Characterization of real-world treatment practices and outcomes among patients with chronic lymphocytic leukemia treated in a Finnish tertiary center.

Objectives: We conducted this retrospective study to characterize the change in chronic lymphocytic leukemia (CLL) treatment patterns between 2005 and 2019, to understand the treatment sequencing across the course of the disease, and to investigate how targeted agents and prognostic testing were implemented into the patient care. Methods: This study included adult patients with CLL treated at the Hospital District of Southwest Finland during the study period. Data were collected from the Turku University Hospital data lake. Results: In total, 122 and 60 patients received first- and second-line treatments for CLL, respectively. The shift from conventional chemoimmunotherapy to targeted treatments in recent years (2014-2019) was observed. The median overall survival times were not reached in patients treated with targeted agents compared to conventional standard treatments in first- and second-line settings and improved toward the end of the study period. Prognostic testing increased during the study follow-up and patients with unmutated immunoglobulin heavy-chain variable showed significantly poorer overall survival and time-to-next-treatment outcomes than patients with mutated immunoglobulin heavy-chain variable. Conclusions: This real-world study implicated added value of targeted chemo-free therapies as reported in randomized clinical trials, and highlighted the necessity of prognostic testing in order to improve treatment selection and patient outcomes.

First Trimester Plasma Glucose Values in Women without Diabetes are Associated with Risk for Congenital Heart Disease in Offspring.

In a retrospective study of 19 171 mother-child dyads, elevated random plasma glucose values during early pregnancy were directly correlated with increased risk for congenital heart disease in offspring. Plasma glucose levels proximal to the period of cardiac development may represent a modifiable risk factor for congenital heart disease in expectant mothers without diabetes.

Methyltransferase expression and tumor suppressor gene methylation in sporadic and familial colorectal cancer.

Molecular mechanisms underlying coordinated hypermethylation of multiple CpG islands in cancer remain unclear and studies of methyltransferase enzymes have arrived at conflicting results. We focused on DNMT1 and DNMT3B, DNA methyltransferases responsible for (de novo) methylation, and EZH2, histone (H3K27) methyltransferase, and examined their roles in tumor suppressor gene (TSG) methylation patterns we have previously established in sporadic and familial cancers. Our investigation comprised 165 tumors, stratified by tissue of origin (117 colorectal and 48 endometrial carcinomas) and sporadic vs. familial disease (57 sporadic vs. 60 familial, mainly Lynch syndrome, colorectal carcinomas). By immunohistochemical evaluation, EZH2 protein expression was associated with a TSG methylator phenotype. DNMT1, DNMT3B, and EZH2 were expressed at significantly higher levels in tumor vs. normal tissues. DNMT1 and EZH2 expression were positively correlated and higher in microsatellite-unstable vs. microsatellite-stable tumors, whether sporadic or hereditary. Ki-67 expression mirrored the same pattern. Promoter methylation of the methyltransferase genes themselves was addressed as a possible cause behind their altered expression. While DNMT1 or EZH2 did not show differential methylation between normal and tumor tissues, DNMT3B analysis corroborated the regulatory role of a distal promoter region. Our study shows that methyltransferase expression in cancer depends on the tissue of origin, microsatellite-instability status, cellular proliferation, and--in the case of DNMT3B--promoter methylation of the respective gene. Translation of methyltransferase expression into DNA methylation appears complex as suggested by the fact that except for EZH2, no clear association between methyltransferase protein expression and TSG methylation was observed.

LINE-1 hypomethylation in familial and sporadic cancer.

