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The immunomodulatory drug lenalidomide has demonstrated efficacy in patients with chronic lymphocytic leukemia (CLL), despite a lack of direct cytotoxic effects in vitro The mechanism of lenalidomide efficacy in vivo is thought to occur via a combination of enhanced immune activity and an alteration of tumor cell-microenvironment interactions. We demonstrate in whole blood from patients with CLL that lenalidomide significantly depletes malignant B cells. Lenalidomide also induced production of interleukin-21 (IL21) and its mRNA in T cells from patients with CLL. In addition, lenalidomide enhanced upregulation of functional IL21 receptor (IL21R) on the cell surface and increased receptor mRNA in vitro The in vitro combination of IL21 and lenalidomide enhanced IL21-mediated cytotoxicity toward CLL cells through a variety of mechanisms. We show association of cell death with upregulation of Bid by IL21, enhanced upregulation of Bid by the combination therapy, and diminished Lck and downstream BCR signaling activation of Syk and PLCG2. Collectively, we demonstrated an immune cell-tumor cell interaction through lenalidomide-mediated induction of IL21 and IL21R, with enhanced IL21-mediated cytotoxicity, which provides justification for this combination in clinical trials for patients with CLL. Cancer Immunol Res; 4(8); 698-707. ©2016 AACR., (©2016 American Association for Cancer Research.)

The luteolytic potency of fenprostalene (a PGF2alpha analog) is about 20-times that of naturally produced PGF2alpha. The objective of this research was to investigate the uterokinetic effects of fenprostalene at a luteolytic dosage (1.0 mg) in the cyclic and early postpartum cow, and in the isolated uterine horn. Uterine motility measurements were conducted on two consecutive days in each cow. Experimental protocol on Day 1 was: spontaneous motility was recorded for 1 h; fenprostalene was injected (1.0 mg i.m.), after which motility was recorded for 2 h; fenprostalene was injected (1.0 mg i.v.) and motility was recorded for 30 min; and oxytocin was injected (40 U i.v.), followed by a 30-min recording period. On Day 2, the treatment sequence was reversed: spontaneous motility was recorded for 1 h; oxytocin was injected (100 U i.m.), after which motility was recorded for 2 h; fenprostalene was injected (1.0 mg i.v.) and motility recorded for 30 min; and oxytocin was injected (40 U i.v.), followed by a 30-min recording period. In the in vitro experiment, different dosages of fenprostalene (5.9, 11.8, 17.6, and 29.4 ng/ml bath solutions) and oxytocin (0.06, 0.12, 0.18, and 0.60 mU/ml bath solutions) were tested in pairs for 1 h. The treatment was then repeated. In a different group, fenprostalene (5.9 ng/ml bath solution) and oxytocin (0.06 mU/ml bath solution) treatments were alternated. Fenprostalene (at luteolytic dosage) was not uterokinetic in either the cyclic or postpartum cow. However, fenprostalene and oxytocin had a significant uterokinetic effect (five- to six-fold pretreatment value) on the isolated uterine horn preparation at all dosages studied. Peak motility occurred between 10 to 15 min, followed by a gradual decrease to 40% at 60 min. When the treatments were repeated at 60 min, oxytocin but not fenprostalene caused a minute, transient contraction. However, fenprostalene-desensitized (by exposure to fenprostalene) uteri reacted significantly to oxytocin, and vice versa.