Abstract P6-11-11: Characteristics of long-term survivors after brain metastases in breast cancer patients

Background: Brain metastases (BM) occur in 10%-15% patients of breast cancer patients. It is associated with poor prognosis, requiring great effort to manage local and systemic treatment for BM. The purpose of this study was to analyze the clinico-pathological characteristics of long-term survivors with BM in breast cancer patients.

Method: 63 patients with breast cancer BM diagnosed from 2002 to 2010 at the Tokyo Metropolitan Komagome hospital were included. Long–term survival group (Long) was defined as to be consisted of the patients with survival duration more than 36 months after diagnosed with BM and the patients with less than 36 month was into Short-term survival group (Short) in this study. The clinico-pathological characteristics were compared between these two groups. Survival rate and prognostic factors of BM were analyzed by the Kaplan–Meier method and employed by Log–Rank test. Multivariate analysis was performed by the Cox proportional hazard model.

Results: Median age of the 63 patients was 53 years (range, 35–78). Median survival time after BM was 12 months (range, 1–168), with about 90 percent of cause of death related to BM (e.g. failure of PS due to BM). As for ER and HER2 status, the number of ER+/HER2- (Luminal:Lum), ER+or-/HER2+ (HER2-enrich:Her2-E), ER-/HER2- (Basal:Bas) were 18, 27, 18, respectively. Among those 63 patients, 11 survived 36 months or more after BM. However, there was no difference in the rate of ER status between Long (55%) and Short (38%), there were significantly high rate of Her2-E case in Long (73%) as compared with Short (29%). Median survival duration after diagnosed with BM of Lum, Her2-E and Bas were 11, 37, 3 months, respectively. Prognosis of Bas was significantly poor (Bas vs. Her2-E p<0.001), and although Her2-E was not significant as compared with ER (p = 0.188), survival time after BM of Her2-E was the tendency to be long. In univariate analysis, Karnofsky performance status (KPS≥70 or <70), HER2 status, disease free interval (from initial diagnosis to first recurrence, DFI≥2years or <2years) had significant impact on survival time after BM. (p = 0.0458, 0.0398, 0.0385, respectively). Meningitis status was a borderline. (p = 0.052) In multivariate analysis, KPS, HER2 status and DFI were significant prognostic factors. (KPS: RR 2.08, 95% CI 1.08-4.07; HER2: RR 2.911, 95% CI 1.396- 6.484; DFI: RR 1.933, 95% CI 0.83-4.102)

Conclusions: Although, it was believed that the prognosis after BM was poor, Her2-E BM had a comparatively good prognosis. An existing report supports extension of the survival time after BM by HER2–targeted treatment in BM cases with Her2 positive breast cancer. This newest study reviles the median survival after BM as 37 months in Her2-E BM group, but that of Bas group was only 3 months and this is not improved at all compared with historically reported survival duration (2.4-4.9months). Our reports suggested that the innovation of Her2–targeted treatment leads this surprising improvement of life extension in HER2 positive BM patients but innovation of cytotoxic agents could not contribute toward improvement of clinical outcome in triple negative BM patients. So the necessity of examining the medical treatment of breast cancer BM according to subtype from now on is also considered.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-11.

Delayed anti-CD3 therapy results in depletion of alloreactive T cells and the dominance of Foxp3+ CD4+ graft infiltrating cells

The engineered Fc-nonbinding (crystallizable fragment-nonbinding) CD3 antibody has lower mitogenicity and a precise therapeutic window for disease remission in patients with type 1 diabetes. Before anti-CD3 can be considered for use in transplantation, the most effective timing of treatment relative to transplantation needs to be elucidated. In this study anti-CD3F(ab')2 fragments or saline were administered intravenously for 5 consecutive days (early: d1-3 or delayed: d3-7) to mice transplanted with a cardiac allograft (H2(b)-to-H2(k); d0). Survival of allografts was prolonged in mice treated with the early protocol (MST = 48 days), but most were rejected by d100. In contrast, in mice treated with the delayed protocol allografts continued to survive long term. The delayed protocol significantly inhibited donor alloreactivity at d30 as compared to the early protocol. A marked increase in Foxp3(+) T cells (50.3 ± 1.6%) infiltrating the allografts in mice treated with the delayed protocol was observed (p < 0.0001 vs. early (24.9 ± 2.1%)) at d10; a finding that was maintained in the accepted cardiac allografts at d100. We conclude that the timing of treatment with anti-CD3 therapy is critical for inducing long-term graft survival. Delaying administration effectively inhibits the alloreactivity and promotes the dominance of intragraft Foxp3(+) T cells allowing long-term graft acceptance.

