Monday, October 6, 2014

Getting more training in research, full schedule.....this is my outlook Calendar

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Saturday, October 4, 2014

Treatment in advanced Head and neck cancer

Cetuximab-Cisplatin-5-FU
adding Taxane does not change survival
question maintenance of Cetuximab
weekly Taxol - carbo
Afatinib
weekly Methotrexate
Gemzar - Cisplatin
Pembrolizumab


for early stage of course
------------------------------chemotherapy and weekly Cisplatin +/-Cetuximab
or RT with Cetuximab

Monday, September 29, 2014

ROLE OF SOX5, A DRIVER FORCE. FROM EPITHELIALIZATION TO METASTASIS





                                              TWIST1 ------!
                                                    !                !
                                                    !                !..................E-CADHERIN
                                                    !                !                                !
                                                 SOX5--------!                                !
                                                    !                        miR125B  - - - SNAIL-1------FGF
                                                    !                                                   !        !
                                                    !                                                   !        !
                                                    !                                              SIP-1  MMP
                                                    !
                                                    !
      _______________________!__________________________________
      !                     !               !                       !                !                   !
   COL2A        AGC-1       PPARs              AP-1        ATF1            C-jun

Saturday, September 27, 2014



Dannemiller Mutombo Kankonde, MD
11601 Pellicano Rd
El Apso, TX 79936
Certificate
Dannemiller certifies that the above individual has participated in the enduring material titled Evolving Strategies for Management of Early-Stage and Metastatic Triple-Negative Breast Cancer on September 27, 2014 and is awarded 2.00 AMA PRA Category 1 Credit(s).

Michelle Montgomery, MA, CCMEP
Director of Continuing Education
 
5711 Northwest Parkway – San Antonio, TX 78249 – Tel: (800) 328-2308 – Fax: (210) 641-8329

Breast cancer/TNBC

*when a woman expected to have BRCA1,or 2 fails to have it
should we go on to find PALB2

*for TNBC
1,Taxol or Taxotere weekly
+Carboplatin AUC6 Q4weeks
or
Eribulin (1.4mg/m2 day 1,8 Q21 )  + Carbo
or
Ixabepilone

or Gem-Carbo + Iniparib or olaparib

VELIPARIB +CARBO+TAXOL


Friday, September 26, 2014

Origin of solid/epithelial and some hematologic tumors: disturbance of Ubiquitilation...

Although there seem to come from every single where,
life seems to try to hide from us the single origin of sufficient disturbance that lead to neoplastic transformation, but every where you turn seems to impose upon us that the single most important process involved in the neoplastic process start as a deficiency in the Ubiquilation process!
Yes one of the E3 (or partner) is involved in many cancer.
The involvement may not be directly involving the cellular E(s), however in many instances, molecules containing a E receptor or attachment site will be involved.
In Breast cancer, the SWI/SNF HAS AN UBIQUITININ BINDING DOMAIN:

"SWI/SNF mutations were widespread across diverse human cancers, with an excess of deleterious mutations, and an overall frequency approaching TP53 mutation. Mutations occurred most commonly in the SMARCA4 enzymatic subunit, and in subunits thought to confer functional specificity (ARID1A, ARID1B, PBRM1, and ARID2). SWI/SNF mutations were not mutually-exclusive of other mutated cancer genes, including TP53 and EZH2 (both previously linked to SWI/SNF). Our findings implicate SWI/SNF as an important but under-recognized tumor suppressor in diverse human cancers, and provide a key resource to guide future investigations."  HUNTER SHAIN et al.
"Remarkably, mutations in SWI/SNF were present at high frequency across many different tumor types (Fig. 1A). The cancers with the highest SWI/SNF mutation rates were ovarian clear cell carcinoma (75%), clear cell renal cell carcinoma (57%), hepatocellular carcinoma (40%), gastric cancer (36%), melanoma (34%), and pancreatic cancer (26%). Across all tumor types, the average frequency of SWI/SNF mutations (19%) approached that of TP53 (26%; shown for comparison in Fig. 1A), the single-most mutated tumor suppressor gene." SHAIN AND JOHNATAN POLLACK

"

Mammalian SWI/SNF-A Subunit BAF250/ARID1 Is an E3 Ubiquitin Ligase That Targets Histone H2B[down-pointing small open triangle]

Xuan Shirley L et al"   " together with cullin 2 and Roc1, assemble into an E3 ubiquitin ligase. The BAF250b BC box mutant protein was unstable in vivo and was autoubiquitinated in a manner similar to that for the VHL BC box mutants. The discovery that BAF250 is part of an E3 ubiquitin ligase adds an enzymatic function to the chromatin-remodeling complex SWI/SNF-A."

