalies are classified as either tumors or malformations based on clinical findings rendered through radiologic evaluation, physical exam, and histologic interpretation. These findings comprise the phenotype of the disorder. Recently, advances in the molecular genetics of vascular anomalies have shed light on the genotype of these disorders. These phenotype/genotype characterizations will provide a more precise classification of vascular anomalies and identify potential therapeutic targets for expanded treatment options in the future. In this chapter, we will review the phenotype/genotype characterizations and the possible therapeutic pathways for targeted pharmacologic therapy.

Prognostic value of Sox2 expression in digestive tract cancers: A meta-analysis.

The aim of the present study was to accurately evaluate the association of Sox2 expression with the survival of patients with digestive tract cancers. Relevant literatures were identified by comprehensively searching databases including the Pubmed, Embase, CBMdisc, and Wanfang (up to October 2014). A meta-analysis was performed to clarify the association between Sox2 expression and overall survival or clinicopathological parameters of patients with digestive tract cancers (esophageal, gastric, and colorectal cancers). The results showed a significant association between high Sox2 expression and poor overall survival in patients with digestive tract carcinomas (HR=1.55, 95% CI=1.04-2.31), especially for patients with esophageal cancer (HR=2.04, 95%CI=1.30-3.22), colorectal cancer (HR=1.40, 95% CI=1.04-1.89), and digestive tract adenocarcinoma (HR=1.80, 95% CI=1.12-2.89), for Europeans (HR=1.98, 95% CI=1.44-2.71) or patients who did not receive neoadjuvant treatment (HR=1.73, 95% CI=1.10-2.72). Furthermore, Sox2 over-expression was highly correlated with vascular invasion (OR=1.86, 95% CI=1.25-2.77) and poor differentiation (OR=1.88, 95% CI=1.14-3.08), especially in esophageal and colorectal cancers. In conclusion, Sox2 expression may serve as a novel prognostic factor for patients with digestive tract cancers. Over-expression of Sox2 that is correlated with vascular invasion and poor differentiation suggests poor outcomes of patients with digestive tract cancers.

Experiencia en el tratamiento de los hemangiomas infantiles con propranolol de producción nacional / Experiences in treating infantile hemangiomas with Cuban-made propranolol

Introducción: los hemangiomas infantiles son los tumores más frecuentes de la infancia. Aunque son de naturaleza benigna, su rápido crecimiento los puede tornar destructivos, incluso con riesgo vital, en alrededor de 1 por ciento de los casos. En la actualidad han sido utilizados los betabloqueadores, como el propranolol oral, con muy buenos resultados. Objetivo: evaluar el efecto y seguridad del propranolol de producción nacional para el tratamiento de hemangiomas infantiles en fase proliferativa. Métodos: estudio descriptivo y aplicado -efectuado desde el 1 de diciembre de 2010 hasta el 31 de junio de 2012- de una serie de 21 pacientes con 26 hemangiomas infantiles en fase proliferativa, atendidos en la Consulta de Dermatología del Hospital Pediátrico Docente Juan Manuel Márquez, y tratados con propranolol de producción nacional por vía oral a 2 mg/kg/día en 2 subdosis. Los pacientes fueron evaluados en consulta quincenal hasta el tercer mes de tratamiento, y después, mensualmente, hasta los 6 meses de duración de este. Se realizó un registro de los efectos adversos. Resultados: en todos los casos, en los primeros días después de comenzado el tratamiento, su efecto positivo (cambios favorables en la coloración o tamaño) fue evidente. Los efectos adversos fueron leves y autolimitados. Se alcanzó respuesta excelente o buena en el 99 por ciento de los pacientes a los 6 meses de tratamiento. Conclusiones: el esquema de tratamiento utilizado con el propranolol oral de producción nacional induce una mejoría rápida de los pacientes con hemangiomas infantiles, acortando considerablemente la evolución natural de estos tumores, con escasos efectos secundarios(AU)

