Linezolid is an antimicrobial agent to treat infections by Gram-positive pathogens, including methicillinresistant Staphylococcus aureus (MRSA). While effective, linezolid treatment frequently is associated with hematological side effects, especially thrombocytopenia. However, little is known about the mechanism of this side effect and the exposure-response relationship. The present population pharmacokinetic/pharmacodynamic (PPK/PD) study was undertaken to elucidate the factors that determine linezolid levels, the relationship between exposure to linezolid and a decrease in platelet counts, and appropriate dosage adjustments based on exposure levels. In total, 50 patients (135 plasma samples) were used for the PPK analysis. The PPK analysis revealed that renal function and severe liver cirrhosis (Child Pugh grade C) significantly affect the pharmacokinetics of linezolid according to the equation clearance (liter/h) ‫؍‬ 2.85 ؋ (creatinine clearance/60.9) 0.618 ؋ 0.472 CIR (CIR indicates cirrhosis status; 0 for noncirrhosis, 1 for cirrhosis patients). Using 603 platelet counts from 45 patients, a PPK/PD analysis with a semimechanistic pharmacodynamic model described the relationship between linezolid exposure and platelet counts quantitatively, and the newly constructed model was validated using external data (776 platelet counts from 60 patients). Simulation indicated considerable risks in patients with insufficient renal function (creatinine clearance, <30 ml/min) or severe liver cirrhosis. For these patients, a reduced dosage (600 mg/day) would be recommended for sufficient efficacy (area under the concentration-time curve over 24 h in the steady state divided by the MIC, >100) and safety.

Hypoxia-inducible factor 1 (HIF-1) is involved in tumor progression/metastasis and activated in various cancers. Here we show that HIF-1A, which plays a major role in HIF-1 activation, is overexpressed in preneoplastic hepatocytic lesions from a very early stage during hepatocarcinogenesis in mice and man. Transcriptional targets of HIF-1, such as vascular endothelial growth factor, glut-1, c-met, and insulinlike growth factor II (IGF-II), were also overexpressed in mouse lesions. Oxygen tension within the lesions was not different from that of the normal hepatic tissues, indicating that HIF-1A expression was independent of hypoxia. On the other hand, Akt, the pathway of which can up-regulate HIF-1A expression, was activated in the mouse lesions, whereas HIF-1A was markedly down-regulated in the mouse hepatocellular carcinoma (HCC) cell lines after treatment with a phosphatidylinositol 3-kinase (PI3K) inhibitor, LY294002, indicating that HIF-1A expression is dependent on PI3K/Akt signaling. Conversely, HIF-1A knockdown by short interfering RNA in the HCC cell line resulted in decreased expression of activated Akt together with the HIF-1 target genes, indicating that Akt activation is reversely dependent on HIF-1 activation. Treating the HCC cells with IGF-II or epidermal growth factor (EGF) up-regulated both phospho-Akt and HIF-1A, whereas inhibition of IGF-II or EGF signaling down-regulated them both, suggesting that IGF-II and EGF can, at least in part, mediate the activation of Akt and HIF-1A. However, Akt was not activated by IGF-II or EGF in the HIF-1A knockdown cells, indicating that expression of the HIF-1 target genes is necessary for the Akt activation. These findings suggest that the reciprocal activation of PI3K/Akt signaling and HIF-1A may be important in the progression of hepatocarcinogenesis.

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Background. Although the prevalence of K‐ras codon 12 mutations in biliary tract (BT) tumors has been addressed in previous studies, the results have shown large discrepancies in mutation frequency. Methods. K‐ras codon 12 mutations were investigated by polymerase chain reaction (PCR)‐denaturing gradient gel electrophoresis (DGGE), a sensitive method for detecting DNA base changes, in a large series of BT tumors. Results. In A‐549 cells, which are known to contain a G to A change at the first base of K‐ras codon 12, the mutation could be detected by DGGE even after 1:16 dilution with normal DNA. Tumor samples were microdissected from paraffin embedded tissue sections to ensure the presence of the tumor cells. K‐ras mutations were detected in 13 of 23 bile duct tumors (56.5%) and in 9 of 23 gallbladder tumors (39.1%) by DGGE. However, no mutations were detected in normal, hyperplastic, and dysplastic BT epithelium or in tumorlike lesions, such as adenomyomatous hyperplasia, cholesterol polyps, and cystitis glandularis proliferans. The samples exhibiting abnormalities on DGGE showed a base change at K‐ras codon 12 when examined by oligonucleotide hybridization. Conclusions. K‐ras codon 12 mutations are seen often in BT tumors, and a combination of microdissection and PCR‐DGGE is an effective approach for their detection. Cancer 1994; 73:2727–33.

