CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / IntroduÃÃo: A Mucosite Intestinal (MI) e a diarrÃia severas sÃo efeitos colaterais freqÃentes (15-25%) e limitantes da quimioterapia do cÃncer de cÃlon com Irinotecano (CPT-11). Atà o presente momento, pouco se conhece sobre a fisiopatologia da MI. Objetivo: Estudar os mecanismos e mediadores envolvidos na mucosite intestinal induzida por CPT-11, verificando a participaÃÃo da protease caspase-1, das citocinas interleucina-1 (IL-1), interleucina-18 (IL-18) e interleucina-33 (IL-33), do Ãxido nÃtrico, de mediadores 5-lipoxigenase e do PAF, assim como a seqÃÃncia de interaÃÃo entre esses mediadores sob aspectos da resposta inflamatÃria e morfofuncionais. MÃtodos: Camundongos Swiss, C57BL/6 (BL), BALB/c (BC) ou knockout para Caspase-1 (Casp-/-), IL-18 (IL-18-/-), Ãxido nÃtrico sintase induzida (iNOS-/-), 5-Lipoxigenase (5-LOX-/-), receptor para PAF (PAFr-/-) machos, 22 g, foram divididos em grupos (n=4-5) e tratados por 4 dias com salina (5 mL/kg, i.p) ou CPT-11 (60 mg/kg, i.p) ou foram prÃ-tratados com IL-18bp (proteÃna ligante de IL18, 200 Âg/animal/4 dias, i.p.), aminoguanidina (AG, 50 mg/kg, s.c, 2x/dia/4 dias), IL-33 (1 Âg/animal/4 dias, i.v, 1h antes do CPT-11) ou loperamida ([4x3 mg/kg e 4x30 mg/kg]/animal, s.c.) em associaÃÃo com CPT-11. No 5 dia, avaliou-se a diarrÃia por escores, o leucograma e, apÃs sacrifÃcio, coletou-se o duodeno para dosagem da atividade de mieloperoxidase (MPO, neutrÃfilos/mg tecido) e de Ãxido nÃtrico sintase induzida (iNOS pM citrulina/h/mg proteÃna), morfometria (razÃo vilo/cripta) e contratilidade in vitro à Acetilcolina (%contraÃÃo em relaÃÃo ao KCl60 mM). Para anÃlise estatÃstica utilizou-se ANOVA/Newman-Keuls ou Kruskal Wallis/Dunn. P<0,05 foi aceito. Resultados: Camundongos BL apresentaram um padrÃo de mucosite intestinal similar ao observado no camundongo Swiss sob aspectos morfofuncionais. O CPT-11 induziu leucopenia em todos os animais independentemente do tratamento aplicado. Adicionalmente, o CPT-11 induziu em animais BL e BC, nÃo tratados, aumento de MPO intestinal, reduÃÃo da relaÃÃo vilo/cripta, amento da contratilidade in vitro e dos eventos de diarrÃia comparados com animais injetados somente com salina (p<0,05). A despeito da administraÃÃo de CPT-11, animais Caspase-1-/-, IL-18-/- ou BC tratados com IL-18bp apresentaram atividade de MPO e de iNOS reduzidas, bem como aumento na relaÃÃo vilo/cripta, menor contratilidade duodenal in vitro e eventos de diarrÃia atenuados em comparaÃÃo aos respectivos controles tratados com salina (p>0,05). Dados idÃnticos tambÃm foram observados em camundongos injetados com IL-33 e que receberam CPT-11. A reduÃÃo na atividade de iNOS naqueles animais motivou o estudo do efeito do CPT-11 em animais iNOS-/- ou tratados com aminoguanidina. Observaram-se menores nÃveis de citocinas IL-1beta e KC, bem como uma atividade de MPO reduzida no duodeno desses animais. AlÃm disso, verificou-se preservaÃÃo da relaÃÃo vilo/cripta e da espessura da camada muscular, menor contratilidade duodenal in vitro e eventos de diarrÃia atenuados similar ao observado nos respectivos controles que receberam apenas salina (p>0,05). PorÃm, a administraÃÃo de CPT-11 a animais PAFr-/- foi capaz de induzir alteraÃÃes morfofuncionais e o aumento da atividade de MPO intestinal. Em camundongos 5-LOX /- ou tratados com loperamida (controle positivo), ambos os grupos injetados com CPT-11, observaram-se aumento da atividade de MPO e alteraÃÃes morfomÃtricas. Contudo, sobre aspectos funcionais de contratilidade in vitro, visualizou-se proteÃÃo. ConclusÃes: Esses resultados sugerem que a via