Introduction: infantile hemangiomas are the most frequent tumors in children. Although they are generally benign, its fast growth may turn them into life-threatening destructive tumors in roughly 1 percent of cases. At present, betablockers such as oral propranolol have been used with very good results. Objectives: to evaluate the effects and safety of Cuban-made propranolol for the treatment of infantile hemangiomas in proliferation phase. Methods: descriptive applied study of 21 patients with 26 infantile hemangiomas in proliferation phase. It was conducted from December 1st 2010 through June 31st 2012. The patients had been seen at the dermatology department of Juan Manuel Márquez teaching pediatric hospital and treated with Cuban-made orally administered propranolol at 2 mg/kg/day divided into 2 sub-doses. They were evaluated every 15 days up to the third month of treatment and monthly up to the 6 months of treatment. Adverse effects were recorded. Results: few days after the beginning of the treatment, the positive effect was evident in all the cases (favorable changes in staining or size). The adverse effects were slight and self-limited. The response to treatment was good or excellent in 99 percent of patients after 6 months of treatment. Conclusions: the treatment with Cuban-made orally administered propranolol induces rapid improvement of infantile hemangiomas in these children, considerably shortening the natural evolution of these tumors with low secondary effects(AU)

Intravitreal bevacizumab in the treatment of vasoproliferative retinal tumours.

AIM: To evaluate the efficacy of intravitreal bevacizumab in the treatment of retinal vasoproliferative tumours (VPT). MATERIALS AND METHODS: Six eyes of 6 patients with VPT who received intravitreal bevacizumab were retrospectively reviewed. All patients received between one and three injections of intravitreal bevacizumab depending upon response to treatment. Best-corrected visual acuity (BCVA), tumour size, and presence of co-pathology or sequelae were noted pre- and postoperatively and then analysed. Subsequent retreatments were performed in patients with recurrent or persistent VPT according to the ophthalmologist's discretion. Retreatments included photodynamic therapy with verteporfin, ruthenium-106 plaque brachytherapy, or endoresection of tumour. RESULTS: The mean follow-up duration was 33.3 months (range 10-66 months). At baseline, the mean logMAR BCVA was 1.45 (Snellen equivalent of 6/165); range 0.10-1.90 (6/8-CF). Following bevacizumab treatment the mean logMAR BCVA was 0.98 (Snellen equivalent of 6/57); range 0.5-1.9 (Snellen equivalent of 6/19 to CF). Therefore, there was no statistically significant change in visual acuity. The mean tumour thickness reduced from 2.4 to 2.1 mm following treatment with bevacizumab. However, this did not reach the statistical significance of P<0.05. Despite the visual improvement following bevacizumab therapy, five out of six patients had recurrence of tumour activity during the follow-up period and required further intervention in order to achieve sustained regression. CONCLUSIONS: Intravitreal bevacizumab appeared to result in temporary reduction of tumour thickness in 3 out of 6 VPT patients. However, neither the reduction in tumour thickness nor the change in visual acuity were statistically significant and intravitreal bevacizumab monotherapy had limited effectiveness in causing long-term regression of the lesions. Additional therapy was indicated in five out of six patients to establish long-term regression. The efficacy of bevacizumab as an adjunct is as yet undetermined and further studies are needed. Presently, we recommend other treatment modalities in the long-term management of VPTs.

A case report of chemo-sensitive intimal pulmonary artery sarcoma.

The incidence rate of pulmonary artery sarcoma is very low, but its prognosis is extremely poor. In this case report, after various initial diagnoses at the early stage, pulmonary artery sarcoma was confirmed by surgery. 1 year later, the tumor recurred. After chemotherapy, the patient showed improvement of the subjective complaint of tightness in the chest, and radiological lesion decreased in size. The survival time was extended by 2.5 years. This is the first case report of pulmonary artery sarcoma with such chemo-sensitivity.

Total resection of the aortic arch intimal sarcoma using the L-incision technique.

A 26-year-old male suffering from sudden right lower abdominal pain and lumbago was referred to our hospital. Enhanced computed tomography demonstrated bilateral kidneys and spleen infarctions, and a large tumour was found occupying the aortic arch and thoracic descending aorta. We suspected that these infarctions were due to tumour embolization. The aortic arch and thoracic descending aorta were resected with the tumour and then reconstructed using the L-incision technique. A microscopic examination revealed the presence of an intimal sarcoma. The patient was treated with adjuvant chemotherapy and showed a good postoperative course. Neither recurrence nor metastasis has been observed during the 3 years since the operation.

