Positive Correlation between Matrix Metalloproteinases and Epithelial-to-Mesenchymal Transition and its Association with Clinical Outcome in Bladder Cancer Patients

Involvement of matrix metalloproteinases (MMPs) in the pathogenesis of urothelial carcinoma elects them to be sensitive marker for clinical and prognostic implications. MMPs regulate tumor growth and invasion by inducing epithelial-to-mesenchymal transition (EMT) which is characterized by the complex reprogramming of epithelial cells and ultimately bring about major changes in the structural organization of bladder urothelium. The present study has been undertaken to evaluate the clinical relevance of MMPs in two distinct types of bladder cancer disease. Expression analysis of MMPs namely MMP-2, MMP-7, MMP-9 and EMT markers including epithelial marker, E-cadherin; mesenchymal markers, N-cadherin and Vimentin; and EMT-activating transcriptional factors (EMT-ATFs), Snail, Slug, Twist and Zeb was done in 64 cases of bladder tumor tissues [{Non-muscle invasive bladder cancer (NMIBC): 35 cases} and {Muscle invasive bladder cancer (MIBC): 29 cases}] by real-time quantitative polymerase chain reaction (RT-qPCR). Immunohistochemistry (IHC) staining was done in matched bladder tumor tissues to evaluate the protein expression and localization of E-cadherin, N-cadherin, Vimentin, Snail, and Slug. Our data showed overexpression of MMP-2, MMP-7 and MMP-9 at transcriptome level in 32.8%, 25% and 37.5% bladder tumor cases respectively. These tumor tissues were examined for higher expression of mesenchymal markers (N-cadherin and Vimentin) at mRNA and protein level and exhibited statistical association with tumor stage and tumor grade (p = 0.02, p = 0.04, Mann-Whitney test). Significant statistical correlation in tumor tissues with overexpressed MMPs has also been observed between gain of transcriptional factors and weak expression of E-cadherin with tumor stage, grade, gender, presence of hematuria and smoking history of the patients. Gene expression patterns of EMT markers in bladder tumors with overexpressed MMPs and their significant association with clinical profile validate the important role of MMPs in the pathogenesis of urothelial carcinoma of bladder (UCB). Increased expression of specific MMPs may affect several downstream EMT programs and thus may improve its diagnostic and prognostic utility in clinical setting.

Abstract P1-05-29: Genomic variants in 5 male breast cancers using whole exome sequencing

This abstract was not presented at the symposium.

Abstract P1-11-07: Frozen section histology evaluation of surgical margins helps perform single step oncologically safe and cost-effective breast conservation surgery

This abstract was withdrawn by the authors.

Urinary B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL): potential biomarkers of active lupus nephritis

B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) help in B cell activation, maintenance and plasma cell survival. B cell infiltration has been demonstrated in kidneys of patients with lupus nephritis (LN). Serum levels of BAFF and APRIL have shown inconsistent relationships with lupus disease activity. We evaluated urinary levels of BAFF and APRIL as biomarker for LN. Thirty-six patients with proliferative lupus nephritis (AN), 10 with active lupus without nephritis (AL) and 15 healthy controls (HC) were studied. APRIL and BAFF levels were measured in both serum and urine using enzyme-linked immunosorbent assay (ELISA). Urine levels were normalized for urinary creatinine excretion. Urine levels were correlated with conventional disease activity markers and histology. Levels were reassessed in 20 AN patients at 6 months after treatment with cyclophosphamide. Urinary APRIL (uAPRIL) and BAFF (uBAFF) levels were raised significantly in AN. uAPRIL, but not uBAFF, correlated moderately with renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in AN (r = 0·36, P < 0·05). On receiver operator curve (ROC) analysis, uBAFF and uAPRIL showed an area under the curve (AUC) of 0·825 and 0·781, respectively, in differentiating between nephritis and non-nephritis, which performed better than low C3, C4 and raised anti-dsDNA antibodies. There was no correlation of serum levels with uBAFF (r = 0·187, P = 0·261) and uAPRIL (r = 0·114, P = 0·494). uAPRIL levels reduced after treatment (mean 125 pg/mg to 36 pg/mg, P < 0·05). uBAFF levels reduced in 16 responders while two of four non-responders had increase in levels. Thus, uBAFF and uAPRIL are potential biomarkers of proliferative lupus nephritis.