Development of high-pressure and high-field ESR system using SQUID magnetometer

We have developed a high-pressure and high-field electron spin resonance (ESR) system using the combination of a commercially available superconducting quantum interference device (SQUID) magnetometer and a clamp-type piston cylinder pressure cell. The magnetic field range is up to 5 T, and the maximum pressure reaches 1.5 GPa. The most characteristic feature of this system is its easy handling as compared with other high-pressure ESR systems. Moreover, the macroscopic magnetization measurement can be performed simultaneously with the microscopic ESR measurement. In addition to these features, the well-established pressure calibration method utilizing the change of superconducting transition temperature of tin can be applied to this system. By using this system, we obtained pressure dependence of the single ion magnetic anisotropy parameter D of NiSnCl(6)·6H(2)O up to 1.5 GPa precisely, and the magnetization behavior of this material under pressure was explained well by its pressure dependence of the D value.

Impact of a cash-for-work programme on food consumption and nutrition among women and children facing food insecurity in rural Bangladesh

OBJECTIVE

To determine whether a cash-for-work programme during the annual food insecurity period in Bangladesh improved nutritional status in poor rural women and children.

METHODS

The panel study involved a random sample of 895 households from over 50,000 enrolled in a cash-for-work programme between September and December 2007 and 921 similar control households. The height, weight and mid-upper arm circumference of one woman and child aged less than 5 years from each household were measured at baseline and at the end of the study (mean time: 10 weeks). Women reported 7-day household food expenditure and consumption on both occasions. Changes in parameters were compared between the two groups.

FINDINGS

At baseline, no significant difference existed between the groups. By the study end, the difference in mean mid-upper arm circumference between women in the intervention and control groups had widened by 2.29 mm and the difference in mean weight, by 0.88 kg. Among children, the difference in means between the two groups had also widened in favour of the intervention group for: height (0.08 cm; P<0.05), weight (0.22 kg; P<0.001), mid-upper arm circumference (1.41 mm; P<0.001) and z-scores for height-for-age (0.02; P<0.001), weight-for-age (0.17; P<0.001), weight-for-height (0.23; P<0.001) and mid-upper arm circumference (0.12; P<0.001). Intervention households spent more on food and consumed more protein-rich food at the end of the study.

CONCLUSION

The cash-for-work programme led to greater household food expenditure and consumption and women's and children's nutritional status improved.

A human anti-CD40 monoclonal antibody, 4D11, for kidney transplantation in cynomolgus monkeys: induction and maintenance therapy

Blockade of CD40-CD154 signaling pathway is an attractive strategy to induce potent immunosuppression and tolerance in organ transplantation. Due to its strong immunosuppressive effect shown in nonhuman primate experiments, anti-CD154 monoclonal antibodies (mAbs) have been tried in clinical settings, but it was interrupted by unexpected thromboembolic complications. Thus, inhibition of the counter molecule, CD40, has remained an alternative approach. In the previous preliminary study, we have shown that 4D11, a novel fully human anti-CD40 mAb, has a fairly potent immunosuppressive effect on kidney allograft in nonhuman primates. In this study, we aimed to confirm the efficacy and untoward events of the 2-week induction and 180-day maintenance 4D11 treatments. In both, 4D11 significantly suppressed T-cell-mediated alloimmune responses and prolonged allograft survival. Addition of weekly 4D11 administration after the induction treatment further enhanced graft survival. Complete inhibition of both donor-specific Ab and anti-4D11 Ab productions was obtained only with higher-dose maintenance therapy. No serious side effect including thromboembolic complications was noted except for a transient reduction of hematocrit in one animal, and decrease of peripheral B-cell counts in all. These results indicate that the 4D11 appears to be a promising candidate for immunosuppression in clinical organ transplantation.

