Friday, May 10, 2013

GENETIC DISTURBANCES IN OVARIAN CANCERS! ANOTHER CASE OF RECEPTOR FAILURE

In many triple negative Breast Cancers, we have submitted that a failure of the receptor for either HER-2 or ER are the origin. Defective Heparan surface may be one example leading to Receptor ineffective performance.  There is a secondary over production of Tumor Growth factor which impact other Receptors which are naturally susceptible leading to hyperplasia and eventually to a neoplastic process.

In ovarian cancer, the findings that the DAB2 gene is suppressed appears to be central to the pathophysiology of this cancer.
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DAB2

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Dab, mitogen-responsive phosphoprotein, homolog 2 (Drosophila)

PDB rendering based on 1m7e.
Available structures
PDB Ortholog search: PDBe, RCSB
Identifiers
Symbols DAB2; DOC-2; DOC2
External IDs OMIM601236 MGI109175 HomoloGene1026 GeneCards: DAB2 Gene
RNA expression pattern
PBB GE DAB2 201278 at tn.png
PBB GE DAB2 201279 s at tn.png
PBB GE DAB2 201280 s at tn.png
More reference expression data
Orthologs
Species Human Mouse
Entrez 1601 13132
Ensembl ENSG00000153071 ENSMUSG00000022150
UniProt P98082 P98078
RefSeq (mRNA) NM_001244871 NM_001008702
RefSeq (protein) NP_001231800 NP_001008702
Location (UCSC) Chr 5:
39.37 – 39.46 Mb
Chr 15:
6.3 – 6.44 Mb

PubMed search [1] [2]
Disabled homolog 2 is a protein that in humans is encoded by the DAB2 gene.[1][2]
DAB2 mRNA is expressed in normal ovarian epithelial cells but is down-regulated or absent from ovarian carcinoma cell lines. The 770-amino acid predicted protein has an overall 83% identity with the mouse p96 protein, a putative mitogen-responsive phosphoprotein;=============================================================

IF YOU FOLLOW THE MONEY FOR A WHILE YOU WILL COME TO THE NATURAL CONCLUSION.  OVARIAN CANCERS HAPPEN IN MOTHERS! AND GUESS WHO DAB2 GENE WILL PICK ON, OF COURSE A GENE CALLED "MOTHER".

Mothers against decapentaplegic homolog 3

From Wikipedia, the free encyclopedia
.
Mothers against decapentaplegic homolog 3 also known as SMAD family member 3 or SMAD3 is a protein that in humans is encoded by the SMAD3 gene.[1][2] SMAD3 is a member of the SMAD family of proteins.
The human SMAD3 gene is located on chromosome 15. It is one of several human homologues of a gene that was originally discovered in the fruit fly Drosophila melanogaster.


Activin and inhibin are two closely related protein complexes that have almost directly opposite biological effects. Activin enhances FSH biosynthesis and secretion, and participates in the regulation of the menstrual cycle. Many other functions have been found to be exerted by activin, including roles in cell proliferation, differentiation, apoptosis,[1] metabolism, homeostasis, immune response, wound repair,[2] and endocrine function. Conversely inhibin downregulates FSH synthesis and inhibits FSH secretion.[3]
Activin is a dimer composed of two identical or very similar beta subunits. Inhibin is also a dimer wherein the first component is a beta subunit similar or identical to the beta subunit in activin. However, in contrast to activin, the second component of the inhibin dimer is a more distantly-related alpha subunit.[4][5] Activin, inhibin and a number of other structurally related proteins such as anti-Müllerian hormone, bone morphogenetic protein, and growth differentiation factor belong to the TGF-β protein superfamily.[6]

 ==============================================================================
SO CLEARLY DEPRESSION AT DAB2 WILL INDUCE DE-SENSITIZATION AT THE TGF-BETA RECEPTOR LEADING TO CHANGES OR MODULATION THAT FAVOR ACTIVIN'S ACTIVITY AND PROLIFERATION

