An RT-PCR-based multi-gene prognostic signature predicts distant metastasis of node negative, ER positive breast cancer from FFPE sections

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Background: Gene expression profiles have been shown to predict distant metastasis risk in breast cancer patients. For routine medical practice, molecular prognostic tests need to be able to quantify metastasis risk with readily available samples and optimally employ regulatory-approved platforms. Methods: 142 early stage, N-, ER+, untreated breast cancer patients were chosen. Mean age was 61.8 (31 - 89) yrs with 72% > 55 yrs. RNA was isolated from 4×10 μm FFPE sections. Using real-time RT-PCR, 200 genes selected from van ‘t Veer et al, Dai et al, Paik et al and additional candidate genes were profiled. Primary endpoint was distant metastasis free survival. A prognostic signature was identified using semi-supervised principal component method. Metastasis score (MS) was calculated from gene expression levels. Results: We identified a unique 15-gene prognostic signature and 3 normalization genes. Probability of metastasis for any time period can be calculated from MS and was evaluated for 2, 5, and 10 yrs. Using median of MS to stratify patients, the high-risk group had a hazard ratio (HR) of 4.1 (95%CI 1.77–9.54, p = 0.001) vs. the low-risk group. 5-yr and 10-yr metastasis free survival rates (std. error) were 0.76 (0.053) and 0.62 (0.064) in the high-risk group and 0.96 (0.025) and 0.90 (0.038) in the low-risk group. Multivariate Cox regression analyses indicated that molecular signature had independent prognostic value with HR of 2.97 (95%CI 1.17 - 7.52, p = 0.022) after adjusting for age, tumor size and grade. Molecular signature was more prognostic in the low-grade subgroup (HR = 6.85, 95%CI 1.81–25.88) than an unstratified analysis. AUC at 5 yr was 0.65 and 0.60 for molecular signature and Adjuvant Online (AO) respectively. The prognosticator combining both had AUC of 0.67. 10-yr metastasis probabilities from MS and AO have low correlation (R2=0.17). Conclusions: A prognostic signature based upon mRNA expression of 15 genes has been identified using FFPE sections with RT-PCR for early stage, N-, ER+ patients. Metastasis score that quantifies distant metastasis risk for any time period, not confounded with any treatment effect, can help clinicians and patients to choose among different therapeutic options. (Lau and Wang contribute equally)

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[Purification and antimicrobial activity of human neutrophil defensins]

Neutrophils are one of the weapons of host defenses against microbial infection. Their ability to kill the invading microorganisms depends on two principle mechanisms. One depends on production of reactive oxygen intermediates (ROI) by stimulated neutrophils, and the other depends on the delivery of antimicrobial contents of the neutrophils' cytoplasmic granules, oxygen-independent. The defensins have the highest concentration in the neutrophils, and the broadest antimicrobial spectrum, being capable of killing gram-positive and gram-negative bacteria, fungi and some envelope viruses. We purified human defensins from the neutrophils' granules by gel permeation chromatography and SDS-preparative acrylamide gel electrophoresis. The molecular weight of human defensins is between 3,000-4,000 daltons. After testing, C. neoformans was susceptible to these defensins. Under condition of 37 degrees C, pH 7.4 and low ionic strength, antifungal activity by human defensins was related to its concentration and incubating time. All of these illustrate that nonoxidative killing mechanism of neutrophils, especially the function of defensins is very important in host defenses.

[Clinical effects of free peroneal artery perforator flaps in repairing forefoot skin and soft tissue defect wounds assisted with three-dimensional computed tomography angiography]

