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At least 865 records · Page 48Linked to original sources
PubMed1988

[Hemodynamic changes and left ventricular function in patients with hypertension during an acute trial of urapidil].

The left ventricular hemodynamic changes were studied in 9 hypertensive patients (6 patients with hypertensive attack and 3 patients with a severe form of the disease) by simultaneous recordings of the M-type echocardiogram, apexcardiogram and phonocardiogram in an acute trial with Urapidil administered intravenously in a dose of 0,7 mg/kg body mass. The arterial pressure and the peripheral vascular resistance decrease. The stroke and the minute volume do not change. The heart rate increases. The telediastolic and telesystolic dimensions of the left ventricle decrease. The percentage amplitude of the aI-wave of the apexcardiogram also decreases. The fraction of the shortening of the left ventricular dimension increases with 23,0%, the ejection fraction increases with 13,5% and the average speed of the circumferential fibres shortening increases with 21,4%. Urapidil applied i.v. exerts a rapid hypotensive action and improves the left ventricular function.

Adult↗
PubMed2026

An open benchmark and language models for AI in aging biology.

Over the past two decades, human aging has been characterized across DNA methylation, transcriptomic, proteomic, and clinical modalities, yet no benchmark evaluates whether AI systems can interpret these heterogeneous data types in the context of aging biology. We introduce LongevityBench, an open suite of 17 tasks spanning five biodata domains, and use it to assess 18 frontier AI systems from six developer teams. Despite recent advances in AI, no single model dominates all tasks, with omics-based age prediction being the hardest task regardless of scale. To test whether these gaps can be closed without frontier-scale resources, we fine-tuned a family of five multitask Longevity-LLMs on domain-specific aging data. The compact (0.6B-9B parameters) Longevity-LLMs matched or exceeded far larger frontier systems on LongevityBench, showing that general-purpose language models can be adapted to structured-omics tasks. We publicly release the benchmark, models, and Longevity Claw, an agentic research interface for aging researchers.

Aging↗
PubMed2006

[Effect of angiogenesis inhibitor SU6668 on the growth and metastasis of gastric cancer in SCID mice].

OBJECTIVE: To study the effect of angiogenesis inhibitor SU6668 on the growth and metastasis of gastric cancer in SCID mice. METHODS: Metastatic model was established by orthotopic implantation of histologically intact human tumor tissue into the gastric wall of SCID mice. Forty-eight mice were randomly divided into four groups, and saline, 5-FU, SU6668, and 5-FU plus SU6668 were administered by i.p. every day for 6 weeks after tumor implantation. The mice were killed and tumor weight, tumor inhibition rate, intratumoral microvessel density(MVD), apoptotic index(AI) and metastasis inhibition were evaluated. RESULTS: Compared with the control, tumor growth was significantly inhibited in mice treated respectively with 5-FU, SU6668 and 5-FU plus SU6668 with inhibition rates of 47.5%, 64.1% and 69.2% respectively. Decreased MVD and increased AI were noted in the mice treated with SU6668 and 5-FU plus SU6668. The incidences of liver and peritoneal metastases was significantly inhibited and decreased to 62.5%, 69.9% in SU6668 group, and 74.9%, 90% in 5-FU plus SU6668 group. The growth and metastasis of human gastric cancer implanted in SCID mice were significantly inhibited in SU6668 group and combined group, especially in combined group. CONCLUSION: Angiogenesis inhibitor SU6668 has a strong inhibitory effect on tumor growth and metastasis of human gastric cancer transplanted in SCID mice, and has synergistic effect combined with cytotoxic agents.

Angiogenesis Inhibitors↗
PubMed1994

Divergent effects of intravenous dobutamine and nitroprusside on left atrial contribution to ventricular filling in dogs with chronic heart failure.