Increased and decreased methylation at specific sequences (hypermethylation and hypomethylation, respectively) is characteristic of tumor DNA compared to normal DNA and promotes carcinogenesis in multiple ways including genomic instability. Long interspersed element (LINE), an abundant class of retrotransposons, provides a surrogate marker for global hypomethylation. We developed methylation-specific multiplex ligation-dependent probe amplification assays to study LINE-1 methylation in cases of colorectal, gastric, and endometrial cancer (N = 276), stratified by patient category [sporadic; Lynch syndrome (LS); familial colorectal cancer type X (FCCX)] and microsatellite instability status. Within each patient group, LINE-1 showed lower methylation in tumor DNA relative to paired normal DNA and hypomethylation was statistically significant in most cases. Interestingly, normal colorectal mucosa samples from different patient groups displayed differences in LINE-1 methylation that mirrored differences between the respective tumor tissues, with a decreasing trend for LINE-1 methylation from patients with sporadic colorectal cancer to LS to FCCX. Despite the fact that the degree of LINE-1 methylation is generally tissue specific, normal colorectal mucosa, gastric mucosa, and endometrium from LS patients showed similar levels of LINE-1 methylation. Our results suggest that the degree of LINE-1 methylation may constitute a "field defect" that may predispose normal tissues for cancer development.

Epigenetic signatures of familial cancer are characteristic of tumor type and family category.

Tumor suppressor genes (TSG) may be inactivated by methylation of critical CpG sites in their promoter regions, providing targets for early detection and prevention. Although sporadic cancers, especially colorectal carcinoma (CRC), have been characterized for epigenetic changes extensively, such information in familial/hereditary cancer is limited. We studied 108 CRCs and 63 endometrial carcinomas (EC) occurring as part of hereditary nonpolyposis CRC, as separate familial site-specific entities or sporadically, for promoter methylation of 24 TSGs. Eleven genes in CRC and 6 in EC were methylated in at least 15% of tumors and together accounted for 89% and 82% of promoter methylation events in CRC and EC, respectively. Some genes (e.g., CDH13, APC, GSTP1, and TIMP3) showed frequent methylation in both cancers, whereas promoter methylation of ESR1, CHFR, and RARB was typical of CRC and that of RASSF1(A) characterized EC. Among CRCs, sets of genes with methylation characteristic of familial versus sporadic tumors appeared. A TSG methylator phenotype (methylation of at least 5 of 24 genes) occurred in 37% of CRC and 18% of EC (P = 0.013), and the presence versus absence of MLH1 methylation divided the tumors into high versus low methylation groups. In conclusion, inactivation of TSGs by promoter methylation followed patterns characteristic of tumor type (CRC versus EC) and family category and was strongly influenced by MLH1 promoter methylation status in all categories. Paired normal tissues or blood displayed negligible methylation arguing against a constitutional methylation abnormality in familial cases.

Latanoprost exerts neuroprotective activity in vitro and in vivo.

Prostaglandins may influence cyclo-oxygenase (COX-2) and nitric oxide (NO) synthase activity, thus interfering with ischemia-induced neurotoxic processes. The prostaglandin synthetic derivative, latanoprost was tested in different in vivo and in vitro models of neuronal damage in order to study its influence on these processes. Ischemia was induced in rats by bilateral occlusion of the carotid arteries for 30 min. Latanoprost (0.01 mg x kg(-1)per die, i.p. for 3 days) or the ionotropic glutamate receptors antagonist, MK-801 (0.1 mg x kg(-1)per die, i.p. for 3 days) were equal in preventing lactate accumulation in retinal tissue of animals subjected to acute ischemia. Similar results were obtained in animals with retinal ischemia induced by increasing intraocular pressure to 120 mm Hg for 45 min. PGF2alpha, PGE2, latanoprost and acid of latanoprost (PhXA85) reduced the release of LDH from primary cultures of human retinal cells in vitro subjected to glutamate (10 microM) or hypoxia/re-oxygenation exposure. This effect was observed only at concentrations of 1-0.01 microM for PGF2alpha and PGE2, and of 0.1-0.001 microM for latanoprost (0.01 microM-0.1 nM for PhXA85). The COX-2 activity in cultured retinal cells exposed to glutamate was measured as PGE2 production when latanoprost was applied compared to arachidonic acid (AA) at different molar concentrations. The COX-2 activity was reduced by arachidonic acid (0.1-0.01 microM) as well as by latanoprost (0.1-0.001 microM) and PhXA85 (0.01-0.001 microM) in retinal cells exposed to glutamate. Inhibition of inducible NO synthase was also found with the same drug concentrations. These results suggest that latanoprost exerts a neuroprotective activity in vitro and in vivo. This effect seems to be present only at low concentrations of the drug. A negative feedback on neuronal COX-2 activity may be possibly involved.