Turbulence in boundary flow of superfluid 4He triggered by free vortex rings

The transition to turbulence in the boundary flow of superfluid 4He is investigated using a vortex-free vibrating wire. At high wire vibration velocities, we found that stable alternating flow around the wire enters a turbulent phase triggered by free vortex rings. Numerical simulations of vortex dynamics demonstrate that vortex rings can attach to the surface of an oscillating obstacle and expand unstably due to the boundary flow of the superfluid, forming turbulence. Experimental investigations indicate that the turbulent phase continues even after stopping the injection of vortex rings, which is also confirmed by the simulations.

Does the permanent portacaval shunt for a small-for-size graft in a living donor liver transplantation do more harm than good?

In order to obviate a small-for-size graft syndrome (SFSGS), a portacaval (PC) shunt had been considered in a case of adult-to-adult living donor liver transplantation (AA-LDLT). In a recent AA-LDLT case, we adopted the PC shunt to resolve SFSGS; however, graft atrophy was observed in the late period of LDLT, thereby resulting in liver dysfunction. Due to the surgical closure of the PC shunt at 11 months post-LDLT, the graft regenerated gradually and resulted in the recovery of the liver function. This experience indicates that the portacaval shunt would overcome SFSGS in the early period of LDLT, while it would cause the graft atrophy and the graft dysfunction in the late period of LDLT.

Prostate cancer screening strategies with re-screening interval determined by individual baseline prostate-specific antigen values are cost-effective

AIMS

To determine whether prostate cancer screening strategies with re-screening interval determined by individual baseline prostate-specific antigen values are cost-effective.

METHODS

Based on the results of an actual contemporary screening program, we established Markov decision analytic models of prostate cancer screening with personalized re-screening interval strategies using cutoff baseline PSA levels for biennial screening as well as a model of uniformly annual or biennial screening. These strategies were compared in terms of cumulative incidence of early cancer and cost-effectiveness.

RESULTS

Early cancer detection rates were similar among all strategies. Personalized strategies were more cost-effective compared to uniform screening strategies. If all participants with negative PSA results uniformly omit annual screening, it would be more costly but less effective (dominated). Contrary, annual screening for all participants would cost too much. These results were robust throughout sensitivity analysis incorporating every assumption in the models.

CONCLUSIONS

This study adds important evidence that personalized rescreening strategies based on individual baseline PSA have advantages of cost-effectiveness against conventional uniform strategies.

Inhibition of apoptosis by menadione on exposure to UVA

Quinones are widely distributed in the environment, both as natural products and as pollutants. This paper reports that one of the simplest quinones, 2-methyl-1,4-naphthoquinone (menadione), effectively inhibited apoptosis in the presence of UVA. Menadione suppressed the apoptosis induced by serum depletion and cell detachment. This effect was significantly enhanced by UVA irradiation. An antioxidant, N-acetylcysteine, completely inhibited the antiapoptotic effects of both menadione itself and menadione plus UVA, and peroxidation of the cells after treatment was observed using a probe to detect the intracellular production of peroxides. By contrast, 2-hydroxy-1,4-naphtoquinone (lawsone) showed no antiapoptotic effect in the presence or absence of UVA. Lawsone is reported not to undergo the redox process that produces reactive oxygen species. These results indicated that intracellular peroxidation contributed to the antiapoptotic effects of both menadione itself and menadione plus UVA. Dysregulation of the apoptotic process is critical to carcinogenesis. The photosensitization of quinone compounds as it relates to the inhibition of apoptosis should be examined in the future.

