Pregnenolone Biosynthesis in C6-2B Glioma Cell Mitochondria

Total Page:16

File Type:pdf, Size:1020Kb

Pregnenolone Biosynthesis in C6-2B Glioma Cell Mitochondria Proc. Nail. Acad. Sci. USA Vol. 89, pp. 5113-5117, June 1992 Neurobiology Pregnenolone biosynthesis in C6-2B glioma cell mitochondria: Regulation by a mitochondrial diazepam binding inhibitor receptor (glial cells/steroidogenesis/benzodiazepines/diazepam binding inhibitor) VASSILIOS PAPADOPOULOS*, PATRIZIA GUARNERIt, KARL E. KRUEGERt, ALESSANDRO GUIDOTTIt, AND ERMINIO COSTAt *Department of Anatomy and Cell Biology and tFidia-Georgetown Institute for the Neurosciences, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007 Contributed by Erminio Costa, March 6, 1992 ABSTRACT The C6-2B glioma cell line, rich in mitochon- been proposed that glial cells can synthesize steroids de novo drial receptors that bind with high affinity to benzodiazepines, (6, 7). In fact, glial cells can convert cholesterol to preg- imidazopyridines, and isoquinolinecarboxamides (previously nenolone, which then may be further metabolized to preg- called peripheral-type benzodiazepine receptors), was investi- nenolone sulfate, 3f3-hydroxy-5-pregnene-20-one, 3/3- gated as a model to study the significance of the polypeptide hydroxy-5-androstene-17-one, 3a-hydroxy-5a-pregnane-20- diazepam binding inhibitor (DBI) and the putative DBI pro- one, and 5a-pregnane-3a,21-diol-20-one, which positively or cessing products on mitochondrial receptor-regulated ste- negatively modulate the GABA-gating of Cl- channels (4, 8). roidogenesis. DBI and its naturally occurring fragments have Although detailed characterization of this biosynthetic appa- been found to be present in high concentrations in C6-2B ratus in glial cells is far from complete, the cytochrome P450 glioma cells, to compete against specific isoquinolinecarboxa- side-chain-cleavage enzyme (P450scc), which participates in mide or 4'-chlorodiazepam binding to mitochondrial recogni- steroid biosynthesis by converting cholesterol to preg- tion sites with high affinity, and to stimulate mitochondrial nenolone, has been identified immunocytochemically in pri- pregnenolone formation. These data suggest that this cell type mary glial cultures and in specific rat brain regions (7, 9). may express both the receptor and the putative agonist ligand Two important findings prompted the present investiga- to regulate steroidogenesis. Therefore, we propose to term this tion: (i) the observations that in adrenal and testis receptors mitochondrial receptor MDR (mitochondrial DBI receptor) to located on the outer membrane of mitochondria and which indicate its responsiveness to DBI in steroid biosynthesis. In the recognize benzodiazepines, isoquinolinecarboxamides, and present work, we show that mitochondria of C6-2B cells imidazopyridines with high affinity-previously defined as convert (22R)-22-hydroxycholesterol to pregnenolone by a peripheral-type benzodiazepine receptors-regulate intram- mechanism blocked by aminoglutethimide. Immunoblotting itochondrial cholesterol transport, the rate-limiting step in high of steroidogenesis (10-12), and (ii) the demonstration that di- confirmed the presence of relatively levels cytochrome azepam binding inhibitor (DBI), a polypeptide abundant in P-450 cholesterol side-chain-cleavage enzyme in C6-2B cell steroidogenic cells (1, 13, 14), can stimulate pregnenolone mitochondria. Furthermore, isoquinolinecarboxamide binding formation in adrenocortical and testicular Leydig cell mito- sites associated with the 18-kDa mitochondrial polypeptide chondria by an interaction with these mitochondrial recep- subunit of the MDR are abundant in C6-2B glioma cell tors (15, 16). The present experiments show that rat glioma mitochondria (B 30 pmol/mg protein) and are coupled to C6-2B cells and mitochondria prepared from these cells the regulation of steroid biosynthesis. Occupancy of MDRs contain the P-45Scc enzyme and thereby convert cholesterol with nanomolar concentrations of the naturally occurring to pregnenolone. This enzymatic reaction can be activated by polypeptide, DBI, as well as its naturally occurring processing nanomolar amounts of DBI and the DBI fragment tetratria- product tetratriacontaneuropeptide [DBI-(17-50)] increases contaneuropeptide [TTN, DBI-(17-50)]. Since DBI, which is pregnenolone formation. Clonazepam and octadecaneuropep- synthesized and processed in glial