BUT DEPRESSION OF DAB2 DOES NOT STOP THERE, THROUGH ITS GIPC1 CONNECTION IT WILL AFFECT VERY BAD ACTORS INCLUDING MYO6 (WHICH DISTURBS ORGANELLE MOVEMENT AND VACUOLE CONTROL TRAFFIC IN THE CELL) AND LPR1,2 A DISFIGURING GENE ASSOCIATED WITH A BAD SYNDROME AND THE "DEVIL" DVL3.  AND REMEMBER A GENE THAT INDUCES MORPHOLOGIC DISTURBANCE SUCH AS THE LRP2 IS DANGEROUS TO DANCE WITH!   ALWAYS REMEMBER THALIDOMIDE WITH ITS SHORT LIMB SYNDROME!
==================================================================================
 Mutations in the LRP2 gene are associated with Donnai-Barrow syndrome.[6]


This disorder is characterized by unusual facial features, including prominent, wide-set eyes with outer corners that point downward; a short bulbous nose with a flat nasal bridge; ears that are rotated backward; and a widow's peak hairline.
Individuals with Donnai-Barrow syndrome have severe hearing loss caused by abnormalities of the inner ear (sensorineural hearing loss). In addition, they often experience vision problems, including extreme nearsightedness (high myopia), detachment or deterioration of the light-sensitive tissue in the back of the eye (the retina), and progressive vision loss. Some have a gap or split in the colored part of the eye (iris coloboma).[2][3]
In almost all people with Donnai-Barrow syndrome, the tissue connecting the left and right halves of the brain (corpus callosum) is underdeveloped or absent. Affected individuals may also have other structural abnormalities of the brain. They generally have mild to moderate intellectual disability and developmental delay.
People with Donnai-Barrow syndrome may also have a hole in the muscle that separates the abdomen from the chest cavity (the diaphragm), which is called a diaphragmatic hernia. This potentially serious birth defect allows the stomach and intestines to move into the chest and possibly crowd the developing heart and lungs. An opening in the wall of the abdomen (an omphalocele) that allows the abdominal organs to protrude through the navel may also occur in affected individuals. Occasionally people with Donnai-Barrow syndrome have abnormalities of the intestine, heart, or other organs and scoliosis.[2][3]

MYO6

From Wikipedia, the free encyclopedia
.
Myosin VI, also known as MYO6, is a protein. It has been found in humans, mice, fruit flies (Drosophila melanogaster), and nematodes (Caenorhabditis elegans).
Myosin VI is a molecular motor involved in intracellular vesicle and organelle transport. It is one of the so-called unconventional myosins.[supplied by OMIM][1]

Interactions

MYO6 has been shown to interact with GIPC1[2][3] and DAB2.[4][5]
=============================================================================

CAN THIS ENTIRE MACHINERY BE SHUT DOWN BY AN ANTI-CD81
I BET YOU! 

THE CENTRAL GENE TO GO AFTER IS GIPC1 FROM MY VOTE, THERE IS THE CROSS-ROAD!  BUT IT INVOLVES THE ADRENAL RECEPTORS AND BETA RECEPTOR OF THE HEART SO CARDIAC MONITOR WOULD BE ADVISED DURING PHASE 1 STUDIES!

If LPR2 is amplified, will that predict activity of Avastin and other immunomodulation?  we know that when morphology is involved, these agents are active!
A WILD WILD TARGET!

While investigating why Gaucher disease would be linked to Lymphoproliferative disorders (Multiple Myeloma,CLL,AML LYMPHOMA INCLUDING THE HODGKIN , AND RARELY ALL.) and following downstream of CD 19, one stumble upon Grb2. just by the extent of its interactions, you know you cannot come-up empty targeting this wild gene.  The crux of the endeavor will be how to electively hit the cancer cell exclusively.

"
Grb2 is best known for its ability to link the epidermal growth factor receptor tyrosine kinase to the activation of Ras and its downstream kinases, ERK1,2. Grb2 is composed of an SH2 domain flanked on each side by an SH3 domain. Grb2 has two closely related proteins with similar domain organizations, Gads and Grap. Gads and Grap are expressed specifically in hematopoietic cells and function in the coordination of tyrosine kinase mediated signal transduction."wikipedia