The part were the SWI/SNF has Histone modulation activity is a relevant one since it points to new creation of sets of molecules that are going to help in the neoplastic transformation.   That in this part of the Silenced DNA, activity at the Ligase will "Unsilence" several genes that will be determinant to the future of the new cell.
=========================================================
In lung cancers, effects at the MDM-2 has now been recognized by studies by DR Zhang (UTEP) that this is one of the most amplified genetic mutation.  Putting the MDM-2 at the onset of cancer pathogenic production.    Yes the disease seems to start here with further secondary amplification of the NPM1 as a result: 

Robert Amson et al
"TPT1"
and

"recruitment of phosphorylated NPM1 to site of DNA damage through RNF-8-dependent Ubiquitin conjugates" Ayaka Koike et al!
implicating BRCA-1 ....

===========================================

The high response rate of Velcade in Myeloma has provided further proof that ubiquitination is a major pathways in this disease
===========================================
In renal cancer
the answer is obvious,

Thursday, September 25, 2014

from ASCO 2014: Treatment of renal cancer

Renal cell cancer

                      setting                          phase III                                             Alternative
                                                           Sunitinib
1st line         Good or Intermediate      Avastin                                               HD-IL-2
                                                           Interferon-alpha
                                                            Pazopanib
                    Poor risk                   Tamsirolimus

================================================================
           Prior Cytokine                      Sorafenib                                           Sunitinib
                                                         Pazopanib                                         Avastin

2nd line      Prior EGFR                Everolimus
therapy       inhibitor                      Axitinib                                             clinical trial

                   Prior MTOR               Clinical trial

From ASCO



Challenges in treating immunocompromised patients

One of the many challenges in treating immunocompromised patient is the lack of predictive bio-markers that help guide treatments of these patients while they are undergoing chemotherapy or any other immunocompromising treatment. In most cases, the treatment is reactive that is we wait until the patient is sick and proceed on to catch up by giving him a combination of Antibiotics, anti-fungals, and other available anti-virals.
We know the patients have either a cellular deficiency or an humoral dysfunction linked to the primary hematologic disease or to treatment.   But we still can't predict what if any infection will be developed.  Perturbation of the integrity of the Gastro-intestinal or pulmonary membranes that could be induced by our therapeutic interventions, and dormant viral (CMV, HH-6,)and bacterial infections (Syphilis,Tuberculosis), all could contribute to an infection outbreak, but no predictive bio-markers are available for current clinical use!
The longer the patient remains neutropenic also impact on what infection can set in!  Briefly, we have no predictive definite Biomarkers to predict what infection will be developed, and in specific cases, in patient undergoing treatment preventive or otherwise.    Ongoing treatment on Tacrolimus or Cyclosporine must be monitored with specific biomarkers that will allow closer monitoring of these patients.  Current medical practice does not allow clear measurement indicators predicting what will happen to the patients.
Another component of these issues, is predicting who will develop a sweet syndrome in our neutropenic patients, and who are susceptible to other rare event such as the PRES (posterior reversible Encephalopathy Syndrome).   Genetic Bio-markers must be out there, our point is just to go get them to declare our readiness for future medicine....

Monday, September 22, 2014

So we said!

According to the US Government on Aging (at least seems to suggest)
to have eternal life you have to have or know some of the genes for these functions:
-Gene(s) to avoid unhealthy choices (ie. blocking Glucogen,controlling lipid,MTOR, CRE gene)
-Genes to keep life sparks (hormones,cytokine,physical exercise,what to eat)
-Gene(s) to keep eternal  youth (Telomeres,MTOR)
-Genes to stay spunky (hormone,routines, MTOR
-Genes that keep you fun (Hormones, cytokines)
-Genes to keep magical transformation (rejuvenating) (Cytokines,
-Genes to avoid physical decline (Exercice under cytokine control
-Genes to avoid vulnerability to disease (Flyn,Lyn directions for looking)

let's go find them!

Saturday, September 20, 2014

News in Prostate Cancer! Getting hot in Las Vegas!

With all the new options for therapy in Prostate cancer, one may wonder if there is still interesting topics and areas of unknown in Prostate cancer.  One thing is for certain, there is no definitive cure for Prostate Cancer and therefore research and progress in this field remain to be accomplished.  And with each conference, one continue to learn new areas of research emphasis.  In Prostate cancer, data free Zones continue to abound as discoveries are made!

Areas of Data free Zone!
------------------------------This is where in clinical practice things are done although there is no clear data to support our practice.

1.Although we all know that patient who fail Lupron should go onto "withdraw", there is no biomarkers to determine who should be chosen for this option.  Often we bypass this withdraw as an option to jump now to Abiraterone or Enzalutamide because we can!  This is however an important period of no therapy that our patients can enjoy with no therapy or side effects!

