Biological Modalities Research Articles

Health hazards among health care personnel

While providing health services, (preventive, curative, rehabilitative), health care personnel (HCP) face hazards. Developments in medical science provide some safety, still modern technology has made health care very complex with many hazards. Biological (viruses, bacteria, and parasites) and chemical (disinfectants, drugs, and diagnostics) therapeutic modalities in health delivery are leading to many disorders in HCP. Needle prick injuries, radiation exposure, violence, psychiatric disorders, stalking by patients, and suicides are common. HCP are at high risk for musculoskeletal disorders, due to patient handling, compounded by increasing number of obese patients. With increase in workload because of human immunodeficiency virus, hardships have increased. Despite potential for exposure to hazards, many HCP lack awareness about prevention. Also the system is not conducive, policies of prevention not clear, inaccessibile, or there is attitude problem. Hence, HCP continue to suffer, more in developing countries. Health managers need to ensure that health care is geared toward assessment of hazards suffered by HCP, there reasons, and do everything possible for prevention.

Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature

ObjectiveParaplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures. Treatment modalities for such fractures, such as stabilization, have no effect on the neurological recovery. Thus, various pharmacological and biological treatment modalities have been used. The more recent trend of using autologous stem cells from the iliac crest has been used in some clinical trials with varying success. Thus, more clinical studies are required to study the effect of this novel approach MethodsThis is a prospective hospital-based cohort study (level IV). The study was conducted in the Dept. of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi from November 2010 to March 2012. Ten patients who had sustained traumatic dorsolumbar vertebral fractures with complete paraplegia were recruited for this study. Under suitable anaesthesia, at the beginning of surgery, 100ml of bone marrow was aspirated. This was centrifuged and buffy coat isolated and then transferred into a sterile tube and sent to the operating room on ice packs. After surgical decompression and stabilization, the buffy coat isolate was injected into the dural sleeve at the site of the injury using a 21G needle. All the patients were evaluated for neurological improvement using the American Spinal Injury Association (ASIA) score and Frankel grade at 6weeks and 3months postoperatively. ResultsThe evaluation at 6weeks showed some improvement in terms of the ASIA scores in 2 patients but no improvements in their Frankel Grade. The other 8 patients showed no improvements in their ASIA scores or their Frankel Grades. The current pilot study has shown that there has been no improvement in most of the recipients of the transplant (n=8). Some patients (n=2) who did show some improvement in their sensory scores proved to be of no significant functional value as depicted by no change in their Frankel Grades. ConclusionThe outcome of current study shows that although this modality of treatment is safe for the patients, it provides no additional benefits on improvement of quality of life among these patients.

Big opportunities for small molecules in immuno-oncology.

The regulatory approval of ipilimumab (Yervoy) in 2011 ushered in a new era of cancer immunotherapies with durable clinical effects. Most of these breakthrough medicines are monoclonal antibodies that block protein-protein interactions between T cell checkpoint receptors and their cognate ligands. In addition, genetically engineered autologous T cell therapies have also recently demonstrated significant clinical responses in haematological cancers. Conspicuously missing from this class of therapies are traditional small-molecule drugs, which have previously served as the backbone of targeted cancer therapies. Modulating the immune system through a small-molecule approach offers several unique advantages that are complementary to, and potentially synergistic with, biologic modalities. This Review highlights immuno-oncology pathways and mechanisms that can be best or solely targeted by small-molecule medicines. Agents aimed at these mechanisms--modulation of the immune response, trafficking to the tumour microenvironment and cellular infiltration--are poised to significantly extend the scope of immuno-oncology applications and enhance the opportunities for combination with tumour-targeted agents and biologic immunotherapies.

Possible role of anaerobes in the pathogenesis of nontuberculous mycobacterial infection.