cells (17), competes tide [DBI-(33-50)], which exhibit a higher affinity for r-ami- against the binding of the mitochondrial receptor ligands nobutyric acid type A receptors but a low affinity for MDR, 1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquin- were ineffective in stimulating pregnenolone synthesis. These olinecarboxamide (PK 11195) and 4'-chlorodiazepam (4'CD) findings provide evidence that C6-2B cells exhibit a significant with an affinity comparable to its potency in the steroidogenic steroidogenic activity which resembles that found in peripheral effect, it appears to be the natural agonist for the receptor that endocrine organs and they suggest that MDRs and DBI are controls steroidogenesis in glial cells. Therefore, we suggest involved in the regulation of glial cell steroidogenesis. that this glial mitochondrial receptor be termed MDR (mito- chondrial DBI receptor). The specific interactions of steroids with putative membrane binding sites associated with the type A receptor for 'y-ami- METHODS nobutyric acid (GABAA receptor) (1-4) has prompted a reexamination of the rapid effects of various steroids on Cell Culture. The C6-2B subclone of the rat glioma C6 cell neuronal function as well as the investigation of the mecha- line was obtained from Gary Brooker at this institute (18). nisms that control the synthesis and release of steroids from These cells were adapted for growth in serum-free Aim V cells in the central nervous system. It appears that steroids of peripheral origin can be taken up from the circulation (5) by Abbreviations: GABA, y-aminobutyric acid; DBI, diazepam binding brain cells, where they bind to specific receptors to form inhibitor; MDR, mitochondrial DBI receptor(s); P450,,c, cholesterol transcription activating factors. In addition, it has recently side-chain-cleavage cytochrome P450 (EC 1.14.15.6); 4'CD, 4'- chlorodiazepam (Ro 5-4864); PK 11195, 1-(2-chlorophenyl)-N- methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide; PK 14105, The publication costs of this article were defrayed in part by page charge 1-(2-fluoro-5-nitrophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquin- payment. This article must therefore be hereby marked "advertisement" olinecarboxamide; TTN, tetratriacontaneuropeptide; ODN, octade- in accordance with 18 U.S.C. §1734 solely to indicate this fact. caneuropeptide. 5113 Downloaded by guest on September 30, 2021 5114 Neurobiology: Papadopoulos et al. Proc. Natl. Acad. Sci. USA 89 (1992) medium (GIBCO). Culture dishes (150 mm diameter) were gel, and subjected to electrophoresis. Proteins were then pretreated with 10 ml ofDulbecco's modified Eagle's medium transferred to nitrocellulose membranes (0.45 pm; Hoefer) (DMEM) supplemented with 10% fetal bovine serum and blotted with a rabbit anti-bovine adrenal P-450SCc anti- (GIBCO) for 4 hr and washed with phosphate-buffered saline. body, obtained from Oxygene (Dallas) or normal rabbit Cells were then plated and grown in Aim V medium. This immunoglobulin. The antigens were detected with goat anti- procedure did not significantly alter the growth rate of the rabbit IgG coupled to horseradish peroxidase (Bio-Rad) using C6-2B cells compared with their growth in serum-containing 3-amino-9-ethylcarbazole and hydrogen peroxide as sub- media. strate (19). Measurement of Mitochondrial Steroid Biosynthesis. Mito- DBI Extraction, Purification, and Assay. DBI was extracted chondria from C6-2B cells were prepared as previously and purified from rat brain as previously described (20). The described (12) and resuspended at a concentration of 2.0 mg purity of the preparations used (>95%) was established by of protein per ml in buffer A (10 mM potassium phosphate SDS/PAGE, amino acid composition, and chromatographic buffer, pH 7.0/0.25 M sucrose/5 mM MgCl2/20 mM KCI/15 characteristics on reverse-phase HPLC (14, 20). DBI-like mM triethanolamine HCI) containing 5 ,uM trilostane (WIN- immunoreactivity of cell extracts was determined by radio- 24540; Sterling-Winthrop Group), an inhibitor of preg- immunoassay (14, 20). Peptides were synthesized and char- nenolone metabolism (11). Various concentrations of MDR acterized as previously described (21). Protein was quantified ligands to be tested were then added in buffer A. The mixture by using the procedure of Bradford (22) with gammaglobulin was preincubated for 5 min at 370C, and the reaction was as a standard. started