Rapamycin may provide a useful means of abrogating tumor growth and controlling hypoglycemia in malignant insulinomas by reducing the malignant beta-cell growth and proliferation as well as inhibiting insulin production.

In these patients, sunitinib reduced biochemical markers and stabilized or reduced tumor bulk and may therefore be a potential therapeutic option for these tumor types.

We studied the mechanism of transepithelial zinc (Zn) transport using monolayers of Caco-2 cells grown on permeable filter supports. 65Zn transport could be fitted to a modified Michaelis-Menten equation, which includes a nonsaturable [linear diffusion constant of nonsaturable component (Kd) = 0.08%.cm-2.90 min-1] and a saturable component [upper well Zn concentration at half Jmax (Kt) = 226 microM and maximal rate of saturable Zn transport (Jmax) = 1.06 nmol.cm-2.90 min-1]. Caco-2 cells contained metal-inducible metallothionein (MT) protein and mRNA as well as mRNA for cysteine-rich intestinal protein (CRIP). Cells pretreated with 10 nM 1 alpha,25-dihydroxyvitamin D3 [1 alpha,25(OH)2D3] for 3 days transported more Zn (159%) than controls (0.48 +/- 0.02 nmol.cm-2.90 min-1) when each was incubated with 100 microM Zn for 90 min. This effect was significant after 24 h of 1 alpha,25-(OH)2D3 pretreatment and continued to increase up to 72 h, with concomitant increases in MT mRNA levels being observed (4-fold by 24 h, 10-fold by 72 h). MT protein levels were only modestly elevated by 72 h 1 alpha,25(OH)2D3 treatment (from 0.32 +/- 0.04 to 0.45 +/- 0.03 nmol MT/mg protein). CRIP mRNA levels were reduced by 1 alpha,25(OH)2D3 treatment. The lysosome-disrupting agent quinacrine (0.5 mM) inhibited basal Zn transport by 68%, suggesting the possible presence of a lysosome-mediated component for transepithelial Zn transport in Caco-2 cells. 1 alpha,25(OH)2D3-stimulated Zn transport was not affected by quinacrine, suggesting that 1 alpha,25(OH)2D3-induced Zn transport is distinct from the putative lysosome-mediated Zn transport pathway.

Orthostasis due to autonomic neuropathy can cause severe debilitation and prove refractory to treatment. This report describes a case of severe sympathetic and parasympathetic autonomic dysfunction as a consequence of acetylcholine receptor antibodies and Sjogren’s syndrome. Symptomatic management, plasma fluid expanders, and IVIG therapy failed to offer a salutary response to the condition. Etanercept therapy provided improvement of the orthostasis and autonomic function measured as high and low frequency respiratory effects on heart rate variability as well as enhancement of skin blood flow using Laser Doppler. It would be of considerable interest to determine the effectiveness of etanercept in other autoimmune neuropathies.