A novel vitamin D gene therapy for acute myeloid leukemia

Current treatment approaches for older adult patients with acute myeloid leukemia (AML) are often toxic and lack efficacy. Active vitamin D3 (1,25(OH)₂D3) has been shown to induce myeloid blast differentiation but at concentrations that have resulted in unacceptable, off-target hypercalcemia in clinical trials. In our study, we found that the combination of 1,25(OH)₂D3 and the hypomethylating agent (HMA) 5-Azacytidine (AZA) enhanced cytotoxicity and differentiation, and inhibited proliferation of several AML cell lines (MOLM-14, HL60) and primary AML patient samples. This observation was corroborated by our RNA sequence analysis data in which VDR, CD14, and BAX expression were increased, and FLT-3, PIM1 and Bcl-2 expression were decreased. To address the hypercalcemia issue, we genetically engineered MOLM-14 cells to constantly express CYP27B1 (the VD3 activating enzyme, 1-α-hydroxylase-25(OH)D3) through lentiviral transduction procedures. Subsequently, we used these cells as vehicles to deliver the CYP27B1 enzyme to the bone marrow of AML mice. We observed that AML mice with CYP27B1 treatment had longer overall survival compared to no treatment and displayed no significant change in calcium level.

School-Aged Anthropometric Outcomes After Endoscopic or Open Repair of Metopic Synostosis

BACKGROUND AND OBJECTIVES

Metopic craniosynostosis can be treated by fronto-orbital advancement or endoscopic strip craniectomy with postoperative helmeting. Infants younger than 6 months of age are eligible for the endoscopic repair. One-year postoperative anthropometric outcomes have been shown to be equivalent, with significantly less morbidity after endoscopic treatment. The authors hypothesized that both repairs would yield equivalent anthropometric outcomes at 5-years postoperative.

METHODS

This study was a retrospective chart review of 31 consecutive nonsyndromic patients with isolated metopic craniosynostosis treated with either endoscopic or open correction. The primary anthropometric outcomes were frontal width, interfrontal divergence angle, the Whitaker classification, and the presence of lateral frontal retrusion. Peri-operative variables included estimated blood loss, rates of blood transfusion, length of stay, and operating time.

RESULTS

There was a significantly lower rate of lateral frontal retrusion in the endoscopic group. No statistically significant differences were found in the other 3 anthropometric outcomes at 5-years postoperative. The endoscopic group was younger at the time of surgery and had improved peri-operative outcomes related to operating time, hospital stay and blood loss. Both groups had low complication and reoperation rates.

CONCLUSIONS

In our cohort of school-aged children with isolated metopic craniosynostosis, patients who underwent endoscopic repair had superior or equivalent outcomes on all 4 primary anthropometric measures compared with those who underwent open repair. Endoscopic repair was associated with significantly faster recovery and decreased morbidity. Endoscopic repair should be considered in patients diagnosed with metopic craniosynostosis before 6 months of age.

Plastic Surgery in the Time of COVID-19

BACKGROUND

 The novel coronavirus disease 2019 (COVID-19) has swept the world in the last several months, causing massive disruption to existing social, economic, and health care systems. As with all medical fields, plastic and reconstructive surgery has been profoundly impacted across the entire spectrum of practice from academic medical centers to solo private practice. The decision to preserve vital life-saving equipment and cancel elective procedures to protect patients and medical staff has been extremely challenging on multiple levels. Frequent and inconsistent messaging disseminated by many voices on the national stage often conflicts and serves only to exacerbate an already difficult decision-making process.

METHODS

 A survey of relevant COVID-19 literature is presented, and bioethical principles are utilized to generate guidelines for plastic surgeons in patient care through this pandemic.

RESULTS

 A cohesive framework based upon core bioethical values is presented here to assist plastic surgeons in navigating this rapidly evolving global pandemic.

CONCLUSION

 Plastic surgeons around the world have been affected by COVID-19 and will adapt to continue serving their patients. The lessons learned in this present pandemic will undoubtedly prove useful in future challenges to come.

Faecal carriage of optrA-positive enterococci in asymptomatic healthy humans in Hangzhou, China

OBJECTIVES

To investigate the faecal carriage of optrA-positive enterococci among asymptomatic healthy humans in Hangzhou, China, and to characterize the genetic context of optrA.