by addition of 15 mM malate (neutralized with 1 M NaOH) and 0.5 mM NADP. The incubation was continued RESULTS for 15 min at 37TC and the reaction was stopped by the Cholesterol Side-Chain Cleavage in C6-2B Mitchodria. addition of 4 vol of cold ethanol. [3H]Pregnenolone [1500 The first step in steroid biosynthesis is the conversion of cpm, 22.6 Ci/mmol (1 Ci = 37 GBq); NEN/DuPont] was cholesterol to pregnenolone, which is catalyzed by P-450.C in added to each sample to monitor the recovery of the extrac- inner mitochondrial membranes. This side-chain-cleavage tion. The samples were then extracted three times with 5 vol reaction occurs via multiple hydroxylation steps of the cho- of n-hexane and the ethanolic phase was evaporated to lesterol side chain. The rate of the side-chain-cleavage reac- dryness. Pregnenolone was measured by a specific
Recommended publications
  • Us Anti-Doping Agency
    2019U.S. ANTI-DOPING AGENCY WALLET CARDEXAMPLES OF PROHIBITED AND PERMITTED SUBSTANCES AND METHODS Effective Jan. 1 – Dec. 31, 2019 CATEGORIES OF SUBSTANCES PROHIBITED AT ALL TIMES (IN AND OUT-OF-COMPETITION) • Non-Approved Substances: investigational drugs and pharmaceuticals with no approval by a governmental regulatory health authority for human therapeutic use. • Anabolic Agents: androstenediol, androstenedione, bolasterone, boldenone, clenbuterol, danazol, desoxymethyltestosterone (madol), dehydrochlormethyltestosterone (DHCMT), Prasterone (dehydroepiandrosterone, DHEA , Intrarosa) and its prohormones, drostanolone, epitestosterone, methasterone, methyl-1-testosterone, methyltestosterone (Covaryx, EEMT, Est Estrogens-methyltest DS, Methitest), nandrolone, oxandrolone, prostanozol, Selective Androgen Receptor Modulators (enobosarm, (ostarine, MK-2866), andarine, LGD-4033, RAD-140). stanozolol, testosterone and its metabolites or isomers (Androgel), THG, tibolone, trenbolone, zeranol, zilpaterol, and similar substances. • Beta-2 Agonists: All selective and non-selective beta-2 agonists, including all optical isomers, are prohibited. Most inhaled beta-2 agonists are prohibited, including arformoterol (Brovana), fenoterol, higenamine (norcoclaurine, Tinospora crispa), indacaterol (Arcapta), levalbuterol (Xopenex), metaproternol (Alupent), orciprenaline, olodaterol (Striverdi), pirbuterol (Maxair), terbutaline (Brethaire), vilanterol (Breo). The only exceptions are albuterol, formoterol, and salmeterol by a metered-dose inhaler when used
    [Show full text]
  • Periodic Hypokalaemic Paralysis, Adrenal Adenoma, and Normal Colonic Transport of Sodium and Potassium
    Gut: first published as 10.1136/gut.14.6.478 on 1 June 1973. Downloaded from Gut, 1973, 14, 478-484 Periodic hypokalaemic paralysis, adrenal adenoma, and normal colonic transport of sodium and potassium PETER RICHARDS1, M. B. S. JONES, AND W. S. PEART From the Medical Unit, St Mary's Hospital Medical School, London SUMMARY A 47-year-old woman was cured of hypokalaemia and recurrent paralysis by the excision of an adrenal adenoma. Hypertension was initially ameliorated but was not cured. Suppression of plasma renin activity was abolished when the adenoma was excised. Repeated measurement of plasma corticosteroids before operation showed a slight increase in aldosterone and normal plasma concentrations of deoxycorticosterone, corticosterone, and cortisol. No evidence of excess mineralo- corticoid was obtained from measurement of the electrolyte composition of colonic fluid or of rectal potential difference, although both these variables responded normally to salt depletion and exogenous aldosterone. The diagnostic importance of the paradoxically normal colonic measure- ments is emphasized and the possibility is considered that the adenoma may have secreted an unidentified hormone. http://gut.bmj.com/ The colon normally responds to excessive plasma not escape from the action of these hormones. One concentrations of aldosterone, corticosterone, and patient has been described in whom colonic sodium deoxycorticosterone by modifying faecal fluid so fluxes were apparently normal and were unchanged that the concentration of sodium is very low and that by the excision of an aldosterone-secreting adrenal of potassium high (Wrong, Morrison, and Hurst, adenoma; potassium influx was nevertheless in- 1961; Wrong and Metcalfe-Gibson, 1965; creased and returned to normal after operation Richards, on September 29, 2021 by guest.