The left atrial (LA) contribution to left ventricular (LV) filling is often attenuated in patients with heart failure. It remains uncertain, however, whether therapy with positive inotropic agents or vasodilators improves or further impairs this maladaptation. In the present study, the effects of intravenous dobutamine and nitroprusside on the LA contribution to LV filling was examined in seven dogs with chronic heart failure produced by multiple sequential intracoronary microembolizations. Pulsed Doppler echocardiography was used to measure mitral inflow velocity before and after an intravenous infusion of dobutamine (4 micrograms/kg/min) and an intravenous infusion of nitroprusside (3 micrograms/kg/min). The percent LA contribution to LV filling was calculated as the ratio of the time-velocity integral of the LA component of mitral inflow velocity (Ai) to the time-velocity integral of total diastolic inflow velocity (Ti) times 100. Dobutamine increased LV filling pressure, LV end-diastolic wall stress, LV end-diastolic stiffness, and Ei, but had no effect on Ai or the percent LA contribution to filling (14% +/- 3% vs 12% +/- 2%) (p < 0.34). In contrast, nitroprusside decreased LV filling pressure, LV end-diastolic wall stress, and end-diastolic stiffness, and increased Ei, Ai, and the percent LA contribution to LV filling (12% +/- 2% vs 17% +/- 2%) (p < 0.01). The results indicate that dobutamine and nitroprusside have divergent effects on the LA contribution to LV filling. In dogs with chronic heart failure, dobutamine appears to impair LA contribution to the LV filling by augmenting LA workload, whereas nitroprusside appears to elicit greater LA contribution to LV filling by reducing the LA workload.

Animals↗
PubMed2005

Effect of nifedipine on C-reactive protein levels in the coronary sinus and on coronary blood flow in response to acetylcholine in patients with stable angina pectoris having percutaneous coronary intervention.

The effects of nifedipine on inflammation and endothelial function in the coronary circulation were studied in patients who had angina pectoris (n = 17). Long-term treatment with nifedipine (nifedipine CR, 20 mg/day for 4 months) decreased levels of C-reactive protein in the coronary sinus (from 0.35 +/- 0.09 mg/dl to 0.07 +/- 0.01 mg/dl, mean +/- SEM, p <0.05) and enhanced acetylcholine-induced increases in coronary blood flow. Thus, nifedipine is effective in decreasing inflammation and incresing endothelial function in the coronary circulation.

Acetylcholine↗
PubMed2005

Pioglitazone increases the fractional catabolic and production rates of high-density lipoproteins apo AI in the New Zealand White Rabbit.

Pioglitazone is an agonist of the peroxisome proliferator-activated receptor gamma (PPARgamma) that raises HDL-cholesterol plasma in humans. Whether pioglitazone-mediated modifications in HDL-apolipoprotein AI (apo AI) turnover in vivo contribute to this effect has not been completely elucidated. Therefore, we performed kinetic studies of HDL-apo AI radiolabeled with 125I in male New Zealand White rabbits after 6 weeks of 0.6 (n = 8), 1.75 (n = 8), and 2.6 mg/kg/day (n = 7) pioglitazone and vehicle (n = 12) treatment. Fractional catabolic rate (FCR) of HDL-apo AI was significantly higher in 1.75 and 2.6 mg/kg pioglitazone-treated animals, as compared with control rabbits (0.057+/-0.014 and 0.049+/-0.01 versus 0.025+/-0.005 pools/h, respectively); these changes were associated to a similar increase in apo AI production rates (PR) (1.24+/-0.62 and 1.14+/-0.40 versus 0.53+/-0.17 mg/kg/h, p < 0.01). Consequently, apo AI plasma levels in pioglitazone-treated animals were similar to those of controls. The apo AI-FRC and -PR correlated with the relative proportion of the HDL3c subclass, as determined by polyacrylamide gradient electrophoresis. Our data demonstrate that pioglitazone markedly modifies apo AI kinetics and enhances the proportion of small HDL3c particles, despite the unchanged apo AI concentration. Whether or not the pioglitazone-induced structural changes of HDL contribute to the anti-atherosclerotic effects of the drug remains to be determined.