caspase-1-IL-18 Ãxido nÃtrico contribui para o desenvolvimento da resposta inflamatÃria e alteraÃÃes morfofuncionais na mucosite intestinal induzida por CPT-11. A IL-33 parece ser um fator protetor compensatÃrio nessa cascata inflamatÃria. A 5-LOX e o PAFr parecem ter papel secundÃrio na patogÃnese da mucosite intestinal por CPT-11. / Introduction: Severe Intestinal Mucositis (IM) and diarrhea are frequent and dose-limiting side-effects of colon cancer chemotherapy with irinotecan (CPT-11). At present, much of IM pathophysiology remains unknown. Aims: To study the mechanisms and inflammatory mediators involved in CPT-11-induced intestinal mucositis, verifying the role of the protease caspase-1, cytokines interleukin-1 (IL-1), interleukin-18 (IL-18) and interleukin-33 (IL-33), nitric oxide, 5-lipoxygenase and PAF as well as the sequence of activation of these mediators in the inflammatory response and morphofunctional contexts. Methods: Swiss, C57BL/6 (BL), BALB/c (BC) male mice or caspases-1(Casp-1-/-), IL-18 (IL-18-/-), inducible nitric oxide synthase (iNOS-/-), 5-Lipoxygenase (5-LOX-/-), PAF receptor (PAFr-/-) knockout mice, 22g, were divided into groups (n=4-5) and treated for 4 days with saline (5 mL/kg, i.p.) or CPT-11 (60 mg/kg, i.p.) or were given IL-18bp (IL-18 binding protein, 200 Âg/animal/4 days, i.p.), aminoguanidine (AG, 50 mg/kg, s.c, 2x/day/4 days), IL-33 (1 Âg/animal/4 days, i.v, 1h previously CPT-11) or loperamide ([4x3 mg/kg and 4x30 mg/kg]/animal, s.c.) co-administered with CPT-11. On day 5, diarrhea and leukocyte counts were assessed, and following sacrifice duodenal portions of the animal were collected to assess myeloperoxidase (MPO, neutrophils/mg tissue) and nitric oxide synthase (iNOS pM citruline /h/mg protein) activity, morphometric analysis, and in vitro contractility (%contraction in relation to KCl 60 mM). ANOVA/Newman Keuls or Kruskal Wallis/Dunn were used as statistical tests. P<0.05 was accepted. Results: IM was morphofunctionally similar in both BL and Swiss. CPT-11 induced leukopenia in all animal lineages despite the treatment given. Additionally, CPT-11 induced MPO, increased in vitro contractility and diarrheic events, and villi/crypt ratio reduction in BL and BC mice in comparison with saline treated mice (p<0.05). Despite the injection of CPT-11, Casp-1-/-, IL-18-/- or IL-18bp treated BC mice presented reduced MPO and iNOS activities and also increased villi/crypt ratio, reduced duodenal in vitro contractility and mild diarrhea similar to saline-treated mice (P>0.05), similar to the patterns seen in IL-33 treated mice. The reduced iNOS activity found in the earlier mice led us to investigate the CPT-11 effect on iNOS /- and aminoguanidine-treated mice. Lower IL-1beta and KC cytokine levels, as well as reduced MPO activity were found. Also, preserved villi/crypt ratio and muscle layer thickness, normal duodenal contractility and diarrheic events were seen similarly to saline-treated mice (p>0.05). However, CPT-11-treated PAFr-/- presented morphofunctional alterations and increased intestinal MPO activity. 5-LOX-/- or loperamide treated mice (positive control), both injected with CPT-11, exhibited increased MPO activity and morphometric alterations, but no exacerbation on in vitro contractility was observable. Conclusion: Taken together, these results suggest the role of caspase-1/Interleukin-18/nitric oxide cascade on pathogenesis of CPT-11-induced morphofunctional alteration and inflammatory response (IM). IL-33 seems to be a compensatory protective factor on this inflammatory cascade. 5-LOX and PAFr show a likely secondary role on IM pathophysiology.