METHODS

A total of 3458 stool samples from healthy individuals were collected and cultured on a selective medium containing 10 mg/L florfenicol and resulting enterococci were screened for the presence of optrA by PCR. OptrA variants were determined by amino acid sequence comparison with the original OptrA from Enterococcus faecalis E349. Whole genome sequencing and PCR mapping were performed to obtain and analyse the genetic environment of optrA.

RESULTS

Similar optrA carriage rates (∼3.5%) were detected in samples from adults (55/1558) and children (66/1900). Linezolid resistance rates for E. faecalis, Enterococcus faecium and other Enterococcus species were 58.5% (38/65), 42.3% (11/26) and 0% (0/31), respectively. Nineteen OptrA variants exhibiting different linezolid MICs were identified. Isolates carrying wild-type OptrA and variants RDK, KLDP, KD, D, RDKP, and EDP generally demonstrated linezolid MICs ≥8 mg/L. The OptrA variants, with fexA upstream and erm(A) downstream, were flanked by IS1216E at one or both ends. The fexA-optrA(wild-type) was located downstream of a Tn554 transposon, and was inserted into the radC gene. The EDM variant was detected in 31/73 enterococci with linezolid MICs ≤4 mg/L. Despite the variable genetic context, Tn558-araC-optrA(EDM)-erm(A)-met was the most common gene array.

CONCLUSIONS

This study revealed a correlation between linezolid MIC, genetic context and OptrA variant. Intestinal colonization of healthy individuals by optrA-positive enterococci is a concern, and active epidemiological surveillance of optrA is warranted.

Estrogen-regulated feedback loop limits the efficacy of estrogen receptor-targeted breast cancer therapy

Endocrine therapy resistance invariably develops in advanced estrogen receptor-positive (ER+) breast cancer, but the underlying mechanisms are largely unknown. We have identified C-terminal SRC kinase (CSK) as a critical node in a previously unappreciated negative feedback loop that limits the efficacy of current ER-targeted therapies. Estrogen directly drives CSK expression in ER+ breast cancer. At low CSK levels, as is the case in patients with ER+ breast cancer resistant to endocrine therapy and with the poorest outcomes, the p21 protein-activated kinase 2 (PAK2) becomes activated and drives estrogen-independent growth. PAK2 overexpression is also associated with endocrine therapy resistance and worse clinical outcome, and the combination of a PAK2 inhibitor with an ER antagonist synergistically suppressed breast tumor growth. Clinical approaches to endocrine therapy-resistant breast cancer must overcome the loss of this estrogen-induced negative feedback loop that normally constrains the growth of ER+ tumors.

Drivers of Hospital Costs in the Self-Pay Facelift (Rhytidectomy) Patient: Analysis of Hospital Resource Utilization in 1890 Patients

INTRODUCTION

Rhytidectomy is one of the most commonly performed cosmetic procedures by plastic surgeons. Increasing attention to the development of a high-value, low-cost healthcare system is a priority in the USA. This study aims to analyze specific patient and hospital factors affecting the cost of this procedure.

METHODS

We conducted a retrospective cohort study of self-pay patients over the age of 18 who underwent rhytidectomy using the Healthcare Utilization Cost Project National Inpatient Sample database between 2013 and 2014. Mean marginal cost increases patient characteristics, and outcomes were studied. Generalized linear modeling with gamma regression and a log-link function were performed along with estimated marginal means to provide cost estimates.

RESULTS

A total of 1890 self-pay patients underwent rhytidectomy. Median cost was $11,767 with an interquartile range of $8907 [$6976-$15,883]. The largest marginal cost increases were associated with postoperative hematoma ($12,651; CI $8181-$17,120), West coast region ($7539; 95% CI $6412-$8666), and combined rhinoplasty ($7824; 95% CI $3808-$11,840). The two risk factors associated with the generation of highest marginal inpatient costs were smoking ($4147; 95% CI $2804-$5490) and diabetes mellitus ($5622; 95% CI $3233-8011). High-volume hospitals had a decreased cost of - $1331 (95% CI - $2032 to - $631).

