Tag Archives: metastatic cancer

Good luck, RBG

Once again the press seems to dancing around a serious health problem of major public figure without saying just what it is.  Just about everyone admires RBG, but saying “The tumor was treated definitively and there is no evidence of disease elsewhere in the body” as the Supreme Court announced yesterday sounds wonderful doesn’t it?  Except that it isn’t.  8 months ago she had two metastatic tumors removed from her lung.  Sometimes it is possible to tell the tissue of origin from slides made from the tumors, but, as far as I can tell, this information was never released.  Now they say there is no sign of tumor elsewhere in her body (just as they said 8 months ago).

One hopes for the best for her.  Agree or disagree with her political philosophy, she is an admirable, brilliant and likable individual who has overcome a lot over the years.

Unfortunately Justice Ginsburg has metastatic cancer.  Her prognosis is not good.  As President Trump said “I’m hoping she’s going to be fine. She’s pulled through a lot. She’s strong, very tough.”

She had better be.

Addendum 28 August ’19

We’ll see how the right responds when RBG passes.  Here’s leftist folk hero Bill Maher on the death of one of the Koch brothers.  There are other similar responses.

Mind the gap (junction that is)

Gap junctions don’t get much play in pharmacology, or even in neurology, where they are widespread in the central nervous system, linking neurons to neurons, astrocytes to astrocytes. They may get quite a bit more if blocking them is a way of treating metastatic disease (see later).

A bit of background if you’re unfamiliar with them. This is from my notes Molecular Biology of the Cell 4th Edition p. 1074

The gap junction is a cylindrical oligomer composed of 6 identical rod shaped subunits (called connexins). They have 4 transmembrane segments and two extracellular loops which contain a beta-strand structure (and which are an essential structural basis for the docking of the two connexons). Multiple connexons in a membrane tend to form hexagonal arrays.

The gap junction spans the lipid bilayer creating a channel along the central axis. The pore is made of two such protein hexamers one from each cell (called a hemichannel or a connexon) arranged end to end. Different tissues have different specific gap junction proteins (connexins). Man has 14 distinct connexins each encoded by a separate gene (20 homologous proteins in man PNAS 103 pp. 5213 – 5218 ’06). Most cell types express more than one. Connexins are capable of assembling into a heteromeric connexon Adjacent cells expressing different connexins can form intercellular channels in which the two aligned dihalf-channels are different. Each gap junction can contain a cluster of a few to MANY THOUSANDS of CONNEXONs.

Neuroscientists should be interested in them as they form a functional ‘synapse’ between cells, e.g. a way of transferring information between them. For the afficienado there will be much more at the end. To flog a nearly dead horse, this is yet another way a wiring diagram of the brain won’t help you understand it — gap junctions don’t show up when you’re looking at classic synapses. For details see https://luysii.wordpress.com/2011/04/10/would-a-wiring-diagram-of-the-brain-help-you-understand-it/

A recent paper in Nature implied that cancer cells can form gap junctions with astrocytes (a glial cell of the brain). Usually we think of gap junctions being of the same cell type, but not here apparently.

Then they describe a mechanism for the cancer cell tweak the astrocyte so it produces something enabling the cancer cell to survive. Here’s whqt they claim

[ Nature vol. 533 pp. 493 – 498 ’16 ] Human and mouse breast and lung cancer cells express protocadherin7 (PCDH7) whicboth promotes (how?) the assembly of carcinoma – astrocyte gap junctions made of connexin43. PCDH7 normally is only expressed in brain. It joints the stialyl transferase ST6GALNAC5 and neuroserpin as brain restricted proteins which metastastic cells from breast and lung cancer use to colonize the brain.

Metastastic cells then uswe the channels to transfer cGAMP to astrocytes activating the STING pathway, which results in InterferonAlpha (IFNalpha) and Tumor Necrosis Factor (TNF), paracrine signals. These activate STAT1 and NFkappaB in the metastatic cells, supporting tumor growth and chemoresistance.

