NEWS
  1. Progress in nanoscience, nanotechnology, and nanomedicine
  2. Low-grade cervical intra-epithelial neoplasia: Does the regression depend on our own gene map and human papillomavirus status?
  3. Endometrial cancer: Advanced disease and chemotherapy
  4. Mammographic density and breast cancer after ductal carcinoma in situ
  5. The ubiquitin-mediated protein degradation pathway in cancer: therapeutic implications
  6. The interplay between Src and integrins in normal and tumor biology
  7. Supportive care in cancer patients (The first Belgrade Education Symposium under the auspices of the Multinational Association of Supportive Care in Cancer)
  8. Press Release: The 2004 Nobel Prize in Physiology or Medicine
 
 
1. Progress in nanoscience, nanotechnology, and nanomedicine

In 2002 there were a few international conferences on nanoscience and nanotechnology in USA (Foresight conference), Europe and Japan (First Japan-UK Nanotechnology Summer School). Also, there were two meetings in Serbia where nanotechnology and biomedicine joint together: one international (SAUM, Belgrade) and other domestic (Academy of Studenica, Studenica).
Big progress has been done in nanotechnology in fabrication of nano-dendritic structure with branches under 3 nm (1nm =10-9m). For the first time researchers from National Institute for Materials Science (Japan), Furuya and Hasegawa produced this dendritic structure under electron beam irradiation using the vapor deposition properties of organometallic gases. Also, they fabricated nano-dendric structures on the substrate by delivering a gas containing the target element to the vicinity of the substrate with a newly developed gas delivery system while maintaining a high vacuum in the electron microscope sample chamber. The size of the structure as a whole and the location of formation can be controlled easily, and combinations of numerous types of substrates and gas sources are possible. This research result is expected to find wide application in research and development of surface-effect devices, nanosized catalyzed, biosensors, and nanobiomedical devices.
Another significant progress has been done in nanoscienece in the field nano-controllers. Two researchers Lidija Matija and Srđan Ribar found solution how to overcome problems with classical control theory in nanoscience and its application in nanotechnology. For the first time in nanoscience they proposed application of fractional calculus rather than classical one. Currently dominant approach to nanotechnology is from physics point of view. However, a chemical approach to nanotechnology is more natural to biological solutions. The first system has more solid phase state, while the second one has more liquid phase state. It is quite obvious that new nanotechnological systems will be on the border on these two phases. Fractal calculus is basic scientific approach to develop control system, which can control all three states: liquid, liquid/solid, and solid.
Đuro KORUGA
 


2. Low-grade cervical intra-epithelial neoplasia: Does the regression depend on our own gene map and human papillomavirus status?

Authors from France published in Obstetrics & Gynecology some interesting results about patients with low-grade cervical intra-epithelial neoplasia (CIN) who have a very good chance of experiencing spontaneous regression. Xavier Sastre-Garau and his colleagues (1) analyzed the probability of regression of these lesions according to the human leukocyte antigen (HLA-DR) and human papilloma virus (HPV) status. The human leukocyte antigen (HLA)-DRB1*13 allele frequency is lower in women with cervical carcinoma than in the general population, suggesting that this allele could exert a protective effect against progression of cervical intraepithelial neoplasia (CIN) associated with human papillomaviruses (HPV). The study sample was composed of 86 women with CIN1 who agreed to regular colposcopic follow-up and no immediate treatment. Biopsy specimens were taken under colposcopy for histology and for the determination of HPV and HLA status. Cases were classified into 3 groups: CIN1 regression, persistence for at least 12 months, or progression to CIN2 or CIN3.
The rate of spontaneous regression (95% confidence interval) at 24 months was 51.6% (39-61.6%) overall compared with 34.7% (13.4-50.8%) in HPV16/18 positive cases and 59.9% (43.7-71.4%) in HPV16/18-negative cases (P = .051). The rate of regression was 71.8% (40.8-86.5%) in patients with HLA-DRB1*13 and 45.9% (31.5-57.2%) in patients with other genotypes (P = .03). Regression reached 90.5% (38.9-98.5%) at 18 months in DRB1*13 patients with HPV16/18-negative-associated CIN (15.1% of the cases). In multi-variable analysis, HLA-DRB1*13 allele and HPV16/18-negative status were independently associated with an increased probability for regression (adjusted hazard ratio 2.1 [1.0-4.1] and 2.5 [1.2-5.4], respectively). They showed that subset of approximately 15% of CIN1 highly likely to show spontaneous regression can be defined using two biologic parameters that characterize the viral causative agent and the host.
REFERENCE
1. Sastre-Garau X, Cartier I, Jourdan-Da Silva N, De Crémoux P, Lepage V, Charron D. Regression of Low-Grade Cervical Intraepithelial Neoplasia in Patients With HLA-DRB1*13. Gen Obstet Gynecol 2004;104:751-5.
Aljosa MANDIC
 