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Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / IntroduÃÃo: O cloridrato de irinotecano (CPT-11) à um inibidor da topoisomerase I, clinicamente efetivo no tratamento de vÃrios tipos de cÃncer. Apesar da mucosite intestinal (MI) acompanhada de severa diarrÃia ser o efeito colateral mais limitante do uso terapÃutico do CPT-11, os exatos mecanismos que levam a estes efeitos nÃo sÃo estabelecidos. Objetivo: avaliar o envolvimento de mediadores inflamatÃrios (citocinas, Ãxido nÃtrico â NO e prostaglandinas â PGs) na patogÃnese dos eventos que acompanham a MI induzida pelo CPT-11; e estudar o efeito de inibidores da sÃntese e liberaÃÃo de citocinas, como pentoxifilina (PTX) e talidomida (TLD), e de um inibidor seletivo da ciclooxigenase-2 (COX-2), o celecoxibe (CLX), na lesÃo intestinal induzida pelo CPT-11. Material e MÃtodos: camundongos Swiss, machos, foram tratados durante quatro dias consecutivos com CPT-11 (50, 75 e 100 mg/kg, i.p.) ou veÃculo (0,5 mL, i.p.), a fim de se obter a melhor dose capaz de induzir injÃrias consistentes com o mÃnimo de letalidade. Os animais foram tratados com PTX (1,7, 5 e 15 mg/kg, s.c.), TLD (15, 30, 60 mg/kg, s.c), CLX (3, 10, 30 mg/kg, gavagem) ou veÃculo (0,5 mL, s.c. ou gavagem), um dia antes da primeira administraÃÃo do CPT-11 (75 mg/kg), e diariamente, atà o sacrifÃcio, no quinto ou sÃtimo dia. Os seguintes parÃmetros foram avaliados: diarrÃia, variaÃÃo de massa corpÃrea, leucograma, sobrevida, anÃlise histopatolÃgica, atividade de mieloperoxidase (MPO), dosagem de citocinas (TNF-&#945;, IL-1&#946; e KC) por ELISA e imunohistoquÃmica para TNF-&#945;, IL-1&#946;, iNOS e COX-2 nas mucosas duodenais. Resultados: CPT-11 induziu diarrÃia significante, acompanhada de perda acentuada de massa corpÃrea, leucopenia e reduÃÃo da sobrevida. As alteraÃÃes histopatolÃgicas intestinais induzidas pelo CPT-11 caracterizaram-se pela presenÃa de infiltrado inflamatÃrio nas cÃlulas da lÃmina prÃpria, perda da arquitetura das criptas e achatamento dos vilos. Observou-se ainda, aumento intestinal na atividade de MPO e dos nÃveis de TNF-&#945;, IL-1&#946; e KC, alÃm do aumento significativo na marcaÃÃo imunohistoquÃmica para TNF-&#945;, IL-1&#946;, iNOS e COX-2. O tratamento com PTX inibiu a diarrÃia tardia, reduziu as alteraÃÃes histopatolÃgicas, a atividade de MPO, e os nÃveis de TNF-&#945;, IL-1&#946; e KC, assim como a marcaÃÃo imunohistoquÃmica para TNF-&#945;, IL-1&#946; e iNOS na mucosa duodenal, entretanto, nÃo preveniu significativamente a perda de massa corpÃrea, a leucopenia e tampouco a mortalidade dos animais. O tratamento com TLD reduziu as lesÃes histopatolÃgicas induzidas pelo CPT-11 na mucosa intestinal, os nÃveis intestinais de MPO e TNF-&#945;, bem como a marcaÃÃo imunohistoquÃmica de TNF-&#945;, mas nÃo foi capaz de prevenir a diarrÃia, a perda de massa corpÃrea, a leucopenia e a sobrevida. O tratamento com CLX nÃo foi capaz de reduzir os parÃmetros inflamatÃrios e sistÃmicos observados nos animais tratados com CPT-11. ConclusÃo: Estes resultados sugerem o envolvimento de TNF-&#945;, IL-1&#946;, KC, NO e PGs na patogÃnese da MI induzida pelo CPT-11. PTX e TLD preveniram significativamente as alteraÃÃes histolÃgicas e inflamatÃrias induzidas pelo CPT-11, entretanto, somente PTX foi capaz de inibir o curso da diarrÃia / Introduction: Irinotecan (CPT-11) is an inhibitor of DNA topoisomerase I and clinically effective against several cancers. A major toxic effect of CPT-11 is delayed diarrhea; however, the exact mechanism by which the drug induces diarrhea has not been established. Purpose: The aim of the present study was to elucidate the involvement of cytokines (TNF-&#945;, IL-1&#946; and KC), nitric oxide (NO) and prostaglandins (PGs) in the pathogenesis of CPT-11-induced mucositis and the effects of the cytokine production inhibitors, pentoxifylline (PTX) and thalidomide (TLD), as well as the effects of the selective cyclooxygenase (COX-2) inhibitor, celecoxib (CLX), in the CPT-11 induced intestinal mucositis, in mice. Materials and methods: the animals were treated with CPT-11 (50, 75 or 100 mg/kg, i.p.) or vehicle (0,5 ml, i.p.) daily for four days, in order to investigate the best