2.How to determine the most efficacious treatment? or what are the most predictive Bio-markers?
3.Are combination therapy better than sequential use of major therapeutic options
4.Is deterioration of performance status a clear indication of exclusion of spileucel-T use since this drug may take up to 6 months before the curb separation to indicate benefit, should Performance status be used for early initiation of chemotherapy...?
4.what is the role of new immune markers?
CD54 upregulation has been used for the appropriateness of use of spileucel-T?  what about CTC - ARv7 the so called "negative Predictor Biomarker"?
5.Given the impact of the marrow, should RAD 223 come always prior to Chemotherapy or after this?  should documented radiological progression in the bone be the indicator of RAD 223 in a pain bearing patient with metastatic Prostate cancer patient?  And how to interpret PSA fluctuation in RAD 223 treated patient?   Should we always continue to associate Lupron or other anti-androgen treatment that adress non bone disease (or visceral disease) while on RAD 223?
6. What in hell is "liquified semen" while on treatment for Prostate cancer?  And now the role of Eosinophilia in so called "good responders" ? should alkaline Phosphatase, or PAP be better biomarker in patient treated will spileucel-T. Or is-it PA-2024?  Could proof of long term memory by T-cell be evidence of further role for a boost in Spileucel-T.  What is the role of "Antigen spread"? and what that has to do with Cancer preservation and resistance?

7Notion of AR Variant that apparantly lack a binding domain for membrane area activity but can still act deeper into the Nucleus, and is -t here that Enzutamide may be more effective since it impairs deep localisation at AR cellular path...and what are the co-factors allowing this deep action of the variant AR.   Should we really look for AKT/PI3K upregulation in resistant diseases?  And actually which gene cross-talk with the AR in resistant cancers?  And the role of combination therapy in these setting...

8.Instead of fighting all these side effect, should we just push further Orchiectomy?
9.role of Gleason once treatment has been started?
10. Is testosterone level <50ng better than 20ng to define hormone resistance disease?
11. how to appreciate cardiac risk in patient on treatment for metastatic Prostate cancer

EH! patient on Abiraterone, always use Prednisone
but you don't have to for Enzalutamide
and always use GCSF while on Cabazitaxel because the one who died fron this chemotherapy did so after the first cycle of chemotherapy!  experimenting without it at your own risk!

etc...and I can go on for days...at CRBCM, we keep ourselves informed!  still a lot of work even in Prostate cancer....

Friday, September 19, 2014

Wynn Las Vegas, a review on Prostate Cancer...

The CRBCM is back in Las Vegas to sharpen its knowledge on Prostate Cancer
what is new ? Is there a new sequence to treating Prostate cancer...are there new bio-markers, new guidelines, new genes to be aware of? these are the few questions that we have forward. The actual conference will be tomorrow.  Here at the Wynn...the setting is perfect...we will update you as quickly as we get the info....for now just let's enjoy the Wynn...

Tuesday, September 16, 2014

Interesting case at CRBCM: Acute Myeloid Leukemia with myelomonocytic differentiation in a patient with possible Lupus

This is a 74 YOHM who presented to Sierra Providence with vomiting, nausea , poor appetite and weight loss, he was found with a severe anemia. A bone marrow biopsy obtained on 08/11/2014 suggested a Hypercellular Marrow involved with Acute myelogenous leukemia with myelomonocytic differentiation.  There was 70 to 80 % of myeloblasts by morphology and flow.  Further cytogenetic studies revealed a positive inversion 16 ( MYH1) with 7q- (DS486). The CBFB was found in 90% of cells and RUNX1-I mutation in 90% of cells. 
Of note: The ANA was positive.   HIV negative.
The patient received a course of hydroxyurea prior to a standard 7+3 induction therapy with Daunarubicin and ARA-C. A new bone marrow biopsy obtained on 09/02/2014 suggests residual disease with 3% blasts 10 to 15% myelomonoblasts.  the patient will need a reinduction therapy with Idarubicin and  ARA-C.
 Prior to this admission, the patient, an old teacher, was otherwise healthy. He has no history of hypertension, diabetes or asthma.
Of interest: The patient's sister has an open Lupus.
===================================================

This case is very interesting as it suggests progression of Lupus into a monocytic AML
did RUNX-1 under various pressure go awry,
did presence of RUNX-1 suggest activity of Etoposide or may be just activity of Decitabine.
but this is an inversion 16 case, should we forgo standard induction because of the patient age?  But he did tolerate induction treatment at the local Hospital.   He had the 7q minus deletion and therefore a bad prognosis indicator mitigating the Inv(16) presence.  Could he have transplant in good hands...the man has a good performance status and flew through his first attempt to induction!
your feed back appreciated! 

Ida will do (
"Idarubicin /ˌdəˈrbɨsɪn/ or 4-demethoxydaunorubicin is an anthracycline antileukemic drug. It inserts itself into DNA and prevents DNA from unwinding by interfering with the enzyme topoisomerase II. It is an analog of daunorubicin, but the absence of a methoxy group increases its fat solubility and cellular uptake.[1] Similar to other anthracyclines, it also induces histone eviction from chromatin.[2]"  wikipedia

So it is! from the Indiana State commissionaire

State Health Commissioner
The Indiana State Department of Health (ISDH) has identified four confirmed cases of respiratory enterovirus EV-D68 among Indiana residents.  Testing was performed at the Centers for Disease Control and Prevention (CDC).  Several other suspect cases are pending testing at the Indiana State Department of Health Laboratory.  Syndromic surveillance of hospital emergency department chief complaints has indicated a higher than expected level of respiratory illness statewide for this time of year.  Several other states, including Colorado, Illinois, Iowa, Kentucky, Kansas, and Missouri, have also identified confirmed EV-D68 cases. 
 