Management of intravenous leiomyomatosis with intracaval and intracardiac extension.

OBJECTIVE: To report the results of management of intravenous leiomyomatosis with intracaval and intracardiac extension at Peking Union Medial College Hospital. METHODS: We reviewed a cohort of 20 patients with intravenous leiomyomatosis extending to the inferior vena cava and heart, focusing on the clinical characteristics, the results of surgical management, and prognosis. RESULTS: The mean age of the patients was 42.4 ± 7.0 years. The clinical manifestations of intravenous leiomyomatosis are various and nonspecific, including pelvic mass, chest tightness and shortness of breath, swelling in the lower extremity, abdominal distension, palpitation, syncope, hypermenorrhea, and skelalgia. All the patients had history of uterine leiomyoma and 16 patients (80%) had undergone uterine leiomyoma operation. After careful preoperative evaluation, nine patients underwent one-stage operations (cardiac surgery, vascular and gynecologic surgery together) and 11 patients underwent two-stage operations (cardiac surgery first, then vascular and gynecologic surgery). There was no significant difference in the postoperative complication rate (33.3% compared with 27.3%; P>.99) between one-stage and two-stage operations. All operations were performed without severe surgical-related complications or death. Approximately 78% of patients had complete resection of tumor and 22.2% of the patients experienced incomplete resection. Eleven (55%) patients received hormone therapy postoperatively. During mean follow-up time of 20.5 months, recurrence occurred in five patients (27.8%) but all the patients survived. CONCLUSIONS: Precise and full-scale preoperative evaluation, complete tumor resection, and multidisciplinary cooperation are crucial for successful treatment.

In vitro effects of the tyrosine kinase inhibitor, masitinib mesylate, on canine hemangiosarcoma cell lines.

This study evaluated the in vitro activity of masitinib mesylate against canine hemangiosarcoma (HSA) cell lines after treatment with increasing concentrations of masitinib mesylate (0.01-100 µM) for 24, 48 and 72 h. Results indicated that masitinib mesylate caused a dose- and time-dependent decrease in HSA cell proliferation. The 50% inhibitory concentration (IC(50) ) at 72 h for three HSA cell lines (DEN, Fitz and SB) was found to be 8.56, 9.41 and 10.65 µM, respectively. Further investigation demonstrated that masitinib mesylate induced apoptosis in all HSA cell lines, including activation of caspase-3/7. Measurement of VEGF levels in cell supernatant found a statistically significant increased VEGF in close proximity to the IC(50) of each cell line followed by a decline back towards baseline. These findings indicate that masitinib mesylate causes dose-dependent HSA cell death in vitro and supports future clinical trials of masitinib for canine HSA.

Phosphotyrosine enrichment identifies focal adhesion kinase and other tyrosine kinases for targeting in canine hemangiosarcoma.

Canine hemangiosarcoma (HSA) is an endothelial cell malignancy driven, in part, by activating mutations in receptor and non-receptor tyrosine kinases. Proteomics, Western blots and a tyrosine kinase inhibitor were used to elucidate activating mechanisms in HSA cell lines. Phosphotyrosine peptides from focal adhesion kinase (FAK) STAT3, Lyn, Fyn and other signal transduction kinases were identified by mass spectrometry. FAK was constitutively activated at tyrosine 397, the autophosphorylation site, and this was reversible with high concentrations of a FAK inhibitor. FAK inhibitor-14 suppressed migration and phosphorylation of FAK tyrosine 397 and tyrosines 576/577 and was cytotoxic to HSA cells suggesting FAK signalling may be an important contributor to canine HSA survival.

[Bleomycin therapy for lymphangioma]. / Tratament cu bleomicina pentru limfangioame.