The association between illicit drug use and infectious complications among trauma patients

Management of patients with traumatic injury is a complex endeavor requiring a concerted effort of multi-organ stabilization and prevention of septic shock. Given that traumatic injury is frequently mediated by illicit drug use, which has previously been associated with immune suppression, it is hypothesized that infectious complications may occur more prevalently in this patient population. In this study, we evaluate the incidence of infectious complications in trauma patients who screened positive for illicit drug abuse. The national trauma databank was queried for all patients who underwent laboratory evaluation for drug use between 2002 and 2009 and between 2013 and 2014. Patient demographics, clinical outcomes (injury severity score [ISS], intensive care unit length of stay [ILOS], hospital length of stay [HLOS], mortality, risk-adjusted ILOS [rILOS] or HLOS [rHLOS]) and infectious complications (pneumonia, superficial surgical site infection, organ space infection, deep space surgical site infection and urinary tract infection) were attained. Out of 5,564,821 incidents, 525,052 admissions met the inclusion criteria. Patients were 41 ± 19 years of age and 72 % were male. Patients positive for drug use were 1.1-fold more likely to develop pneumonia, 1.2-fold more likely to develop superficial site infection, and 1.3-fold more likely to develop organ space infection. No statistically significant variations in ILOS, HLOS, rILOS, rHLOS or mortality were noted. Traumatic patients who screen positive for illicit drug use are more likely to develop infectious complications. Therefore, vigilance and appropriate preventative measures should be considered in this unique group of patients.

Abstract P3-01-06: Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients

Background:

Sentinel lymph node biopsy (SLNB) is the current standard of care for surgical staging of clinically node negative axilla (N0) early breast cancer patients undergoing primary surgery. SLN- identification rate (IR) of 90% and SLN- false negative rate (FNR) of 10% are considered minimum acceptable indices for SLNB. Its role in staging axillae in patients undergoing post-NACT surgery is somewhat unclear. In India, and most low-and-middle income countries, large operable breast cancers (LOBC) and locally advanced breast cancers (LABC) constitute a large proportion of breast cancer patients treated. These patients are usually are treated with NACT, followed by surgery and radiation therapy. In a prospective validation SLNB study, we investigated the accuracy of SLNB in staging post-NACT N0 axilla in a patient cohort that were LOBC or LABC at the time of initial presentation.

Methods:

Hundred consenting non-inflammatory LOBC/LABC patients (mean age 49.3+8.6; index stage T3,N0-1=21; T4b,N0-1=33; T1-3,N2a=24; T4b,N2a=22) who were N0 after NACT at time of surgery (Breast conservation surgery in 19, Mastectomy in 81) were included. Majority had Infiltrating ductal carcinoma (n=87), and grade II/III tumors (n=93); 45 were hormone receptor positive (+), 29 had HR negative (-) HER2(+); and 26 had triple negative breast cancer on IHC sub-typing. Commonest NACT regimen used was Anthracycline followed by taxanes in 83. SLNB was performed using low-cost methylene-blue and 99mTc-Antimony-colloid, which were produced in-house using well standardized protocols, with clearance of the institutional ethics committee. Irrespective of the SLN histology, a complete axillary dissection (ALND) was carried out in all. SLN-IR and SLN-FNR were calculated, comparing the histological status of the SLN and the ALND specimen. Factors predicting non-identified SLN and false negative SLN were evaluated in uni-variate and multi-variate analysis.

Results:

With a combination of methylene blue dye and radiopharmaceutical, the SLN-IR was 81%. Mean number of SLN removed was 2.4+/-1.02. Mean number of nodes removed at ALND was 13.3+/-2.2. SLN-IR varied significantly (p&lt;0.05) per index stage, and were- 90.4% in T3,N0-1; 84.4% in T4b,N0-1; 83.3% in T1-3,N2a; and 63.6% in T4bN2a. The FNR was 17.3% for the whole cohort. FNR varied significantly (p&lt;0.05) per index stage, and were- 8.3% in T3,N0-1; 14.9% in T4b,N0-1; 22.2% in T1-3,N2a; and 30% in T4bN2a. Factors found predictive of non-identified SLN were tumor stage T4b, nodal stage N2a, extra-nodal spread, and LVI. Factors found predictive of FNR SLN were tumor stage T4b, nodal stage N2a, and extra-nodal spread.