Immunostimulation and growth faltering in UK infants

The purpose of the study was to determine whether chronic immunostimulation could explain growth faltering in disadvantaged children in the UK, as it does in developing countries such as The Gambia. In all, 216 infants, age 10-21 months, were recruited when blood samples were taken for the routine or clinical purposes of a longitudinal study tracking a larger cohort of children. Aliquots of blood were collected on Guthrie cards to determine blood concentrations of albumin (Alb), alpha(1)-antichymotrypsin (ACT), and immunoglobulin G (IgG). Haemoglobin concentrations were determined by routine hospital laboratory analysis. Heights and weights were measured and converted to z-scores; birth weights were used with recruitment weight to calculate a 'thrive index' for each child. Age-corrected plasma IgG concentration was negatively associated with both height- and weight-for-age z-scores (P = 0.042 and 0.038, respectively) but not with the thrive index or body mass index z-scores. Blood haemoglobin levels were positively related to height- and weight-for age z-scores, as well as to the thrive index (P = 0.026, 0.014, and 0.007, respectively). Although significant, these relationships could only account for a small part the observed growth variation. Although the relationships were weak, the results suggest that some of the observed variation in growth of these UK infants may be explained on the basis of persistent immunostimulation or poor iron status. In terms of markers of immunostimulation (Alb, ACT, ACT:Alb ratio, IgG), both absolute levels and relationships with height-for-age are substantially different than those previously observed in cohort studies of infants in The Gambia.

Ionizing radiation-induced macrophage activation: augmentation of nitric oxide production and its significance

Radiation is an important therapy for many kinds of cancer. However, it can result in the inflammation and accompanying injury. Recently, it is being recognized that the nitric oxide (NO) produced in macrophages activated by ionizing radiation is an important mediator. Ionizing radiation has been confirmed to potentiate NO production in macrophages, though the mechanism is not clear. We have shown that the increase of NO production in irradiated macrophages contributed to tumoricidal activity, with the activation mechanisms differing between high-dose and low-dose irradiation. High-dose irradiation activates macrophages directly, whereas low-dose irradiation acts indirectly through interaction with neighboring cells and the paracrine induction of cytokines. In this review, we discuss the augmentation of NO production in macrophages by ionizing radiation and its mechanism and significance. In radiotherapy, the control of NO levels both in whole-body and in the tumor is important to prevent irradiation-induced injury and for the cancer to regress.

Susceptibility to vesicoureteral reflux in Japanese is linked to HLA-DR antigen

OBJECTIVES

To determine whether vesicoureteral reflux is associated with the human leukocyte antigen (HLA) genes.

METHODS

We evaluated 40 Japanese patients (27 males and 13 females) with reflux. HLA-DR low-resolution genotyping and high-resolution typing of HLA-DRB1 alleles were performed. The frequencies of the HLAs and alleles were calculated and compared with those previously reported in 493 healthy Japanese.

RESULTS

Low-resolution typing showed that the frequency of the HLA-DR11 antigen was significantly higher in the patients with reflux than in the control group. High-resolution typing revealed that the frequencies of HLA-DRB1*1101 and 1502 alleles were significantly higher in the patients with reflux than in the control group. In the patients with and without renal scarring, the frequencies of the HLA-DR11 antigens and HLA-DRB1*1101 alleles were significantly lower in those with renal scarring. In the patients with and without the chief complaint of urinary tract infection symptoms, the frequencies of HLA-DR13 antigens and HLA-DRB1*1302 alleles were significantly lower in those with that chief complaint.

CONCLUSIONS

The susceptibility to reflux is, in part, controlled by HLA genes themselves or an unknown gene or genes, the locus for which is located close to the DRB1 gene. The lack of a HLA-DRB1*1101 allele and DRB1*1302 allele in patients with reflux might be connected with renal scarring and urinary tract infection, respectively.