Recent advances in cultivation-independent molecular biological modalities for detecting bacterial species have indicated that several bacterial species may play a role in the pathogenesis of certain infectious diseases. The aim of this study was to evaluate the role of bacterial flora in the pathogenesis of nontuberculous mycobacteriosis (NTM) using a bacterial floral analysis of bronchoalveolar lavage fluid (BALF) with 16S rRNA gene sequencing in patients with bronchiectasis. Fifty-eight patients with bronchiectasis evaluated using chest computed tomography were enrolled. BALF obtained from the most affected lung lesions was evaluated using culture and culture-independent methodologies. Approximately 600 bp of the bacterial 16S rRNA gene (E341F-E907R) was amplified via polymerase chain reaction using universal primers, and clone libraries were constructed. Nucleotide sequences of 96 randomly chosen clones for each specimen were determined, and the homology was searched using a basic local alignment search tool to determine the bacterial phylotypes and their proportions (bacterial floral analysis) in each specimen. Twenty-nine patients with bronchiectasis were diagnosed with NTM based on culture-based methods using Ogawa medium. The molecular method showed a significantly high rate of anaerobes among the patients with NTM compared with that observed in the bronchiectasis patients without NTM. In addition, findings of collapse/consolidation were significantly related to the proportion of Prevotella species in the BALF samples determined using the molecular method (P < 0.001). Given the results of the present study, anaerobes may play an important role in the pathogenesis of bronchiectasis in patients with NTM.

The biochemistry behind biopesticide efficacy

Abstract Biopesticides have the potential to play an important role in sustainable, environmentally safe pest control. A diverse range of biopesticides employ chemical modes of action. This review explores three such biopesticides: a fungus used in weed control, beneficial bacteria controlling fungal and bacterial disease and a virus active against insect pests. Through these case studies, we demonstrate that biopesticides rely on both chemical and biochemical approaches and complementary biological modalities. Hence, biopesticides are more complex than synthetic pesticides. The latter typically utilize a single chemical with a single mode of action, while the former often have more complex or holistic modes of action. The success of current and future biopesticides could be enhanced through increased research focusing on the chemistry involved.

Nail psoriasis: the journey so far.

Nail involvement is an extremely common feature of psoriasis and affects approximately 10-78% of psoriasis patients with 5-10% of patients having isolated nail psoriasis. However, it is often an overlooked feature in the management of nail psoriasis, despite the significant burden it places on the patients as a result of functional impairment of manual dexterity, pain, and psychological stress. Affected nail plates often thicken and crumble, and because they are very visible, patients tend to avoid normal day-to-day activities and social interactions. Importantly, 70-80% of patients with psoriatic arthritis have nail psoriasis. In this overview, we review the clinical manifestations of psoriasis affecting the nails, the common differential diagnosis of nail psoriasis, Nail Psoriasis Severity Index and the various diagnostic aids for diagnosing nail psoriasis especially, the cases with isolated nail involvement. We have also discussed the available treatment options, including the topical, physical, systemic, and biological modalities, in great detail in order to equip the present day dermatologist in dealing with a big clinical challenge, that is, management of nail psoriasis.

Current challenges and opportunities in nonclinical safety testing of biologics

Nonclinical safety testing of new biotherapeutic entities represents its own challenges and opportunities in drug development. Hot topics in this field have been discussed recently at the 2nd Annual BioSafe European General Membership Meeting. In this feature article, discussions on the challenges surrounding the use of PEGylated therapeutic proteins, selection of cynomolgus monkey as preclinical species, unexpected pharmacokinetics of biologics and the safety implications thereof are summarized. In addition, new developments in immunosafety testing of biologics, the use of transgenic mouse models and PK and safety implications of multispecific targeting approaches are discussed. Overall, the increasing complexity of new biologic modalities and formats warrants tailor-made nonclinical development strategies and experimental testing.

Significance of Anaerobes and Oral Bacteria in Community-Acquired Pneumonia

BackgroundMolecular biological modalities with better detection rates have been applied to identify the bacteria causing infectious diseases. Approximately 10–48% of bacterial pathogens causing community-acquired pneumonia are not identified using conventional cultivation methods. This study evaluated the bacteriological causes of community-acquired pneumonia using a cultivation-independent clone library analysis of the 16S ribosomal RNA gene of bronchoalveolar lavage specimens, and compared the results with those of conventional cultivation methods.MethodsPatients with community-acquired pneumonia were enrolled based on their clinical and radiological findings. Bronchoalveolar lavage specimens were collected from pulmonary pathological lesions using bronchoscopy and evaluated by both a culture-independent molecular method and conventional cultivation methods. For the culture-independent molecular method, approximately 600 base pairs of 16S ribosomal RNA genes were amplified using polymerase chain reaction with universal primers, followed by the construction of clone libraries. The nucleotide sequences of 96 clones randomly chosen for each specimen were determined, and bacterial homology was searched. Conventional cultivation methods, including anaerobic cultures, were also performed using the same specimens.ResultsIn addition to known common pathogens of community-acquired pneumonia [Streptococcus pneumoniae (18.8%), Haemophilus influenzae (18.8%), Mycoplasma pneumoniae (17.2%)], molecular analysis of specimens from 64 patients with community-acquired pneumonia showed relatively higher rates of anaerobes (15.6%) and oral bacteria (15.6%) than previous reports.ConclusionOur findings suggest that anaerobes and oral bacteria are more frequently detected in patients with community-acquired pneumonia than previously believed. It is possible that these bacteria may play more important roles in community-acquired pneumonia.