Animals↗
PubMed2003

Chronic exercise reduces adhesion molecules/iNOS expression and partially reverses vascular responsiveness in hypercholesterolemic rabbit aortae.

To investigate exercise effects on the vascular function in hypercholesterolemia, male New Zealand White rabbits were divided into four groups; i.e. the normal diet control, the high cholesterol diet control, normal diet with exercise, and high cholesterol diet with exercise. High cholesterol diet groups were fed 2% cholesterol rabbit chow for 8 weeks. Animals of exercise groups ran on a treadmill at 0.88 km/h for 10-60 min/day, 5 day/week, and 8 weeks in total. Thoracic aortae were, then, isolated for functional and immunohistochemical analysis. We found that in rabbit aortae, (1). high cholesterol diet feeding caused lipid deposition and intimal thickening, induced expression of P-selectin, VCAM-1, MCP-1 and iNOS, and impaired acetylcholine (ACh)-evoked vasorelaxation; (2). exercise significantly reduced the protein expression of adhesion molecules/iNOS, and the intimal thickness in hypercholesterolemia; (3). chronic exercise enhanced ACh-evoked vasorelaxation in normal rabbits, but it only significantly improved vascular responses to the high dose (10(-6) M) of ACh in hypercholesterolemic rabbits; (4). both exercise and diet effects on vascular responses were mediated by altering the release of NO and endothelium-derived hyperpolarization factor. We conclude that exercise training decreases the expression of adhesion molecules and iNOS, and ameliorates the severe vascular dysfunction induced by high cholesterol feeding.

Acetylcholine↗
PubMed2002

Short-term effects of anastrozole treatment on insulin-like growth factor system in postmenopausal advanced breast cancer patients.

Insulin-like growth factors (IGFs) play a fundamental role in cancer development by acting in both an endocrinal and paracrinal manner, and hormone breast cancer treatments affect the IGF system by modifying circulating growth factor levels. We evaluated total IGF-1, IGF-2, IGF binding protein (IGFBP)-1 and IGFBP-3 in the blood of 34 postmenopausal advanced breast cancer patients (median age 63 years, range 41-85) treated with anastrozole, a non-steroidal structure aromatase inhibitor (NSS-AI). The plasma samples were obtained at baseline, and after 2, 4, 8 and 12 weeks of treatment. The IGFs were quantitated by means of sensitive radioimmunoassays (RIAs). IGF-1 significantly increased during anastrozole treatment (baseline versus 12 weeks, P=0.031), IGF-2 showed a trend towards an increase, and IGFBP-1 constantly but not significantly decreased; IGFBP-3 did not seem to be affected at all. The anastrozole-induced changes in IGFs and IGFBP-1 appeared to be different in the patients receiving a clinical benefit from those observed in non-responders. We have previously shown that letrozole (a different type of NSS-AI) modifies blood IGF-1 levels, and the results of this study of the biological effects of anastrozole on the components of the IGF system confirm our previous observations.

Adult↗
PubMed1994

Effects of perindopril on serum lipids in hypertensive patients with hyperlipidemia.

The effect of the angiotensin-converting enzyme (ACE)-inhibitor perindopril on serum lipids and apolipoprotein concentrations were assessed in a multicenter, randomized, double-blind, placebo-controlled study in 51 hyperlipidemic patients treated for mild hypertension. Perindopril was given as a single morning dose (4 mg) for 6 weeks. During the treatment period, blood pressure (BP) was significantly (p < 0.001) reduced from 159/99 to 148/90 mm Hg by verum treatment and from 158/101 to 151/95 mm Hg (NS) by placebo treatment. Neither total cholesterol and triglycerides nor high-density-lipoprotein and apolipoprotein AI and B levels were significantly altered by drug treatment as compared with placebo. Although perindopril had good antihypertensive effect in patients with mild hypertension and hyperlipidemia, it had no adverse effects on lipid metabolism in these patients. Therefore, perindopril is recommended for antihypertensive treatment, especially in hypertensive patients with concomitant hyperlipidemia.