3. Endometrial cancer: Advanced disease and chemotherapy

According to the Register of Cancer the standard incidence rates of endometrial cancer in central part of Serbia are 9.1 in 1996 and 12.3 in 1999 per 100 000. Endometrial cancer is still the most curable among ten most common cancers in women because PMB, as a leading clinical symptom, occurs mostly when disease is still limited to the uterine corpus (International Federation of Gynecology and Obstetrics [FIGO] stage I and II in which the probability of long-term disease-free survival is high) (1). Patients with endometrial cancer who have localized disease are usually curable by hysterectomy and bilateral salpingo-oophorectomy. Best results are obtained with either of two standard treatments: hysterectomy or hysterectomy and adjuvant radiation therapy (when deep invasion of the myometrial muscle [one half the depth] or grade 3 tumor with myometrial invasion is present). Where is the place of progestogen therapy in treatment of endometrial cancer?
Progestogen therapy was subscribed widely in the past. A meta-analysis of 6 randomized trials involving a total of 3,339 women has shown no survival benefit for adjuvant progestogen therapy in endometrial cancer (2). A subsequently published randomized trial of 1012 women also failed to demonstrate any survival benefit (3). It is shown that surgery and radiotherapy are the two most combined modalities of treatment for endometrial cancer in early stages of the disease.
Is there any place of chemotherapy in advanced endometrial cancer?
US researchers have now, for the first time, presented the final results of the pivotal trial that first demonstrated the benefits of adding cisplatin to doxorubicin in patients with endometrial carcinoma.
J. Tate Thigpen (University of Mississippi School of Medicine, Jackson, Missouri) and colleagues showed, at the initiation of the study, doxorubicin and cisplatin ranked as the most active agents in endometrial carcinoma (4). This trial of stage III, IV, or recurrent disease evaluated whether combining these agents increases response rate (RR) and prolongs progression-free survival (PFS) and overall survival (OS) over doxorubicin alone. 281 of patients were eligible for study. Regimens were doxorubicin 60 mg/m2 intravenously or doxorubicin 60 mg/m2 plus cisplatin 50 mg/m2 every 3 weeks until disease progression, unacceptable toxicity, or a total of 500 mg/m2 doxorubicin.
There were 12 (8%) complete (CR) and 26 (17%) partial responses (PR) among 150 patients receiving doxorubicin versus 25 (19%) CRs and 30 (23%) PRs among patients receiving the combination. The overall response rate was higher among patients receiving the combination (42%) compared with patients receiving doxorubicin (25%; P = .004). Median PFS was 5.7 and 3.8 months, respectively, for the combination and single agent. The PFS hazard ratio was 0.736 (95% CI, 0.577 to 0.939; P = .014). Median OS was 9.0 and 9.2 months, respectively, for the combination and single agent. Overall death rates were similar in the two groups (hazard ratio, 0.928; 95% CI, 0.727 to 1.185). Nausea, vomiting, and hematological toxicities were common. The combination produced more grade 3 to 4 leukopenia (62% vs. 40%), thrombocytopenia (14% vs. 2%), anemia (22% vs. 4%), and nausea/vomiting (13% vs. 3%).
Compared with doxorubicin alone, combination treatment was associated with a significantly improved overall response rate (42 percent vs. 25 percent) and increased progression-free survival (5.7 months vs. 3.8 months), but, at the same time, it had a negligible impact on overall survival (9.0 vs.9.2 months), and increased toxicity.
REFERENCE
1. Mandic A, Vujkov T. Endometrial cancer: Diagnostic methods in postmenopausal vaginal bleeding. Arch Oncol 2003;11(2):97-101.
2. Martin-Hirsch PL, Lilford RJ, Jarvis GJ. Adjuvant progestagen therapy for the treatment of endometrial cancer: review and meta-analyses of published randomised controlled trials. Eur J Obstet Gynecol Reprod Biol 1996;65(2):201-7.
3. COSA-NZ-UK Endometrial Cancer Study Groups. Adjuvant medroxyprogesterone acetate in high-risk endometrial cancer. Int J Gynecol Cancer 1998;8:387-91.
4. Thigpen JT, Brady MF, Homesley HD, Malfetano J, DuBeshter B, Burger RA et al. Phase III Trial of Doxorubicin With or Without Cisplatin in Advanced Endometrial Carcinoma: A Gynecologic Oncology Group Study. J Clin Oncol 2004;22:3902-8.
Aljosa MANDIC