Paclitaxel-eluting balloons or paclitaxel-eluting stents for the treatment of small-vessel coronary artery disease?

Obstructive lesions in small coronary vessels are frequent, but the percutaneous coronary intervention (PCI) of these lesions remains a challenge in contemporary practice. Failure of revascularization after PCI is principally related to restenosis of the treated vessel [1]. After PCI, vessel caliber is inversely proportional to the antirestenotic efficacy of the treatment [2,3]. Consequently, the drawbacks intrinsic to PCI, such as mechanical vessel recoil and constrictive remodeling (after plain old balloon angioplasty), as well as neointimal hyperplasia (after stent implantation), become deleterious in this setting, principally due to the vessel’s reduced ability to accommodate a given degree of late lumen loss necessitating repeat revascularization procedures. The introduction of bare-metal stents (BMS) has represented a monumental leap in interventional cardiology; however, their use in small vessels did not provide the benefits demonstrated in other types of lesions. A noteworthy trial, ISAR-SMART, comparing balloon angioplasty with BMS in vessels with a caliber between 2.0 and 2.8 mm, showed no significant differences between the two groups in angiographic or clinical restenosis at follow-up [4]. The limitations of BMS for preventing restenosis are explained by the fact that the absolute magnitude of extra acute gain achievable by stenting over balloon angioplasty in small-vessel disease is relatively small and does not compensate for the reduced capacity of these small-caliber vessels to accommodate for increased neointimal hyperplasia seen after stent implantation. The pathophysiological mechanisms underlying BMS failure in this setting have led to the search for pharmaceutical methods and biological modalities to prevent restenosis. Therefore, by targeting the biological mechanisms that underlie neointimal hyperplasia and by providing an effective delivery system that results in adequate local tissue–drug

Tumor necrosis factor-α inhibitor therapy and fetal risk: A systematic literature review

Tumor necrosis factor-α inhibitors (anti-TNFs) are effective in the treatment of inflammatory bowel disease (IBD) recalcitrant to conventional medical therapy. As the peak incidence of IBD overlaps with the prime reproductive years, it is crucial to establish pharmacologic regimens for women of childbearing age that achieve effective disease control without posing significant fetal harm. A systematic literature review was performed to identify all human studies with birth outcomes data after maternal exposure to infliximab, adalimumab, or certolizumab pegol within 3 mo of conception or during any trimester of pregnancy. Live births, spontaneous abortions or stillbirths, preterm or premature births, low birth weight or small for gestational age infants, and congenital abnormalities were recorded. Fifty selected references identified 472 pregnancy exposures. The subsequent review includes general information regarding anti-TNF therapy in pregnancy followed by a summary of our findings. The benefits of biologic modalities in optimizing disease control during pregnancy must be weighed against the potential toxicity of drug exposure on the developing fetus. Although promising overall, there is insufficient evidence to prove absolute safety for use of anti-TNFs during pregnancy given the limitations of available data and lack of controlled trials.

Haberlea Rhodopensis has Potential as a New Drug Source Based on its Broad Biological Modalities