Effects of sulfinpyrazone on retinal damage induced by experimental diabetes mellitus in rabbits.

The protective activity of the phenylbutazone derivative, sulfinpyrazone on retinal lesions has been assessed in rabbits with severe streptozotocin-induced diabetes. Sulfinpyrazone (8 mg kg-1 per day per os) was administered in diabetic animals in two different experimental procedures: for 135 days in a preventive approach (beginning on the day of initial hyperglicaemia); and for 30 days in a therapeutic approach (beginning on the day of appearance of severe retinal damage). The drug treatment made either with the preventive or the therapeutic approach reduced the incidence of serious retinal lesions and increased that of light lesions as assessed by a biomicroscopic method. Biochemical analyses showed that experimental diabetes was accompanied by sustained decrease in glucose and pyruvate and an increase of the lactate content in the retina. A decrease of alpha-ketoglutarate and citrate and an increase of succinate were also observed along with a decrease of ATP, ADP and an increase in AMP. Either the preventive or the therapeutic approach was followed by an increased pyruvate and ATP content and decreased lactate and AMP content in the retinal tissue. It is possible that this drug acts on the retinal tissue by inhibiting platelet aggregation and protecting vasal endothelium with the consequent suppression of the release of vasoactive substances that facilitate platelet adhesion.

Effects of beta-blockers association with pilocarpine on rabbit intraocular pressure and heart rate.

The effect of 7-days BID (twice in a day) or TID (three times in a day) administration of the eye-drop combinations of timolol and pilocarpine (0.5% and 2%, respectively), metipranolol and pilocarpine (0.1% and 2%, respectively) or placebo on intraocular pressure (IOP) and heart rate (HR) of conscious rabbits were studied in order to assess the pharmacological potency of the combinations and their heart side effects. TID administration of both pharmacological combinations was followed by similar decrease of IOP as measured over 24 h (at 4.00 and 20.00 h). After the BID administration, a reduction in IOP was observed only twice with the timolol-pilocarpine combination. In contrast, a constant reduction in IOP was seen with the metipranolol-pilocarpine combination. Furthermore, the TID administration of the timolol-pilocarpine combination exerted a decrease of IOP that appeared to be more pronounced than that observed after the BID administration of the same combination, while no difference was found between the TID and BID administration of the metipranolol-pilocarpine treatment. Heart rate, when measured after 7 days of treatment, appeared to be constantly decreased only in the group of animals which received the TID administration of timolol-pilocarpine combination. The present results suggest that the BID or TID administration of metipranolol-pilocarpine combination was fully effective in reducing IOP without influencing HR. The timolol-pilocarpine association appeared to be fully active in reducing IOP only under the TID administration schedule. However, this rate of administration was followed by a constant reduction of HR. Thus, on a dose basis the metipranolol-pilocarpine combination appeared to be more effective in reducing IOP and less effective in inducing bradycardia than the timolol-pilocarpine association.

Behavioral effects of amylin injected intracerebroventricularly in the rat.

Amylin is a peptide of pancreatic origin that has been reported to possess high-affinity binding sites in the brain and to affect central dopaminergic and serotonergic neurotransmission. Administered ICV the peptide induced a dose-dependent decrease of locomotor activity without affecting grooming and sniffing. At a dose of 5 micrograms/ rat, it antagonized the hypermotility and stereotypies induced by s.c. injection of amphetamine (2 mg/kg) or of the dopamine receptor agonist, apomorphine (250 mg/kg). Amylin did not change significantly the effect of haloperidol (0.5 mg/kg, s.c.) on locomotor activity, grooming, and sniffing. Moreover, the peptide did not modify the locomotor behavior of animals injected with the 5-HT2 antagonist, ritanserin (2 mg/kg, s.c.). These results suggest that amylin may exert motor effects, probably by interfering with central dopaminergic neurotransmission.