4. Mammographic density and breast cancer after ductal carcinoma in situ
Habel LA, Dignam JJ, Land SR et al. JNCI 2004;96(19):1467-72.

Women with ductal carcinoma in situ (DCIS) are at substantially increased risk for a second breast cancer, but few strong predictors for these subsequent tumors have been identified. We used Cox regression modeling to examine the association between mammographic density at diagnosis of DCIS of 504 women from the National Surgical Adjuvant Breast and Bowel Project B-17 trial and risk of subsequent breast cancer events. In this group of patients, mostly 50 years old or older, approximately 6.6% had breasts categorized as highly dense (i.e., =75% of the breast occupied by dense tissue). After adjusting for treatment with radiotherapy, age, and body mass index, women with highly dense breasts had 2.8 (95% confidence interval [CI] = 1.3 to 6.1) times the risk of subsequent breast cancer (DCIS or invasive), 3.2 (95% CI = 1.2 to 8.5) times the risk of invasive breast cancer, and 3.0 (95% CI = 1.2 to 7.5) times the risk of any ipsilateral breast cancer, compared with women with less than 25% of the breast occupied by dense tissue. Our results provide initial evidence that the risk of second breast cancers may be increased among DCIS patients with highly dense breasts.


5. The ubiquitin-mediated protein degradation pathway in cancer: therapeutic implications
Burger AM, Seth AK. Eur J Cancer 2004;40(15):2217-29.

The highly conserved eukaryotic ubiquitin-proteasome system (UP-S) plays a pivotal role in protein homeostasis and is critical in regulating normal and cancer-related cellular processes. The hierarchical nature of the UP-S provides a rich source of molecular targets for specific intervention and has therefore arisen as a promising approach to innovative anticancer therapies. The first in class proteasome inhibitory agent Bortezomib (Velcade) has recently obtained regulatory approval for the treatment of multiple myeloma. Ubiquitin-mediated degradation is a complex process that is comprised of well defined steps involving ubiquitin-activating enzymes (E1s), ubiquitin-conjugating enzymes (E2s) and ubiquitin ligases (E3s). Although a single E1 activates the ubiquitin conjugation machinery, a large number of E2 conjugating enzymes and E3 ligases are now known to exist. Proteins tagged with ubiquitin are subsequently recognised by the proteasome for digestion and fragmentation. The enzymatic nature, multitude of E3s and their specific substrate recognition predestines them as therapeutic targets. This article will review known inhibitors of the proteasome and their molecular mechanisms as well as ongoing developments and promising avenues for targeting substrate-specific E3 ligases that are likely to yield a new class of therapeutics that will serve and complement the armamentarium of anticancer drugs.


6. The interplay between Src and integrins in normal and tumor biology
Playford MP, Schaller MD. Oncogene 2004;23(48):7928-46.