EV-D68 infections can be mild and self-limited, but children with asthma are at risk for severe respiratory illness and may require hospitalization to receive intensive supportive therapy.  Patients with asthma should carefully maintain their current medical management and follow their asthma action plan to monitor for early signs of exacerbation.  People who smoke are also at higher risk for severe enterovirus infections.
 
The CDC recommends hospitals use standard, contact, and droplet precautions when caring for patients.  Alcohol-based hand sanitizers are not effective against EV-D68.  Bleach-based disinfectants, like those used for rhinovirus and norovirus, are effective for environmental cleaning.
 
Clinicians are advised to suspect enterovirus infection in patients hospitalized with asthma exacerbations or severe respiratory illness.  To confirm the presence of EV-D68 in Indiana and further characterize this illness, the ISDH Laboratory is temporarily requesting that clinicians send nasopharyngeal and oropharyngeal swabs in the same transport medium or upper respiratory aspirates:
·         Patients must test positive for rhinovirus/enterovirus before submission to the ISDH Laboratory.  Indicate this positive test result and the test method on the specimen submission form.  Specimen submissions lacking this information will not be tested.
·         Specimens from patients who test positive for rhinovirus/enterovirus do not need prior authorization.
·         Specimens do not need to be tested for influenza and respiratory syncytial virus (RSV) prior to submission.
 
Sequencing will be conducted to identify the specific viral strain.  Instructions for specimen submissions to ISDH for testing are located on the ISDH enterovirus page at http://www.in.gov/isdh/26487.htm under the laboratory specimen information section. Specimens should arrive at the ISDH Laboratory Monday-Friday excluding state holidays within three days of the collection date.  Specimens must be submitted using LIMSNET.  To sign up for a LIMSNET account, contact the ISDH LIMS HelpDesk at 317-921-5506 or 1-888-535-0011.
 
Healthcare providers who identify outbreaks or unusual occurrences of respiratory illness should contact Shawn Richards, Outbreak Supervisor, at srichard@isdh.in.gov or 317.233.7125 to inquire about specimen submission and further investigation to identify the cause of these outbreaks.
 
Most enterovirus infections in the U.S. occur seasonally during the summer and fall, and enterovirus outbreaks tend to occur in several-year cycles.  Respiratory enteroviruses include EV-D68 and rhinovirus and are transmitted through contact with secretions from the eyes, nose, and mouth (saliva, mucus, sputum) of an infected person; having close contact with an infected person, such as touching or shaking hands; and touching objects or surfaces that have been contaminated with infectious secretions.
 
No vaccine is available to prevent infection with respiratory enteroviruses, and no antiviral medication is available.  Health care providers should recommend the following:
·         Clean:  wash hands often with soap and water for 20 seconds
·         Cover:  cover sneezes and coughs with your sleeve or a tissue
·         Contain:  prevent spreading illness to others by staying home if you are sick
·         Avoid close contact and sharing cups or eating utensils with those who are ill
·         Disinfect frequently touched surfaces
·         Avoid smoking or exposure to second-hand smoke
                                                                                                                            
For questions regarding epidemiology/surveillance, please contact Shawn Richards at srichard@isdh.in.gov or 317.233.7740.   For questions on specimen collection or submission please contact Stephanie Dearth at stdearth@isdh.in.gov or 317.921.5843.  
 
For more information on enteroviruses, please visit the following websites:
 
Indiana State Department of Health website at http://www.in.gov/isdh/26487.htm.
 
Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/non-polio-enterovirus
 
William C. VanNess II, MD
State Health Commissioner

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Wednesday, September 10, 2014

life in a nutshell

Without further details, and in general
from the time we are born, one seem to cross 4-5 critical phases
first phase:
1.  After conception, there seems to be priority to cellular Multiplication, and as the fetus is being formed, cellular multiplication will be the preponderant direction of metabolic and physiologic reactions.   These metabolic reactions will be limited by rules of differentiation and location of cell in developing tissue.   It seems that gene silencing by methylation or otherwise (shutting down of Histone-DNA  modulation, or miRNA amplification) will be a driving forces in many location...
Self recognition will be one of the many driving forces marking this period as the Fetus expand...HLA A, B

2. As we are born, HLA C & D will go to play
As defense mechanisms mature against foreign bodies and organisms, there is a parallel growth and maturation of tissues started after conception. And early organs particularly of the endocrine origin start and expand production and activities, shaping further the new "man".  This burst of life will continue into the adolescence

3.Then come "the sexual revolution" as the organisms prepare to make new "man" and leave legacy.  The burst of sexual hormones appears one of the most important stage of life as reproductive life will have a deep effect of our HLA C, D.  Particularly in women, Estrogen will while expanding sexual organs, will shut down rejection of a potential baby who may be "foreign" (carrying partial natural father genes) to the woman body!
HLA A, B will see themselves dampened,  At gene level, significant disturbance of DNA Modulation and Methylation will be driven from Estrogen.  So much so, this is the time of diagnosis and worsening of Autoimmune diseases (with thyroid dysfunction following)...genes disturbances driven by these Estrogen or sex hormones'effects may include exposure of genetic abnormalities (BRCAs, and in men, the germ cells and other congenital genetic disturbances) and early cancers!   Any one treating Autoimmune diseases, will have the run for their money when following patients in this age range (reproductive stage).