    [Show full text]
  • The Role of Highly Selective Androgen Receptor (AR) Targeted
    P h a s e I I S t u d y o f I t r a c o n a z o l e i n B i o c h e m i c a l R e l a p s e Version 4.0: October 8, 2014 CC# 125513 CC# 125513: Hedgehog Inhibition as a Non-Castrating Approach to Hormone Sensitive Prostate Cancer: A Phase II Study of Itraconazole in Biochemical Relapse Investigational Agent: Itraconazole IND: IND Exempt (IND 116597) Protocol Version: 4.0 Version Date: October 8, 2014 Principal Investigator: Rahul Aggarwal, M.D., HS Assistant Clinical Professor Division of Hematology/Oncology, Department of Medicine University of California San Francisco 1600 Divisadero St. San Francisco, CA94115 [email protected] UCSF Co-Investigators: Charles J. Ryan, M.D., Eric Small, M.D., Professor of Medicine Professor of Medicine and Urology Lawrence Fong, M.D., Terence Friedlander, M.D., Professor in Residence Assistant Clinical Professor Amy Lin, M.D., Associate Clinical Professor Won Kim, M.D., Assistant Clinical Professor Statistician: Li Zhang, Ph.D, Biostatistics Core RevisionHistory October 8, 2014 Version 4.0 November 18, 2013 Version 3.0 January 28, 2013 Version 2.0 July 16, 2012 Version 1.0 Phase II - Itraconazole Page 1 of 79 P h a s e I I S t u d y o f I t r a c o n a z o l e i n B i o c h e m i c a l R e l a p s e Version 4.0: October 8, 2014 CC# 125513 Protocol Signature Page Protocol No.: 122513 Version # and Date: 4.0 - October 8, 2014 1.
    [Show full text]
  • Order in Council 1243/1995
    PROVINCE OF BRITISH COLUMBIA ORDER OF THE LIEUTENANT GOVERNOR IN COUNCIL Order in Council No. 12 4 3 , Approved and Ordered OCT 121995 Lieutenant Governor Executive Council Chambers, Victoria On the recommendation of the undersigned, the Lieutenant Governor, by and with the advice and consent of the Executive Council, orders that Order in Council 1039 made August 17, 1995, is rescinded. 2. The Drug Schedules made by regulation of the Council of the College of Pharmacists of British Columbia, as set out in the attached resolution dated September 6, 1995, are hereby approved. (----, c" g/J1"----c- 4- Minister of Heal fandand Minister Responsible for Seniors Presidin Member of the Executive Council (This pan is for adnwustratlye purposes only and is not part of the Order) Authority under which Order Is made: Act and section:- Pharmacists, Pharmacy Operations and Drug Scheduling Act, section 59(2)(1), 62 Other (specify): - Uppodukoic1enact N6145; Resolution of the Council of the College of Pharmacists of British Columbia ("the Council"), made by teleconference at Vancouver, British Columbia, the 6th day of September 1995. RESOLVED THAT: In accordance with the authority established in Section 62 of the Pharmacists, Pharmacy Operations and Drug Scheduling Act of British Columbia, S.B.C. Chapter 62, the Council makes the Drug Schedules by regulation as set out in the attached schedule, subject to the approval of the Lieutenant Governor in Council. Certified a true copy Linda J. Lytle, Phr.) Registrar DRUG SCHEDULES to the Pharmacists, Pharmacy Operations and Drug Scheduling Act of British Columbia The Drug Schedules have been printed in an alphabetical format to simplify the process of locating each individual drug entry and determining its status in British Columbia.