Adult↗
PubMed2004

Reliability of immunoglobulin G antitoxoplasma avidity test and effects of treatment on avidity indexes of infants and pregnant women.

The immunoglobulin G antitoxoplasma avidity test (Vidas; BioMérieux) is an immunoenzymatic test useful for excluding acute infection after the onset of pregnancy. The avidity index (AI) is the ratio of the signal in a test sample washed with urea, which disrupts low-avidity complexes, to that washed without urea. An AI of >0.3 is taken to mean that infection had occurred more than 4 months ago. The increase of the AI with time and the influence of the different treatments given to pregnant women and their newborns were evaluated. A total of 59 pregnant women (271 sera) and their 60 neonates (199 sera) were tested from 1998 to 2002. There were five groups of women based on the type and duration of treatment given. Thirteen pregnant women (group 1) did not receive any treatment, 15 (group 2), 11 (group 3), and 17 (group 4) women received treatment with spiramycin (9 MIU/day) for 0.5 to 2, 2.5 to 5, and 5.5 to 8 months, respectively, and the last 3 women (group 5) received tritherapy (pyrimethamine-sulfonamide and spiramycin alternatively) for 1.5 to 2.5 months. All of the maternal sera collected in the first 6 months had an AI of <0.30, with a mean of 0.07 (range, 0.01 to 0.21). The increase was slow (0.02/month), and there was no significant difference when comparisons were made between the treatment groups. Neonates with proven maternofetal transmission had an increasing AI, unlike those without transmission. However, long-term therapy with pyrimethamine-sulfonamide, as opposed to treatment with spiramycin alone, was found to slow down the progression of the AI. An AI of >0.2 is sufficient to exclude acute infection in pregnant women. In neonates, it is not of major use to diagnose congenital infection; however, it could be a good indicator of compliance and efficacy of treatment of infected infants.

Animals↗
PubMed2002

Renal medullary nitric oxide deficit of Dahl S rats enhances hypertensive actions of angiotensin II.

Studies were designed to examine the hypothesis that the renal medulla of Dahl salt-sensitive (Dahl S) rats has a reduced capacity to generate nitric oxide (NO), which diminishes the ability to buffer against the chronic hypertensive effects of small elevations of circulating ANG II. NO synthase (NOS) activity in the outer medulla of Dahl S rats (arginine-citrulline conversion assay) was significantly reduced. This decrease in NOS activity was associated with the downregulation of protein expression of NOS I, NOS II, and NOS III isoforms in this region as determined by Western blot analysis. In anesthetized Dahl S rats, we observed that a low subpressor intravenous infusion of ANG II (5 ng. kg(-1). min(-1)) did not increase the concentration of NO in the renal medulla as measured by a microdialysis with oxyhemoglobin trapping technique. In contrast, ANG II produced a 38% increase in the concentration of NO (87 +/- 8 to 117 +/- 8 nmol/l) in the outer medulla of Brown-Norway (BN) rats. The same intravenous dose of ANG II reduced renal medullary blood flow as determined by laser-Doppler flowmetry in Dahl S, but not in BN rats. A 7-day intravenous ANG II infusion at a dose of 3 ng. kg(-1). min(-1) did not change mean arterial pressure (MAP) in the BN rats but increased MAP in Dahl S rats from 120 +/- 2 to 138 +/- 2 mmHg (P < 0.05). ANG II failed to increase MAP after NO substrate was provided by infusion of L-arginine (300 microg. kg(-1). min(-1)) into the renal medulla of Dahl S rats. Intravenous infusion of L-arginine at the same dose had no effect on the ANG II-induced hypertension. These results indicate that an impaired NO counterregulatory system in the outer medulla of Dahl S rats makes them more susceptible to the hypertensive actions of small elevations of ANG II.