Meclofenamate and tonabersat are ‘modulators’ of gap junctions, breaking the loop between metastatic cancer cell and the astrocyte. Adding them to the tissue culture studied in the paper, inhibited tumor growth. So here might be a way treat metastatic cancer — particularly since meclofenamate is an FDA approved generic drug available without a prescription.

I think the mechanism described above is incomplete — why should a tumor cell transfer something to another cell to have it secrete something which makes the original cell use something it already had.

Now for a few of the things gap junctions are doing in the brain.

[ Neuron vol. 90 pp. 810 – 823 ’16 ] ManhyGABAeric interneurons (are there other kinds?) IN VITRO are coupled by gap junctions. This work used dual patch clamp recordings of interneurons IN VIVO. They studied coupled cerebellar Golgi cells, and showed that, in the presence of spontaneous background synaptic activity, electrically coupled cerebellar Golgi cells showed robust milliSecond precision correlated activity. This was further enhanced by sensory stimulation.

The electrical coupling equlized membrane potential fluctuations, so that coupled neurons approach action potential threshold together. They say that something called spike triggered spikelets transmitted through gap junctions conditionally triggered postJunctional spikes, if both neurons were close to threshold.

Spikelets are brief low amplitude potentials which look like action potentials but which are much smaller. A spike cannot be generated without a much larger potential change than provided by a spikelet, because the spikelet voltage is too small to activate the ion channels of electrically excitable membranes.

So gap junctions controls the temporal precision and degree of both spontaneous and sensory evoked correlated activity betwen interneurons, by the cooperative effects of shared synaptic depolarization and spikelet transmission.

[ Neuron vol. 90 pp. 912 – 913, 1043 – 1056 ’16 ] It has been found that the strength of electrical coupling between neurons in a network is highly variable (even in the same neuron, so it could be coupled at different strengths with each of its partners). Site specific modulation of electrical coupling quickly reconfigures networks of electrically coupled neurons in the retina. Phosphorylation of connexin36 alters its conductivity.

The number of gap junctions determines the strength of ele tical coupling between cerebellar Golgi cells. Ultrastructural analysis shows that gap junctions vary widely in size, which also influences coupling strength (according to a computer simulation). These are dendro-dendritic electrical synapses (widespread in the brain between inhibitory interneurons).

Only 18% or so of the channels present at the gap junctions account for the boserved strength of electrical transmission between cerebellar golgi cells.

Somato-somatic junctions occur in the mammalian trigeminal mesencephalic nucleus. Could the excess junctions be acting as adhesion molecules.

In one system, the turnover of gap junction channel proteins is rapid and comparable with that of glutamic acid receptors.

Gap junctions are ‘low pass filters’ (they pass slow fluctuations of membrane potential better than they pass rapid fluctuations). This is why the electrical synapses are inhibitory — each action potential from a Golgi cell consists of a rapid (but brief) depolarizing spike followed by a relatively deep and protracted afterhyperpolarization — which is 200 times longer than the spike — and transmitted much more effectively.

Inhibition by sparse excitatory input breaks up Golgi network synchronization, because the coupling to adjacent cells is different for each one, causing dispersion of the spikes.

In quietly attentive animals cerebellar Golgi cells generate rhythmic synchronous activity at 8 Hertz. The same behavior is seen in cerebellar slices. The hyperpolarizing electrical post-synaptic potentials (PSPs) are the only synchronizing force. This is the default state, but it can be disrupted by a variety of sensory stimuli (or by movements) which reduce spiking frequency and rhythmicity.

Golgi cells can inhibit thousands of granule cells, and every granule cell gets inhibitory input from 4 – 8 Golgi cells. The transient nature of network desynchronization ‘could’ allow the cerebellar input layer to act as a timing device over the 10 milliSecond to 1 second timescale.