Background: Bone marrow-derived endothelial progenitor cells (EPCs) are critical for metastatic progression. This study explores the effect of tetrathiomolybdate (TM), an anti-angiogenic copper chelator, on EPCs in patients at high risk for breast cancer recurrence.
Patients and methods:This phase 2 study enrolled breast cancer patients with stage 3 and stage 4 without evidence of disease (NED), and stage 2 if triple-negative. TM 100 mg orally was administered to maintain ceruloplasmin <17 mg/dl for 2 years or until relapse. The primary end point was change in EPCs.Results: Forty patients (28 stage 2/3, 12 stage 4 NED) were enrolled. Seventy-five percent patients achieved the copper depletion target by 1 month. Ninety-one percent of triple-negative patients copper-depleted compared with 41% luminal subtypes. In copper-depleted patients only, there was a significant reduction in EPCs/ml by 27 (P = 0.04). Six patients relapsed while on study, of which only one patient had EPCs maintained below baseline. The 10-month relapse-free survival was 85.0% (95% CI 74.6%-96.8%). Only grade 3/4 toxicity was hematologic: neutropenia (3.1% of cycles), febrile neutropenia (0.2%), and anemia (0.2%).Conclusions: TM is safe and appears to maintain EPCs below baseline in copper-depleted patients. TM may promote tumor dormancy and ultimately prevent relapse.
Plasma cell acid phosphatase (AP) activity and thymidine labeling index (LI%) were evaluated concomitantly in 52 patients with monoclonal gammopathies. AP score, percentage of AP positive plasma cells, and LI% were significantly higher in 26 patients with multiple myeloma (MM) at the time of diagnosis than in 11 monoclonal gammopathy of undetermined significance (MGUS) and eight smoldering myeloma (SM) patients. LI% had the highest statistical correlation with disease status. A 1% cutoff could clearly separate the patients with progressive MM compared to those with stable disease (SM-MGUS) (P less than .001). There was a significant overall correlation between the AP score and LI% (P less than .005). Since LI% is a recognized powerful prognostic factor, this correlation suggests that the AP score can also be a reliable test predicting patient survival duration. In addition, we identified a subgroup of IgG MM patients with very high tumor mass who had a low LI% but a high AP score. This was associated with very poor patient survival and indicated the discrete prognostic importance of AP score in this subgroup with low LI%. Thus, both the LI% and AP score can be recommended as helpful clinical tests in patients with monoclonal gammopathies.
Thyroid-stimulating hormone, the catecholamine isoproterenol, and prostaglandins E1 and E2, all substances known to increase cAMP concentration in thyroid tissue, accelerate the formation of follicular cavities in explanted thyroid of 15-day-old rat foetuses. Dibutyryl-cAMP added to the medium, but not sodium fluoride, also stimulates the folliculogenesis. Since fluoride stimulates membrane adenylate cyclase but does not increase the intracellular cAMP level, these results show that cAMP is involved as a second messenger in the activation of foetal thyroid morphogenesis induced by hormones. They indicate also that the thyroid gland of the foetal rat is capable of responding to hormonal stimulation as early as the 15th day of pregnancy; this implies that on day 15, the foetal thyroid possesses receptors not only for the thyroid-stimulating hormone, but also for catecholamines and prostaglandins.
Incubation in a culture medium with and without TSH of 16 day-old foetal thyroid glands induces hypertrophy of the Golgi apparatus which may be correlated with a considerable increase in the number of secretory vesicles. A stereological study performed during the first 6 hr of incubation showed that: vesicle secretion was biphasic; vesicle secretion was heterogeneous with two different populations of vesicles; When TSH (20 mU and 80 mU) was added to the medium, the volume density of the follicular lumina increased; at least during the first 6 hr TSH seemed to be necessary to the formation of follicular lumina.
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