Lymphangiomas are uncommun congenital malformations of the lymphatic system, that involve the skin and subcutaneous tissues. Of the several types of treatment, surgical excision has been the preferred. There is a high recurrence rate because lymphangiomas tend to infiltrate the surrounding tissues. The bleomycin is a cytotoxic antitumoral antibiotic, that causes modifications of DNA. It has been also successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. We report the cases of five patients, with congenital lymphangioma, localized on the leg, in cervical and latero-thoracal region, treated with repeated intralesional bleomycin injections. The treatment indication was given by the location of this lesions and the infiltration of the surrounding vital tissues, that made the complete surgical excision impossible. Intralesional injection of bleomycin into the lymphangiomas was given at a dose, not exceeding 0,5 mg/kg of body weight, at intervals of 4 weeks. Complete resolution (n = 4) or significant improvement (n = 1) occurred in all patients treated. No other treatment was needed. We didn't notice local or general adverse effects. With this method we set the purpose to treat effectively this congenital malformations, obviating the need for invasive primary surgery or systemic treatment regimens. Toward other methods, intralesional bleomycin injections have a minimal risk of side effects (ulceration, pulmonary fibrosis).

Retinal vascular tumor and peripheral retinal vasculitis in the setting of systemic tuberculosis.

Tuberculosis commonly affects the eye by causing neovascularization, peripheral vasculitis, and choroidal tubercles. The authors describe a 28-year-old man with systemic tuberculosis who presented with a retinal vascular tumor, peripheral retinal vasculitis, retinal neovascularization, and vitreous hemorrhage causing acute vision loss. He was successfully treated with systemic anti-tuberculosis medications, retinal photocoagulation, and focal ablative diode laser to the tumor. Ophthalmologists should consider performing a purified protein derivative test and a chest x-ray for any patient with a history suspicious for tuberculosis who presents with a vascular tumor.

Intravascular B-cell lymphoma: the role of skin biopsy.

Intravascular B-cell lymphoma is a rare aggressive systemic neoplasm with cutaneous and neurological presentations, which commonly eludes the diagnosis ante mortem. First reported in 1959 as "angioendotheliomatosis proliferans" by Pfleger and Tappeiner, it is a subtype of extranodal diffuse large-B-cell lymphoma defined by an intravascular proliferation of clonal lymphocytes. We describe a case of intravascular lymphoma in a 68-year-old female who presented with altered mental status and indurated, erythematous, ecchymotic plaques with overlying telangiectasia and ulceration. The diagnosis was made by skin biopsy of an abdominal plaque revealing large hyperchromatic cells filling the lumina of several small blood vessels within the dermis and subcutis. CD20 and CD79a immunostains were strongly positive, confirming the diagnosis of intravascular large-B-cell lymphoma. On review of a previous biopsy from another institution, which was reported to be nondiagnostic, we were able to find tumor cells in the blood vessels but only very focally. The presence of a brisk, perivascular, nonneoplastic lymphocytic infiltrate may have obscured the identification of tumor cells. This case illustrates an unusual subtype of extranodal diffuse large-B-cell lymphoma, which demonstrates protean clinical presentations, requires microscopic examination for diagnosis, but can be easily overlooked on skin biopsy.

Endothelial cells and cancer.

Endothelial cells play a key role in the development and function of blood and lymph vessels. Excessive proliferation and transformation of endothelial cells lead to pathological angiogenesis/lymphangiogenesis or vascular malfunctions which are hallmarks of malignant disorders. There is emerging evidence that circulating endothelial progenitor cells (EPCs) also contribute significantly to these processes. Major progress has been achieved over the past few years in the identification of key molecules involved, and in targeting tumour angiogenesis for human therapy. Current research efforts are concentrated on deciphering the origin and functional properties of endothelium in various tumours, as well as endothelial neoplasms themselves. The aim of these studies is to investigate the molecular mechanisms regulating mobilisation of EPCs from bone marrow, and their homing and differentiation into mature endothelium in situ at sites of neovascularisation, as well as the role of viral oncogenes in regulating the plasticity and extending the life span of endothelial cells. Integrated understanding of the mechanisms regulating the properties and function of endothelial cells during tumourigenesis is resulting in the development of a number of exciting and bold approaches for the treatment of cancer.