Objective: To investigate the clinical effects of free peroneal artery perforator flaps in repairing forefoot skin and soft tissue defect wounds assisted with three-dimensional computed tomography angiography (3D-CTA). Methods: A retrospective observational study was conducted. From March 2017 to September 2019, 15 patients with skin and soft tissue defect wounds in the forefoot were treated in the Department of Burn and Plastic Surgery of Yidu Central Hospital of Weifang, including 12 males and 3 females, with age of 18-60 years. The wound area on admission was 3.0 cm×3.0 cm-9.0 cm×8.0 cm. The 3D-CTA examination before operation was performed to select the peroneal artery perforating vessels with appropriate length of vascular pedicle and good blood perfusion. According to the wound area and the perforating vessels of the peroneal artery located by 3D-CTA, the peroneal artery perforator flaps of 3.5 cm×3.5 cm-9.5 cm×8.5 cm carried with lateral sural cutaneous nerve was designed and cut, and the nerve was anastomosed with the nerve of the wound. The wound in the donor site of the flap was directly sutured or covered with medium-thickness skin graft from the thigh. The consistencies of type, diameter, and perforating position of perforating vessel of the peroneal artery detected by 3D-CTA before the operation with those of the actual measurement during operation were observed. The length of time for flap cutting and the survival of the flap after operation were recorded. During follow-up of 12 months after the operation, the patients were instructed to evaluate the foot function according to the Maryland foot function score standard, and the wound healing in the donor area and the occurrence of complications affecting the motor function of limb were observed. Data were statistically analyzed with paired sample t test. Results: The types of peroneal artery perforating vessels in patients measured during the operation were septocutaneous perforator of 12 cases, musculocutaneous perforator of 2 cases, and musculomuscular septal perforator of 1 case, which were consistent with those measured by preoperative 3D-CTA. The diameter of the peroneal artery perforating vessel measured by preoperative 3D-CTA was (1.38±0.17) mm, which was close to (1.40±0.19) mm measured during the operation (t=0.30, P>0.05). The horizontal distance from the starting point of the perforating vessel to the outer edge of the shank was (42±6) mm, and the vertical distance from the starting point of the perforating vessel to the level of the lateral ankle tip was (219±14) mm measured by preoperative 3D-CTA, which were respectively close to (43±6) and (221±15) mm of intraoperative measurement (with t values of 0.46 and 0.38, respectively, P>0.05). The length of time for cutting flap was (31±6) min. All flaps survived post operation without vascular crisis. During follow-up of 12 months after the operation, the foot function was evaluated as excellent in 11 cases, good in 3 cases, and fair in 1 case, the donor site wound healed well, the scar was not noticeable with no contracture, and the motor function of joints was not affected. Conclusions: Free peroneal artery perforator flap is one of the effective methods to reconstruct skin and soft tissue defect wounds in the forefoot, and the risk of surgery can be reduced when the anatomical location of the perforating vessels is confirmed by 3D-CTA.

Transforming growth factor beta differentially regulates expression of integrin subunits in guinea pig airway epithelial cells

The integrin family is composed of a large number of heterodimers, each one mediating distinct interactions with extracellular matrix and/or cell surface ligands. The expression of integrins appears to be tightly regulated in vivo, but the mechanisms by which cells control the formation and surface expression of specific pairs of subunits have not been well characterized. Two integrin subunits, the alpha subunit alpha v, and the beta subunit beta 1, could pose special problems in regulation because of their capacity to associate with multiple partners. In the present study, we have examined the effects of the cytokine transforming growth factor beta 1 (TGF-beta 1) on the expression of alpha v- and beta 1-containing integrins in primary cultures of guinea pig airway epithelial cells, e.g. cells that we have previously found to express multiple potential partners for both alpha v and beta 1. TGF-beta 1 increased the surface expression of both alpha v- and beta 1-containing heterodimers after periods of stimulation from 24 to 72 h. These increases in surface expression were associated with significant increases in the concentrations of mRNA encoding each of the partners of alpha v and beta 1, but with only minimal increases in mRNA encoding alpha v and beta 1 themselves. Airway epithelial cells metabolically labeled with [35S]methionine during stimulation with TGF-beta 1 demonstrated only a minimal increase in the synthesis of new alpha v protein at a time when synthesis of alpha v's beta subunit partners and surface expression of alpha v-containing heterodimers were dramatically increased. These data suggest that, at least in some cells, promiscuous integrin subunits (both alpha and beta) may normally be synthesized in excess. Thus, the surface expression of specific integrin heterodimers can be regulated primarily through regulation of the synthesis of the specific partners of these subunits.

Ultrastructural calcification of glomerular immune complexes

We report a previously undescribed ultrastructural calcification of glomerular immune complex depositions in a patient with lupus nephritis. Such processes give rise to a distinctive ultrastructural calcified microspheriol in electron-dense immune deposits, and were associated with hypercalcemia and nephrocalcinosis. The cause of hypercalcemia in this patient was uncertain, but related to a granulomatous inflammation and abscess of the breast. Whereas ultrastructural microcalcification was associated with hypercalcemia, its distribution in the segmental glomerular lesions suggests that an inflammatory process was contributory. The clinical follow-up indicates that the microcalcifications of immune complexes have not affected the outcome of nephritis and renal function.

