Aromatase inhibitors (AI) profoundly suppress estrogen levels in postmenopausal women and are effective in breast cancer prevention among high-risk postmenopausal women. Unfortunately, AI treatment ...is associated with undesirable side effects that limit patient acceptance for primary prevention of breast cancer. A double-blind, randomized trial was conducted to determine whether low and intermittent doses of letrozole can achieve effective estrogen suppression with a more favorable side-effect profile. Overall, 112 postmenopausal women at increased risk for breast cancer were randomized to receive letrozole at 2.5 mg once daily (QD, standard dose arm), 2.5 mg every Monday, Wednesday, and Friday (Q-MWF), 1.0 mg Q-MWF, or 0.25 mg Q-MWF for 24 weeks. Primary endpoint was suppression in serum estradiol levels at the end of letrozole intervention. Secondary endpoints included changes in serum estrone, testosterone, C-telopeptide (marker of bone resorption), lipid profile, and quality-of-life measures (QoL) following treatment. Significant estrogen suppression was observed in all dose arms with an average of 75% to 78% and 86% to 93% reduction in serum estradiol and estrone levels, respectively. There were no differences among dose arms with respect to changes in C-telopeptide levels, lipid profile, adverse events (AE), or QoL measures. We conclude that low and intermittent doses of letrozole are not inferior to standard dose in estrogen suppression and resulted in a similar side-effect profile compared with standard dose. Further studies are needed to determine the feasibility of selecting an effective AI dosing schedule with better tolerability.
Rituximab is a humanized monoclonal antibody directed against CD20-positive B cells and originally developed for the treatment of non-Hodgkins lymphoma. We report a case of severe mucous membrane ...pemphigoid responsive to rituximab infusions. The clinical presentation, etiology, and management options for mucous membrane pemphigoid are also discussed.
Several different models have been proposed for the transmembrane structure of receptors for the neurotransmitter L-glutamate. In this study, the sites of N-linked oligosaccharides on GluR6, a member ...of the kainate class of ionotropic glutamate receptors, were examined. Site-directed mutagenesis was utilized to alter the consensus sequence at three potential sites for N-linked glycosylation in the carboxyl-terminal half of the molecule. The presence of a carbohydrate substitution was monitored by shifts in the relative molecular weight of the mutant receptors on immunoblots. Molecular weight shifts were observed for the mutants N515Q and N720Q and for two companion mutants, T517A and T722A, which also eliminate the consensus sequence for N-linked glycosylation. No shift in molecular weight was observed in the the mutant N574Q. These results indicate that asparagines 515 and 720 are glycosylated and thus are likely located extracellularly. In immunocytochemical analyses of GluR6 expressed in baculovirus-infected cells, permeabilization with detergents was required for immunostaining with a carboxyl-terminal antibody, indicating that the carboxyl terminus is located intracellularly. Electrophysiological recordings of the mutant receptors expressed in human embryonic kidney cells demonstrated that the amplitudes of the kainate-activated currents mediated by the N574Q, N720Q, and the T722A mutants were not significantly different from currents mediated by wild type GluR6 receptors, while the currents mediated by the N515Q and T517A mutants were significantly depressed. Based on these findings, we propose a model for the transmembrane topology of GluR6.
There is a strong correlation between Hebbian, NMDA receptor-dependent long-term potentiation (LTP), place-cell firing, and learning and memory. We made glutamate receptor 2 (GluR2) null mutant mice ...that show enhanced non-Hebbian LTP in hippocampal CA1 neurons and impaired performance in a spatial learning task. We concluded that in vivo hippocampal place cells of GluR2 mutant mice were functionally impaired because (1) only 22.6% of CA1 neurons showed place fields in GluR2 mutant mice, which was significantly lower than that (43.8%) in wild-type mice; (2) GluR2 mutant place fields were much less precise; and (3) GluR2 mutant place fields were extremely unstable. Our data suggest that place cells of GluR2 knock-out mice did not form robust place fields, and that enhanced non-Hebbian LTP might play a negative role in their formation.
Paraneoplastic syndromes can precede the initial manifestation and diagnosis of cancer. Paraneoplastic syndromes are a heterogeneous group of disorders caused by mechanisms other than the local ...presence of tumor cells. These phenomena are mediated by humoral factors secreted by tumor cells or by tumor mediated immune responses. Among paraneoplastic syndromes, chronic intestinal pseudo-obstruction (CIPO) is rare and represents a particularly difficult clinical challenge. Paraneoplastic CIPO is a highly morbid syndrome characterized by impaired gastrointestinal propulsion with symptoms and signs of mechanical bowel obstruction. Clinical outcomes of paraneoplastic CIPO are often deleterious. The current standard of care for the management of CIPO includes supportive treatment with promotility and anti-secretory agents. However, the majority of patients with CIPO eventually require the resection of the non-functioning gut segment. Here, we present a 62-year-old patient with anti-Hu antibody associated paraneoplastic CIPO and underlying small cell lung cancer who underwent treatment with cisplatin and etoposide. Herein, we discuss diagnosis, prognosis, proposed mechanisms, treatment options, and future potential therapeutic strategies of paraneoplastic CIPO.
The inhibitory effects of pentobarbital on various AMPA receptors expressed (GluR1, GluR3, GluR1/3, GluR1/2, and GluR2/3) in Xenopus oocytes were examined. Combinations of AMPA receptor subunits that ...included GluR2 demonstrated a much higher sensitivity to blockade by this barbiturate and the apparent co-operativity of the interaction of pentobarbital with the receptor was reduced. This evidence demonstrates that the GluR2 subunit alters the structure of AMPA receptors in such a way as to facilitate any interaction with this barbiturate.
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