Conclusions:

Considering SLN-IR of 90% and SLN-FNR of 10% as acceptable standards, SLNB in post-NACT N0 patients undergoing surgery was not found robust in staging the axilla, with the exception of patients with index stage T3,N0-1 who had SLN-IR of 90.4% and SLN-FNR of 8.3%. Patients with (pre-NACT) skin involvement(T4b), matted axillary nodes(N2a) and LVI are fraught with high-risk of non-identification and false-negative SLNB.

Citation Format: Agarwal G, Gambhir S, Lal P, Rajan S, Krishnani N, Mishra A, SabaRetnam M, Agarwal A, Chand G, Verma AK, Mishra SK, Kumari N, Agrawal V, Kheruka SC. Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-06.

Abstract P6-03-08: Novel recurrent lncRNA fusions detected in breast cancer using RNA-Seq technology in a neoadjuvant setting

Background: Recent discoveries of recurrent and targetable gene fusions in breast cancer suggest the need to characterize the functional significance of such genomic aberrations within larger cohorts. We quantified fusion transcript expression in patient samples using RNASeq to identify recurrent gene fusion events in breast cancer as well as study the fusions post-brief exposure to mono-therapy.

Methods: We sequenced transcriptomes of core biopsy RNA from 130 breast tumors obtained from brief-exposure preoperative clinical trials BrUOG 211A/211B. HER2- patients were treated with brief exposure to bevacizumab (B) or nab-paclitaxel (nP) followed by treatment with B/nP/carboplatin while HER2+ patients received brief exposure to trastuzumab (T) or nP followed by T/nP/carboplatin. Paired-end sequencing on 75 baseline biopsies and 55 post-exposure biopsies using amplified total RNA yielded 55 million reads on average perlsample. Fusion transcript abundance was evaluated using 2 pipelines, TopHat-Fusion and deFuse, due to their complementary strategies in fusion detection. We eliminated gene-pseuodogene fusion pairs as likely false positives arising due to alignment artifacts. Fusions that met 1 or more of the following 3 criteria were considered high confidence:

i) Called by both deFuse and TopHat. ii) Called by deFuse with probability &gt;95% iii) Called by TopHat with &gt; 15 reads supporting the fusion.

Results: We identified high confidence gene fusions, detected by both TopHat and deFuse, in 73 of the 75 baseline biopsies with 16 fusions on average per sample. We looked for modulation of gene fusions upon brief exposure to therapy in 55 patients that had post exposure biopsy data and found that out of the 545 high confidence fusions detected across these patients, 62 (11.37%) of the fusions were found to be still present after the therapy exposure. For the recurrent fusion analyses, we considered the 75 baseline samples. We found a total of 1158 unique candidate fusions. Out of these, 116 (10%) were recurrent in more than 1 patient. After further filtering, we were able to narrow down to 9 (0.77%) fusions that were reliable since they were predicted by both the algorithms in different patients. 2 of these 9 fusions involved GAS5 as a partner gene. GAS5 have been studied to have a role in apoptosis and its down-regulation has been associated with cell proliferation, which makes it a very interesting fusion candidate.

Conclusions: We find that gene fusions in breast cancer are highly heterogeneous but are enriched with cancer-related pathway genes. This is the first study to report 2 novel gene-lincRNA fusion transcripts: MDN1-GAS5 and GABRB3-GAS5. Both these fusions are called in the baseline & post-therapy for atleast 1 patient (different patients each). GAS5 has been found as participating in a fusion in B-cell lymphoma. We are currently in the process of validating the fusion calls using qRT-PCR. The heterogeneity of detected fusions suggests that multiple mechanisms could underlie the selective advantage of tumor cells expressing fusion transcripts. The brief-exposure preoperative paradigm provides a unique opportunity to evaluate modulation of fusion transcripts that can shed light on their functional importance.

Citation Format: Agrawal V, Varadan V, Banerjee N, Miskimen K, Vadodkar A, Abu-Khalaf M, Sikov W, Harris L, Dimitrova N. Novel recurrent lncRNA fusions detected in breast cancer using RNA-Seq technology in a neoadjuvant setting. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-03-08.