dose able to induce intestinal mucositis without important mortality. In another set of experiments, the animals received PTX (1.7, 5, 15 mg/kg, s.c.), TLD (15, 30, 60 mg/kg, s.c.), CLX (3, 10, 30 mg/kg, oral gavage) or vehicle (0,5 ml, s.c. or oral gavage) one day before the 1st administration of CPT-11 (75 mg/kg; i.p.) and daily until the sacrifice, on the 5th or 7th day. The systemic parameters evaluated were: diarrhea, body mass variation, survival curve and leucogram. In addition, it was also performed histological analysis, myeloperoxidase (MPO) activity assay, duodenum levels of TNF-&#945;, IL-1&#946; and KC by ELISA and immunohistochemistry for TNF-&#945;, IL-1&#946;, iNOS and COX-2 in the duodenal segments. Results: CPT-11 induced an important diarrhea, weight loss, leucopenia and mortality increase. It was also observed histopathological changes, such as shortened villi, loss of the crypt architecture and inflammatory cells infiltration, observed in the lamina propria, as well as, an increase in MPO activity, TNF-&#945;, IL-1&#946; and KC tissue levels and a marked immuno-staining for TNF-&#945;, IL-1&#946;, iNOS and COX-2. The treatment with PTX inhibited the delayed diarrhea and reduced the following parameters: histopathological alterations, MPO activity, tissue levels of TNF-&#945;, IL-1&#946; and KC, and the immuno-staining for TNF-&#945;, IL-1&#946; and iNOS, however, did not prevent leucopenia, weight loss and mortality. TLD significantly reduced all the inflammatory parameters evaluated, but was not able to prevent diarrhea, leucopenia, weight loss and mortality. On the other hand, CLX did not inhibit the inflammatory nor the systemic alterations induced by CPT-11. Conclusion: These results suggest an important role of TNF-&#945;, IL-1&#946;, KC, NO and PGs in the pathogenesis of intestinal mucositis induced by CPT-11. PTX and TLD showed a protector effect in intestinal structures, however, only PTX reduced the severity of CPT-11-induced diarrhea

The crystal structures of two thermostable carboxylesterase Est30 and Est55 from Geobacillus stearothermophilus were determined to help understand their functions and applications in industry or medicine. The crystal structure of Est30 was determined at 1.63 Å resolution by the multiple anomalous dispersion method. The two-domain Est30 structure showed a large domain with a modified alpha/beta hydrolase core including a seven, rather than an eight-stranded beta sheet, and a smaller cap domain comprising three alpha helices. A 100 Da tetrahedral ligand, propyl acetate, was observed to be covalently bound to the side chain of Ser94 in the catalytic triad. This ligand complex represents the first tetrahedral intermediate in the reaction mechanism. Therefore, this Est30 crystal structure will help understand the mode of action of all enzymes in the serine hydrolase superfamily. Est55 is a bacterial homologue of the mammalian carboxylesterases involved in hydrolysis and detoxification of numerous peptides and drugs and in prodrug activation. Est55 crystals were grown at pH 6.2 and pH 6.8 and the structures were determined at resolutions of 2.0 and 1.58 Å respectively. Est55 folds into three domains, a catalytic domain, an α/β domain and a regulatory domain. This structure is in an inactive form; the side chain of His409, one of the catalytic triad residues, is pointing away from the active site. Moreover, the adjacent Cys408 is triply oxidized and lies in the oxyanion hole, which would block the entry of substrate to its binding site. This structure suggested a self-inactivation mechanism, however, Cys408 is not essential for enzyme activity. Mutation of Cys408 showed that hydrophobic side chains at this position were favorable, while polar serine was unfavorable for enzyme activity. Both Est30 and Est55 were shown to hydrolyze the prodrug CPT-11 into the active form SN-38. Therefore, Est30 and Est55 are potential candidates for use with irinotecan in cancer therapy. The catalytic efficiency (kcat/Km) of Est30 is about 10-fold lower than that of Est55. The effects of the Cys408 substitutions on Est55 activity differed for the two substrates, p-NP butyrate and CPT-11. Mutant C408V may provide a more stable form of Est55.