Interactions

Grb2 has been shown to interact with Arachidonate 5-lipoxygenase,[5][6] Lymphocyte cytosolic protein 2,[7][8][9][10][11] GAB2,[12][13][14] B-cell linker,[15][16][17][18] Abl gene,[19][20] CD28,[21][22] FRS2,[23][24][25][26] Mitogen-activated protein kinase 9,[27][28] CD22,[29][30] NEU3,[31] ETV6,[12] MAP2,[32][33] Dock180,[34][35] PIK3R1,[36][37] SH2B1,[38][39] CRK,[40][41][42] GAB1,[7][43][44] MST1R,[45][46] DNM1,[47][48] Huntingtin,[49] Src,[50][51] Beta-2 adrenergic receptor,[52] VAV2,[53][54] ADAM15,[55] RAPGEF1,[56][57] VAV1,[58][59][60][61] HER2/neu,[54][62][63] Epidermal growth factor receptor,[2][43][53][62][64][65][66][67][68][69] PDGFRB,[69][70][71] PTK2,[72][73][74][75][76] Erythropoietin receptor,[77][78] Linker of activated T cells,[79][80][81] Dystroglycan,[82] SH3KBP1,[83][84] Granulocyte colony-stimulating factor receptor,[85] DCTN1,[86] CDKN1B,[87] Colony stimulating factor 1 receptor,[88] EPH receptor A2,[89] KHDRBS1,[43][90][91] RET proto-oncogene,[92][93] PLCG1,[94][95][96] TrkA,[97][98] PRKAR1A,[66] Janus kinase 2,[99][100] MUC1,[101] CD117,[78][102][103] Fas ligand,[104][105] Janus kinase 1,[100][106] VAV3,[53][107] BCAR1,[73][108] PTPN1,[109][110] INPP5D,[111] ITK,[112][113] SHC1,[51][53][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132] PTPN12,[133] C-Met,[134][135] PTPN11,[71][85][127][136][137][138][139][140][141] Glycoprotein 130,[61] PTPN6,[51][136][142] Syk,[51][136] MAP4K1,[143][144][145][146] Wiskott-Aldrich syndrome protein,[147][148] NCKIPSD,[149][150] PTPRA,[151][152][153] BCR gene,[12][115][154][155][156][157] CBLB,[158][159][160] Cbl gene,[9][24][51][90][124][158][161][162][163][164][165][166][167] SOS1,[8][24][42][43][48][51][53][60][68][90][95][101][115][122][124][131][168][169][170][171][172] IRS1,[100][114][173] TNK2,[116][174] MED28,[175] MAP3K1[176] and HNRNPC.[177]


You just look at the variety of interaction and you know this is an important step to anything in the cellular sun!  WOW!
Gerb2 a lifetime project!
AQUA TECHNOLOGY-AUTOMATED QUANTITATIVE ANALYSIS
IT IS A QUANTITATIVE IMMUNOPHENOTYPING TECHNIQUE
DISCUSSED BY EXPERTS (ASCO/CAP GUIDELINES AND NCCN TASKFORCE) MOST APPROPRIATE FOR SAMPLE WITH 'LOW NUCLEAR STAINING".  it has proven itself for measurement of ER and PR positivity in breast cancers!
The Cutt-off is 5.2 for determining receptor status
AQUA combines immunofluorescence and automated image technology.

NCCN
- ER and PR negative tumor status should be retested if tumor histology is lobular,tubular or mucinous because these types of tumors are rarely negative
-Also retest if tumors are GRADE1 since these are rarely negative
-Retesting is indicated at Diagnosis and at Relapse
-The option of endocrine therapy for ER&PR negative tumors does not depend on level of hormone Receptor Expression.

With this technique,
the cut off point for positive HER-2 is 572
less than 572, no HER-2 expression
more than 572, positive HER-2 

(Material provided by Genoptix )

Thursday, May 9, 2013

News

Special Announcement About Tolvaptan

A major announcement was made by Otsuka Pharmaceutical Co. on Saturday, Nov. 3, 2012 at the American Society of Nephrology (ASN) meeting regarding the results of the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease Outcomes (TEMPO) Trial.
This is the first time that a drug specifically targeted to alter ADPKD progression in humans has been shown to be of benefit. This is an exciting milestone for PKD patients and the Foundation. (It is important to know that though tolvaptan is already approved for treatment of other medical conditions, the doses of tolvaptan used in the TEMPO trial were significantly higher than used in previous studies of other diseases. In addition, ADPKD patients are a unique patient population. Because of this, until the data are reviewed in detail by Otsuka and the FDA, it could be dangerous to take tolvaptan for treatment of PKD.)
The concept of using vasopressin blockade as a way of slowing ADPKD progression was originally developed by Dr. Vincent Gattone, whose research has been in part supported by the PKD Foundation. The Foundation is proud to have been a part of this critical work, and our hope is that this is just the first step toward finding other treatments that will improve the quality of people's lives who suffer from PKD.
Click on the links below to read the full announcement and learn more about the study.

