Markedly improved overall survival in 10 consecutive patients with metastatic basal cell carcinoma.

BACKGROUND: Metastatic basal cell carcinoma (BCC) is a rare but life-threatening condition. Prior estimates of overall survival (OS) from time of diagnosis of distant metastasis to death are approximately 8-14 months. However, these estimates are based on analyses of case reports published prior to 1984. OBJECTIVES: To assess an updated OS in patients with metastatic BCC at a single academic institution. METHODS: Using patients seen from 1997 to 2011, a retrospective chart review was performed on biopsy-confirmed cases of distant metastatic BCC at Stanford University School of Medicine. Kaplan-Meier analysis was used to determine OS and progression-free survival (PFS). RESULTS: Ten consecutive cases of distant metastatic BCC were identified. Median OS was 7·3 years [95% confidence interval (CI) 1·6-∞]; median PFS was 3·4 years (95% CI 1·1-5·2). CONCLUSIONS: Our findings suggest that OS in patients with distant metastatic BCC may be more favourable than previously reported.

Induction of basal cell carcinoma features in transgenic human skin expressing Sonic Hedgehog.

Hedgehog (HH) signaling proteins mediate inductive events during animal development. Mutation of the only known HH receptor gene, Patched (PTC), has recently been implicated in inherited and sporadic forms of the most common human cancer, basal cell carcinoma (BCC). In Drosophila, HH acts by inactivating PTC function, raising the possibility that overexpression of Sonic Hedgehog (SHH) in human epidermis might have a tumorigenic effect equivalent to loss of PTC function. We used retroviral transduction of normal human keratinocytes to constitutively express SHH. SHH-expressing cells demonstrated increased expression of both the known HH target, BMP-2B, as well as bcl-2, a protein prominently expressed by keratinocytes in BCCs. These keratinocytes were then used to regenerate human skin transgenic for long terminal repeat-driven SHH (LTR-SHH) on immune-deficient mice. LTR-SHH human skin consistently displays the abnormal specific histologic features seen in BCCs, including downgrowth of epithelial buds into the dermis, basal cell palisading and separation of epidermis from the underlying dermis. In addition, LTR-SHH skin displays the gene expression abnormalities previously described for human BCCs, including decreased BP180/BPAG2 and laminin 5 adhesion proteins and expression of basal epidermal keratins. These data indicate that expression of SHH in human skin recapitulates features of human BCC in vivo, suggest that activation of this conserved signaling pathway contributes to the development of epithelial neoplasia and describe a new transgenic human tissue model of neoplasia.

Basal cell carcinomas in mice overexpressing sonic hedgehog.

Mutations in the tumor suppressor gene PATCHED (PTC) are found in human patients with the basal cell nevus syndrome, a disease causing developmental defects and tumors, including basal cell carcinomas. Gene regulatory relationships defined in the fruit fly Drosophila suggest that overproduction of Sonic hedgehog (SHH), the ligand for PTC, will mimic loss of ptc function. It is shown here that transgenic mice overexpressing SHH in the skin develop many features of basal cell nevus syndrome, demonstrating that SHH is sufficient to induce basal cell carcinomas in mice. These data suggest that SHH may have a role in human tumorigenesis.

Monstrous attempts at adnexogenesis: regulating hair follicle progenitors through Sonic hedgehog signaling.

Epithelial organs such as the vertebrate hair control periodic self-renewal by regulating the growth of progenitor cells. Recent studies implicate Sonic hedgehog target gene induction in the growth of multipotent hair follicle epithelium and the development of a variety of hair follicle tumors such as basal cell carcinomas. These studies suggest Sonic hedgehog signaling may regulate progenitor cells in other organs.

The Drosophila nuclear receptors: new insight into the actions of nuclear receptors in development.

In Drosophila melanogaster, an increasing number of members of the steroid hormone receptor superfamily are being identified and characterized. Molecular and genetic analysis of receptor function provides evidence for a set of functions underlying the determination of pattern formation, metamorphosis, eye development, and reproduction. Many of the Drosophila receptor genes show striking homologies to mammalian receptor genes. This suggests that genetic analysis in flies could facilitate the generation of biological models that pertain to complex hormonal responses in development and which are relevant to both vertebrate and invertebrate systems.

Transcriptional inhibition by a glucocorticoid receptor-beta-galactosidase fusion protein.

Binary developmental decisions and homeostatic regulation by steroids require negative transcriptional regulation to balance steroid-mediated stimulatory effects. Human glucocorticoid receptor mutants were used to identify regions important for trans-repression of the gene encoding the alpha subunit of chorionic gonadotropin. While the amino terminus is not critical, the DNA binding and ligand binding domains are required for efficient repression. However, the function of the carboxyl terminus can be substituted by a polypeptide from the human mineralocorticoid receptor or beta-galactosidase gene. The function of these fusion repressors supports the model that the human glucocorticoid receptor negatively regulates transcription via a steric hindrance mechanism. These results suggest a potentially general strategy for creation of sequence-specific transcriptional repressors.