CONCLUSION

Cost variation for inpatient rhytidectomy procedures is dependent on preoperative risk factors (diabetes and smoking), postoperative complications (hematoma), and regional trends (West region). Rhytidectomy surgery is highly centralized and increasing hospital volume significantly decreases costs. Clinicians and hospitals can use this information to discuss the drivers of cost in patients undergoing rhytidectomy.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

CDK12 Inhibition Reverses De Novo and Acquired PARP Inhibitor Resistance in BRCA Wild-Type and Mutated Models of Triple-Negative Breast Cancer

Although poly(ADP-ribose) polymerase (PARP) inhibitors are active in homologous recombination (HR)-deficient cancers, their utility is limited by acquired resistance after restoration of HR. Here, we report that dinaciclib, an inhibitor of cyclin-dependent kinases (CDKs) 1, 2, 5, and 9, additionally has potent activity against CDK12, a transcriptional regulator of HR. In BRCA-mutated triple-negative breast cancer (TNBC) cells and patient-derived xenografts (PDXs), dinaciclib ablates restored HR and reverses PARP inhibitor resistance. Additionally, we show that de novo resistance to PARP inhibition in BRCA1-mutated cell lines and a PDX derived from a PARP-inhibitor-naive BRCA1 carrier is mediated by residual HR and is reversed by CDK12 inhibition. Finally, dinaciclib augments the degree of response in a PARP-inhibitor-sensitive model, converting tumor growth inhibition to durable regression. These results highlight the significance of HR disruption as a therapeutic strategy and support the broad use of combined CDK12 and PARP inhibition in TNBC.

Utility of intraoperative and postoperative radiographs in pediatric cochlear implant surgery

OBJECTIVE

Routine plain film radiographs are often obtained to confirm proper placement of electrode after pediatric cochlear implant surgery. Objective is to evaluate necessity of routine radiographs in pediatric cochlear implant cases.

STUDY DESIGN

Retrospective review.

SETTING

Two tertiary care academic centers.

SUBJECTS AND METHODS

Review of all children that underwent cochlear implantation from January 2003 thru June 2015. Exclusions include patients without intraoperative evoked compound action potential (ECAP) data or radiographs and patients undergoing revision surgeries.

RESULTS

235 pediatric patients underwent 371 cochlear implants. ECAP measurements were not available in two cases and were excluded from study. Radiographs were obtained in 35/369 cases due to intraoperative concern and four had abnormal findings. All four cases underwent change in management. One other patient had an x-ray because of difficult insertion and abnormal ECAP. Radiograph was normal; however, incision was opened and electrodes inserted further. Overall, 5/369 cases had changes in management intraoperatively. In all five cases, abnormalities were suspected by clinician judgment or abnormal ECAP measurements. Routine radiographs were completed in 349/369 cases and one was abnormal. This patient had known partial insertion due to cochlear fibrosis from meningitis and abnormal radiograph did not result in change in management.

CONCLUSION

Clinician suspicion and/or abnormal ECAP prompted suspicion for abnormal electrode placement prior to evaluation with radiograph in all cases in which change in management occurred. Intraoperative radiographs may be valuable in setting of clinical suspicion. Routine radiographs do not result in change in management and are, therefore, unnecessary.

Abstract LB-257: Estrogen signaling in mature luminal and luminal progenitor cells of BRCA2 carriers and non-carriers

Background: Carriers of mutations in the breast cancer susceptibility gene BRCA2 have a 50-80% lifetime risk of developing breast cancers, about 70% of which are positive for estrogen receptor (ER), a key oncogenic hormone receptor. Metastatic ER+ tumors also respond to PARP inhibitors associated with their DNA repair defect. There remains much to understand regarding estrogen signaling in BRCA2 carriers and preventing cancers in this high-risk population.

Methods: We studied the transcriptomes and in-vitro growth of luminal progenitors and mature luminal cells derived from primary human normal breast tissue obtained from BRCA2 carriers and wild-type patients undergoing prophylactic mastectomy and reduction mammoplasty procedures, respectively. Subsequently, formalin-fixed paraffin-embedded breast cancer tissue samples from twelve case-control matched pairs of BRCA2 carriers and wild-type patients were investigated for ER genomic binding, H3K27Ac enhancer marks, and gene expression changes.