4.Cessation of the reproductive phase is even more dangerous, adding fire to injury. Estrogen cessation or major decrease will have a violent effects on lipids, endothelial cell membranes (made of lipids) and their main components (the various integrins and Cytokines).  Indeed membranes are the storage of these molecules and various membranes will drive death phenomena such as stroke and cardiac events.  Inflammatory processes and ultimately membrane related genes (ie. MUCs ) could lead to neoplastic transformations in many cases!

5.  And as life continues, The cytokines and various integrins will become increasingly important, unleashing muscle deterioration, lipid dysfuction, immune failures,  further drop of hormones, dementia and memory issue that we have to call "phase of senescence".   "consensus" to cell sudden death and "remain dead" justifies sudden death and is a membrane event   (NOTCH)!  (in some case it may involve only the Brain, and of course the Heart!).

to be continued!

The CRBCM...working hard with perspective!


4.

Sunday, September 7, 2014

Bold proposed study in the fight against Colorectal cancer!

Proposed study to reduce Colon cancer
"Combination of Ciprofloxacin and Motrin for 6 days every 2 months for 2-3 years could reduce by half frequency of colon cancers in people over 50 years in the next 10 years following the 3 years of the study medication administration"

The study is based on a suggested understanding that insidious infection and inflammatory process due to growth of undue infection brewing in the Colon of sedentary adults generates a number of Cytokines that lead to polyps and cancer production.   The study assumes that by reducing an infection by the use of Ciprofloxacin, inflammatory processes will be significantly reduced, and that the use of anti-inflammatory could further reduce cytokine exposure to significantly reduce cancer transformation of colonic cells!

Target Population: above 50 years old
as compared to similar cohort of the general population located in same city.

Observed cohort will undergo colonoscopy at year 3, 8, 13.

Corollary  events to be observed stroke and Cardiovascular in the observed population Vs the cohort in the general local population.  We anticipate a small reduction here also.

Now these kinds of scientific observations are more done in scandinavian countries which are more immersed  with these statistical technics while others will see the downfall first!  science data are waiting...and colon cancer frequency remain unaltered.   I even suspect that cancer of the stomach could also be reduced!

Friday, September 5, 2014

Wednesday, September 3, 2014

One thing about Cytokines

One of the misconception about cytokines is that not only that they are supposed to act like Hormones or even Vitamins to specific receptors but that they need sufficient detectable concentrations to induce incremental changes in the body physiology.   In cancers, TGB does need to be very noticeable to have a autocrine function for a particular neoplastic cell, helping its growth.   In laboratory however acting directly against its receptors may have tangible effect.  It may control metastatic spread of disease.
Another interesting aspect is at various levels of the cytokines, the physiologic effect could be contrary to the original effect, that is a Cytokine could be excitatory at low dose, and inhibitory at high level.
Cytokine can affect metabolism so that only a certain direction is imposed to the metabolism such what happens in dementia (ie: effect on Phosphatases).  Whether  the G proteins have a dramatic role is clearly suggested! And may prone one to open dementia.  It is quite clear that the Cytokine found in elderly are different then in the young as if there is a switch from Hormone preponderence to a Cytokine phase.  Also a greater Mitochondrial abnormal physiology seems to characterize senility leading to susceptibilty to deadly tone of common infections.
At higher doses, cytokines enleash further actions as if affecting non conventional effects. (ie high dose interferon and high dose IL-2) It is as if at these doses new set of receptors (death receptors, PD-1) become better reachable directly or indirectly.  And of course the muscles and vascular receptors are by now overwhelmed and appears the most affected.  And here comes depression and memory deficiency the hallmark of these diseases.   Increasingly it is now thought that in patients with high blood pressure and diabetic patient, it is the increasing disturbance in Cytokine that lead to stroke and Heart attacks...the dreadful transition from hormone preponderance to the Cytokine kingdom is followed by unhealthy consequences and deterioration of protective effect of hormone is as a result!
The effect on Mitochondrial activities overall push forward immunomodulation and anti-inflammatory role promoting the role of NSAID.   But this role is muddled by the various impacts of various agents on JUNK and c-FOS....

to be continued...
CRBCM always continuing its progress! And the circle will be soon closed!

