Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib

ABSTRACT: BACKGROUND: BRAF inhibitors such as vemurafenib are a new family of biological drugs, recently available to treat metastatic malignant melanoma. METHODS: We present the case of a 38-year-old man affected by metastatic melanoma who had been under treatment with vemurafenib for a few days. The patient suffered from sudden onset of abdominal pain due to intra-abdominal hemorrhage with profuse hemoperitoneum. An emergency abdominal sonography confirmed the clinical suspicion of a splenic rupture. RESULTS: The intraoperative finding was hemoperitoneum due to splenic two-step rupture and splenectomy was therefore performed. Histopathology confirmed splenic hematoma and capsule laceration, in the absence of metastasis. CONCLUSIONS: This report describes the occurrence of a previously unreported adverse event in a patient with stage IV melanoma receiving vemurafenib.     

Incidence and risk factors for non-alcoholic steatohepatitis: prospective study of 5408 women enrolled in Italian tamoxifen chemoprevention trial

Objective To assess the incidence, cofactors, and excess risk of development of non-alcoholic fatty liver disease, including non-alcoholic steatohepatitis, attributable to tamoxifen in women.Design Prospective, randomised, double blind, placebo controlled trial.Setting and participants 5408 healthy women who had had hysterectomies, recruited into the Italian tamoxifen chemoprevention trial from 58 centres in Italy.Intervention Women were randomly assigned to receive tamoxifen (20 mg daily) or placebo for five years.Main outcome measure Development of non-alcoholic fatty liver disease in all women with normal baseline liver function who showed at least two elevations of alanine aminotransferase (≥ 1.5 times upper limit of normal) over a six month period.Results During follow up, 64 women met the predefined criteria: 12 tested positive for hepatitis C virus, and the remaining 52 were suspected of having developed non-alcoholic fatty liver disease (34 tamoxifen, 18 placebo)—hazard ratio = 2.0 (95% confidence interval 1.1 to 3.5; P = 0.04). In all 52 women ultrasonography confirmed the presence of fatty liver. Other factors associated with the development of non-alcoholic fatty liver disease included overweight (2.4, 1.2 to 4.8), obesity (3.6, 1.7 to 7.6), hypercholesterolaemia (3.4, 1.4 to 7.8), and arterial hypertension (2.0, 1.0 to 3.8). Twenty women had liver biopsies: 15 were diagnosed as having mild to moderate steatohepatitis (12 tamoxifen, 3 placebo), and five had fatty liver alone (1 tamoxifen, 4 placebo). No clinical, biochemical, ultrasonic, or histological signs suggestive of progression to cirrhosis were observed after a median follow up of 8.7 years.Conclusions Tamoxifen was associated with higher risk of development of non-alcoholic steatohepatitis only in overweight and obese women with features of metabolic syndrome, but the disease, in both the tamoxifen and the placebo group, after 10 years of follow up seems to be indolent.     

Investigation of the in vitro biotransformation of R-(+)-thalidomide by HPLC, nano-HPLC, CEC and HPLC–APCI-MS

High-performance liquid chromatography (HPLC), nano-HPLC, capillary electrochromatography (CEC) and on-line HPLC–atmospheric pressure chemical ionization mass spectrometry (APCI-MS) techniques were used for the identification and detailed characterization of two new metabolites of the former sedative drug thalidomide (TD). The advantages of nano-HPLC and CEC are higher peak efficiency and a drastic decrease in the analysis time, which, together with lower sample dilution during the analyses, allowed to obtain a detection sensitivity that was comparable to HPLC with common-sized columns. Both, nano-HPLC and CEC could be realized in the commercially available capillary electrophoresis system HP^3D. On-line HPLC–APCI-MS coupling is a very useful technique for the rapid identification of metabolites without any need for reference compounds.     

Fast atom bombardment mass spectrometry analysis of opioid peptides

Positive and negative ion fast atom bombardment mass spectrometries have been used to determine the amino acid sequence-determining fragment ion information of opioid peptides containing from 5 to 10 amino acid residues. The opioids investigated include several enkephalins, dynorphin A fragments 1-7 through 1-10, and alpha- and beta-neoendorphins. Data obtained in the two ionization polarities provide complementary information and exhibit the C-terminal- and the N-terminal-containing amino acid sequence-determining fragment ions that are formed by cleavage of the bond between the carbonyl group and the alpha-carbon (-CHR-CO-), the peptide amide bond (-CO-NH-), and the amino-alkyl (-NH-CHR-) bond. The C-terminal sequence ions are dominant in the positive ion mode, whereas the C-terminal and N-terminal ions are equally important in the negative ion mode. Detection limits for full mass scans extend down to the picomole range. The apparent role of hydrophobicity of the amino acid residues on the fragmentation characteristics of the peptide is discussed.     