Results: Luminal progenitors and mature luminal cells have different gene expression patterns. Unsupervised clustering of transcriptomes from normal tissue of three pairs of BRCA2-mutant and wildtype patients suggested that BRCA2 mutation status can segregate transcriptomes from luminal progenitors but not mature luminal cells. These differential transcriptomes in luminal progenitor cells from BRCA2 carriers were enriched for cell proliferation genes. In agreement, greater proliferative phenotype was observed in BRCA2-mutant luminal progenitor cells in comparison to the wild-type cohort. Interestingly, clustering analyses of twelve pairs of breast tumors indicated no clear differences between ER cistromes, enhancer marks and gene expression between BRCA2 carriers and wildtype patients. Because luminal progenitor cells are more likely to contribute to tumorigenesis, we hypothesize that the identified BRCA2-mutant signature in normal progenitor cells could be retained in tumors obtained from BRCA2 carriers.

Conclusions: There are differential gene expression patterns between luminal progenitors and mature luminal cells obtained from normal human breast tissue. The transcriptomes in the luminal progenitor but not mature luminal cells segregate differently based on the BRCA2 mutation status. This identified BRCA2-mutant gene signature in luminal progenitor cells is enriched for pro-proliferation pathways, and BRCA2-mutant luminal progenitor cells exhibit higher cell proliferation, suggesting a potential cell-of-origin in BRCA2-associated breast cancers. Importantly, no significant differences in transcriptomes and ER cistromes are observed in breast tumors from BRCA2 carriers and non-carriers, indicating a need to identify BRCA2-mutant gene signature that may assist in segregating ER+ breast cancers in this high-risk populations. The knowledge from this study may assist in pioneering strategies for cancer prevention in high-risk BRCA2 mutation carriers.

Citation Format: Hari Singhal, David Chi, Elgene Lim, Housheng He, Raga Vadhi, Prakash K. Rao, Henry W. Long, Andrea L. Richardson, Judy Garber, Myles Brown. Estrogen signaling in mature luminal and luminal progenitor cells of BRCA2 carriers and non-carriers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-257. doi:10.1158/1538-7445.AM2017-LB-257

Abstract 3376: Reprogramming the estrogen signaling network is a potential mechanism for human breast tumorigenesis

Background: The estrogen receptor (ER) is expressed in approximately 70% of sporadic breast cancers and is known to activate genes driving cell proliferation. Much work in the field has characterized the mechanisms of ER signaling behind cancer progression and eventual metastasis, and therapeutic targeting of the ER signaling pathway has proven effective. However, little is known regarding the role of ER in the initial process of transformation. Since ER possesses pro-differentiation roles in normal breast development yet becomes one of the drivers of breast cancer, altered ER function is then likely a crucial early step. We seek to investigate the role of ER from the perspective of the normal breast to allow for mechanistic insights into breast tumorigenesis.

Methods: To model the normal breast epithelium, viable tissue specimens from patients undergoing reduction mammoplasty were obtained and enriched for breast epithelial cells via fluorescence-activated cell sorting (FACS). Fresh-frozen ER+ breast tumor samples were then obtained for comparison. RNA-seq, ChIP-seq for ER, and genome-wide CRISPR screening in the presence of estrogen stimulation in both normal breast and breast tumor were performed. These various modalities of genomic data were then integrated and analyzed to identify patterns in breast tumorigenesis.

Results: Gene expression profiling via RNA-seq of breast epithelial cells from seven reduction mammoplasties reveals a drastically different and muted normal response to estrogen stimulation. Genes that promote cell cycling and cell proliferation were down-regulated in normal breast but were up-regulated in breast cancer cells. Furthermore, differential ER binding alone via ER ChIP-seq is capable of segregating ten primary breast tumors from seven normal breast tissues with very few overlapping sites. Deeper motif analysis reveals the enrichment of novel transcription cofactor GRHL2 in the binding sites most closely associated to ER+ breast cancer. Further findings via genome-wide CRISPR screens reveal GRHL2 as an essential gene in luminal ER+ breast cancer with predictive ability in cancer risk and prognosis.

Conclusions: Cellular reprogramming of the ER signaling network may alter the functioning phenotype of normal mammary epithelial cells and offer insights into the series of events necessary for developing breast cancer. Notably, ER activation does not promote cellular proliferation in normal mammary epithelial cells, and the interaction with transcriptional cofactors such as GRHL2 can be a driving mechanism for breast tumorigenesis. Unraveling the differential ER signaling in normal mammary epithelium and breast cancer will enhance our understanding of breast cancer and aid the development of more effective prevention strategies and targeted therapeutics.