Phosphatidylserine induces apoptosis in CHO cells without mitochondrial dysfunction in a manner dependent on caspases other than caspases-1, -3, -8 and -9

Treatment of Chinese hamster ovary K1 cells with phosphatidylserine (PS) caused typical apoptosis with distinct morphological and biochemical features in a dose- and time-dependent manner. However, unlike camptothecin-induced apoptosis, changes in mitochondrial transmembrane potential were not observed. In addition, cytochrome c release did not occur in PS-induced apoptosis. A pan caspase inhibitor, Z-VAD, significantly inhibited the apoptosis, but inhibitors of caspase-1, -3, -8 and -9 did not. Activities of caspase-1, -3, -8 and -9 were increased by treatment of the cells with camptothecin, but not with PS. These results suggest that PS-induced apoptosis occurs without the collapse of mitochondrial transmembrane potential and without the release of cytochrome c, in a manner independent of caspase-1, -3, -8 and -9.

UVA irradiation induces energy-independent phospholipid-flip in mammalian plasma membrane

Translocation from the outer to the inner membrane leaflet (flip) of phospholipids after ultraviolet A (UVA) irradiation was investigated in Chinese hamster ovary cells. Fluorescent 1-palmitoyl-2-[6-[(7-nitro-2-1,3-benzox- adiazol-4-yl)amino]caproyl]-sn-glycero-3-phosphoserine (NBD-labeled phosphatidylserine [NBD-PS]) was used to assay transbilayer lipid movement. A marked increase in flip of NBD-PS was observed immediately after low-dose UVA irradiation which was not lethal and returned to the basal level after 6 h. UVA-induced flip was not attributed to the increase of permeability by UVA irradiation because cells that were negative for staining with propidium iodide also showed increased flip of NBD-PS. Furthermore, the enhancement was independent of adenosine 5'-triphosphate, demonstrating the lack of involvement of phospholipid translocase. Marked increases were also observed in flip of both NBD-phosphatidylethanolamine and NBD-phosphatidylcholine immediately after UVA irradiation, showing that the increase was independent on the head groups of phospholipids. These findings indicated that UVA changes the flip-flop of phospholipids and that the cell membrane is a molecular and cellular target of UVA.

Purification of the major allergen of red soft coral (Dendronephthya nipponica)

Red soft coral (RSC; Dendronephthya nipponica, a marine coelenterate) causes spiny lobster fishermen living along the Pacific coast of Miyazaki Prefecture in Japan to develop occupational allergies, such as conjunctivitis, rhinitis, dermatitis and bronchial asthma. The aim of this study was to purify and to characterize RSC allergen, which causes occupational asthma in spiny lobster fishermen. The allergic responsiveness of spiny lobster fishermen to RSC was examined. The examinations included specific IgE production, skin test responses, lymphocyte stimulation tests and specific IgG production. We found that RSC has a strong sensitizing activity in humans at a molecular weight of 10 kD or more, while it has no IgE-producing activity at a molecular weight of less than 10 kD. Neither the nonatopic controls nor the atopic non-coral-allergic controls exhibited any RAST-binding activity to any fraction. For the purification and the identification of this new allergen component, repeated gel filtration of the RSC extract was performed on a Sephacryl S-200 column, followed by gel filtration on a Superose-6 column. The purified major allergen component Den n 1, which is separated on a Mono-Q column, showed intradermal responses, lymphocyte stimulating activity and specific IgG-producing activity in RSC-induced bronchial asthma patients. The 53-kD component was electroblotted on a polyvinylidene difluoride membrane. The N-terminal amino acid sequence of this new allergen component (Den n 1) was determined as Asp-Asp-Ile-Asn-Arg-Tyr-Ala-Phe-Asp-Asn-Lys-Ile-Asn- Asp-Lys-Leu-Phe-Asp-His-Trp-Gln-Ser.

Synthetic and theoretical studies on group-transfer imidoylation of organotellurium compounds. remarkable reactivity of isonitriles in comparison with carbon monoxide in radical-mediated reactions