[The cloning of threonine operon in vivo and mutagenesis in vitro in E. coli]

Report here was the selection of the E. coli strain producing 1.2% threonine. The wild type threonine operon was cloned in vivo and subcloned in vitro. The subclone was mutagenizied in vitro and a clone pTHR12-9-1 producing threonine was obtained. Also the effect of pTHR12-9-1 on threonine yield of hosts producing different amount of threonine was studied. We found that pTHR12-9-1 could promote the production of threonine in lower yield hosts, but it reduced the production of threonine in higher yield hosts. The phenomenon was discussed.

A60 THE NEURAL SIGNAL, CALCITONIN GENE-RELATED PEPTIDE (CGRG) ENHANCES A REGULATORY PHENOTYPE IN THE HUMAN IL-4 TREATED HUMAN MACROPHAGE

Background

Recent studies in pre-clinical models of disease have revealed the ability of murine and human IL-4-treated macrophages (M(IL4)) to promote wound recovery and reduce the severity of colitis. An unbiased RNA-sequence analysis of human blood-derived macrophages revealed increased expression of the RAMP1 chain of the CGRP receptor in IL-4 treated cells, raising the intriguing possibility of neural control of regulatory macrophages in the context of neuroimmune interaction in colitis. Thus, we sought to address if this mRNA signal translated into increased RAMP1 protein, if/how CGPR affected M(IL4) function, and if this applied to macrophages from patients with IBD as well as those from healthy donors.

Aims

To determine if CRGP-RAMP1 signalling in human IL-4 treated macrophages enhances a regulatory phenotype.

Methods

Peripheral blood mononuclear cells from healthy volunteers and individuals with IBD were cultured on plastic (2h, 37°C) and non-adherent cells removed. The adherent cells were cultured with recombinant hM-CSF (10 ng/ml) for 7 days. The resultant macrophages (2.5×105) were differentiated with IL-4 (48h 20 ng/mL) and assessed by qPCR and immunocytochemistry. In other cells, CGRP (10 nM) was added 24h after IL-4 and (1) cAMP (2) cytokines and (3) phagocytosis of inert FITC-beads measured, and (4) the capacity of supernatant from the cells to promote healing in wounded Caco2 epithelial monolayers tested.

Results

Compared to non-treated macrophages (M(0)), M(IL4)s from healthy individuals had increased mRNA for both chains of the CGRP-receptor (i.e. RAMP1 and CLR), and increased surface expression of the receptor as shown by immunostaining and CGRP-evoked cAMP. The IL-4 evoked RAMP1 mRNA was only detected in macrophages from 50% of the patients with active IBD. M(IL4)s treated with CGRP showed enhanced expression of the mannose receptor (CD206, allows detection of bacteria), increase phagocytosis of inert beads/macrophages. Moreover, CGRP increases VEGF and CCL18 expression in M(IL4), and soluble mediators from these cells promoted in vitro epithelial wound repair.

Conclusions

Reduced expression of CGRP and its receptor has been shown in IBD. The findings herein, demonstrating how CGRP-RAMP1 signalling can reinforce and enhance a regulatory, reparatory phenotype in human macrophages reveals another aspect of IBD pathophysiology. We speculate that loss of this neuroimmune axis (i.e. CGRP/Nerve-M(IL4) interaction) has the potential to significantly impair mucosal healing in IBD.

Funding Agencies

CCCAlberta Innovates in Health Innovation

[Role of hyperinsulinemia in pathogenesis of polycystic ovary syndrome and treatment by reduction of insulin secretion]

OBJECTIVE

To investigate the role of insulin in the polycystic ovary syndrome (PCOS) pathogenesis and application of Metformin in the treatment of PCOS.

METHODS

Serum androgen, luteinizing hormone (LH) and sex hormone-binding globulin(SHBG) concentration during fasting and serum 17 alpha-hydroxyprogesterone (17-OHP), LH level in response to gonadotropin-releasing hormone agonist (GnRH-a) stimulation were determined. Oral glucose-tolerance tests(OGTT) before and after oral administration of metoformin for 8-12 weeks were performed in 12 obese and 11 lean women with PCOS.

