Recurrent adult-onset hypophyseal Langerhans cell histiocytosis after radiotherapy: A case report

INTRODUCTION: Langerhans cell histiocytosis is a rare disease within the adult population, with very few cases reported as solitary hypophyseal lesions in adults. Of the reported cases, most have been treated successfully with surgery, radiotherapy, and/or chemotherapy. Radiotherapy has been thought to be curative at the relatively low dose of 20Gy. Here we report a case of recurrent hypophyseal Langerhans cell histiocytosis 9 months after radiotherapy with an interval period of symptomatic and radiographic response to therapy. CASE PRESENTATION: A 50-year-old Caucasian woman who had headaches, memory difficulties, and diabetes insipidus was found to have a 2.5cm suprasellar mass. Langerhans cell histiocytosis was diagnosed following stereotactic brain biopsy. Further workup revealed no other lesions. Initial radiation treatment succeeded in shrinking the tumor and relieving clinical symptoms temporarily; however, growth and recurrence of clinical symptoms was noted at 9 months. Re-irradiation was well tolerated and the patient had no acute side effects. CONCLUSION: Isolated hypophyseal involvement by Langerhans cell histiocytosis in adults is a unique presentation of a rare disease. Although radiotherapy doses as low as 20Gy have been reported to offer control, this case demonstrates that higher doses may be warranted to ensure tumor control. With modern imaging and radiotherapy techniques higher doses should offer little increased more durable risk to surrounding critical structures

Estrogen receptor dimerization: ligand binding regulates dimer affinity and dimer dissociation rate Mol Endocrinol 16

Nuclear receptors form strong dimers that are essential for their function as transcription factors, and it is thought that ligand binding can affect dimer stability. In this report, we describe convenient fluorescence resonance energy transfer (FRET)-based methods for measuring the thermodynamic and kinetic stability of dimers of the estrogen receptor-� ligand-binding domain (ER�-LBD). We have developed receptors that are chemically labeled with a single fluorophore in a site-specific manner. These fluorophore-labeled ERs are functional and can be used to measure directly the affinity and stability of ER�-LBD dimers. Our results indicate that unliganded ER�-LBDs exist as very stable dimers and that the dissociation rate of these dimers is slow (t 1/2

Detection of perillyl alcohol and its metabolite perillic acid in postsurgical glioblastoma tissue after intranasal administration of NEO100: illustrative case.

BACKGROUND: Intranasal delivery of NEO100, a pharmaceutical-grade version of the natural monoterpene perillyl alcohol (POH), is undergoing clinical phase IIa testing as a treatment for glioblastoma (GBM). However, so far there is no evidence that intranasal delivery of NEO100 indeed results in POH reaching intracranial malignancies in a patient. OBSERVATIONS: After surgical removal of her recurrent GBM tumor, a patient received daily intranasal NEO100 therapy for more than 3 years before a second recurrence emerged. At that time, a final dose of NEO100 was given shortly before the tumor tissue was surgically removed, and the tissue was processed for high-performance liquid chromatography analysis of POH and its primary metabolite, perillic acid (PA). Both molecules could readily be detected in the tumor tissue. LESSONS: This is the first demonstration of POH and PA in brain tumor tissue from any patient. It reveals that intranasal administration of NEO100 is a valid approach to achieve delivery of this agent to a brain tumor. In view of the noninvasive and safe nature of this method, along with tentative indications of activity, our findings add confidence to the notion that intranasal administration of NEO100 holds potential as a new treatment option for brain-localized malignancies

347 Histopathology of Necrotic Spinal Cord Tissue Exudate Collected During Surgical Implantation of a Biodegradable Scaffold Following Acute Spinal Cord Injury: Pre-clinical and Clinical Findings

