Malignant pleural mesothelioma (MPM) is an asbestos-induced cancer with poor prognosis that displays characteristic alterations in microRNA expression. Recently it was reported that the expression of a subset of microRNAs can distinguish between MPM and adenocarcinoma of the lung. However, the functional importance of these changes has yet to be investigated. We compared expression of miR-192, miR-193a-3p and the miR-200 family in normal pleura and MPM tumor specimens and found a statistically significant reduction in the levels of miR-193a-3p (3.1-fold) and miR-192 (2.8-fold) in MPM. Transfection of MPM cells with a miR-193a-3p mimic resulted in inhibition of growth and an induction of apoptosis and necrosis in vitro. The growth inhibitory effects of miR-193a-3p were associated with a decrease in MCL1 expression and were recapitulated by RNAi-mediated MCL1 silencing. Targeted delivery of miR-193a-3p mimic using EDV minicells inhibited MPM xenograft tumour growth, and was associated with increased apoptosis. In conclusion, miR-193a-3p appears to have importance in the biology of MPM and may represent a target for therapeutic intervention.

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Clinical pharmacy services aim to optimise health outcomes and improve patient safety throughout all steps of the medicines management pathway, by ensuring the quality use of medicines and minimising medication-related problems. The role of the pharmacist includes gathering and documenting medication histories, performing medication reconciliation and undertaking clinical medication reviews. These services support collaborative approaches between patients, carers and the multidisciplinary team to develop patient-centred medication management plans. The practice of pharmacotherapy at the Walker Unit shares features in common with prescribing in acute child and adolescent mental health inpatient units, but there are some differences. This chapter will in particular seek to highlight the characteristics of pharmacotherapy that are distinct to longer stay intensive psychiatric care.