Citation Format: David Chi, Hari Singhal, Lewyn Li, Henry W. Long, Judy E. Garber, Myles A. Brown. Reprogramming the estrogen signaling network is a potential mechanism for human breast tumorigenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3376. doi:10.1158/1538-7445.AM2017-3376

The influence of delipidation on triglyceride and LIPIN1 of porcine embryos derived from parthenogenetic activation

Proteins in the LIPIN family play key roles in lipid synthesis mainly on triacylglycerol (TAG) biosynthesis, and they also act as transcriptional coactivators to regulate the expression of genes involved in lipid metabolism with other nuclear factors. Hence, this study was designed to investigate LIPIN1 in pig oocytes and embryos by the delipidation. After delipidation, the content of lipids (LDs) and TAG in MII oocyte was significantly reduced; however, a similar increasing tendency of TAG was shown during embryos development. Subsequently, the expression of genes related to TAG biosynthesis including GPAT1, AGPAT1, AGPAT2, LIPIN1, DGAT and the nuclear factors interacted with LIPIN1 including PPARα and PPARγ was investigated. It is obvious that DGAT and GPAT1, and LIPIN1 increased significantly after delipidation at 1-cell and 4-cell stage, and the expression of PPARα and PPARγ also increased at 4-cell stage. By immunofluorescence staining and Western blots, LIPIN1 was found to exhibit a dynamic localization pattern and gradually increase with the development of delipated embryo. In the early developmental stages (1-, 2- and 4-cell stages), it was distributed over the cortical layer. But at the blastocyst stage, a homogeneous distribution of LIPIN1 was observed in cytoplasm. At 2-cell stage, the expression of PPARα decreased when LIPIN1 was interfered by small interfering RNA, but PPARγ has no significant difference. Therefore, in this study, we find after delipidation, the content of TAG and LIPIN1 will gradually increase during embryo development and nuclear factor PPARα and PPARγ can also be affected by delipidation. The interaction of LIPIN1 and PPARα exists in porcine embryo.

[Not Available]

A cross was made of Elymus repens onto the wheat cultivar Crocus and BC1 progeny advanced to BC1F7 by single seed descent. Sixteen lines were selected based on agronomic performance and evaluated in an FHB epiphytotic nursery. Eight lines with FHB resistance were selected. Based on GISH analysis, line P1142-3-1-5 had 42 chromosomes with one pair of chromosomes showing telomeric translocations on both arms. This chromosome was identified as 3D by using SSR markers. An evaluation of lines with single translocations revealed that FHB resistance was contributed by the translocation on the long arm of chromosome 3D. That line has minimal linkage drag and should be amenable to applications in breeding for disease resistance.

Abstract P4-21-37: Phase I trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer

Background

Preclinical and clinical studies suggest that trastuzumab resistance in HER2 amplified breast cancer (HER2+ BC) is mediated by cross-activation of alternative signaling pathways. Computational analysis and pooled whole-genome RNAi screens in HER2 transformed BC cell lines identified the IL6/JAK2/STAT3 axis as a master regulator pathway. The combination of trastuzumab plus ruxolitinib, a JAK1/JAK2 inhibitor, demonstrated synergistic tumor growth inhibition in mouse xenografts of HER2 transformed BC cell lines. These data provide the rationale for studying the efficacy of ruxolitinib and trastuzumab in a clinical trial.

Design

This is a multi-center, open-label, phase I/II trial of ruxolitinib plus trastuzumab in patients (pts) with HER2+ metastatic BC (MBC) who have progressed on >2 HER2-directed therapies in the metastatic setting (including trastuzumab, pertuzumab and T-DM1). The phase I is an adaptive design with 10 pts, using the time-to-event continual reassessment method to determine the recommended phase II dose. Phase II will be a non-randomized, open-label trial with 30 evaluable pts. The duration of a treatment cycle is 21 days, with trastuzumab given on Day 1 and ruxolitinib taken orally twice daily continuously. The primary endpoint of phase I is to determine the maximum tolerated dose of the drug combination. The phase I dose range for ruxolitinib is 10-25 mg BID (dose level 0: 20 mg BID). Response is assessed by imaging every 9 weeks. Blood samples and optional tissue biopsies are obtained for biomarker analysis at the following time points: pre-treatment, on-treatment C2D1, and at progression.