ABSTRACTHaberlea rhodopensis—a Balkan endemite belonging to the group of resurrection plants, was studied as a potential source of novel cancer modulating drugs. Human embryonic (HEK293 p53++/+) and prostate cancer cell lines—LNCaP (p53+/+) and PC3 (p53−/-) were used as a model to follow the reaction to oxidative and genotoxic stress after pre-treatment with H. rhodopensis extract. Oxidative stress was estimated by flow cytometry (FCS) andfluorescent plate reader (FPR) using reactive oxygen speciesfluorescent dye (H2DCFDA). UV induced DNA damage was assessed by FCS PUMA (p53 upregulated modulator of apoptosis) expression. Inflammatory pathways were challenged using synthetic peptidoglycan by FCS Act1 expression and NFkB reporter stable cell line. Pre-treated-cells were assessed using DCF dye (FPR and FCS) for ROS (Reactive Oxygen Species) generation after dose-dependent H2O2 stress and decreased signal compared to non-treated cells. H. rhodopensis had cumulative effect on cell death in PC3 cells. UV-inducedgenotoxic stress resulted in FCS-detected PUMA upregulation only in PC3. Haberlea treated cells had better vitality and their challenge using a bacterial peptidoglycan resulted in an upregulation of Act1, but only in LNCaP cells. The NFkB reporter vector revealed transcription factor activation upon treatment with only peptidoglycan, while Haberlea pre-treatment resulted in negative modulation of the NFkB induction.Our data show that H. rhodopensis extracts have anti-oxidative effect in cancer vs. normal cell lines and differentially modulate distinct cell lines in genotoxic and inflammatory stress, favoring NFKB activation in p53+/+ cells, while suppressing its signaling in p53−/- cells.

PCR-Based Multiparametric Assays in Single Cells

Pathologists have long known that the functional state of a tissue is best understood from an overview of the different cells making up that tissue—cells that may differ radically in their lineage, their phase in the cell cycle, their responses to stimuli, and their clonal history of somatic mutation, e.g., in a tumor. With the radically expanding opportunities for the molecular analysis of nucleic acids, proteins, and combinations thereof, there is currently great interest in collecting information at cellular resolution, rather than recording population means, as has been common practice in molecular biology (1). In this issue of Clinical Chemistry , Stahlberg and coauthors (2) describe an interesting approach for jointly measuring DNA copy numbers and concentrations of mRNAs, microRNAs, and proteins in individual cells. These authors prepared single-cell lysates that were subsequently divided into separate reactions for each of the measured molecular species, and they recorded all of the results of the molecular-detection reactions via real-time quantitative PCR. This report represents an important first step in a new approach to detect multiple biological modalities in single cells with high analytical sensitivity and specificity. Nothing is quite new under the sun, of course, and there are already a number of approaches for molecular analyses at the level of individual cells. Various in situ analyses that provide cellular-level resolution are routinely used for analyzing DNA, RNA, or protein in populations of cells and in tissue sections. …

Biotechnologies in the Treatment of Degenerative Disc Disease of the Cervical Spine

ABSTRACTDegenerative disc disease of the cervical spine is a common medical condition in the population with underlying aging, genetic, mechanical and environmental factors. It is characterized with structural collapse, osteophyte formation and loss of the loading function of the intervertebral disc. As a consequence a compression of neural structures is observed with axial neck pain, cervical radiculopathy and myelopathy.Currently, the cervical interbody fusion and artificial disc implantation are the available operative treatment options when medications and physiotherapy are ineffective. New strategies focusing on biologic modalities would be appealing. We review the advanced biotechnologies in the treatment of degenerative disc disease of the spine.Many studies are focused on therapeutic molecules capable to influence the biochemical and structural processes of intervertebral disc degeneration. These factors are categorized as anticatabolics, mitogens, chondrogenic morphogens and intracellular regulators. Another step that further opposes the simple injection of tissues with therapeutic molecules is gene therapy seeking to transfer genetic material into target cells, which in turn become in situ factories for the long-term production of desired proteins. The use of tissue-engineered intervertebral disc constructs may prove helpful when treating degenerative cervical disc disease. An in vitro technology designed to produce cartilage or bone with desired biomechanical properties to repair damaged tissues is available nowadays. In the near future the golden standard might be the replacement of the degenerated disc with biological rather than polymer or metal prostheses.However, the cost-effectiveness of the reviewed approaches has not been definitively established. Regardless of its efficacy, the safety and economic issues may ultimately determine whether these therapies are viewed as an acceptable alternative to the recent treatment options.