Alteration of opioid peptide concentrations in the rat pituitary following survivable closed head injury

Concentration changes of methionine enkephalin-like immjnoreactivity (ME-li) and -endorphin-like immunoreactivity (BE-li) in the rat pituitary following diffuse brain injury were studied. Closed head injury was induced by a weight-drop trauma device (450 g×2 m). The level of closed head injury used in this study altered the pituitary opioid peptide concentrations. The level of ME-li did not change in the experimental groups 3 hours, 10 hours, 24 hours, and 3 days after the trauma, but significantly increased by 34% 10 days after the trauma. BE-li remained constant 3 hours and 10 hours following the injury, increased by 48% at 24 hours, and remained at this level for 10 days after the trauma (44% at 3 days, and 40% at 10 days). The levels of ME-li and BE-li in the control sham-operated rats did not change during these times. The present measurements of BE-li and ME-li in the pituitary indicate that the opioid peptides that derive from two different neuropeptidergic systems, proopiomelanocortin (POMC) and preproenkephalin A, respectively, may participate in the pathophysiology of a closed head injury.     

Hepatocyte Growth Factor-Induced Expression of Ornithine Decarboxylase, c-met,and c-mycIs Differently Affected by Protein Kinase Inhibitors in Human Hepatoma Cells HepG2

Binding of hepatocyte growth factor (HGF) to its receptor Met induces autophosphorylation and activation of the tyrosine kinase activity. In HGF-treated HepG2 cells, we studied: (i) the expression patterns of early(c-myc,c-jun,and c-fos) and delayed-early (ornithinedecarboxylase and c-met) response genes and (ii) thepossible involvement of protein kinase transducersin the control of the expression of c-metand of other genes eventually induced downstream. c-metand c-mycmRNAs peaked 1–2 h after HGF, while c-junandc-fosmRNAs slightly increased at 1 h. Ornithinedecarboxylase activity was induced earlier (4 h) thanthe mRNA (8–10 h). The transducers involved in HGF-triggered gene inductions were investigated using different protein kinase inhibitors: genistein for the receptor tyrosine kinase, herbimycin A for the nonreceptor tyrosine kinase (pp60^c-src), wortmannin for phosphatidylinositol 3-kinase (PI3K) and H7 for protein kinase C (PKC). The similarity of responses to PKC inhibition led to suppose that c-mycand ornithinedecarboxylase mRNAs were induced sequentially along the same transduction pathway triggered by HGF. Ornithine decarboxylase activity seemed to be largely regulated by phosphorylation(s). The mRNA expression of c-junwas likely to undergo a negative regulation through a mechanism involving PI3K, while that ofc-metseemed to be almost independent from various protein kinases (PI3K, pp60^c-src, and PKC).     

Polyamines and diamine oxidase activity in maternal, embryonal, and fetal tissues of rat after chronic ethanol consumption

The effects of maternal ethanol consumption for 4 weeks before and throughout gestation on polyamine content and diamine oxidase activity of maternal, embryonal and fetal tissues are reported. At the 12th day of pregnancy, a decrease of putrescine in the liver of the mother and marked increases in putrescine, cadaverine and spermidine in embryos were observed. At day 18, putrescine and cadaverine diminished in maternal liver and placenta, and no changes in amine content in fetal liver and brain were found. At day 12, diamine oxidase activity increased in maternal liver and placenta, whereas it greatly diminished in embryos. At day 18, enzyme activity decreased in maternal liver, placenta, fetal liver and brain. These results indicate that chronic ethanol ingestion induces alterations in polyamine concentrations and metabolism in growing and developing tissues during pregnancy that might contribute to the adverse effect of ethanol on conceptual development.     

Reduction of oligopeptides to amino alcohols with borane

Reduction of olipopeptides to amino alcohols with borane in tetrahydrofuran is investigated and optimized. The products are characterized by thin-layer chromatography, gas chromatography, and mass spectrometry. The method proves to be side-product-free and very fast; complete derivatization is achieved within 4 h.     

Cell cycle-dependent accumulation in vivo of transposition-competent complexes between recombination signal ends and full-length RAG proteins

V(D)J recombination is initiated by a specialized transposase consisting of RAG-1 and RAG-2. Because full-length RAG proteins are insoluble under physiologic conditions, most previous analyses of RAG activity in vitro have used truncated core RAG-1 and RAG-2 fragments. These studies identified an intermediate in V(D)J recombination, the signal end complex (SEC), in which core RAG proteins remain associated with recombination signal sequences at the cleaved signal ends. From transfected cells expressing affinity-tagged RAG proteins, we have isolated in vivo assembled SECs containing full-length RAG proteins and cleaved recombination substrates. SEC formation in vivo did not require the repair proteins DNA-dependent protein kinase, Ku80, or XRCC4. In the presence of full-length RAG-2, SEC formation in vivo was cell cycle-regulated and restricted to the G(0)/G(1) phases. In contrast, complexes accumulated throughout cell cycle in cells expressing a RAG-2 CDK2 phosphorylation site mutant. Both core and full-length SECs supported transposition in vitro with similar efficiencies. Intracellular SECs, which are likely to persist in the absence of coding ends, represent potential donors whose transposition is not suppressed by the non-core regions of the RAG proteins.