Gammasecretase Inhibition Results in Both Caspase Dependant and Independent Apoptosis in Breast Cancer Cell Lines

BackgroundNotch signalling is normally involved in lateral inhibition during embryogenesis and is found to be de regulated in many breast cancers. Gamma-secretase is an enzyme complex formed by constitution of Nicastrin, APH1, Presenilin and Pen2 and is involved in the cleavage of notch proteins. We investigated the effects of γ-secretase inhibition and its mechanism of action in breast cancer cell lines.Materials and MethodsGrowth assay was performed using Gammasecretase inhibitor-1(Z-Leu-Leu-Nle-CHO) in MCF-7, MDA-MB-231, T47D and ZR-75 breast cancer cell lines and 226 U19 and MCF10A non tumourigenic epithelial cell lines at concentrations between10nM and 60uM. Expression of Bcl-2, Bcl-XL, P-Bad and XIAP were measured by Western blot and cell cycle analysis was done by FACS in MCF-7 and MDA-MB-231 cells treated with GSI-1 at 0.75μM, 2μM and 5μM for 48 hours. Caspase 3 and 7 activity was measured in MCF-7 and MDA-MB-231 cells treated with GSI-1 at 0.75μM, 2μM and 5μM for 24 and 48 hours using Promega assay kit. MCF-7 cells were also treated with 0.75μM GSI-1 and DMSO in five replicates for 48 hours and gene array was performed using 44K Agilent array. Fold changes of AKR1B10 and Osteopontin genes were confirmed by Real time PCR at 0.75μM of GSI-1 in MCF-7 and they were also measured at concentrations of 2μM and 5μM in MCF-7 and MDA MB 231 cells using Taqman.ResultsThe 4 cancer cell lines MCF-7, MDA-MB231, ZR-75 and T47D showed growth inhibition in a dose dependant manner and were killed at 5uM. However this concentration did not affect the non tumourigenic cell lines. Expression of Bcl-2, Bcl-XL, inhibitor of apoptosis (XIAP) and P-BAD went down with escalating doses of GSI-1 at 48 hours in both MCF-7 and MDA MB 231 cells. Cell cycle analysis confirmed increase in the percentage of cells in G2M arrest leading to apoptosis at 48 hours in the same cell lines. However we observed increase in Caspase 3 and 7 activity only in MDA-MB-231 not in MCF-7 cells. Gene array in MCF-7 cells treated with GSI1 showed 15 and 4 fold changes in the expression of AKR1B10 and Osteopontin. There was also dose dependant increase in the expression these two genes with GSI-1 in MCF-7 but no such change was observed in MDA MB 231 cells.DiscussionThis is the first time we are reporting the effect of GSI-1 and its possible mechanism of action in breast cancer cell lines. Apoptosis appears to be the main mechanism of cell death as evidenced by our Western blots and FACS analysis in MCF-7 and MDA MB 231 cell lines. However, MCF-7 did not show any Caspase 3/7 activity implying other mechanisms may be involved in the induction of apoptosis. Production of reactive oxygen species (ROS) triggers the damage to mitochondrial membrane and release of cytochrome c, Apoptosis inducing Factor and Endonuclease G resulting in the initiation of Caspase independent apoptosis. AKR1B10 and Osteopontin were shown to be highly expressed in conditions resulting in increased production of ROS. Thus inhibition of γ-secretase enzyme results in breast cancer cell death in a dose which was non lethal to non tumourigenic cell lines. Both Caspase dependant and independent apoptosis appear to be involved in the mechanism of cell death.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3129.

Hope in psychiatry: a review of the literature

OBJECTIVE

Hope has long been considered an important therapeutic factor in medicine, nursing and mental health and recently received attention as a central component of recovery. However, conceptual clarity, applicability and the predictive value of hope remain unclear. This review aims to define hope, review current approaches to assessment, and outline research evidence linking hope with effectiveness.

METHOD

We conducted a comprehensive review of publications on the conceptualisation and measurement of hope, and on its use as a predictive variable specifically in mental health patients.