Bridging Molecular Genetics and Biomarkers in Lewy Body and Related Disorders

Recent advances have been made in defining the genetic and molecular basis of dementia with Lewy bodies (DLBs) and related neurodegenerative disorders such as Parkinson's disease (PD) and Parkinson's disease dementia (PDD) which comprise the spectrum of “Lewy body disorders” (LBDs). The genetic alterations and underlying disease mechanisms in the LBD overlap substantially, suggesting common disease mechanisms. As with the other neurodegenerative dementias, early diagnosis in LBD or even identification prior to symptom onset is key to developing effective therapeutic strategies, but this is dependent upon the development of robust, specific, and sensitive biomarkers as diagnostic tools and therapeutic endpoints. Recently identified mutations in the synucleins and other relevant genes in PD and DLB as well as related biomolecular pathways suggest candidate markers from biological fluids and imaging modalities that reflect the underlying disease mechanisms. In this context, several promising biomarkers for the LBD have already been identified and examined, while other intriguing possible candidates have recently emerged. Challenges remain in defining their correlation with pathological processes and their ability to detect DLB and related disorders, and perhaps a combined array of biomarkers may be needed to distinguish various LBDs.

Antileukemia and antitumor effects of the graft-versus-host disease: A new immunovirological approach

In leukemic mice, the native host's explicit and well-defined immune reactions to the leukemia virus (a strong exogenous antigen) and to leukemia cells (pretending in their native hosts to be protected "self" elements) are extinguished and replaced in GvHD (graft-versus-host disease) by those of the immunocompetent donor cells. In many cases, the GvHD-inducer donors display genetically encoded resistance to the leukemia virus. In human patients only antileukemia and anti-tumor cell immune reactions are mobilized; thus, patients are deprived of immune reactions to a strong exogenous antigen (the elusive human leukemia-sarcoma retroviruses). The innate and adaptive immune systems of mice have to sustain the immunosuppressive effects of leukemia-inducing retroviruses. Human patients due to the lack of leukemiainducing retroviral pathogens (if they exist, they have not as yet been discovered), escape such immunological downgrading. After studying leukemogenic retroviruses in murine and feline (and other mammalian) hosts, it is very difficult to dismiss retroviral etiology for human leukemias and sarcomas. Since no characterized and thus recognized leukemogenic-sarcomagenic retroviral agents are being isolated from the vast majority of human leukemias-sarcomas, the treatment for these conditions in mice and in human patients vastly differ. It is immunological and biological modalities (alpha interferons; vaccines; adoptive lymphocyte therapy) that dominate the treatment of murine leukemias, whereas combination chemotherapy remains the main remission-inducing agent in human leukemias-lymphomas and sarcomas (as humanized monoclonal antibodies and immunotoxins move in). Yet, in this apparently different backgrounds in Mus and Homo, GvHD, as a treatment modality, appears to work well in both hosts, by replacing the hosts' anti-leukemia and anti-tumor immune faculties with those of the donor. The clinical application of GvHD in the treatment of human leukemias-lymphomas and malignant solid tumors remains a force worthy of pursuit, refinement and strengthening. Graft engineering and modifications of the inner immunological environment of the recipient host by the activation or administration of tumor memory T cells, selected Treg cells and natural killer (NKT) cell classes and cytokines, and the improved pharmacotherapy of GvHD without reducing its antitumor efficacy, will raise the value of GvHD to the higher ranks of the effective antitumor immunotherapeutical measures. Clinical interventions of HCT/HSCT (hematopoietic cell/stem cell transplants) are now applicable to an extended spectrum of malignant diseases in human patients, being available to elderly patients, who receive non-myeloablative conditioning, are re-enforced by post-transplant donor lymphocyte (NK cell and immune T cell) infusions and post-transplant vaccinations, and the donor cells may derive from engineered grafts, or from cord blood with reduced GvHD, but increased GvL/GvT-inducing capabilities (graft-versus leukemia/tumor). Post-transplant T cell transfusions are possible only if selected leukemia antigen-specific T cell clones are available. In verbatim quotation: "Ultimately, advances in separation of GvT from GvHD will further enhance the potential of allogeneic HCT as a curative treatment for hematological malignancies" (Rezvani, A.R. and Storb, R.F., Journal of Autoimmunity 30:172-179, 2008 (see in the text)). It may be added: for cure, a combination of the GvL/T effects with new targeted therapeutic modalities, as elaborated on in this article, will be necessary.