see previous blog

 What weakens the blood vessel for stroke to occur
is it an acute process
is it a long standing transformation due to or inducing cytokine release (can we capture the moment?)
what about the the role of the HIF gene? the MTOR, CRE and the Adenyl Cyclase
what is the exact role of VEGF (or the various VEGF)
what is the role of the endothelial genes/integrins/what A4Beta.
what is the level of metalloproteases before and at rupture
stress on the Cateins
can the FGF-1 tell us a thing
what is the PDGFR reaction
secretion of platelet during clotting at blood vessel
what is happening in the endothelial cells, what can preclude the secondary incident that happens within a year
is the therapeutic response adequate
does Aspirin good as an universal response (based on impact on the c-jun--c-fos taken indiviual or by ratio)
what is the c-fos and c-jun behavior ?
Role of Avastin if any
what cytokines are involved?
level of coagulation factors
what factor V has to to
what about the homocystein?
does vitamin D level affected or induces it?

Monday, September 1, 2014

Important aspect of immunomodulation, the case of the T-reg!

T cell Regulator have plenty of expression of FOXP3 (Scurfin) and this statement summarize the power of Foxp3,
Roli Khattri et al "express glucocorticoid-induced tumor-necrosis factor receptor–related (GITR) protein. The forced expression of Foxp3 also delays disease in CTLA-4-/- mice, indicating that the Scurfin and CTLA-4 pathways may intersect and providing further insight into the TR cell lineage."

Use of Azacytidine and other Histone modulating agents seems to increase Treg cells and therefore TNF receptor stimulation yielding an uncontrolled inflammatory effect leading to some level of Apoptosis.   The involvement of CTLA-4 must be clearly noticed!

What triggers the expansion of Foxp3 expressing cell is being debated :" the influence of solely TGF-β, so the difference between a proinflammatory and a pro-regulatory scenario is the presence of a single interleukin. IL-6 or IL-21 is being debated by immunology laboratories as the definitive signaling molecule. It seems so far that murine studies point to IL-6 whereas human studies have shown IL-21."  Wikipedia
could Vidaza induced expansion of Treg be compared with IL-21 induced Treg expansion for further answers?   Remembering that MGUS is TNF driven, is there a role here?

Could association of IL-23 expands the force of Ipilimumab?  or can Vidaza do it since there is a clear proclaimed link?

wait a minute, it gets better" Two lines of functional evidence strongly supported that FoxP3 serves as tumour suppressive transcription factor in cancer development. First, FoxP3 represses expression of HER2, Skp2, SATB1 and MYC oncogenes and induces expression of tumour suppressor genes P21 and LATS2 in breast and prostate cancer cells. Second, over-expression of FoxP3 in melanoma,[12] glioma, breast, prostate and ovarian cancer cell lines induces profound growth inhibitory effects in vitro and in vivo. However, this hypothesis need to be further investigated in future studies." Wikipedia

Is that means
1.In Her-2 negative disease, Vidaza may have a supportive role?
2.what in hell Skp2 add to this
3.MYC is proliferation in chief
4.LATS2 ?????
5. and of course P21, who saw this coming!

Then come this from Marsha Willis-Karp et al:"Tim-3, a member of the T cell immunoglobulin mucin family, is expressed by TH1 cells. Analysis of Tim-3–Tim3 ligand signaling now shows this pathway is intimately involved in the counter-regulation of T helper type 1 immune responses."

DOES THIS MEANS TIM-3 ENTERS THE PATHOGENESIS OF MUCINOUS CARCINOMA?  THESE TUMOR ARE NOTICED LATE AND GENERALLY MORE ADVANCED AT TIME OF DIAGNOSIS.
FUN LOOKING IN ALL THIS!

Activities at CRBCM

Our long endeavors continue
we have heard from NIH, they need more details for our research grant application for c-Myc and c-FOS, we are going to continue this line of research since so much is at stake!
we have concluded our mission in Indiana, will complete submissions.
work at the Plasma center has drastically increased as more involvement is required now to achieve the same role, we continue to follow-up on request for further Cytokine research needs here.  These places have significant access to plasma and Cytokines...Part of this work may include creation of a school of Biomedical Research in El Paso (part of an integral lab development)!  Prospective studies underway!
46 patients planned to be seen this week in clinic and 15 day calls, expansion is arriving, we will skip the trip to Indiana in September...
In October, it is confirmed we will be back at Kosciusko hospital,Warsaw Indiana, for more Oncology work...
This next Month, CRBCM will welcome the help of Orianne Brunet for the finalization of our work completed 1 year ago at Cielo Vista Mall.  Orianne will help set up our immunization program!
CRBCM is looking into ensuring independently access to care by indigent cancer patients!
CRCBM will closely follow CPRIT deliberations coming this Sept 3rd in Houston...
We are looking to publish within the next 2-3 months our work on lung cancer...CRBCM...research work continua...