RESULTS

Forty-nine definitions of hope were identified, which were grouped into seven emergent dimensions. Thirty-two measurement tools were identified, although few have been used in research involving mental health patients. Eleven studies investigated hope as a predictive variable for differing outcomes, with inconclusive results.

CONCLUSION

Many conceptual frameworks for hope have been proposed, but empirical evidence on its predictive power in mental health is lacking.

Extended work hours and risk of acute occupational injury: A case-crossover study of workers in manufacturing

OBJECTIVE

This study was designed to determine whether injury risk among manufacturing workers was related to hours worked during the previous week.

METHODS

A case-crossover design was utilized to contrast hours worked prior to an injury shift with those worked prior to a non-injury shift for hourly workers. Paired t-tests were used to determine significance of the difference. Conditional logistic regression was used to assess dose-response.

RESULTS

Hours worked prior to injury significantly exceeded hours during the control week. Workers who worked more than 64 hr in the week before the shift had an 88% excess risk compared to those who worked 40 hr or fewer, P < 0.05.

CONCLUSION

The study provides evidence that injury risk is related to time worked during the previous week. Control of overtime in manufacturing may reduce risk of worker injury.

Assessing the needs of pregnant women and mothers with severe mental illness: the psychometric properties of the Camberwell Assessment of Need - Mothers (CAN-M)

There is an absence of standardized validated instruments to assess the complex needs of pregnant women and mothers with severe mental illness. We aimed to develop a standardized assessment of need for pregnant women and mothers with severe mental illness. Staff and service users were asked to identify relevant domains of need. Professional experts and service users were then surveyed and asked to rate the importance of the domains of the Camberwell Assessment of Need - Mothers version (CAN-M). Reliability was established using 36 service user-staff pairs. Concurrent validity was assessed with the Global Assessment of Functioning. Inter-rater reliability (concordance) coefficients for unmet needs were 0.93 (95% confidence interval 0.89 to 0.98) (service users) and 0.83 (95% confidence interval 0.73 to 0.94) (staff); test-retest reliability coefficients were 0.91 (95% confidence interval 0.86 to 0.97) and 0.85 (95% confidence interval 0.73 to 0.96), respectively. Relevant CAN-M domains correlated with the Global Assessment of Functioning-symptom (Spearman's r correlation coefficient = -0.36, 95% confidence interval = -0.62 to -0.04, p = 0.05) and Global Assessment of Functioning-disability subscales (Spearman's r correlation coefficient = -0.52, confidence interval = -0.73 to -0.23, p < 0.01). We conclude that the CAN-M is a reliable and valid instrument for assessing the needs of pregnant women and mothers with severe mental illness.

Who decides what evidence is? Developing a multiple perspectives paradigm in mental health

OBJECTIVE

To compare different perspectives on evidence in relation to mental health care.

METHOD

The method and materials constitute a selective literature review comparing key elements of evidence-based medicine and evidence-based policy with perspectives on evidence from users, carers and professionals. The aim was to develop an argument concerning these comparisons.

RESULTS

What constitutes evidence from the perspectives of different stakeholders is a field of contestation.

CONCLUSION

It is timely for a multiple perspective paradigm on evidence in science to be developed and this paper initiates this process in relation to mental health care.

An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical, and service issues

BACKGROUND

Assertive community treatment (ACT) has been applied to a number of disorders in the adult population, such as schizophrenia, with some degree of success; its use in the treatment of people with intellectual disability (ID) and mental illness has received little attention. Despite the high costs of ID in health and social care, there has been very little evidence-based practice for people with ID and mental illness, and it remains a neglected area of research. Aims The aims of this study were an exploratory comparison of the effectiveness of an ACT model for the treatment of mental illness in people with ID (ACT-ID) with a standard community treatment (SCT-ID) approach.

METHOD

A Randomized controlled trial design was adopted and allocation was made by stratified randomization by an independent statistician. The prognostic factors used in the randomization were gender and psychiatric diagnosis (psychosis vs. affective). Service users were randomly allocated to either ACT-ID or SCT-ID.