Biomechanical and Biologic Augmentation for the Treatment of Massive Rotator Cuff Tears

Recent studies have reported that massive rotator cuff tears do not heal as predictably as, and may have diminished clinical outcomes compared with, smaller rotator cuff tears. An improved understanding of the biologic degeneration and the biomechanical alterations of massive rotator cuff tears should provide better strategies to optimize outcomes. The approach to patients with massive rotator cuff tears requires careful assessment of the patient and the extent of rotator cuff degeneration to determine the appropriate treatment. For a rotator cuff tear that is repairable, the goal is to produce a tension-free, anatomical repair that restores the footprint using soft tissue releases and various suturing techniques, including double-row, transosseous-equivalent suture bridges or the rip-stop stitch. For irreparable cuff tears, the surgeon may elect to proceed with 1 of 2 approaches: (1) palliative surgical treatment—that is, rotator cuff debridement, synovectomy, biceps tenotomy, tuberoplasty and/or nonanatomical repair with partial repair; or (2) salvage treatment with various tendon transfers. Even though the biomechanical constructs for rotator cuff repairs have been improved, the integrity of the repair still depends on biologic healing at the tendon-to-bone junction. There has been much interest in the development of a scaffold to bridge massive rotator cuff tears and adjuvant biologic modalities including growth factors and tenocyte-seeded scaffolds to augment tendon-to-bone healing. The treatment of rotator cuff disease has improved considerably, but massive rotator cuff tears continue to pose a challenging problem for orthopaedic surgeons.

The roles of sex and serotonin transporter levels in age- and stress-related emotionality in mice

Mood disorders are influenced by genetic make-up and differentially affect men and women. The s/l promoter polymorphism in the serotonin transporter (SERT) gene moderates both trait emotion and the vulnerability to develop depressive states in humans. Similarly, male mice lacking SERT (Knockout/KO) display an elevated emotionality phenotype. We now report that the SERT-KO phenotype is maintained throughout late-adulthood, and that female KO mice develop a larger emotionality phenotype with increasing age. Thus, to test the hypothesis that these findings reflected a putative sexual dimorphism in SERT-mediated modulation of emotionality, we submitted adult male and female wild-type, heterozygous (HZ) and KO mice to unpredictable chronic mild stress (UCMS) and assessed behavioral changes. In males, the elevated SERT-KO emotion-related behavior converged with other groups after UCMS. Conversely, female SERT-KO displayed a normal non-stressed baseline, but highest UCMS-induced emotionality. SERT-HZ displayed variable and intermediate phenotypes in both experiments. Thus, consistent results across different biological modalities (age, stress) revealed a high contribution of SERT genotype for baseline “trait” emotionality in males, and low contribution for females. In contrast, age-correlated and stress-induced behavioral changes resulted in a high SERT genotype-mediated behavioral variance in females, but low in males. This suggests that high emotionality states associated with low SERT were differentially achieved in males (high baseline/trait) compared to females (increased vulnerability to develop high emotionality). This sex-by-SERT double dissociation provides a framework to investigate molecular substrates of emotionality regulation in concert with serotonin function and may contribute to the sexually dimorphic features of mood disorders.

A review of novel biological tools used in screening for the early detection of lung cancer

Lung cancer is the most common cancer worldwide and causes more deaths per year than any other cancer. It has a very poor 5-year survival rate of 8–16%, partly because...

Bevacizumab-associated hypertension: etiology, incidence, and management

Bevacizumab (Avastin) is a recently developed monoclonal antibody, which targets the vascular endothelial growth factor signaling pathway, and is currently used in combination with cytotoxic agents as first-line or second-line therapy for patients with metastatic colon cancer. Hypertension is a known risk factor associated with the use of bevacizumab. In this report, we describe the incidence, etiology, and management of patients with this complication.

The combination of FOLFOX4 and bevacizumab may enable salvage surgery of unresectable liver metastases in colon cancer

Colorectal cancer treatment has experienced important advances in the last 5 years. New targeted therapies have been included in the classical regimens based on 5-fluorouracil, oxaliplatin, or irinotecan. This new approach has brought great revolution in the treatment of this type of cancer. Bevacizumab (Avastin), a new antivascular endothelial growth factor drug, has been shown to improve overall survival in combination with chemotherapy in first-line and second-line settings as compared with standard chemotherapy regimens alone. This case report demonstrates our experience with bevacizumab in a colon cancer patient with liver, lung, and regional lymph node metastases who had a relapse in the liver after adjuvant treatment with capecitabine (Xeloda). The addition of bevacizumab to the FOLFOX4 regimen resulted in a partial response that provided an opportunity for salvage hepatic surgery.