FROM THE PKD FOUNDATION!
1."NO INSURANCE STATUS" KILLING YOUNG PEOPLE WITH CANCER IN EL PASO.

Young people holding small jobs can barely afford life on their own and one of the sacrifice they make is health insurance.  In El Paso, a border town of the great State of Texas at least 30% of working young families do not have health insurance.  You can get by with a headache, Tylenol is available without prescription.  But when you have cancer, young people are waiting for death in silence.  Many have found their qualification for MEDICAID which these days means a government certificate of "no insurance".  Not only its payments are meaningless but it is very hard to come by!  Therefore most physicians do not take patients with it.  At Medicare and Medicaid, the government uses its time to imagine new ways (Red tape) to cut or escape payment all together.  The new latest method is to claim "we have a new computer system". "your claim was entered incorrectly or in the old system" we could not pay you because we could not find your claim in the new system".  Who is responsible for entering data in the system in the first place or why is it the physician responsibility when a government personnel did not do its work.  Rather than dealing with this mess physicians and some hospitals are turning away patients.  And the best way to turn patient away is NO FOLLOW-UP APPOINTMENT ONCE CANCER DIAGNOSIS IS MADE.  You can't show up at the ER for cancer,  cancer does not cause a pressing symptom while it is spreading.  So we have a walking dead situation where a normal looking individual is living of the knowledge of having cancer but with no treatment!
In this border town, Mexico is the answer for many!  There they get treated as far as their money can take them...they comeback to die in their home fully disconnected for the American Health system most of the time having missed to the latest treatment available in the US.

WHILE ALL THIS IS HAPPENING, POLITICIANS AND LOCAL JOURNALISTS TURN THEIR BACK!

2.SHE CAME TO DIE IN MY ARMS!

May 8th, 2013, I was waiting for a new patient when I ended up with such case.  A desperate mother seeing her daughter dying, brought her to my clinic hours before her death which she escaped after IV fluid was given in a reluctant ER where I was forced to take the patient urgently!

A 25 year old American woman, mother of 3 kids, was reportedly sick without health insurance, she sought treatment in Mexico, she was reported to have an aggressive form of Leukemia (ALL).  She received chemotherapy reportedly for a full year.   With her money exhausted she could no longer afford to go back and follow-up could not be accomplished.  The last bone marrow obtained just 6 weeks ago showed no leukemia but the marrow beaten by chemotherapy is failing to make cell blood cell as it should.  Over the last few weeks she has been home weakening by the time she was brought to the office in wheelchair, she had not walk for over a week, going in and out of consciousness, she dry and Anemic...the ER gave her fluid but no blood and discharged her with NO FOLLOW-UP APPOINTMENT.   Contacted by the family, I referred the patient for transfusion to the only hospital still helping the poor, for how long your guess is as good as mine? The woman should now be evaluated for transplant but now she is free of cancer but mostly dying for lack of follow-up!

IF YOU CAN HELP IN ANYWAY, CONTACT OUR OFFICE !
THIS NOT THE ONLY CASE


Wednesday, May 8, 2013

TREATING RESISTANCE TO HER-2 TARGETED THERAPY HAS NOW BEEN CLEARLY DEFINED.
In all evidence, the receptor resistance can be induced by change in shape, change in molecular content, and and change in molecular nature of product with which it interacts.  As it pertains to the Human Epidermal Growth factor Receptor or HER-2  Receptor, downstream interaction is with the PI3K/AKT/MTOR.
We now take it for granted as a truth that when,in a pathway, some thing clog the action, we target downstream steps.  If you can't stop the enemy in the street, or gate, try stop him at your doorstep.
So instead of stopping the Her-2 Receptor, inhibit the MTOR, mammalian target of Rapamycin!