Estrous cycle variations in levels of cholecystokinin immunoreactivity within cells of three interconnected sexually dimorphic forebrain nuclei. Evidence for a regulatory role for estrogen.

The central part of the medial preoptic nucleus (MPNc), the encapsulated part of the bed nucleus of the stria terminalis (BSTe), and the posterodorsal part of the medial nucleus of the amygdala (MeAp) are all though to be involved in the neural control of female reproductive behavior, as well as other neuroendocrine mechanisms. Although the developmental importance of gonadal steroids during the perinatal period on these sexual dimorphisms is well known, an understanding of possible activational effects on these cell groups of circulating gonadal steroids in the adult is less clear. In the present study we evaluated the number of cholecystokinin (CCK)-immunoreactive cells present within MPNc, BSTe, and MeAp of regularly cycling female rats over the estrous cycle. In addition, the effects of ovariectomy and estrogen replacement on CCK staining were also examined. The number of CCK-immunoreactive cells within each cell group varied over the estrous cycle with the fewest cells present in animals sacrificed while in diestrus. Proestrous female rats showed a greater number of cells within each nucleus, while intermediate numbers were found for animals in estrus. These changes appear to be due, at least in part, to changes in levels of circulating estrogen, since subcutaneous implants of estradiol prevented the decline in the number of CCK-stained cells within MPNC, BSTe, and MeAp that was seen in untreated, ovariectomized female rats. Thus, the present findings support the hypothesis that levels of CCK within cells of these three sexually dimorphic cell groups are regulated by circulating gonadal steroids within a physiologically relevant time frame and may possibly contribute to the activation of female reproductive behavior as well as other neuroendocrine functions.

Steroid hormone receptor homologs in development.

The steroid/thyroid receptor superfamily are ligand-dependent transcription factors which consist of distinct functional domains required for transcriptional control of a network of genes. Members of this superfamily are beginning to be studied for their contribution to embryogenesis. Two human receptors for the vertebrate morphogen retinoic acid have been isolated and further characterized on model promoters. Moreover, the presence of homologs of these receptors in Drosophila reveals that members of this superfamily predate the divergence of the vertebrates and invertebrates. One locus is knirps-related (knrl), whose product is closely related to that of the gap segmentation gene knirps (kni). knrl is one of the most diverged steroid receptor-like molecules and displays a spatially restricted blastoderm pattern.

Relationship between the product of the Drosophila ultraspiracle locus and the vertebrate retinoid X receptor.

The vitamin A derivative, retinoic acid, can regulate morphogenesis and differentiation in vertebrates. Two different subfamilies of the steroid receptor superfamily of transcription factors, the retinoic acid receptors and the retinoid X receptor, mediate the effects of retinoic acid. As part of an analysis of the hormonal control of development, we have examined the Drosophila genome for retinoic acid receptor homologues. Here we describe one such gene, XR2C, which encodes a product with structural similarity to the human retinoic acid-responsive transcription factor, retinoid X receptor. This receptor-like protein is encoded by ultraspiracle (usp), a locus required both maternally and zygotically for pattern formation. The discovery that the usp product is a retinoid X receptor homologue suggests that similar chemical cues underlie morphogenic signalling in vertebrate and invertebrate systems.

The Drosophila retinoid X receptor homolog ultraspiracle functions in both female reproduction and eye morphogenesis.

Ultraspiracle (usp) encodes the Drosophila cognate of RXR, the human retinoid X receptor. To examine how RXR subfamily members function in development, we have undertaken a phenotypic analysis of usp mutants. usp is required at multiple stages of development for functions that occur in a wide variety of tissues. usp is required in the eye-antennal imaginal disc for normal eye morphogenesis and in the somatic and germline tissues of adult females for fertilization, eggshell morphogenesis and embryonic development. An unusual sunken eye phenotype with marked ventral-dorsal polarity appears to be caused by a lack of usp function in the imaginal disc cells that reside between the eye and antennal anlage. The usp functions include cell autonomous and non-cell autonomous components, suggesting that usp controls the production of factors important for both cell-cell communication and cellular differentiation. These usp signalling pathways have mechanistic parallels to steroid and retinoid action in developing vertebrate tissues.

Molecular analysis of the inheritance and stability of the mitochondrial genome of an inbred line of maize.

