Reduction in alkaline phosphatase is associated with longer survival in primary sclerosing cholangitis, independent of dominant stenosis

BACKGROUND

Alkaline phosphatase (ALP) is an important serum marker in primary sclerosing cholangitis (PSC). Patients with obstruction of the large bile ducts due to dominant strictures (DS) are a special, clinically important phenotype.

AIM

To determine the impact of ALP reduction on liver transplantation-free survival in PSC patients with DS.

METHODS

Prospective cohort study in 215 PSC patients. We performed subgroup analysis for patients without DS (no DS, n = 84), DS at first presentation (DS early, n = 72) and development of DS during the course of the study (DS late, n = 59). We evaluated two scores of ALP reduction. ALP reduction 1 was defined as ALP normalisation, 50% reduction compared with baseline values, or reduction below 1.5 times of upper limit of normal (ULN) within 6 months. ALP reduction 2 was defined as ALP reduction below 1.5 times of ULN within 12 months.

RESULTS

Of the patients, 59.5% reached an ALP reduction 1 and 56.7% according to ALP reduction 2. Achievement of each score was associated with longer transplantation-free survival in all three groups (ALP reduction 1: no DS P = 0.001; DS early P < 0.001; DS late P = 0.022; ALP reduction 2: no DS P = 0.014; DS early P = 0.001; DS late P = 0.002). Cox-regression analysis revealed each score as an independent predictor for improved transplantation-free survival (ALP reduction 1 and 2 P < 0.001 each). We further analysed previously published scores of ALP improvement in PSC showing also improved survival in patients with ALP normalisation or a reduction below 1.5 times of ULN (P = 0.003, P = 0.001, respectively), whereas the score determined by 40% reduction did not show significant differences in survival (P = 0.55).

CONCLUSIONS

Reduction in alkaline phosphatase values within the first year is associated with improved transplantation-free survival in patients with primary sclerosing cholangitis independent of the presence of dominant strictures. Alkaline phosphatase might be an adequate surrogate marker for outcome assessment in clinical studies both for patients with and without dominant strictures.

Nodding syndrome in Tanzania may not be associated with circulating anti-NMDA-and anti-VGKC receptor antibodies or decreased pyridoxal phosphate serum levels-a pilot study

BACKGROUND

Nodding syndrome (NS) is a seemingly progressive epilepsy disorder of unknown underlying cause. We investigated association of pyridoxal-phosphate serum levels and occurrence of anti-neuronal antibodies against N-methyl-D-aspartate (NMDA) receptor and voltage gated potassium channel (VGKC) complex in NS patients.

METHODS

Sera of a Tanzanian cohort of epilepsy and NS patients and community controls were tested for the presence of anti-NMDA-receptor and anti-VGKC complex antibodies by indirect immunofluorescence assay. Furthermore pyridoxal-phosphate levels were measured.

RESULTS

Auto-antibodies against NMDA receptor or VGKC (LG1 or Caspr2) complex were not detected in sera of patients suffering from NS (n=6), NS plus other seizure types (n=16), primary generalized epilepsy (n=1) and community controls without epilepsy (n=7). Median Pyridoxal-phosphate levels in patients with NS compared to patients with primary generalized seizures and community controls were not significantly different. However, these median pyridoxal-phosphate levels are significantly lower compared to the range considered normal in Europeans.

CONCLUSIONS

In this pilot study NS was not associated with serum anti-NMDA receptor or anti-VGKC complex antibodies and no association to pyridoxal-phosphate serum levels was found.

Satellite-based climate information within the WMO RA VI Regional Climate Centre on Climate Monitoring

Abstract. The World Meteorological Organization (WMO) established Regional Climate Centres (RCCs) around the world to create science-based climate information on a regional scale within the Global Framework for Climate Services (GFCS). The paper introduces the satellite component of the WMO Regional Climate Centre on Climate Monitoring (RCC-CM) for Europe and the Middle East. The RCC-CM product portfolio is based on essential climate variables (ECVs) as defined by the Global Climate Observing System (GCOS), spanning the atmospheric (radiation, clouds, water vapour) and terrestrial domains (snow cover, soil moisture). In the first part, the input data sets are briefly described, which are provided by the EUMETSAT (European Organisation for the Exploitation of Meteorological Satellites) Satellite Application Facilities (SAF), in particular CM SAF, and by the ESA (European Space Agency) Climate Change Initiative (CCI). In the second part, the derived RCC-CM products are presented, which are divided into two groups: (i) operational monitoring products (e.g. monthly means and anomalies) based on near-real-time environmental data records (EDRs) and (ii) climate information records (e.g. climatologies, time series, trend maps) based on long-term thematic climate data records (TCDRs) with adequate stability, accuracy and homogeneity. The products are provided as maps, statistical plots and gridded data, which are made available through the RCC-CM website (www.dwd.de/rcc-cm).

Fut2 genotype is a risk factor for dominant stenosis and biliary candida infections in primary sclerosing cholangitis

BACKGROUND

A recent genome-wide association study identified the FUT2 secretor status and genotype defined by the single-nucleotide polymorphism rs601338 as potential genetic risk factor in primary sclerosing cholangitis (PSC), which significantly influences biliary bacterial composition.