RESULTS

There were no statistically significant differences between ACT-ID and SCT-ID in terms of the level of unmet needs, carer burden, functioning and quality of life, but borderline evidence of a difference between treatment groups in quality of life in favour of SCT-ID. Both SCT-ID and ACT-ID groups decreased level of unmet needs and carer burden, and increased functioning. SCT-ID also led to a small increase in quality of life.

Threshold 2: the reliability, validity and sensitivity to change of the Threshold Assessment Grid (TAG)

OBJECTIVE

This study investigated the psychometric properties of the Threshold Assessment Grid (TAG), a new assessment of the severity of mental health problems.

METHOD

A total of 605 patients were recruited from 10 mental health adult and elderly services in London, UK. TAG ratings and other standardized definitions of severe mental illness were completed by referrers. TAG, Global Assessment of Functioning (GAF), Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and Health of the Nation Outcome Scale (HoNOS) ratings were completed by mental health service staff. Construct validation on extreme groups was investigated.

RESULTS

Construct and concurrent validity were good. Referrer TAG scores predicted mental health team view of referral suitability, but not whether assessments were offered. Test-retest reliability was good, interrater reliability ranged from good to poor in different domains (but adequate for total TAG score), internal consistency was appropriate. Sensitivity to change requires further investigation.

CONCLUSION

The TAG can be recommended for use by all agencies when making referrals to mental health services.

Threshold 3: the feasibility of the Threshold Assessment Grid (TAG) for routine assessment of the severity of mental health problems

BACKGROUND

Evidence-based practice requires the development of measures which are suitable for everyday clinical use ('feasible'). There is no consensus as to how to establish feasibility.

METHOD

The feasibility of a new assessment - the Threshold Assessment Grid (TAG) - for use when making referrals to mental health services was tested by training mental health teams in using the TAG and other standardised assessments, asking referrers to ten mental health services in London also to complete a TAG, surveying TAG users, and evaluating a feedback meeting at which TAG data were presented.

RESULTS

One hundred and one (61%) mental health staff received training, and 445 (74%) referrers of 600 patients completed TAGs. Sixty-five (65%) questionnaires from TAG users were completed, and 24 (80%) people attending feedback meetings evaluated the TAG. These allowed the extent to which the TAG is brief, simple, relevant, acceptable, available and valuable to be investigated.

CONCLUSION

The TAG exhibited good feasibility when used by mental health staff, and moderate feasibility when used by referrers. This approach can be used to investigate the feasibility of other standardised assessments.

Dobutamine-induced augmentation of left ventricular ejection fraction predicts survival of heart failure patients with severe non-ischaemic cardiomyopathy

AIMS

The prognosis of patients with severe non-ischaemic dilated cardiomyopathy is variable. The predictive value of currently utilized tests is suboptimal. The purpose of this study was to determine the prognostic value of dobutamine-induced augmentation of left ventricular ejection fraction in patients with non-ischaemic dilated cardiomyopathy.

METHODS AND RESULTS

Sixty-two patients with left ventricular ejection fraction < or =0.30 underwent exercise testing with gas exchange analysis and assessment of left ventricular ejection fraction at rest and after a 10-min intravenous infusion of dobutamine at 10 microg x kg(-1) x min(-1), using equilibrium radionuclide ventriculography. Age was 48+/-11 years, 32% females, functional class 2.6+/-0.6, resting left ventricular ejection fraction 0.20+/-0.06, and peak exercise oxygen consumption (mVO2) 19+/-6 ml x kg(-1) x min(-1). Mean dobutamine-induced augmentation of left ventricular ejection fraction (DeltaLVEF) was 0.09+/-0.06 (median 0.08, range -0.03 to 0.26). Follow-up was 25+/-15 months during which there were 12 deaths and five transplantations. Patients were divided into two groups based on median DeltaLVEF. The transplant-free survival was better in the group with higher DeltaLVEF (94% vs 64%, P<0.008). In multivariate analysis incorporating age, gender, duration of chronic heart failure, functional class, right and left ventricular ejection fraction, DeltaLVEF, left ventricular end-diastolic volume index, and mVO2, only DeltaLVEF was predictive of 1-year, 3-year, and overall transplant-free survival (RR 0.09, 0.03, and 0.13;P 0.03, 0.09, and 0.08 respectively). The linear correlation between DeltaLVEF and mVO2(r=0.3) and between DeltaLVEF and left ventricular ejection fraction (r=0.5) was weak.