    [Show full text]
  • Medication Use for the Risk Reduction of Primary Breast Cancer in Women: a Systematic Review for the U.S
    Evidence Synthesis Number 180 Medication Use for the Risk Reduction of Primary Breast Cancer in Women: A Systematic Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA-290-2015-00009-I, Task Order No. 7 Prepared by: Pacific Northwest Evidence-Based Practice Center Oregon Health & Science University Mail Code: BICC 3181 SW Sam Jackson Park Road Portland, OR 97239 www.ohsu.edu/epc Investigators: Heidi D. Nelson, MD, MPH Rongwei Fu, PhD Bernadette Zakher, MBBS Marian McDonagh, PharmD Miranda Pappas, MA L.B. Miller, BA Lucy Stillman, BS AHRQ Publication No. 19-05249-EF-1 January 2019 This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (HHSA-290-2015-00009-I, Task Order No. 7). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.
    [Show full text]
  • Treatment of Cushing's Disease
    D CUEVAS-RAMOS and M FLESERIU Treatment of Cushing’s disease 223:2 R19–R39 Review Treatment of Cushing’s disease: a mechanistic update Daniel Cuevas-Ramos1,2 and Maria Fleseriu3 1Department of Medicine, Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, California, USA Correspondence 2Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias should be addressed Me´ dicas y Nutricio´ n Salvador Zubira´ n, Mexico City, Mexico to M Fleseriu 3Departments of Medicine and Neurological Surgery, and Northwest Pituitary Center, Oregon Health & Science Email University, 3181 SW Sam Jackson Park Road (BTE 472), Portland, Oregon 97239, USA fl[email protected] Abstract Cushing’s disease (CD) is characterized by an ACTH-producing anterior corticotrope pituitary Key Words adenoma. If hypothalamus–pituitary–adrenal (HPA) axis physiology is disrupted, ACTH " cortisol secretion increases, which in turn stimulates adrenocortical steroidogenesis and cortisol " Cushing’s disease production. Medical treatment plays an important role for patients with persistent disease " ACTH after surgery, for those in whom surgery is not feasible, or while awaiting effects of " pasireotide radiation. Multiple drugs, with different mechanisms of action and variable efficacy and " mifepristone tolerability for controlling the deleterious effects of chronic glucocorticoid excess, are " ketoconazole available. The molecular basis and clinical data for centrally acting drugs, adrenal " LCI699 steroidogenesis inhibitors, and glucocorticoid receptor antagonists are reviewed, as are " cabergoline potential novel molecules and future possible targets for CD treatment. Although progress has been made in the understanding of specific corticotrope adenoma receptor physiology Journal of Endocrinology and recent clinical studies have detected improved effects with a combined medical therapy approach, there is a clear need for a more efficacious and better-tolerated medical therapy for patients with CD.
    [Show full text]
  • Use of Aromatase Inhibitors in Breast Carcinoma
    Endocrine-Related Cancer (1999) 6 75-92 Use of aromatase inhibitors in breast carcinoma R J Santen and H A Harvey1 Department of Medicine, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA 1Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA (Requests for offprints should be addressed to R J Santen) Abstract Aromatase, a cytochrome P-450 enzyme that catalyzes the conversion of androgens to estrogens, is the major mechanism of estrogen synthesis in the post-menopausal woman. We review some of the recent scientific advances which shed light on the biologic significance, physiology, expression and regulation of aromatase in breast tissue. Inhibition of aromatase, the terminal step in estrogen biosynthesis, provides a way of treating hormone-dependent breast cancer in older patients. Aminoglutethimide was the first widely used aromatase inhibitor but had several clinical drawbacks. Newer agents are considerably more selective, more potent, less toxic and easier to use in the clinical setting. This article reviews the clinical data supporting the use of the potent, oral competitive aromatase inhibitors anastrozole, letrozole and vorozole and the irreversible inhibitors 4-OH andro- stenedione and exemestane. The more potent compounds inhibit both peripheral and intra-tumoral aromatase. We discuss the evidence supporting the notion that aromatase inhibitors lack cross- resistance with antiestrogens and suggest that the newer, more potent compounds may have a particular application in breast cancer treatment in a setting of adaptive hypersensitivity to estrogens. Currently available aromatase inhibitors are safe and effective in the management of hormone- dependent breast cancer in post-menopausal women failing antiestrogen therapy and should now be used before progestational agents.