Anti-glomerular basement membrane crescentic glomerulonephritis: A report from India and review of literature

Anti-glomerular basement membrane (anti-GBM) disease is an autoimmune disease that most commonly presents as rapidly progressive glomerulonephritis with or without pulmonary involvement. It is characterized by the presence of antibodies directed to antigenic targets within glomerular and alveolar basement membranes. This study was performed to evaluate the clinicopathological features and outcome in anti-GBM crescentic glomerulonephritis (CrGN) at a tertiary care center in North India over a period of 9 years (January 2004 to December 2012). A diagnosis of anti-GBM CrGN was made in the presence of >50% crescents, linear deposits of IgG along GBM, and raised serum anti-GBM antibody titer. Of 215 cases of CrGN diagnosed during this period, 11 had anti-GBM CrGN. Anti-GBM CrGN was found at all ages but was most common in the third to fifth decade with no gender predilection (mean age 48 +/- 15 years, 13–67 years). Patients presented with a mean serum creatinine of 10.2 +/- 5.3 mg/dl and sub-nephrotic proteinuria. Pulmonary involvement was present in two patients. Myeloperoxidase-antineutrophil cytoplasmic antibody was positive in two (2/11) elderly patients. Follow-up was available in four patients for a range of 30-270 (mean 99.5 ± 114.5) days, two remained dialysis dependent while two died due to uremia and sepsis. Our findings show that anti-GBM disease is a rare cause of CrGN in India, accounting for only 5% of patients. It usually presents as a renal-limited disease and is associated with a poor renal outcome.

Human Herpesvirus 8-Related Primary Effusion Lymphoma After Liver Transplantation

Primary effusion lymphoma is a rare subclass of non-Hodgkin lymphoma associated with human herpesvirus 8 infection and principally seen in human immunodeficiency virus-positive patients. We report on the case of a 72-year-old human immunodeficiency virus-negative male with a hepatic transplant 10 years prior, who presented with a symptomatic right-sided pleural effusion and was found to have primary effusion lymphoma by flow cytometric and cytopathologic examination. Immunohistochemistry of his lymphoma cells was positive for human herpesvirus 8. Both he and his donor had no identifiable risk factors for human herpesvirus 8 infection. The patient was intolerant of antiviral therapy and chemotherapy, dying 7 months after diagnosis. Posttransplant primary effusion lymphoma is exceedingly rare and carries a very poor prognosis. Individualized treatment strategies are necessary given the scant body of published literature with guidance based solely on case reports.

Immunoglobulin A dominant membranoproliferative glomerulonephritis in an elderly man: A case report and review of the literature

Immunoglobulin A (IgA) dominant membranoproliferative glomerulonephritis (MPGN) is rare, described only as case reports. We report a rare case of an elderly man presenting with rapidly progressive renal failure and nephrotic range proteinuria with histological, immunofluorescence, and ultrastructural findings supporting a diagnosis of IgA dominant MPGN. Autoimmune disease, cryoglobulinemia and infection-associated glomerulonephritis were excluded. Remission was achieved within 3 months of treatment. This case highlights an uncommon diagnosis with a good response to therapy. The differential diagnosis of IgA nephropathy with MPGN-like pattern is discussed.

The effects of glucose-lowering therapies on diabetic kidney disease

Chronic hyperglycemia and its associated metabolic products are key factors responsible for the development and progression of diabetic chronic kidney disease (CKD). Endocrinologists are tasked with detection and management of early CKD before patients need referral to a nephrologist for advanced CKD or dialysis evaluation. Primary care physicians are increasingly becoming aware of the importance of managing hyperglycemia to prevent or delay progression of CKD. Glycemic control is an integral part of preventing or slowing the advancement of CKD in patients with diabetes; however, not all glucose-lowering agents are suitable for this patient population. The availability of the latest information on treatment options may enable physicians to thwart advancement of serious renal complication in patients suffering from diabetes. This review presents clinical data that shed light on the risk/benefit profiles of three relatively new antidiabetes drug classes, the dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 analogs, and sodium glucose co-transporter 2 inhibitors, particularly for patients with diabetic CKD, and summarizes the effects of these therapies on renal outcomes and glycemic control for endocrinologists and primary care physicians. Current recommendations for screening and diagnosis of CKD in patients with diabetes are also discussed.