So now inhibiting the MTOR is a strategy to stop resistance or add to the effect of target therapy aimed at HER-2.
and guess what, it works!  Proof of concept did materialize in clinical trials!  

Scientist now are also taking the Her-2 Receptor targeting molecule, attach it to a powerful chemotherapy molecule and send the whole thing into the cell (concept of T-DM1).

Trastuzumab emtansine

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Trastuzumab emtansine ?
Monoclonal antibody
Type Whole antibody
Source Humanized (from mouse)
Clinical data
Trade names Kadcyla
Pregnancy cat. D (US)
Legal status -only (US)
Routes Intravenous infusion
Pharmacokinetic data
Bioavailability N/A
Protein binding 93% (in vitro)
Metabolism Hepatic (CYP3A4/3A5-mediated)
Half-life 4 days
Identifiers
CAS number 1018448-65-1 
ATC code None
UNII SE2KH7T06F 
KEGG D09980 
Chemical data
Formula C6448H9948N1720O2012S44·(C47H62ClN4O13S)n
Mol. mass 148.5 kDa
  (what is this?)  (verify)
Trastuzumab emtansine (INN;[1][2] in the United States, ado-trastuzumab emtansine, trade name Kadcyla) is an antibody-drug conjugate consisting of the monoclonal antibody trastuzumab (Herceptin) linked to the cytotoxic agent mertansine (DM1).[3][4][5][6] Trastuzumab alone stops growth of cancer cells by binding to the HER2/neu receptor, whereas mertansine enters cells and destroys them by binding to tubulin.[7] Because the monoclonal antibody targets HER2, and HER2 is only over-expressed in cancer cells, the conjugate delivers the toxin specifically to tumor cells.[8]
In the EMILIA clinical trial of women with advanced HER2 positive breast cancer who were already resistant to trastuzumab alone, it improved survival by 5.8 months compared to the combination of lapatinib and capecitabine.[8] Based on that trial, the U.S. Food and Drug Administration (FDA) approved marketing on February 22, 2013.[9][10][11]
Trastuzumab emtansine was developed by Genentech. The planned cost is expected to be $9,800 a month, or $94,000 for a typical course of treatment.[10] wikipidea.

ANOTHER STRATEGY CREATED BY SCIENTIST!


Pertuzumab

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Pertuzumab ?
Monoclonal antibody
Type Whole antibody
Source Humanized (from mouse)
Target HER2
Clinical data
Trade names Perjeta; Omnitarg
Licence data US FDA:link
Pregnancy cat. D (US)
Legal status -only (US)
Routes Intravenous
Identifiers
CAS number 380610-27-5 
ATC code L01XC13
UNII K16AIQ8CTM Yes
KEGG D05446 Yes
ChEMBL CHEMBL2007641
Chemical data
Formula  ?
  (what is this?)  (verify)
The structure of HER2 and pertuzumab
Pertuzumab (also called 2C4, trade name Perjeta) is a monoclonal antibody. The first of its class in a line of agents called "HER dimerization inhibitors". By binding to HER2, it inhibits the dimerization of HER2 with other HER receptors, which is hypothesized to result in slowed tumor growth.[1] Pertuzumab received US FDA approval for the treatment of HER2-positive metastatic breast cancer on June 8, 2012.[2] Pertuzumab was developed at Genentech and is now owned by Roche which acquired Genentech in 2009.

Tuesday, May 7, 2013

DON'T BEAT YOURSELF, THE WORK HAS BEEN DONE BY VON HOFF ET AL!