Imidoylation of organotellurium compounds with isonitriles has been investigated in conjunction with the radical-mediated C1 homologation reaction by using CO and isonitriles. Carbon-centered radicals generated photochemically or thermally from organotellurium compounds react with isonitriles in a group-transfer manner to give the corresponding imidoylated products. Organotellurium compounds have been found to serve as effective precursors of a wide variety of stabilized radicals, namely benzyl, alpha-alkoxy, alpha-amino, and acyl radicals, which take part in the imidoylation with high efficiency. The reactions are compatible with various functional groups, and can be carried out in various solvents including environmentally benign water. The reactivity of isonitriles has been compared with that of CO through competition experiments, and the results indicate that isonitriles are superior to CO as radical acceptors in reactions with stabilized radicals. The origin of the differences has been addressed in theoretical studies with density functional theory calculations using the B3LYP hybrid functional. The calculations suggest that both carbonylation and imidoylation proceed with low activation energies, and that there are virtually no differences in the kinetic sense. Instead, it indicates that thermodynamic effects, namely differences in the stability of the acyl and the imidoyl radicals, control the overall course of the reactions.

Identification and cloning of genes associated with the guinea pig skin delayed-type hypersensitivity reaction

Although the cellular and molecular mechanisms underlying the delayed-type hypersensitivity (DTH) reaction have been investigated, the functions of infiltrating leukocytes and skin resident cells in the elicitation phase of the DTH reaction are not completely understood. To gain more insight into the role of these cells in the DTH reaction, we identified about 250 cDNA fragments showing elevated expression during the DNCB-induced guinea pig skin DTH reaction by differential display analysis. Characterization of 50 of them led to the identification of 28 genes whose expression was elevated in the DNCB-induced DTH reactive tissue. Sequencing of the 28 cDNA fragments and homology search analysis demonstrated that 10 of them represented known genes, some of which, in particular elafin (an elastase inhibitor) and ferritin, are considered to play roles in the DTH reaction. The other 18 fragments are probably derived from unknown genes. Cloning of the cDNAs of one of these genes indicated that it is that for guinea pig tryptophanyl-tRNA synthetase (WRS), a protein found to be induced by interferon-gamma and upregulated during the late stages of mononuclear phagocyte maturation in vitro. Strong induction of the WRS gene during the DTH reaction suggests its involvement in the in vivo immune response.

[A lung cancer patient whose renal scintigram showed transient renal dysfunction after administration of contrast material for CT]

We encountered a patient whose renal scintigram showed renal tubular damage four days after administration of contrast material for CT. As no secretion of radioisotope to the urinary tract was observed on the scintigram and the renogram did not show a secretionary phase, renal tubular damage was suspected. As the renal damage disappeared six days after administration of the contrast material, the damage seemed to be transient, disappearing within five days. Caution is needed with the use of renotoxic drugs such as anti-tumor drugs, especially within five days after administration of contrast materials.

Catalytic Activity of Hexokinase in Reversed Micelles

Reversed micelles can control the size of water pools and the physical property of water by changing W(0)(=[water]/[surfactant]). Hexokinase (HK) activity seems to be easily affected by the microenvironment in the neighborhood of the enzyme because it is assumed that HK binds to the outer mitochondrial membrane by insertion of its hydrophobic NH(2) tail. The catalytic activity of HK was examined in reversed micelles in order to study the effect of the microenvironment in the neighborhood of HK on the activity. Sodium bis(2-ethylhexyl)sulfosuccinate (AOT), hexadecyltrimethyl ammonium chloride (HTAC), and octaoxyethylene dodecyl ether (C(12)E(8)) were used as anionic, cationic, and nonionic surfactants, respectively. HK activity was obtained by measuring ATP and ADP amounts with HPLC. The high electrostatic inner surfaces of AOT and HTAC reversed micelles were not favorable for HK to exhibit the catalytic activity, but the activity in HTAC reversed micelles was 2-3 times higher than that in AOT reversed micelles and the activities in both reversed micelles revealed an optimum at W(0)=10. The phenomenon was discussed in connection with the location of HK, nonuniform distribution of substrates, and the size and physical properties of the water pools. On the other hand, HK activity was much higher in C(12)E(8) reversed micelles than in AOT and HTAC reversed micelles and increased with the concentration of C(12)E(8). This suggests that HK activity is easily revealed in hydrated ethylene oxide chains. In conclusion, it was demonstrated that HK activity depends on the microenvironment such as the electrostatic field, the physical properties of water, and the hydrophobicity. Copyright 2001 Academic Press.