    [Show full text]
  • Clinical Trial of Multiple Endocrine Therapy For
    [CANCER RESEARCH (SUPPL.) 42, 3458s-3460s, August 1982] 0008-5472/82/0042-OOOOS02.00 Clinical Trial of Multiple Endocrine Therapy for Metastatic and Locally Advanced Breast Cancer with Tamoxifen-Aminoglutethimide- Danazol Compared to Tamoxifen Used Alone1 Trevor J. Powles, C. Gordon, and R. C. Coombes Medical Breast Unit, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, England Abstract Multiple-endocrine therapy with combinations of various This paper reports a controlled randomized clinical trial types of treatment has not been evaluated properly in spite of which compared treatment of advanced breast cancer with the success of individual types of hormone treatment. This tamoxifen to treatment with a combination of TAD.2 paper reports the early results of a randomized controlled clinical trial comparing tamoxifen (10 mg 2 times/day)-amino- Patients and Methods glutethimide (250 mg 3 times/day)-danazol (100 mg 3 times/ Between September 1979 and April 1981, 122 patients with as day)-hydrocortisone (20 mg 2 times/day) (TAD) with tamoxifen sessable metastatic or locally advanced breast cancer have been (10 mg 2 times/day). randomized to receive either tamoxifen (10 mg twice/day) or a com Analysis of the first 107 assessable patients indicates objec bination of tamoxifen (10 mg twice/day), aminoglutethimide (250 mg tive response (criteria of the International Union Against Can 3 times/day), danazol (100 mg 3 times/day), and hydrocortisone (20 cer) in 33% of patients receiving tamoxifen versus 50% of mg twice/day). All patients were at least 1 year postmenopausal, with patients receiving TAD. Duration of response to TAD is identical histologically confirmed breast cancer and with a life expectancy of at to duration of response to tamoxifen alone.
    [Show full text]
  • Labeling Text Or Submitted Document Name: Draft Labeling (With Or Without Minor Editorial Revisions Included in the Letter)
    DOCUMENT INFORMATION PAGE This page is for FDA internal use only. Do NOT send this page with the letter. Application #(s): NDA 20-726/S-008 Document Type: NDA Letters Document Group: NDA Supplement Approval Letters Approval, effective on date of letter, based on enclosed labeling text or submitted Document Name: draft labeling (with or without minor editorial revisions included in the letter). Shortcut ID Code: SNDA-I1 COMIS Decision Code AP Drafted by: AMS/12-31-02 Revised by: Initialed by: Pease/1-13-03 Sridhara/1-14-03 Chen/1-14-03 Cohen/1-14-03 Johnson/1-14-03 Finalized: AMS/1-15-03 Filename: DFS Key Words: Notes: Version: 12/18/2002 END OF DOCUMENT INFORMATION PAGE The letter begins on the next page. DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration Rockville, MD 20857 NDA 20-876/S-008 Novartis Pharmaceuticals Corporation One Health Plaza, Building 105/2W200 Hanover, New Jersey 07936-1080 Attention: Arlene Wolny, Associate Director Drug Regulatory Affairs Dear Ms. Wolny: Please refer to your supplemental new drug application dated March 15, 2002, received March 18, 2002, submitted under section 505(b) of the Federal Food, Drug, and Cosmetic Act for Femara (letrozole) tablets, 2.5 mg. We acknowledge receipt of your submissions dated November 15, 2002 and January 2, 2003. This supplemental new drug application provides for updating the safety and efficacy data for Femara for first-line treatment of postmenopausal women with hormone receptor positive or hormone receptor unknown locally advanced or metastatic breast cancer and includes revisions to the Clinical Studies, Precautions, and Adverse Reactions sections of the labeling.