TARGET TESTED BY IHC                    DRUG PROPOSED AS INTERACTING WITH TARGET

1.EGFR..................................................CETUXIMAB,ERLOTINIB,GEFITINIB
2.SPARC................................................ABRAXANE
3.c-KIT...................................................IMATINIB,SUNITINIB,SORAFENIB
4.ER........................................................TAMOXIFEN,AROMATASE INHIBITOR,TOREMIFENE,
................................................................PROGESTATIONAL AGENT
5.PR........................................................(SAME AS ER) ADD GOSERELIN
6.ANDROGEN RECEPTOR..................FLUTAMIDE,ABARELIX,BICALUTAMIDE,LEUPROLIDE,
................................................................GOSERELIN
7.PGP......................................................DOXORUBICIN,ETOPOSIDE,DOCETAXEL,VINORELBINE
................................................................PLEASE AVOID NATURAL PRODUCT
8.HER-2/NEU.........................................TRASTUZUMAB
9.PDGFR.................................................SUTENT,GLEEVEC,SORAFENIB (NEXAVAR)
10. CD52.................................................ALEMTUZUMAB
11.CD25..................................................DENILEUKIN DIFTITOX
12.HSP90................................................GELDANAMYCIN, CNF2024
13.TOP2A...............................................DOXORUBICIN, EPIRUBICIN, ETOPOSIDE

THIS WAS PUBLISHED THROUGH ASCO

Comments

We can now go wild testing gene on our specimen.  Basically after failure of standard of care, re-biopsy and adjust the attack using these agents!

Geldanamycin is a benzoquinone ansamycin antibiotic that binds to Hsp90 (Heat Shock Protein 90) and inhibits its function. HSP90 client proteins play important roles in the regulation of the cell cycle, cell growth, cell survival, apoptosis, angiogenesis and oncogenesis.

Hsp90-geldanamycin complex. PDB 1yet[1]
Geldanamycin induces the degradation of proteins that are mutated in tumor cells such as v-Src, Bcr-Abl and p53 preferentially over their normal cellular counterparts. This effect is mediated via HSP90. Despite its potent antitumor potential, geldanamycin presents several major drawbacks as a drug candidate (namely, hepatotoxicity) that have led to the development of geldanamycin analogues, in particular analogues containing a derivatisation at the 17 position: (wikipedia)

Conceptually, this drug should be tested in triple negative breast cancer where receptors will fail  stressing the cell to amplify HSP90.   As a matter of facts, this drug should most likely be used widely given the importance of cellular stress in Neoplasia (including leukemia).

Invivo gene reports:

"Hsp90 is a ubiquitous molecular chaperone critical for the folding, assembly and activity of multiple mutated and overexpressed signaling proteins that promote the growth and/or survival of tumor cells. Hsp90 client proteins include mutated p53, Raf-1, Akt, ErbB2 and hypoxia-inducible factor 1a (HIF-1a) [1]. Binding of GA to Hsp90 causes the destabilization and degradation of its client proteins [2]."    So disease where mutations of HSP90 "clients appear to be a driver mutation, should have Geldamycin theoritically !

"However due to poor aqueous solubility and liver toxicity, GA has not moved forward in clinical trials. To overcome these undesirable properties, numerous GA analogs have been synthesized which differ only in their 17-substituent. These include 17-allylamino-demethoxygeldamycin (17-AAG) and 17-dimethylamino- geldanamycin (17-DMAG) that have completed phase I and are currently entering phase II clinical trials."

Monday, May 6, 2013

RESEARCH AT CRBCM
==================
We, the CRBCM, would like to thank one more time MDHonors from London UK for allowing us to kick start the lung cancer Biomarker early detection project.  The project is unique because it  will help detect early lung cancer in heavy smoker.  Hopefully it will help find lung cancer at a still resectable level where we can make a difference in prognosis.  It will strengthen the hand of the surgeon in small lesions where currently observation may be deemed dangerous if the lesion being observed is indeed a cancer which may metastasize if given more time.  We have worked hard and set up collaboration with the statistics lab at UTEP, and Biomedical labs at UTEP and Texas Tech through the pathology lab.  We were just waiting for the funding to initiate the project.
This one research project will be completed in 4 phases:
*1st phase will be to obtain tissue through Banks: The tissues will be from patients with lung cancer in order to determine the prevalence of these genetic abnormalities in cancer tissues.  This part is critical because it will also ascertain our detection methods in patients with the cancer!

*The second phase will be the recruitment of Heavy smoker candidates, 2-3 pack/day for greater than  30-40 years who will be willing to sign a consent for participation and agree to let us collect samples of blood and sputum. And apply those testing techniques learned in the first phase!

*Conclusions and publications of our results will follow in the 3rd phase.

*4th phase is the development of an early lung cancer detection kit for by using our findings.

We thank MDHonors for their trust and funding!

At the CRBCM, we work hard to always deliver on our promises.