Angiotensin II↗
PubMed2003

Effects of high-cholesterol diet and parallel exercise training on the vascular function of rabbit aortas: a time course study.

It is plausible to assume that exercise training, when applied early enough, can completely correct atherosclerotic defects. Using rabbit aortic specimens, we examined the effects of chronic exercise and high-cholesterol diet feeding on vascular function for different time periods. Male New Zealand White rabbits were divided into four groups: the normal diet groups with or without exercise training and the high-cholesterol diet groups with or without exercise training. Animals in high-cholesterol diet groups were fed 2% cholesterol rabbit chow for 2, 4, or 6 wk. Those in exercise training groups ran on a treadmill at 0.88 km/h for up to 40 min/day, 5 days/wk for the same period of time as the diet feeding. Thoracic aortas were isolated for functional and immunohistochemical analyses. We found that 1). although high-cholesterol diet feeding (>or=2 wk) elevated serum cholesterol levels and impaired acetylcholine-evoked vasorelaxation, only the latter effect was reversed by exercise training; 2). the effects of diet and exercise on acetylcholine-evoked vasorelaxation were mainly due to altered release of nitric oxide and endothelium-derived hyperpolarizing factor; and 3). diet feeding for 4 or 6 wk caused significant lipid deposition and expression of P-selectin, VCAM-1, monocyte chemoattractant protein-1, and inducible nitric oxide synthase, which were largely reduced by exercise training. In conclusion, parallel exercise training almost completely reverses the early-stage endothelial dysfunction caused by high-cholesterol diet feeding.

Acetylcholine↗
PubMed2001

Synchronization of ovulation using GnRH or hCG with the CO-Synch protocol in suckled beef cows.

The objectives of this study were to evaluate replacing GnRH with hCG and the effects of 48-h calf removal (CR) on pregnancy rates of cows synchronized with the CO-Synch protocol. Suckled beef cows (n = 467) at two locations were assigned to treatment by breed, age, and calving date. Treatment included either GnRH with (n = 121) or without CR (n = 117) or hCG with (n = 115) or without CR (n = 114) using the CO-Synch protocol. On d 0 and 9, cows received either hCG (2,500 IU, i.m.) or GnRH (100 microg, i.m.), and on d 7 all cows received PGF2alpha (25 mg). At one location, blood samples were collected from all cows (n = 203) on d -14, -7, 0, 7, 9, and 16. Calves were removed on d 7 and returned on d 9 (48 h) from approximately half of the cows that received GnRH or hCG. Cows that were detected in estrus between d 6 and 9 were bred approximately 12 h later and received no further injections. Cows not observed in estrus by d 9 received a second injection of either GnRH or hCG and were timed-inseminated. The AI pregnancy rates for GnRH-treated cows with or without CR and hCG-treated cows with or without CR were 46, 49, 35, and 34%, respectively (P = 0.44). Pregnancy rates of cows differed by treatment x age interaction (P = 0.07), hormone (P = 0.09), and hormone x age (P = 0.01) but not by CR (P = 0.66) or CR x age (P = 0.33). Among 2-yr-olds, pregnancy rates were higher for cows treated with hCG without CR than for cows that received GnRH with calf removal, whereas cows treated with hCG with CR and GnRH without CR were intermediate. In addition hCG-treated 2-yr-olds had higher pregnancy rates than GnRH-treated 2-yr-olds regardless of calf presence, but the reverse was true for older cows. Overall, GnRH-treated cows (48%) had a higher (P = 0.09) pregnancy rate than hCG-treated cows (34%). Among anestrous cows, GnRH and hCG were similar (P = 0.40) in their ability to induce ovulation and corpus luteum formation after the first and second injections of GnRH (31 and 76%, respectively) or hCG (39 and 61%, respectively). More (P = 0.001) hCG-treated cows exhibited short estrous cycles following timed AI. We conclude that hCG is not a suitable replacement for GnRH to synchronize ovulation with the CO-Synch protocol in multiparous cows, although further evaluation among primiparous cows is warranted using hCG with the CO-Synch protocol.