Thursday, August 28, 2014

DEEP INTO THE BOWEL OF EPIGENIC PHENOMENA

Deep into the bowel of epigenic phenomena dances important genes dances

RuvB-like 1 gene, a gene so important it may have been borrowed or copied from the E-Coli because of its ATPase potentials, and here at epigenic level, it may interact with the c-Myc

but also with the Catenin and p400.(wikipidea)  It listens to membrane phenomena through the Catenin,  impact commitment to proliferation through the Myc,  modify the Actins through the ACTL6A (?gene to be watched Taxotere use).  Careful also, by interacting with p400, it is getting cues from Ubiquitination E1A...its ATPase activity impacts histone /chromosome remodeling and favor transcription...

you cannot touch this without hearing from it...careful now...

Tuesday, August 26, 2014

Thoughts about a Novel approach to cancer treatment


With the success of PDL-1/PD-1 and the suspicion that cancer cells build mechanisms to escape natural immunity from inducing Apoptosis at onset, one is excited to try and restore the avoided mechanisms and see if re-injected cancer cells that have been through plasmid treatments as applied by nobel price winner Yamanaka,  the piggyBac  tranposon system  (wikipedia) applied  by other, and miRna guided amplification of specifically suppressed genes in cancer.
  The restoration could also involve prominent mutation genes known to be suppressed such as PTEN  and E-Cadherins in specific cancer cells cells prior to re-infusion.   By restoring these levelsi in cancer cells that have been extracted from patients , Once re-infused, one wonder if this will trigger a response that will extend to unaltered cancer cells in the body.   The genes must be relevant and should consider restoration of the HLA-1-type automatic reaction.   (or re-stimulating Death Receptor) ...some refinement now needed!

CRBCM, always coming up with new line of attacks against cancers!

WHEN YOU ARE GOOD, YOU COULD BE EXCELLENT: THE CASE OF VELCADE

SOURCE FDA/MEDSCAPE
"The U.S. Food and Drug Administration has approved Velcade (bortezomib) for the retreatment of adult patients with multiple myeloma who have previously received and responded to Velcade therapy and have then relapsed at least six months after the completion of that treatment.

The drug is a proteasome inhibitor that was first approved for treatment of myeloma in 2003 (OT 8/25/03 issue), and it was approved for injection in 2008 (OT 8/25/08 issue). Velcade was approved in 2006 for the treatment of patients with mantle cell lymphoma who have received at least one prior therapy. And, the drug’s label was updated in 2012 to include the subcutaneous method of administration in its approved indications including multiple myeloma and mantle cell lymphoma after at least one prior therapy (OT 2/25/12 issue).

The recent actions for the drug follow data from the single arm, open-label, Phase II RETRIEVE trial of 130 patients who had previously received and responded to Velcade-based therapy and had relapsed at least six months after that prior Velcade treatment. The data showed one patient had a complete response and 49 patients had a partial response; and the median duration of response was 6.5 months.

The most common adverse effects reported in patients receiving Velcade were thrombocytopenia, diarrhea, herpes zoster, and pneumonia. Adverse reactions that led to discontinuation of treatment occurred in 13 percent of the patients. Other common side effects included fever, decreased appetite, fatigue, and rash.

Velcade is co-developed by Millennium/Takeda and Janssen Pharmaceutical Companies."


CRBCM IS GLAD TO HEAR DR MUYEMBE TAMFUM IS HEADING TO LIBERIA FOR THE EBOLA OUTBREAK THERE!

DR MUYEMBE, WAS FIRST MY MICROBIOLOGY PROFESSOR
AND WAS DEAN OF THE MEDICAL SCHOOL WHILE 1 WAS STILL A STRUGGLING MEDICAL STUDENT, IT IS GOOD TO HEAR THAT 31 YEARS AFTER I GRADUATED FROM THIS SCHOOL, HE IS STILL STRONG ENOUGH TO UNDERTAKE THESE KINDS OF OPERATIONS!   ONE THING IS FOR SURE, WHEN YOU ARE GOOD, YOU ARE GOOD....DR MUYEMBE STAYS VERY HIGH IN OUR EYES!  MAY GOD BLESS HIM!

And life goes on

Dear Mutombo Kankonde,
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Monday, August 25, 2014

Unveiling the Cytokines!

It is increasingly suggested that the role of what we call the Cytokines, once looked at closely, is much broader and remains one of the insufficiently explored phenomena of life.  The key to their "secrecy" and unexplored facet is linked to their Multi-plurality (indeed there are many Cytokines), their ability to act at low quantity level (they act on specific receptors) and act insidiously (3 years after a Brain injury, Cytokine manifestation is through lack of memory, or decreased focus on things, or even change in weight)!
The effect is often not patent but definitely present such as minimal fever, minimal diarrhea or some joint pains!  But it is the Cytokines at work.
In COPD, the "thin puffer"is an example of a clinical presentation of Cytokine at play!  One tend to brush out the deleterious effects of smoking because one did not develop "COPD" or lung cancer.   This even a woman who had a stroke 20 years ago...and looks older then people of her age.   The deleterious effects of smoking can vary according to our gene background among other things, and of course also, according to the various receptors that an individual has!  While some may indeed develop lung cancers, many other will develop Bladder cancer, or simply get old faster, or develop memory problems, or lack of ability to gain weight !  Its all depend on many factors including the production of Cytokines!