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Mucin-producing tumors of the pancreas (MPT) are characterized by the production of much mucin and a benign course after surgical treatment. We examined 16 cases of MPT and 20 cases of "common" pancreatic duct cell carcinomas (DCC) in regard to K-ras and p53 mutations. The mutations were detected by constant denaturant gel electrophoresis in combination with other techniques using PCR products amplified from the samples microdissected from the tissue sections. K-ras codon 12 mutations were identified in all MPT and in 95% of DCC. On the other hand, p53 mutations were found in four of 20 (20%) DCC, and p53 was immunocytochemically overexpressed in 3 of the 4 mutated cases. However, no p53 mutations and no p53 overexpression were identified in the 16 MPT. These results indicate that, although the K-ras codon 12 mutations may be almost essential for the development of both MPT and DCC, p53 mutations seemed to be involved mainly to the latters.

Mutational activation of beta-catenin and cyclin D1 over-expression are a frequent change in mouse hepatic tumors. Although activated beta-catenin may bind to T cell factor (TCF) family members and transcriptionally activate the cyclin D1 gene, either beta-catenin or cyclin D1 may be activated by various pathways independently of beta-catenin mutations. In this study, we investigated beta-catenin activation and mutations, cyclin D1 expression, H-ras mutations and phosphorylation of extracellular signal regulated protein kinases 1/2 (ERK1/2), Akt and glycogen synthetase kinase 3beta (GSK3 beta) in mouse hepatic carcinogenesis. Nuclear/cytoplasmic staining of beta-catenin, a sign of beta-catenin activation, was frequently observed in association with the high nuclear cyclin D1 labeling index in the hepatic tumors at the late stage of carcinogenesis. The beta-catenin activation was further suggested by the fact that all hepatocellular carcinoma (HCC) cell lines examined showed the nuclear beta-catenin/TCF4 complex together with cyclin D1 over-expression. However, the fact that only 31.8% (7/22) of the lesions with the nuclear/cytoplasmic beta-catenin staining showed beta-catenin mutations indicated that beta-catenin was activated not only by its own mutations but also by other reason(s). On the other hand, there was no correlation between the beta-catenin/cyclin D1 activation and the H-ras mutations or phosphorylation of Akt, GSK3 beta and ERK1/2, although GSK3 beta was frequently over-expressed in the tumors. These results indicate that, although beta-catenin and cyclin D1 activation are well correlated, the Akt/GSK3 beta and ras/ERK1/2 pathways may not play a major role in the beta-catenin/cyclin D1 activation.

Background: Analysis of genes that are differentially expressed in patients with atopic dermatitis (AD) and normal individuals will provide important information on the underlying molecular pathogenetic mechanisms of AD. Methods: Transcript of freshly isolated peripheral blood T cells from 59 individuals were analyzed with a fluorescent differential display (FDD) method. Ninety-two differentially expressed genes were identified in this manner. Additionally, real-time quantitative RT-PCR was employed to investigate the expression of the FDD-selected genes and also genes related to T cell function. Results: A number of genes, including CC chemokine receptor 4, T cell-specific tyrosine kinase (Emt/Itk), integrin β1, integrin α6, IQGAP1 and MAR/SAR DNA-binding protein (SATB1), were shown to be more highly expressed in patients with moderate and/or severe AD than in controls or patients with mild AD. Because the products of these upregulated genes influence chemotaxis, adhesion, migration and Th2 polarization, it is suggested that in more severe AD, circulating T cells may function differently in this regard. Several other genes, the role of which in T cell function is currently unknown, were also found to be differentially expressed in AD. These included the heat shock protein 40 and vasopressin-activated calcium-mobilizing receptor 1. Conclusion: The upregulated genes identified in this work may serve as useful markers for moderate to severe AD as opposed to normal or mild AD and also as markers indicating progression to more severe AD. Further functional characterization will provide a better understanding of the pathophysiology of circulating T cells in AD.