CONCLUSION

Dobutamine-induced augmentation of left ventricular ejection fraction is a strong prognostic variable, independent of exercise capacity and resting ventriculographic variables, in severe non-ischaemic systolic dysfunctional heart failure.

An immunoglobulin G1 monoclonal antibody highly specific to the wall of Cryptosporidium oocysts

The detection of Cryptosporidium oocysts in drinking water is critically dependent on the quality of immunofluorescent reagents. Experiments were performed to develop a method for producing highly specific antibodies to Cryptosporidium oocysts that can be used for water testing. BALB/c mice were immunized with six different antigen preparations and monitored for immunoglobulin G (IgG) and IgM responses to the surface of Cryptosporidium oocysts. One group of mice received purified oocyst walls, a second group received a soluble protein preparation extracted from the outside of the oocyst wall, and the third group received whole inactivated oocysts. Three additional groups were immunized with sequentially prepared oocyst extracts to provide for a comparison of the immune response. Mice injected with the soluble protein extract demonstrated an IgG response to oocysts surface that was not seen in the whole-oocyst group. Mice injected with whole oocysts showed an IgM response only, while mice injected with purified oocyst walls showed little increase in IgM or IgG levels. Of the additional reported preparations only one, BME (2-mercaptoethanol treated), produced a weak IgM response to the oocyst wall. A mouse from the soluble oocyst extract group yielding a high IgG response was utilized to produce a highly specific IgG(1) monoclonal antibody (Cry104) specific to the oocyst surface. Comparative flow cytometric analysis indicated that Cry104 has a higher avidity and specificity to oocysts in water concentrates than other commercially available antibodies.

Reliability and validity of the CANDID--a needs assessment instrument for adults with learning disabilities and mental health problems

BACKGROUND

People with learning disabilities and mental health problems have complex needs. Care should be provided according to need.

AIM

To develop a standardised needs-assessment instrument for adults with learning disabilities and mental health problems.

METHOD

The Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) was developed by modifying the Camberwell Assessment of Need (CAN). Concurrent validity was tested using the Global Assessment of Functioning (GAF) and the Disability Assessment Schedule (DAS). Test-retest and interrater reliability were investigated using 40 adults with learning disabilities and mental health problems.

RESULTS

CANDID scores were significantly correlated with both DAS (P < 0.05) and GAF scores (P < 0.01). Correlation coefficients for interrater reliability were 0.93 (user), 0.90 (career), and 0.97 (staff ratings); for test-retest reliability they were 0.71, 0.69 and 0.86 respectively. Mean interview duration was less than 30 minutes.

CONCLUSIONS

The CANDID is a brief, valid and reliable needs assessment instrument for adults with learning disabilities and mental health problems.

Threshold Assessment Grid (TAG): the development of a valid and brief scale to assess the severity of mental illness

BACKGROUND

Lack of consensus about the meaning of severe mental illness makes it difficult to prioritise the severely mentally ill for specialist mental health care. The goal of this study was to develop a valid and brief assessment of severity of mental illness.

METHOD

Six search workshops (n = 57) using consensus techniques developed a draft assessment acceptable to users, carers, practitioners and policy makers. A two-round Delphi consultation (n = 58) was held to identify consensus on this instrument.

RESULTS

Search workshops agreed seven domains relevant to identifying the severely mentally ill: intentional and unintentional self-harm, risk from and to others, and survival, psychological, and social needs and disabilities. The Delphi consultation indicated at least agreement with all aspects in both rounds.

CONCLUSIONS

The Threshold Assessment Grid (TAG) is a brief method of identifying the severely mentally ill, which has adequate face, concurrent, construct and content validity.