Abstract P4-04-07: Heterogeneous gene fusions detected by RNASeq show enrichment of insulin signaling pathway genes in breast cancer

Background: Recent discoveries of recurrent and targetable gene fusions in breast cancer suggest the need to characterize the functional significance of such genomic aberrations within larger cohorts. We quantify fusion transcript expression in patient samples using RNASeq and evaluate their functional significance using biological pathway enrichment analysis.

Methods: We sequenced transcriptomes of core biopsy RNA from 97 breast tumors obtained from brief-exposure preoperative clinical trials BrUOG 211A/211B. HER2- patients were treated with brief exposure to bevacizumab (B) or nab-paclitaxel (nP) followed by treatment with B/nP/carboplatin while HER2+ patients received brief exposure to trastuzumab (T) or nP followed by T/nP/carboplatin. Paired-end sequencing on 55 baseline biopsies and 42 post-exposure biopsies using amplified total RNA yielded 55 million reads on average per sample. We assigned RNASeq-based PAM50 subtypes for each of the samples using standard methodology. Fusion transcript abundance was evaluated using two independent pipelines, TopHat and deFuse, due to their complementary strategies in fusion detection. We eliminated fusions of genes with their respective pseudogenes as likely false positives arising due to alignment artifacts. TopHat fusion calls with total supporting reads ≥10 and deFuse calls with probability of fusion ≥0.7 were considered reliable.

Results: We identified high confidence gene fusions, detected by both TopHat and deFuse, in 30 of the 55 baseline biopsies (54.4%), with 3.3 fusions on average per sample and a maximum of 10. Fusions were predominantly associated with chromosomal aberrations (75%), with putative deletions responsible for 32% of fusions and translocations responsible for 43%. We find a high level of fusion transcript heterogeneity within breast cancers, detecting a total of 80 fusions across the 30 samples with only three fusions recurrent in two samples with high expression in each: MDN1-GAS5 in two basal breast cancers, KRAS-GRIP1 and ITPR2-CCDC91 in two LumB cancers. Several cancer-related genes were found to be fusion partners: AKT3-SMYD3, CREB1-PPP1R1C, FLOT2-TOP2A and FOXC1-ARID1B. Pathway analysis of the fusion genes at baseline revealed enrichment of proteasome (p = 0.000752), tight junction (p = 0.027), insulin signaling (p = 0.0284) and melanogenesis (p = 0.05) pathways after multiple testing correction (FDR≤0.25). We looked for modulation of gene fusions upon brief exposure to therapy in 18 patients and found a majority of the baseline fusion transcripts to be present post-brief exposure in 44% of the patients, irrespective of therapy regimen.

Conclusions: We find that gene fusions in breast cancer are highly heterogeneous but are enriched with cancer-related pathway genes. This is the first study to report a novel gene-lincRNA fusion transcript (MDN1-GAS5). We are currently validating the fusion calls using qRT-PCR. The heterogeneity of detected fusions suggests that multiple mechanisms could underlie the selective advantage of tumor cells expressing fusion transcripts. The brief-exposure preoperative paradigm provides a unique opportunity to evaluate modulation of fusion transcripts that can shed light on their functional importance.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-04-07.

Camel milk: a possible boon for type 1 diabetic patients

Poor nutrition in utero and in early life combined with over nutrition in later life may also play a role in epidemic of diabetes. The efficacy of camel milk consumption as an adjunct to routine diabetic management in type 1 diabetes is a approach showing new rays of hope to cope with this disorder by adding a food supplement with medicinal values. Research on the beneficial aspects of camel milk has been taking place in different corners of globe since last three decades. Continuous efforts to disclose the role of camel milk in diabetes has rendered it title of 'white gold&apos;. Biochemical studies has revealed the components e.g. insulin like protein, lactoferrin, immunoglobulins are responsible for imparting camel milk the scientific weightage. In parallel, epidemiological surveys stating low prevalence of diabetes in communities consuming camel milk clearly indicate towards its hopeful role in maintaining hyperglycemia. This article shades light on camel milk production, composition, characteristics as well as it expresses positive effect of camel milk on blood glucose level, insulin dose, beta cell function. This review also compiles various epidemiological studies carried out to bring forth utility of camel milk suggesting it as a useful food supplement or alternative therapy for type 1 diabetic patients.