Age Factors↗
PubMed2006

Adjuvant endocrine therapy in hormone receptor-positive postmenopausal breast cancer: evolution of NCCN, ASCO, and St Gallen recommendations.

Endocrine therapy has a firm role in adjuvant treatment of women with hormone receptor-positive invasive breast cancer. Until recently, tamoxifen was the most commonly used adjuvant endocrine therapy in premenopausal and postmenopausal women. Several randomized clinical trials have studied the third-generation selective aromatase inhibitors (AIs) (anastrozole, letrozole, and exemestane) as adjuvant endocrine therapy in postmenopausal women. These studies compared therapy with an AI alone versus tamoxifen alone; 2 to 3 years of tamoxifen followed by switching to an AI versus continuation of tamoxifen; or extended therapy with an AI after approximately 5 years of tamoxifen therapy. No statistically significant differences in overall survival were observed. A single trial using extended treatment with an adjuvant AI suggests a small, statistically significant survival advantage in women with axillary lymph node-positive disease while showing no statistically significant decrease in survival with the use of an AI. The toxicities of the AIs are generally acceptable, with fewer endometrial cancers, gynecologic complaints, and thromboembolic events, but more bone fractures and arthralgias compared with tamoxifen alone. Three widely disseminated treatment guidelines, the National Comprehensive Cancer Network Breast Cancer Clinical Practice Guidelines in Oncology, the American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors, and the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer, now incorporate AIs in the adjuvant therapy of postmenopausal women with estrogen receptor-positive breast cancer.

Female↗
PubMed2002

[Fibrates].

Fibrates regulates not only plasma lipid metabolism but vascular biology by activating nuclear receptor peroxisome proliferating activated alpha (PPAR alpha). Major effects on plasma lipid levels are lowering plasma triglyceride level and elevating plasma HDL cholesterol level, whereas its effect on plasma cholesterol level is moderate compared to HMG-CoA reductase inhibitor. As a mechanism for its effects on plasma lipid levels and atherosclerosis, recent studies reported that fibrates activates various genes involved in metabolism of remnants and HDL such as lipoprotein lipase, apo AI, apo AII, and apo CIII genes through the interaction with PPAR alpha, lowering atherogenic lipoproteins and elevating anti-atherogenic lipoproteins. Furthermore, fibrates may influence the process of atherosclerosis by modifying inflammatory process in vascular wall. Recent clinical studies demonstrated that fibrates significantly reduce cardiovascular events in patients with either hypertriglyceridemia or low HDL cholesterol level.

Bezafibrate↗
PubMed2006

[ERK1/2 pathway involved in the expression of ETB receptors of the culturing smooth muscle cells of rat mesenteric artery].

AIM: To determine the involvement of extracellular signal-regulated kinase 1/2 (ERK1/2) pathway in the expression of endothelin receptor type B (ETB) during culture. METHODS: SB386023, a specific inhibitor for ERK1/2 pathway, was used to define the intracellular signaling pathway for the upregulation of ETB receptors and sarafotoxin 6c (S6c), a selective agonist for ETB receptors, induced contraction in isolated rat superior mesenteric arteries. The contraction was recorded by a sensitive in vitro myograph and the receptor mRNA was quantified by a real-time PCR. The phosphorylated ERK1/2 proteins were analyzed by phosphoELISA assay. RESULTS: S6c induced strong contractile responses of the artery after culture for 24 h, while there was no response to S6c in fresh vessel segments. The enhanced contractile response to S6c paralleled with an increase of mRNA for ETB receptors. The phosphorylated ERK1/2 proteins significantly increased after culture for 3 h. After co-culture with SB386023 for 24 h, S6c-induced contractions significantly decreased with reduction of Emax from (217 +/- 14) % to (127 +/- 23) % (P <0.01). This response paralleled with a decreased level of ETB receptor mRNA. CONCLUSION: ERK1/2 pathway was involved in the up-regulation of ETB receptors on smooth muscle cells isolated from rat mesenteric arteries during culture.