RESULTS

After oral administration of metformin for 8-12 weeks, fasting insulin concentration in obese group and area under curve (AUC) after OGTT in lean group decreased significantly. There were significant decrease in basal 17 alpha-hydroprogesterone, androstenedione, testosterone concentration, and increase in serum SHBG concentration in obese and lean groups. Basal LH and the response of serum 17-OHP, LH to GnRHa were not significantly changed.

CONCLUSIONS

Hyperinsulinemia may play an important role in hyperandrogenism GnRH-a of PCOS, and metformin may be used in the treatment of PCOS.

[Determination of captopril plus its disulfide metabolites in human plasma]

A new and sensitive HPLC method has been developed for the determination of captopril plus its disulfide metabolites (total captopril) in human plasma. Captopril disulfides and the drug covalently bound to protein were reduced with sodium borohydride to captopril. After liquid-liquid extraction, captopril was treated with o-phthalaldehyde in the presence of D-phenylalanine. The fluorescent derivative of captopril was measured by HPLC using a C-18 reversed phase column with fluorescence detection at the excitation and emission wavelengths of 235 nm and 440 nm, respectively. The mobile phase consisted of a methanol-acetonitrile-phosphate buffer (0.02 mol.L-1, pH 6.4) mixture (30:30:135, v/v), and was set at a flow rate of 1 ml.min-1. The linear range of the assay was between 5 ng.ml-1 (lower limit of quantitation) and 300 ng.ml-1 for total captopril in plasma. The method was successfully applied to determine plasma concentrations of captopril plus its disulfide metabolites in hypertensive patients and was demonstrated to be suitable for the therapeutic drug monitoring.

[Comparison of roxithromycin bioavailability of a conventional and a dispersible tablet formulation]

Following oral administrations of a single dose of 150 mg roxithromycin dispersible tablet (formulation A, a new formulation for clinical trial) and conventional tablet (formulation B, purchased from the market) to each of 10 healthy male volunteers in a randomized crossover design, the plasma levels of active drug at different times were determined by a microbial assay with Micrococcus luteus CMCC (B) 28001 and the plasma concentration-time profiles were obtained. The Tmax values of formulation A and B obtained were 1.7 +/- 0.9 and 3.7 +/- 1.6 h, the Cmax values were 4.97 +/- 1.17 and 2.04 +/- 1.26 micrograms.ml-1 and the AUC0-->infinity values were 62.2 +/- 11.9 and 35.0 +/- 16.9 micrograms.h.ml-1, respectively. Surprisingly, the relative bioavailability of formulation B was found to be only 59.8% +/- 32.6% (P < 0.01). The low bioavailability of the latter formulation was attributed to poor release of roxithromycin in the gastric site, which was proposed as a key factor to influence drug absorption. Other related factors were also discussed.

[Long-term monitoring of artificial vagina reconstructed with sigmoid colon]

OBJECTIVE

To observe the influence of the artificial plastic vagina on overall patient health.

METHODS

Length and width of the artificial vagina were measured. Histological studies were performed under light and electron microscope. Vaginal bacterial flora were analyzed using the drop-implant method. Vaginal HPV and ER were detected with ABC histochemical staining.

RESULTS

According to the results of anatomic measurements, artificial vagina was similar to normal vagina. The reductions of glands in the mucosa and collagen fibers as well as interstitial tissue hyperplasia in the lower segment of artificial vagina were documented. Four kinds of bacteria indigenous to the sigmoid colon were found in artificial vagina and were studied microbiologically with only differences in the amount and detection rates of bacteria flora. The positive presentation of HPV was not significantly different from that in the control group. The positive presentation of estrogen receptor (ER) in the epithelium of artificial vagina was not found.

CONCLUSION

The reconstruction of artificial vagina with sigmoid colon is a safe, effective and satisfactory procedure for the patient.

[Precipitation of chlorella virus FJ-1 by polyethylene glycol(PEG8000)]

Chlorella virus FJ-1 was isolated in Fujian Province of China. It can be precipitated by polyethylene glycol(PEG8000) and the best condition if 7% PEG8000 and 4% NaCl. But the precipitation efficiency of PEG8000 is lower than that of ultracentrifugation.