Results

Phase I started accrual in the fall of 2014. The trial has accrued 12 patients, with 9 evaluable and 3 non-evaluable patients. Of the evaluable patients, the mean age was 55.9 (range 32-69). Of these, 7 were postmenopausal (78%) 5/9 (56%) were estrogen receptor positive, and all had measurable disease. The mean number of prior lines of therapy in the metastatic setting was 5.6 (range: 3-8), including a mean of 3.2 (range: 2-5) prior regimens containing HER2 targeted therapies. As of 6/12/16, 2 patients remain on therapy. As this is an adaptive design, efficacy and drug tolerability will not be mentioned in this abstract to not bias the ongoing analysis. However, we anticipate that by SABCS 2016, 10 evaluable patients will have completed the DLT period – at which point, complete data will be presented.

Conclusion

Ruxolitinib plus trastuzumab is a novel, non-chemotherapy containing regimen. The phase I analysis is ongoing. We plan on reporting full safety/tolerability and efficacy data once 10 evaluable patients have completed the phase I (9/10 have currently completed DLT period). Given an early signal in HER2+ breast cancer, in this heavily pretreated population we will proceed directly to a phase II trial with the combination.

Citation Format: Mundi PS, Lee S, Chi D, Bhardwaj A, Makower D, Cigler T, Crew KD, Hershman DL, Califano A, Silva J, Kalinsky KM. Phase I trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-37.

Abstract A03: Effects of survivin and lymphoma cell-derived exosomes on natural killer cell function

Tumors alter their microenvironment to promote survival using methods such as angiogenesis promotion, growth signals, and immune suppression. The immune system, whose regular function is to recognize and eradicate infected or abnormal cells, often seems unresponsive to transformed neoplastic cells. Many of the methods employed by tumors to reduce immune function are unclear, but there is evidence for T cell suppression, increased myeloid-derived suppressor cells (MDSCs), and reduced natural killer (NK) cell activity. NK cells are among the first cells to recognize and destroy abnormal cells due to their inherent killing capabilities. However, many types of cancers inhibit the surveillance and cytotoxic abilities of NK cells by releasing exosomes, vesicles that can modulate tumor microenvironment and intercellular communication for the purpose of enhancing tumor malignancy. Exosomes as a means for immunomodulation of tumor microenvironment have been the focus of recent research. These 50-150 nm sized lipid bound vesicles are secreted by many cell types, including immune cells and tumor cells, and the unique protein, lipid, mRNA and miRNA contents contribute to the complex intercellular communication occurring between malignant and normal cells. Cancer patients often have increased numbers of exosomes circulating through their body, including patients with hematological malignancies, such as lymphoma. Recently, cancer cell exosomes have been found to contain Survivin, an Inhibitor of Apoptosis (IAP) protein that prevents cell death and induces Th2 polarity shift and decreases proliferation and cytotoxicity of CD8+ T lymphocytes. The purpose of this study is to explore the effect of Survivin and cancer cell-derived exosomes, which contain Survivin, on the immune functions of NK cells. The hypothesis is that Survivin and exosomes will decrease NK cell functions by suppressing NK cell production or release of cytokines and cytotoxic granules. NK cells were obtained from peripheral blood using magnetic NK cell isolation kit from Miltenyi Biotec and exosomes were obtained from conditioned media from two lymphoma cell lines (WSU-DLCL2 and WSU-FSCCL) using ExoQuickTM (System Biosciences). Flow cytometry methods were used to evaluate degranulation capacity by measuring levels of CD107a, as well as expression of activating receptor NKG2D, cytotoxic granules (perforin, Granzyme B) and cytokines (TNF-α, IFN-γ). RNA message expression was investigated using both block RT-PCR and qPCR. Results showed little significant difference in ability to degranulate when exposed to stimuli, and NKG2D levels did not change after exposure to Survivin or lymphoma exosomes. Although ImageJ analysis of block PCR showed some instances of decreased band densities in some donors treated with Survivin protein, RNA levels in general did not show a trend between NK donors in response to treatment. However, protein expression of Granzyme B, perforin, TNF-α, and IFN-γ did appear to decrease after Survivin treatment. This work is still in the early stages and results are inconsistent due to donor variability. More samples are required, as well as further studies on NK cell functional cytotoxicity.