AIM

To determine the impact of the rs601338-FUT2 genotype on frequency of biliary infections, development of dominant stenosis and liver-transplantation-free survival in patients with PSC.

METHODS

Cohort study of 215 patients with PSC treated at our tertiary care centre with respect to their rs601338-FUT2 genotype. Results of endoscopic retrograde cholangiography and bile culture were analysed; 639 biliary samples were obtained, cultured and subjected to microbial analysis. Clinical and laboratory data were analysed using chart reviews.

RESULTS

For the rs601338-FUT2 genotype, 69 patients (32.1%) were found to be wildtype (GG), 97 (45.1%) patients were heterozygous (AG) and 49 patients (22.8%) were homozygous-mutated (AA). In addition to alterations in the bacterial pattern, especially in heterozygous carriers, patients with mutated alleles had a marked increase in the frequency of biliary Candida infections (P = 0.025). Further, patients with mutated alleles showed an increased frequency of episodes of cholangitis (P = 0.0025), development of dominant stenosis (P < 0.002) and a reduced actuarial transplantation-free survival (P = 0.044). Levels of biliary Ca19-9 were significantly elevated in the homozygous-mutated patients.

CONCLUSIONS

The rs601338-FUT2 genotype is strongly associated with episodes of cholangitis, fungobilia and the incidence of dominant stenosis, which are three clinical hallmarks of PSC; FUT2 is thus an important genetic risk factor for host-microbial diversity and disease progression in PSC.

Abstract P6-06-48: Breast cancer subtypes and metastatic pattern at the Regional Breast Center Dresden

Background: Breast cancer is classified into the subtypes luminal A, luminal B (HER2 positive or negative), HER2 enriched (not luminal) and triple negative (St. Gallen International Breast Cancer Conference 2011). These breast cancer subtypes show differences in response to therapies and prognosis. Amongst others prognosis is depended on hormone receptor positivity, extent and localization of metastases. Routine screening for metastatic disease is not part of the guidelines for breast cancer aftercare although in oligometastatic disease surgery or local ablative therapies can be used to improve outcome. We evaluated if tumor aftercare should be individualized due to different patterns of metastases of the breast cancer subtypes.

Methods: Four hospitals incorporated into the Regional Breast Center Dresden as a certified center of excellence for treating breast cancer. We retrospectively evaluated sites and characteristics of metastases and survival data according to the intrinsic breast cancer subtypes from patients treated between 2006 and 2011. Immunohistochemical detection of estrogen and progesterone receptor, grading and overexpression of HER2 oncogene was used for identifying tumor subtypes. All data were collected at the Clinical Cancer Registry Dresden.

Results: In 2006 routinely identification of overexpression of HER2 started. Since that time 2334 patients had therapy for breast cancer- 12,4% (290/2334) with metastatic disease (7.2%; 168/2334 primary and 5.2%; 122/2334 relapse). Mean duration of follow up was 38 months. Metastatic disease was more frequently found in HER2 enriched, 27.2%; 30/110, and triple negative, 19.7%; 44/223, than in the luminal subtypes: luminal A 8.3%; 107/1284, luminal B HER2 negative 12.2%; 23/188, luminal B HER2 positive 16%; 36/225. Luminal A and B HER2 negative subtypes showed a preference for solely bone metastases (43%; 56/130) which was rare in triple negative breast cancer (6.8% 3/44). If bone metastases occurred in triple negative breast cancer they mostly appeared together with visceral and/or brain metastatic disease (27%; 12/44). Solely visceral metastases were found in the HER2 enriched subtype (46.7%; 14/30), luminal B HER2 positive (38.9%; 14/36), and triple negative breast cancer (20.2%; 19/44). Brain metastases were more frequently observed in triple negative breast cancer (22.7%; 10/44). Overall survival rate at 5 years for metastatic disease was 38.5% (95%CI 28.2-52.5) for luminal A, 23.1% (95%CI 12.0-44.5) for luminal B (HER2 negative), 11.9% (95%CI 5.5-25.7) for luminal B (HER2 positive), 27.6% (95%CI 14.4-52.8) for HER2 enriched and 6.5% (95%CI 2.4-17.1) for triple negative subtype.

Conclusion: Different patterns of metastatic disease were seen according to the subtypes of breast cancer. An individualized tumor aftercare that includes screening for visceral metastasis might improve prognosis of patients with luminal B HER positive, HER enriched and triple negative subtype. Further investigation on patients eligible for metastatic surgery should be performed with longer follow up and evaluated with respect to post-interventional survival.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-48.

Both STAT1 and STAT3 are favourable prognostic determinants in colorectal carcinoma

BACKGROUND

Aberrant activities of Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling pathways have been implicated in the development and spread of various cancer entities, among them colorectal carcinoma (CRC). Transcription factors STAT3 and STAT1, both downstream effectors of interleukin (IL)-6 and its receptor, are involved in growth and developmental control of CRC cells. Constituents of the signalling network around IL-6 and STAT activation are discussed as potential biomarkers and therapeutic targets in CRC.