Src family nonreceptor protein tyrosine kinases transduce signals that control normal cellular processes such as cell proliferation, adhesion and motility. Normally, cellular Src is held in an inactive state, but in several cancer types, abnormal events lead to elevated kinase activity of the protein and cause pleiotropic cellular responses inducing transformation and metastasis. A prerequisite of the ability of a cancer cell to undergo metastasis into distant tissues is to penetrate surrounding extracellular matrices. These processes are facilitated by the integrin family of cell adhesion molecules. As is the case with Src, altered integrin activity or substrate affinity can contribute to the neoplastic phenotype. Therefore, understanding the interplay between Src and integrin function has been of intense interest over the past few years. This review focuses on the role of Src and integrin signaling in normal cells and how this is deregulated in human cancer. We will identify the key players in the integrin-mediated signaling pathways involved in cell motility and apoptosis, such as FAK, paxillin and p130(CAS), and discuss how Src signaling affects the formation of focal adhesions and the extracellular matrix. FAK, paxillin and p130(CAS), and discuss how Src signaling affects the formation of focal adhesions and the extracellular matrix.


7. Supportive care in cancer patients
(The first Belgrade Education Symposium under the auspices of the Multinational Association of Supportive Care in Cancer)

The international education Symposium "Supportive care in cancer patients" was organized in Belgrade (October 2nd, 2004), under the auspices of the Institute for Oncology and Radiology of Serbia and Multinational Association of Supportive Care in Cancer (MASCC). The goal of the Symposium was to promote supportive care discipline in the region of Central and Eastern Europe. The need for the course was identified through requests from oncologists and other relevant clinicians involved in the care of patients with cancer. The main learning objectives were: (1) to increase awareness and applicable knowledge of supportive care, its goals and achievements, (2) to highlight the concept of quality of life in oncology, (3) to cover evaluation and management of common physical symptoms (cancer pain, dyspnoea), complications of cancer (bone metastases, anorexia/cachexia) and of major toxicities induced by anticancer treatment (nausea and vomiting, myelosuppression, febrile neutropenia), and (4) to present philosophy and the key concepts of end of life care. The course was also intended to inspire and motivate the audience with the best international lecturers. Topics were reviewed and discussed by the many leading international experts willing to donate their time and experience to this symposium.
The Symposium had 154 participants, mainly physicians (oncologists, internal medicine specialists, general practitioners, geriatricians, young doctors in training for general oncology), but also nurses and other relevant clinicians (clinical psychologists) from Serbia and Montenegro and other European countries (Bosnia & Herzegovina, Bulgaria, Greece, France, Slovenia). A total of 68 completed evaluation forms were returned. Using the 1-5 scale, the overall rating of the Symposium topic was 4.63, of the content 4.65, while the organization and duration were rated 4.65 and 4.40, respectively (Table 1). The topic and the content of the Symposium were most frequently described as 'systematization of the existent knowledge' (20/68, 29.4%) or "stimulative for further work" (20/68, 29.4%). The most frequent responses to the question 'How would you describe methods of work applied in the Symposium?' were: "illustrative and easy to remember" (24/63, 38.1%), 'usual' (22/63, 34.9%) or "up-to-date, but without active involvement of participants" (10/63, 15.9%). The technical facilities provided were described as "satisfactory in the given conditions" (27/66, 40.9%) as well as "pleasant and inspiring" (22/66, 33.3%). Taking into consideration the content, quality of presentation as well as quality of slides / visual support the speakers were given the average rating of = 4. The overall rating of the quality of the education offered at this Symposium was 4.50 (range 1: poor; 5: excellent): more than 90% of participants graded the Symposium as very good (24/68, 35.3%) or excellent (40/68, 58.8%). Every effort was made to provide the participants with congress material of high quality. All presentations were published in the scientific journal Archive of Oncology, the only journal in our country specialized in oncology. Moreover, MASCC has strongly supported us by sending free copies of the official journal "Supportive care in cancer" and copies of recently published guidelines for the prevention and treatment of cancer-therapy induced oral and gastrointestinal mucositis.
In our opinion the education results achieved justify organization of such symposiums in the future. The broadening of the topics to include evaluation and management of other physical symptoms/complications of cancer (tumor-induced nausea and vomiting, fatigue, intestinal obstruction), other treatment toxicities (cancer-therapy induced oral mucositis), psychological symptoms of cancer (depression, delirium), as well as social and spiritual support was suggested. Moreover, longer duration of the Symposium was proposed as well as more active involvement of participants through thematic workshops. The Symposium was intended to bring together oncologists, other relevant clinicians, and representatives of the pharmaceutical industry to facilitate cooperation and communication between them. Moreover, the intention was also to increase awareness in public of supportive care as a discipline in oncology: successful press conference was organized and the Symposium received extensive media coverage on both national and local TV. The message conveyed is that supportive care is to be acknowledged as a discipline which is capable of helping the patient and the family achieve the best possible quality of life in every phase of malignant disease, and consequently an integral part of comprehensive cancer care. Oncologists, other relevant clinicians, the public in general, being banded together and gathered around this Symposium, may further negotiate with the regulatory authorities and advocate for the successful removal of barriers to effective supportive and palliative care.
The Symposium was supported by: Serbian Medical Association-Section for Oncology, Ministry of Health, Republic of Serbia, Ministry of Science and Environmental Protection, Republic of Serbia, French Ministry of Foreign Affairs, International Association for Hospice and Palliative Care (IAHPC), and European Association for Palliative Care (EAPC), Center for Palliative Care in Eastern Europe (EAPC-EAST).
Table 1. Evaluation of the Symposium (N=68, 1-5 scale)