Citation Format: Heather R. Ferguson Bennit, Amber Gonda, Jenniffer Licero Campbell, Laura Oppegard, David Chi, Nathan R. Wall. Effects of survivin and lymphoma cell-derived exosomes on natural killer cell function. [abstract]. In: Proceedings of the AACR Special Conference: Function of Tumor Microenvironment in Cancer Progression; 2016 Jan 7–10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2016;76(15 Suppl):Abstract nr A03.

Abstract 3941: Novel biomarkers and multiplexed NGS to stratify FFPE NSCLC by tumor infiltrating lymphocytes and histopathology phenotypes

There is increasing evidence supporting the association of tumor infiltrating lymphocytes (TIL) and drug sensitivity of solid tumors. In particular, primary and meta-analyses have reported a positive correlation between TIL level and outcome in advanced non-small cell lung cancer (NSCLC) treated with checkpoint inhibitors such as PD-1 and PD-L1. Recent trials with immunotherapies have started including TIL assessment in the study protocol in recognition of this metric as a predictive and prognostic biomarker. TIL levels are typically quantified by visual assessment of H&E-stained tumor sections. While this approach is generally accepted as the standard, there is an increased recognition that visual assessment of H&E-stained slides lacks precision and is relatively subjective (Salgado R, 2015; Schalper KA, 2015). Furthermore, as investigators are often also interested in measurements of additional biomarkers such as IFNg as well as the drug targets, a gene panel approach offers a convenient solution to objectively quantify expression levels of these informative markers. Here we report the discovery and verification of a unique gene expression signature that is capable of stratifying FFPE samples of NSCLC tumors by TIL levels and histopathology phenotypes (adenocarcinoma vs. squamous cell carcinoma). Gene expression was measured by an RNA Ion AmpliSeq Gene Expression research panel* containing 200 assays. Each research sample was measured with replicates at library generation step and sequencing step. Technical replicates were found to have >0.99 correlation among each other. Assays on the panels were also found to be robust with respect to low input amount (1-10 ng RNA). *For Research Use Only. Not for use in diagnostic procedures.

Citation Format: Ann Mongan, Sophie Rozenzhak, Geoffrey Bien, David Chi, Hiroyoshi Nishikawa, Fiona Hyland, Jim Godsey. Novel biomarkers and multiplexed NGS to stratify FFPE NSCLC by tumor infiltrating lymphocytes and histopathology phenotypes. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3941.

Abstract 1386: Clinical research results for a NGS-based kit for targeted detection of clinically relevant gene rearrangements in lung tumor samples

In recent years, advances in next-generation sequencing (NGS) technologies have enabled faster and cheaper methods for uncovering the genetic basis of disease. For cancer, NGS based screening for known tumor subtypes may inform diagnosis and allow the clinician to tailor a specific therapeutic approach in the future. Here, we present the testing results of one such NGS based kit used to detect specific chromosomal translocations in retrospective non-small cell lung cancer (NSCLC) samples by targeting specific breakpoints in known fusion transcripts.

The included panel tested consists of a single primer pool containing amplicon designs to simultaneously screen for over 75 specific rearrangements involving the receptor tyrosine kinase (RTK) genes ALK, RET and ROS1 as well as NTRK1. The panel was compatible with formalin-fixed paraffin-embedded (FFPE) lung tumor research samples and achieved high-sensitivity down to 10 ng of RNA input. In addition, amplicon assays designed at the 5’ and 3’ ends the RTK genes provide non-specific evidence that a translocation exists in a sample by comparing expression imbalance between the two ends.

Testing was carried out at three external clinical research laboratories. In addition to positive and negative control samples, each site contributed FFPE lung tumor research samples for which ALK fusion status was known prior to NGS library preparation carried out using the Ion AmpliSeq™ workflow. For site-specific samples (n = 144, 16 samples per sequencing run), high concordance, sensitivity and specificity were measured at 97.2%, 90.5% and 98.4%, respectively.

Citation Format: Jeoffrey J. Schageman, José Luis Costa, Orla Sheils, John E. Glassco, David Chi, Jon Sherlock, John Bishop, Rosella P. Petraroli, Kelli S. Bramlett. Clinical research results for a NGS-based kit for targeted detection of clinically relevant gene rearrangements in lung tumor samples. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1386.