Animals↗
PubMed1994

Morphology and spatial distribution of GABAergic neurons in cat primary auditory cortex (AI).

This is a survey of the distribution, form, and proportion of neurons immunoreactive for gamma-aminobutyric acid (GABA) or glutamic acid decarboxylase (GAD) in cat primary auditory cortex (AI). The cells were studied in adult animals and were classified with respect to their somatic size, shape, and laminar location, and with regard to the origins and branching pattern of their dendrites. These attributes were used to relate each of the GAD-positive neuronal types to their counterparts in Golgi preparations. Each layer had a particular set of GABAergic cell types that is unique to it. There were 10 different GABAergic cell types in AI. Some were specific to one layer, such as the horizontal cells in layer I or the extraverted multipolar cells in layer II, while other types, such as the small and medium-sized multipolar cells, were found in every layer. The number and proportion of GABAergic cells were determined by using postembedding immunocytochemistry. The proportion of GABAergic neurons was 24.6%. This was slightly higher than the values reported elsewhere in the neocortex. The laminar differences in density and proportion of GABAergic and non-GABAergic neurons were also comparable (though somewhat higher) to those found in other cortical areas: thus, 94% of layer I cells were GABAergic, while the values in other layers ranged from 27% (layer V) to 16% (layer VI). Layer VI had the most heterogeneous population of GABAergic neurons. The proportion of these cells across different regions within AI was studied. Since some receptive field properties such as sharpness of tuning and aurality are distributed non-uniformly across AI, these might be reflected by regional differences across the cerebral cortex. There were significantly more GABAergic somata in layers III and IV in the central part of AI, along the dorsoventral axis, where physiological studies report that the neurons are tuned most sharply (Schreiner and Mendelson [1990] J. Neurophysiol. 64:1442-1459). Thus, there may be a structural basis for certain aspects of local inhibitory neuronal organization.

Animals↗
PubMed2005

Aromatase inhibitors: combinations with fulvestrant or signal transduction inhibitors as a strategy to overcome endocrine resistance.

There is an increasing rationale for effective combinations of endocrine therapy with novel drugs that target aberrant signal transduction pathways in estrogen receptor (ER) positive breast cancer. Prolonged endocrine therapy can be associated with an acquired increase in peptide growth factor signaling (EGFR, HER2), together with cross-talk activation of ER-dependent gene transcription and cell growth that leads to endocrine resistance. Current approaches to target these pathways include both the selective ER downregulator fulvestrant, and various signal transduction inhibitors (STIs). Fulvestrant can overcome resistance to tamoxifen (TAM-R) and long-term estrogen deprivation (LTED-R) in experimental models by reducing ER expression, and represents a current option for post-menopausal women with endocrine resistant ER+ve breast cancer. Emerging data suggest that fulvestrant's effect may be greater when combined with estrogen deprivation, and several phase III trials are assessing fulvestrant combined with aromatase inhibitors (AIs). Small molecule STIs such as tyrosine kinase inhibitors (TKIs), farnesyltransferase inhibitors (FTIs) and mTOR antagonists are also active in breast cancer. Pre-clinical data suggest that combined endocrine/STI therapy may result in greater growth inhibition than either therapy alone, and thus delay emergence of resistance. Several clinical trials are now examining STIs combined with AIs both in the tamoxifen-resistant and first-line advanced breast cancer setting, while pre-surgical studies are investigating the efficacy of combined endocrine/STI therapy utilising biological primary endpoints. This article reviews the pre-clinical rationale for this strategy and the clinical trials in this area.

Antineoplastic Agents, Hormonal↗