    [Show full text]
  • 2019 Prohibited List
    THE WORLD ANTI-DOPING CODE INTERNATIONAL STANDARD PROHIBITED LIST JANUARY 2019 The official text of the Prohibited List shall be maintained by WADA and shall be published in English and French. In the event of any conflict between the English and French versions, the English version shall prevail. This List shall come into effect on 1 January 2019 SUBSTANCES & METHODS PROHIBITED AT ALL TIMES (IN- AND OUT-OF-COMPETITION) IN ACCORDANCE WITH ARTICLE 4.2.2 OF THE WORLD ANTI-DOPING CODE, ALL PROHIBITED SUBSTANCES SHALL BE CONSIDERED AS “SPECIFIED SUBSTANCES” EXCEPT SUBSTANCES IN CLASSES S1, S2, S4.4, S4.5, S6.A, AND PROHIBITED METHODS M1, M2 AND M3. PROHIBITED SUBSTANCES NON-APPROVED SUBSTANCES Mestanolone; S0 Mesterolone; Any pharmacological substance which is not Metandienone (17β-hydroxy-17α-methylandrosta-1,4-dien- addressed by any of the subsequent sections of the 3-one); List and with no current approval by any governmental Metenolone; regulatory health authority for human therapeutic use Methandriol; (e.g. drugs under pre-clinical or clinical development Methasterone (17β-hydroxy-2α,17α-dimethyl-5α- or discontinued, designer drugs, substances approved androstan-3-one); only for veterinary use) is prohibited at all times. Methyldienolone (17β-hydroxy-17α-methylestra-4,9-dien- 3-one); ANABOLIC AGENTS Methyl-1-testosterone (17β-hydroxy-17α-methyl-5α- S1 androst-1-en-3-one); Anabolic agents are prohibited. Methylnortestosterone (17β-hydroxy-17α-methylestr-4-en- 3-one); 1. ANABOLIC ANDROGENIC STEROIDS (AAS) Methyltestosterone; a. Exogenous*
    [Show full text]
  • Are We Missing the Issues That Really Matter?
    A mixed method study on the prevalence, severity and experience of genitourinary symptoms and the impact on sexual function and QoL in postmenopausal women on endocrine therapy for early breast cancer MARIANA S. SOUSA ARE WE MISSING THE ISSUES THAT REALLY MATTER? 1 ARE WE MISSING THE ISSUES THAT REALLY MATTER? A mixed method study on the prevalence, severity and experience of genitourinary symptoms and the impact on sexual function and quality of life in postmenopausal women on endocrine therapy for early breast cancer Mariana de Souza e Sousa A thesis in fulfillment of the requirements for the degree of Doctor of Philosophy Prince of Wales Clinical School Faculty of Medicine University of New South Wales Australia 2015 iii PLEASE TYPE THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: de Souza e Sousa First name: Mariana Other name/s: N/A Abbreviation for degree as given in the University calendar: PhD School: Prince of Wales Clinical School Faculty: Medicine Title: Are we missing the issues that really matter? A mixed-method study on the prevalence, severity and experience of genitourinary symptoms and the impact on sexual function and Qol in postmenopausal women on endocrine therapy for early breast cancer Abstract 350 words maximum: (PLEASE TYPE) The underlying hypothesis of this PhD Is that the negative Impact of adjuvant endocrine therapy on genitourinary symptoms In postmenopausal women with early breast cancer has been underestimated In clinical trials and that there are a myriad of genitourinary symptoms related to or exacerbated by endocrine therapies that are commonly not reported by women to their oncologists.
    [Show full text]
  • Clinical Protocol : Topotecan Plus Cisplatin Induction Followed By
    UCI 03-16 Revised Version date 04/25/2011 Clinical Protocol UCI 03-16: Phase II Chemoprevention Trial - Anastrozole in the DCIS and early invasive breast cancer in postmenopausal women 1.0 OBJECTIVE 1.1 To assess the efficacy in terms of reduction in Ki-67(as a surrogate endpoint to breast cancer risk reduction) in patients treated with anastrozole. 1.2 To measure the histopathological response and correlate the degree of histopathological response with the degree of Ki-67 response. 1.3 To compare pretreatment vascular density with post treatment vascular density using MRI 1.4 To compare pretreatment markers of angiogenesis with post treatment marker of angiogenesis. 1.5 To correlate MR imaging response to markers of angiogenesis response. 1.6 To correlate ER, Ki-67, angiogenesis markers and MRI response to histopathological changes 2.0 BACKGROUND A. SPECIFIC AIMS Breast cancer is a genetically heterogeneous disease. Hormone receptor expression occurs in the majority of postmenopausal breast cancer and defines the subset that can be treated and prevented with hormone modulators. Hormone modulators include antiestrogen like tamoxifen and aromatase inhibitor that block the formation of estrogens in the adrenal glands and peripheral tissue. Hormone modulators have been established in treatment of invasive breast cancer. These agents not only been established as treatment for breast cancer but also have demonstrated efficacy as chemopreventive agents. Tamoxifen has been established as a chemopreventive agent in reducing the development of breast cancer in patients who are at high risk of developing breast cancer. Intriguing results have been obtained in the reduction of breast cancer event rates in established breast cancer patients treated with anastrozole as compared to patients treated with tamoxifen, providing the first glimpse of its efficacy as a chemopreventive agent.
    [Show full text]