Abstract INTRODUCTION Acute implantation of biodegradable scaffolds following spinal cord injury (SCI) has been shown pre-clinically to reduce chronic cavitation, increase white matter sparing, and increase the deposition of neuropermissive remodeled tissue. The surgical procedure of scaffold implantation allows for the gentle removal of acutely necrotic tissue resulting in a cavity in which the scaffold is placed. Here we report for the first time on the histopathological findings in both animal and human tissue specimens. METHODS Pre-clinically, experimental spinal cord contusion injuries were performed as previously reported in pigs. Clinically, the ongoing INSPIRE study (NCT02138110) is currently enrolling baseline T2-T12/L1 subjects with neurologically complete (AIS A) SCI within 96 hours of injury. The surgical procedure for implantation consists of durotomy and sometimes myelotomy. Commonly, damaged spinal cord tissue under pressure spontaneously extrudes after piotomy in pure contusion injuries. This tissue sample is collected and submitted for histopathologic analysis. RESULTS >24 hours post severe contusion/compression injury in a pig model, hematoxylin and eosin-stained (H&E) paraffin sections revealed myelin and axonal degeneration along with numerous scattered spheroids (swollen axons) with hemorrhage and acute inflammation at the wound site. Surgical pathology reports document neuropil disruption and devitalization in samples collected during surgery at 40 and 82 hours post-injury. In the patient implanted at 40 hours, the tissue specimen contained fragments of disrupted neuropil with swollen and fragmented axons as evaluated by H&E and neurofilament immunohistochemistry. CONCLUSION Severe SCI leads to the rapid formation of irreversibly damaged parenchyma. Our findings in animal and human tissue samples revealed acute tissue disruption and devitalization within 24–82 hours post-injury. This time frame was too short to appreciate phagocytosis, gliosis, or axon sprouts. Future patient enrollment and tissue collection in the ongoing clinical study will continue to build upon these initial observations

Recurrent adult-onset hypophyseal Langerhans cell histiocytosis after radiotherapy: a case report

Abstract Introduction Langerhans cell histiocytosis is a rare disease within the adult population, with very few cases reported as solitary hypophyseal lesions in adults. Of the reported cases, most have been treated successfully with surgery, radiotherapy, and/or chemotherapy. Radiotherapy has been thought to be curative at the relatively low dose of 20Gy. Here we report a case of recurrent hypophyseal Langerhans cell histiocytosis 9 months after radiotherapy with an interval period of symptomatic and radiographic response to therapy. Case presentation A 50-year-old Caucasian woman who had headaches, memory difficulties, and diabetes insipidus was found to have a 2.5cm suprasellar mass. Langerhans cell histiocytosis was diagnosed following stereotactic brain biopsy. Further workup revealed no other lesions. Initial radiation treatment succeeded in shrinking the tumor and relieving clinical symptoms temporarily; however, growth and recurrence of clinical symptoms was noted at 9 months. Re-irradiation was well tolerated and the patient had no acute side effects. Conclusion Isolated hypophyseal involvement by Langerhans cell histiocytosis in adults is a unique presentation of a rare disease. Although radiotherapy doses as low as 20Gy have been reported to offer control, this case demonstrates that higher doses may be warranted to ensure tumor control. With modern imaging and radiotherapy techniques higher doses should offer little increased more durable risk to surrounding critical structures.</p

Phase I trial of intranasal NEO100, highly purified perillyl alcohol, in adult patients with recurrent glioblastoma.

Background: Better treatments for glioblastoma (GBM) patients, in particular in the recurrent setting, are urgently needed. Clinical trials performed in Brazil indicated that intranasal delivery of perillyl alcohol (POH) might be effective in this patient group. NEO100, a highly purified version of POH, was current good manufacturing practice (cGMP) manufactured to evaluate the safety and efficacy of this novel approach in a Phase I/IIa clinical trial in the United States. Methods: A total of 12 patients with recurrent GBM were enrolled into Phase I of this trial. NEO100 was administered by intranasal delivery using a nebulizer and nasal mask. Dosing was 4 times a day, every day. Four cohorts of 3 patients received the following dosages: 96 mg/dose (384 mg/day), 144 mg/dose (576 mg/day), 192 mg/dose (768 mg/day), and 288 mg/dose (1152 mg/day). Completion of 28 days of treatment was recorded as 1 cycle. Adverse events were documented, and radiographic response Results: Intranasal NEO100 was well tolerated at all dose levels and no severe adverse events were reported. PFS-6 was 33%, OS-12 was 55%, and median OS was 15 months. Four patients (33%), all of them with isocitrate dehydrogenase 1 (IDH1)-mutant tumors, survived \u3e24 months. Conclusion: Intranasal glioma therapy with NEO100 was well tolerated. It correlated with improved survival when compared to historical controls, pointing to the possibility that this novel intranasal approach could become useful for the treatment of recurrent GBM