This project combines oncolytic Vaccinia virus (VV) with irinotecan (CPT-11) for the treatment of cancer. VV can infect, replicate in and destroy cancer cells, yet leave healthy cells relatively unaffected. CPT-11 is a chemotherapeutic of which ~5% is converted to the more active chemotherapeutic SN-38 by endogenous carboxylesterase (CE) enzymes. SN-38 is a topoisomerase I inhibitor that induces DNA double strand breaks, leading to growth arrest and apoptosis. Consequently, VV has been engineered to express a more effective isoform of the CE enzyme. The virus’ tumour tropism should restrict enhanced conversion of CPT-11 to the tumour. Neither CPT-11 nor SN-38 interfered with VV replication or spread. Engineered recombinants expressed CE enzyme which, when combined with CPT-11, produced DNA double strand breaks and cancer cell death. In vitro, the combination of CE-virus and CPT-11 killed more K-562 cancer cells than its non-CE counterpart and CPT-11.

This project combines oncolytic Vaccinia virus (VV) with irinotecan (CPT-11) for the treatment of cancer. VV can infect, replicate in and destroy cancer cells, yet leave healthy cells relatively unaffected. CPT-11 is a chemotherapeutic of which ~5% is converted to the more active chemotherapeutic SN-38 by endogenous carboxylesterase (CE) enzymes. SN-38 is a topoisomerase I inhibitor that induces DNA double strand breaks, leading to growth arrest and apoptosis. Consequently, VV has been engineered to express a more effective isoform of the CE enzyme. The virus’ tumour tropism should restrict enhanced conversion of CPT-11 to the tumour. Neither CPT-11 nor SN-38 interfered with VV replication or spread. Engineered recombinants expressed CE enzyme which, when combined with CPT-11, produced DNA double strand breaks and cancer cell death. In vitro, the combination of CE-virus and CPT-11 killed more K-562 cancer cells than its non-CE counterpart and CPT-11.

This project combines oncolytic Vaccinia virus (VV) with irinotecan (CPT-11) for the treatment of cancer. VV can infect, replicate in and destroy cancer cells, yet leave healthy cells relatively unaffected. CPT-11 is a chemotherapeutic of which ~5% is converted to the more active chemotherapeutic SN-38 by endogenous carboxylesterase (CE) enzymes. SN-38 is a topoisomerase I inhibitor that induces DNA double strand breaks, leading to growth arrest and apoptosis. Consequently, VV has been engineered to express a more effective isoform of the CE enzyme. The virus’ tumour tropism should restrict enhanced conversion of CPT-11 to the tumour. Neither CPT-11 nor SN-38 interfered with VV replication or spread. Engineered recombinants expressed CE enzyme which, when combined with CPT-11, produced DNA double strand breaks and cancer cell death. In vitro, the combination of CE-virus and CPT-11 killed more K-562 cancer cells than its non-CE counterpart and CPT-11.

Indiana University-Purdue University Indianapolis (IUPUI) / Colorectal cancer is the third most common type of cancer and the third most common cause of cancer-related mortality. There are three types of treatment available to patients, either individually or in combination. Treatments are radiation, chemotherapy, and surgery. In a Phase II clinical trial at IUSM, a multimodality approach was chosen. The patients with locally advanced rectal cancer received preoperative treatment with capecitabine and irinotecan (CPT-11) combination followed by chemoradiation with capecitabine and finally surgery to improve response and decrease local recurrence. Irinotecan and Capecitabine are both prodrugs activated in vivo to SN-38 and 5-FU, respectively. Identification of the molecular markers for 5-FU and Irinotecan efficacy and toxicity is important for the development of more efficient and less toxic treatment strategies for patients with colorectal cancer. The goal of this study was to determine the expression levels of the genes involved in activation and metabolism of capecitabine and irinotecan in pre and post treatment specimens from these patients. The genes quantitated by real-time PCR were carboxylesterase 1 and 2 (CES1 and CES2), thymidylate synthase (TS), β-glucoronidase (β-GUS), thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD) and topoisomerase I (Topo I). The UGT1A1*28 polymorphism in UDP glucuronosyltransferase 1 is associated with SN-38 toxicity. Therefore, the UGT1A1*28 polymorphism status in patients was determined by PCR-sequencing. Correlative analysis of gene expression and UGT1A1*28 mutation with clinical outcome in this Phase II study was completed.