Question
Responded
N(%)
Grade point average
Range
(Min-Max)
Highest rate
N (%)
Education topic
63 (92.6)
4.81
3-5
53 (84.1)
Content
67 (98.5)
4.63
2-5
51 (76.1)
Organization
62 (91.2)
4.65
1-5
46 (74.2)
Duration
62 (91.2)
4.40
2-5
37 (59.7)
Our warmest thanks go to all the lecturers, participants and sponsors.
Svetislav JELIC, Chairman of the Symposium
Snezana BOSNJAK, Co-chairman


8. Press Release: The 2004 Nobel Prize in Physiology or Medicine
Source: www.nobelprize.org


The Nobel Assembly at Karolinska Institutet has today decided to award The Nobel Prize in Physiology or Medicine for 2004 jointly to Richard Axel and Linda B. Buck for their discoveries of "odorant receptors and the organization of the olfactory system" (4 October 2004)
Summary. The sense of smell long remained the most enigmatic of our senses. The basic principles for recognizing and remembering about 10,000 different odours were not understood. This year's Nobel Laureates in Physiology or Medicine have solved this problem and in a series of pioneering studies clarified how our olfactory system works. They discovered a large gene family, comprised of some 1,000 different genes (three per cent of our genes) that give rise to an equivalent number of olfactory receptor types. These receptors are located on the olfactory receptor cells, which occupy a small area in the upper part of the nasal epithelium and detect the inhaled odorant molecules. Each olfactory receptor cell possesses only one type of odorant receptor, and each receptor can detect a limited number of odorant substances. Our olfactory receptor cells are therefore highly specialized for a few odours. The cells send thin nerve processes directly to distinct micro domains, glomeruli, in the olfactory bulb, the primary olfactory area of the brain. Receptor cells carrying the same type of receptor send their nerve processes to the same glomerulus. From these micro domains in the olfactory bulb the information is relayed further to other parts of the brain, where the information from several olfactory receptors is combined, forming a pattern. Therefore, we can consciously experience the smell of a lilac flower in the spring and recall this olfactory memory at other times.
Richard Axel, New York, USA, and Linda Buck, Seattle, USA, published the fundamental paper jointly in 1991, in which they described the very large family of about one thousand genes for odorant receptors. Axel and Buck have since worked independent of each other, and they have in several elegant, often parallel, studies clarified the olfactory system, from the molecular level to the organization of the cells.
The olfactory system is important for life quality.
When something tastes really good it is primarily activation of the olfactory system which helps us detect the qualities we regard as positive. A good wine or a sunripe wild strawberry activates a whole array of odorant receptors, helping us to perceive the different odorant molecules. A unique odour can trigger distinct memories from our childhood or from emotional moments - positive or negative - later in life. A single clam that is not fresh and will cause malaise can leave a memory that stays with us for years, and prevent us from ingesting any dish, however delicious, with clams in it. To lose the sense of smell is a serious handicap - we no longer perceive the different qualities of food and we cannot detect warning signals, for example smoke from a fire. Olfaction is of central importance for most species. All living organisms can detect and identify chemical substances in their environment. It is obviously of great survival value to be able to identify suitable food and to avoid putrid or unfit foodstuff. Whereas fish has a relatively small number of odorant receptors, about one hundred, mice - the species Axel and Buck studied - have about one thousand. Humans have a somewhat smaller number than mice; some of the genes have been lost during evolution.
Smell is absolutely essential for a newborn mammalian pup to find the teats of its mother and obtain milk - without olfaction the pup does not survive unaided. Olfaction is also of paramount importance for many adult animals, since they observe and interpret their environment largely by sensing smell. For example, the area of the olfactory epithelium in dogs is some forty times larger than in humans.