METHODS

By immunohistochemical analysis of a tissue microarray covering >400 CRC biopsies, the expression and activity status of STAT1, STAT3 as well as of IL-6 and the IL-6 receptor α-chain was determined. The outcome was correlated with clinical information and patients' survival data. Colorectal carcinoma biopsies were also analysed for specific DNA-binding activity of STATs.

RESULTS

Statistical analysis showed tendential associations between individual STATs, IL-6/IL-6 receptor-α and clinicopathological parameters. The study revealed a significant correlation of high STAT1 activity with longer patient overall survival. Surprisingly, strong STAT3 expression in surgical specimens was correlated with an increase in median overall survival by about 30 months. Statistical analysis revealed that high expression levels of STAT1 and STAT3 were associated. This finding was backed up by biochemical data that showed simultaneous STAT1 and STAT3 DNA-binding activity in randomly selected CRC biopsies.

CONCLUSION

By multivariate data analysis, we could show that STAT3 expression and activity constitutes an independent favourable prognostic marker for CRC.

MRI findings in people with epilepsy and nodding syndrome in an area endemic for onchocerciasis: an observational study

BACKGROUND

Onchocerciasis has been implicated in the pathogenesis of epilepsy. The debate on a potential causal relationship between Onchocerca volvulus and epilepsy has taken a new direction in the light of the most recent epidemic of nodding syndrome.

OBJECTIVE

To document MRI changes in people with different types of epilepsy and investigate whether there is an association with O. volvulus infection.

METHODS

In a prospective study in southern Tanzania, an area endemic for O. volvulus with a high prevalence of epilepsy and nodding syndrome, we performed MRI on 32 people with epilepsy, 12 of which suffered from nodding syndrome. Polymerase chain reaction (PCR) of O. volvulus was performed in skin and CSF.

RESULTS

The most frequent abnormalities seen on MRI was atrophy (twelve patients (37.5%)) followed by intraparenchymal pathologies such as changes in the hippocampus (nine patients (28.1%)), gliotic lesions (six patients (18.8%)) and subcortical signal abnormalities (three patients (9.4%)). There was an overall trend towards an association of intraparenchymal cerebral pathologies and infection with O. volvulus based on skin PCR (Fisher's Exact Test p=0.067) which was most pronounced in children and adolescents with nodding syndrome compared to those with other types of epilepsy (Fisher's Exact Test, p=0.083). Contrary to skin PCR results, PCR of CSF was negative in all patients.

CONCLUSION

The observed trend towards an association of intraparenchymal cerebral pathological results on MRI and a positive skin PCR for O. volvulus despite negative PCR of CSF is intriguing and deserves further attention.

Repetitive transcranial magnetic stimulation influences mood in healthy male volunteers

Introduction

The influence of repetitive transcranial magnetic stimulation (rTMS) on mood in healthy people is uncertain, as former studies show divergent results. Previous studies in healthy volunteers focused exclusively on the immediate effect of a single session of rTMS on mood.

Aims

The aim of this study was to analyse the influence on mood of a series of 9 High Frequency (HF) rTMS stimulations of the left dorsolateral prefrontal cortex (DLPFC).

Methods

44 young healthy male volunteers were randomly assigned to receive 9 sessions of active HF-rTMS (n = 22) or sham rTMS (n = 22) over the left DLPFC. Each session in the active group consisted of 15 trains of 25 Hz starting with 100% of motor threshold. Sham stimulation was performed following the same protocol, but using a sham coil. The variables of interest were the Beck Depression Inventory (BDI) and Visual Analogue Scales (VAS) which quantified “mood”, “enjoyment” and “energy”.

Results

We found a significant reduction of the BDI score in the active group (GLM, p < 0.001) whereas no significant changes of the BDI score were caused by sham stimulation (GLM, p = 0.109). We did not find significant differences caused by active or sham stimulation in VAS scales except for the VAS labelled lively/gloomy immediately after stimulation. The active group was found to be more “gloomy” (p = 0.001).

Conclusions

Our data support the hypothesis that a 9-day long series of HF-rTMS of the left DLPFC improves mood, analysed by BDI in healthy young men.

A Novel LMNA Mutation Causes Altered Nuclear Morphology and Symptoms of Familial Partial Lipodystrophy (Dunnigan Variety) with Progeroid Features

Dunnigan-type partial lipodystrophy (familial partial lipodystrophy, Dunnigan variety, FPLD2) can be caused by LMNA mutations. We identified a novel heterozygous LMNA mutation, P485R, in a patient referred to the International Registry of Werner Syndrome because of features consistent with that of progeroid disorder but who was wild type at the WRN locus. The novel mutation is located 2 amino acids away from the canonical FPLD mutations in exon 8 of the LMNA gene. Immunocytochemical analysis revealed abnormal nuclear morphology characteristic of laminopathies within primary fibroblast cultures, but not in a lymphoblastoid cell line, in keeping with previous observations. Our findings indicate that FPLD2 should be considered in the differential diagnosis of the Werner syndrome.