*Role in Traumatic Brain Injury:
This where the effect is dramatic, indeed after a brain injury, there is a healing on location, and science has shown that even if the area directly involved may control movement, science has observed that individual afflicted by trauma may several years later develop Post Traumatic Syndrome (PTSD) with lack of sleep, and memory problems even if the Hippocampus was not involved in the original trauma:

" Humans and other mammals have two hippocampi, one in each side of the brain. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation. The hippocampus is located under the cerebral cortex;[1] and in primates it is located in the medial temporal lobe, underneath the cortical surface. It contains two main interlocking parts: Ammon's horn[2] and the dentate gyrus." wikipedia

Meaning that after the trauma had occurred, further distruction to the Hippocampus will result independently in susceptible individuals.  Science has learned that Macrophages that come to clean-up to debris and scavenge the abnormalities, will also liberate Cytokines that, for repair efforts mainly, but for lack of specificity to receptors, and by being discharged in distant milieu, will induce the PTSD!   These effects are most dramatic in the post-synaptic nerve cell distant from the trauma location!   Suffice is to say that Various interventions are trying to minimize to slow the processes at the trauma occurrence and subsequently...The department of defense (DOD) is working feverishly of some of these questions  (at least we hope!).  The thing is it is the Cytokines we are most focused on!

POST RADIATION TO THE BRAIN, "PTSD" happens.  It is well known that patient who underwent Radiation to the Brain for any reasons may end-up with "post radiation dementia"  This is one of the many reason some balk at Radiation post a successful treatment in limited stage small cell lung cancer despite the standard recommendation of PCI (premature Cranial Irradiation) at completion of treatment!

In COPD!
almost a parallel thing happens!
Indeed as a result of insults from smoking, and constant havocs by smoking occasions, inflammations and subsequent scars are caused to happens by our friendly smokers!  And innocent bystanders experience the wrath of the phenomena we come to know as the "secondary smoking".  And well beyond the inflammatory insults of smoking, well beyond the scarring of the lungs from smoking, there is a secondary secretion of cytokines to the presence of the "scars".   Indeed, when you think of the scars as a inert "object", in a living cellular environment, scars are made of chemical substances that the cell continue to (in a reflex) interact with
and somewhere in there cytokines of certain different kinds are constantly being secreted, affecting receptors including some at distant locations!   It is believed that this is how aging and certain diseases noted in elderly are generated...

TO BE CONTINUED!

Friday, August 22, 2014

Focus of the RCC1 gene

RCC1----Crm1---Ran guanine nucleotide exchange factor
according to Nemergut:" RanBP3 acts as a scaffold protein to promote the efficient assembly of export complexes."
from REN : "These results are consistent with the hypothesis that Ran functions directly in at least two pathways, one, dependent on RanBP1, that affects cell cycle progression and RNA export, and another, independent of RanBP1, that affects nuclear protein import."

Paschal et al :"
the nuclear guanine nucleotide exchange factor (RanGEF), and the Ran import receptor (NTF2). The recent identification of the Saccharomyces cerevisiae protein Mog1p as a suppressor of temperature-sensitive Ran mutations suggests that additional regulatory proteins remain to be characterized."

Dig this by REN et al! and you will understand that the anti-VEGF is still the begining of the membrane The small Ras-related GTP binding and hydrolyzing protein Ran has been implicated in a variety of processes, including cell cycle progression, DNA synthesis, RNA processing, and nuclear-cytosolic trafficking of both RNA and proteins. Like other small GTPases, Ran appears to function as a switch: Ran-GTP and Ran-GDP levels are regulated both by guanine nucleotide exchange factors and GTPase activating proteins, and Ran-GTP and Ran-GDP interact differentially with one or more effectors.story:
"

No CPRIT No Problem!

We have submitted all kinds of research projects
we have tried to compete, we have teased congressmen
we have met all kinds of people who have promised to help
but what we understood is that these political Texas institutions will not help us,
the need for cancer patients is great, and CRBCM needs to grow parallel to these  institutions,
Greater East Cancer Center is growing, we got to grow without their help...
We are going to have to grow free of these political institutions
because our cause is just...cancer needs a response that we can mount...lets progress beside them!

To not waste time

At least 2 projects that will get funding from CPRIT will join ideas developed here already and have been addressed here.  the MDM-2 as a source of neoplasia transformation and being one of the genes to be  included in our proposed kit for early cancer detection.   What is important though, that further work performed by DR Zhang and DR CHOI at UTEP has advanced several 10 additional co-genes that also participate in the same neoplastic transformation and needs to be looked at the same time in order to really advance otherwise 3 years from now they will find what we already have found!   This team needs to see us rapidly to combine efforts for advancement!