A large family of odorant receptors. The olfactory system is the first of our sensory systems that has been deciphered primarily using molecular techniques. Axel and Buck showed that three per cent of our genes are used to code for the different odorant receptors on the membrane of the olfactory receptor cells. When an odorant receptor is activated by an odorous substance, an electric signal is triggered in the olfactory receptor cell and sent to the brain via nerve processes. Each odorant receptor first activates a G protein, to which it is coupled. The G protein in turn stimulates the formation of cAMP (cyclic AMP). This messenger molecule activates ion channels, which are opened and the cell is activated. Axel and Buck showed that the large family of odorant receptors belongs to the G protein-coupled receptors (GPCR).
All the odorant receptors are related proteins but differ in certain details, explaining why they are triggered by different odorous molecules. Each receptor consists of a chain of amino acids that is anchored into the cell membrane and traverses it seven times. The chain creates a binding pocket where the odorant can attach. When that happens, the shape of the receptor protein is altered, leading to G protein activation.
One type of odorant receptor in each olfactory receptor cell. Independently, Axel and Buck showed that every single olfactory receptor cell expresses one and only one of the odorant receptor genes. Thus, there are as many types of olfactory receptor cells as there are odorant receptors. It was possible to show, by registering the electrical signals coming from single olfactory receptor cells, that each cell does not react only to one odorous substance, but to several related molecules - albeit with varying intensity. Buck's research group examined the sensitivity of individual olfactory receptor cells to specific odorants. By means of a pipette, they emptied the contents of each cell and showed exactly which odorant receptor gene was expressed in that cell. In this way, they could correlate the response to a specific odorant with the particular type of receptor carried by that cell.
Most odours are composed of multiple odorant molecules, and each odorant molecule activates several odorant receptors. This leads to a combinatorial code forming an "odorant pattern" - somewhat like the colours in a patchwork quilt or in a mosaic. This is the basis for our ability to recognize and form memories of approximately 10,000 different odours. Olfactory receptor cells activate micro regions in the olfactory bulb. The finding that each olfactory receptor cell only expresses one single odorant receptor gene was highly unexpected. Axel and Buck continued by determining the organization of the first relay station in the brain. The olfactory receptor cell sends its nerve processes to the olfactory bulb, where there are some 2,000 well-defined microregions, glomeruli. There are thus about twice as many glomeruli as the types of olfactory receptor cells.
Axel and Buck independently showed that receptor cells carrying the same type of receptor converge their processes into the same glomerulus, and Axel's research group used sophisticated genetic technology to demonstrate in mice the role of the receptor in this process. The convergence of information from cells with the same receptor into the same glomerulus demonstrated that also glomeruli exhibit remarkable specificity (see figure).

In the glomeruli we find not only the nerve processes from the olfactory receptor cells but also their contacts with the next level of nerve cells, the mitral cells. Each mitral cell is activated only by one glomerulus, and the specificity in the information flow is thereby maintained. Via long nerve processes, the mitral cells send the information to several parts of the brain. Buck showed that these nerve signals in turn reach defined micro regions in the brain cortex. Here the information from several types of odorant receptors is combined into a pattern characteristic for each odour. This is interpreted and leads to the conscious experience of a recognizable odour.
Pheromones and taste. The general principles that Axel and Buck discovered for the olfactory system appears to apply also to other sensory systems. Pheromones are molecules that can influence different social behaviours, especially in animals. Axel and Buck, independent of each other, discovered that pheromones are detected by two other families of GPCR, localized to a different part of the nasal epithelium. The taste buds of the tongue have yet another family of GPCR, which is associated with the sense of taste.
REFERENCE. Buck L, Axel R. Cell 1991;65:175-87.


© Institute of Oncology Sremska Kamenica, Last updated December 21, 2004