We have investigated the inheritance of the mitochondrial DNA (mtDNA) restriction endonuclease digestion patterns of maize inbred line B37N in individual plants and pooled siblings in lineages derived from five separate plants in the third generation following successive self-pollinations. The restriction fragment patterns of the different mtDNA samples were compared after digestion with five endonucleases. No differences were visible in the mobilities of the 199 fragments scored per sample. Hybridization analysis with two different cloned mtDNA probes, one of which contains homologies to a portion of the S2 plasmid characteristic of cms-S maize, failed to reveal cryptic variation. The apparent rate of genomic change in maize mtDNA from inbred plants appears to be very slow, compared with the faster rates of change seen in maize tissue cultures and with the documented rapid rate of inter- and intraspecific variation for mammalian mtDNA.

Drosophila ultraspiracle modulates ecdysone receptor function via heterodimer formation.

The vertebrate retinoid X receptor (RXR) has been implicated in the regulation of multiple hormonal signaling pathways through the formation of heteromeric receptor complexes that bind DNA with high affinity. We now demonstrate that ultraspiracle (usp), a Drosophila RXR homolog, can substitute for RXR in stimulating the DNA binding of receptors for retinoic acid, T3, vitamin D, and peroxisome proliferator activators. These observations led to the search and ultimate identification of the ecdysone receptor (EcR) as a Drosophila partner of usp. Together, usp and EcR bind DNA in a highly cooperative fashion. Cotransfection of both EcR and usp expression vectors is required to render cultured mammalian cells ecdysone responsive. These results implicate usp as an integral component of the functional EcR. By demonstrating that receptor heterodimer formation precedes the divergence of vertebrate and invertebrate lineages, these data underscore a central role for RXR and its homolog usp in the evolution and control of the nuclear receptor-based endocrine system.

The Drosophila gene knirps-related is a member of the steroid-receptor gene superfamily.

Molecular cloning has demonstrated that the receptors for steroid, retinoid and thyroid hormones are part of a large superfamily of nuclear regulatory proteins. In vertebrates these molecules regulate diverse biological processes such as pattern formation, cellular differentiation and homeostasis. The universal necessity for embryonic and adult cells to respond to their external environment might mean that members of this family pre-date the divergence of vertebrates and invertebrates. We have screened a Drosophila genomic library for steroid receptor homologues using a human retinoic acid receptor complementary DNA as a hybridization probe. Several clones were recovered, one of which mapped to chromosomal position 77E1-2, the cytological location of the gap segmentation gene knirps. Sequence analysis of a cDNA clone representing the human retinoic acid receptor homologue showed similarity of the predicted protein to the vertebrate steroid receptors, as well as to the predicted knirps gene product. In situ hybridization of a cDNA probe to wild-type embryos revealed a uniform distribution of transcripts that were apparently maternally derived. Zygotic transcript accumulation begins in a broad anteroventral domain before the cellular blastoderm stage. At the cellular blastoderm stage two additional circumferential bands of transcript appear.

Characterization of three RXR genes that mediate the action of 9-cis retinoic acid.

An understanding of the differences and similarities of the retinoid X receptor (RXR) and retinoic acid receptor (RAR) systems requires knowledge of the diversity of their family members, their patterns of expression, and their pharmacological response to ligands. In this paper we report the isolation of a family of mouse RXR genes encoding three distinct receptors (RXR alpha, beta, and gamma). They are closely related to each other in their DNA- and ligand-binding domains but are quite divergent from the RAR subfamily in both structure and ligand specificity. Recently, we demonstrated that all-trans retinoic acid (RA) serves as a "pro-hormone" to the isomer 9-cis RA, which is a high-affinity ligand for the human RXR alpha. We extend those findings to show that 9-cis RA is also "retinoid X" for mouse RXR alpha, beta, and gamma. Trans-activation analyses show that although all three RXRs respond to a variety of endogenous retinoids, 9-cis RA is their most potent ligand and is up to 40-fold more active than all-trans RA. Northern blot and in situ hybridization analyses define a broad spectrum of expression for the RXRs, which display unique patterns and only partially overlap themselves and the RARs. This study suggests that the RXR family plays critical roles in diverse aspects of development, from embryo implantation to organogenesis and central nervous system differentiation, as well as in adult physiology.

Identification of a nuclear receptor that is activated by farnesol metabolites.

Nuclear hormone receptors comprise a superfamily of ligand-modulated transcription factors that mediate the transcriptional activities of steroids, retinoids, and thyroid hormones. A growing number of related proteins have been identified that possess the structural features of hormone receptors, but that lack known ligands. Known as orphan receptors, these proteins represent targets for novel signaling molecules. We have isolated a mammalian orphan receptor that forms a heterodimeric complex with the retinoid X receptor. A screen of candidate ligands identified farnesol and related metabolites as effective activators of this complex. Farnesol metabolites are generated intracellularly and are required for the synthesis of cholesterol, bile acids, steroids, retinoids, and farnesylated proteins. Intermediary metabolites have been recognized as transcriptional regulators in bacteria and yeast. Our results now suggest that metabolite-controlled intracellular signaling systems are utilized by higher organisms.