Non-Thermal Plasma as a Unique Delivery System of Short-Lived Reactive Oxygen and Nitrogen Species for Immunogenic Cell Death in Melanoma Cells

Breakthroughs in cancer immunotherapies have demonstrated considerable success, though not without limitations. Non-thermal plasma (NTP) for cancer therapy has been emerging as a potential adjuvant treatment via induction of immunogenic cell death (ICD). Cancer cells undergoing ICD stimulate a patient's immune system to mount an anticancer response. While promising, the underlying mechanisms of NTP-induced ICD must be closely examined. Here, the interaction between non-thermal plasma and cancerous cells is studied. The short-lived reactive oxygen and nitrogen species (e.g., hydroxyl radicals, atomic oxygen, nitric oxide) produced by plasma are the main effectors that elicit ICD in melanoma while, surprisingly, persistent species do not. This is demonstrated in vitro using a dielectric barrier discharge plasma system and is validated in a vaccination assay in vivo. Plasma generation of reactive species appears to be dictated by the total energy. Collectively, this work provides fundamental insight into plasma interactions with biological material. Furthermore, it lays the foundation for future development of NTP systems for clinical translation. The addition of plasma systems into the existing arsenal of cancer therapies opens the possibility for new combination strategies for safer and more robust control of cancer.

Abstract P3-13-11: The outcomes of ReFilx soft tissue filler as an immediate reconstruction technique for lumpectomy followed by radiotherapy

Introduction: Lumpectomy for breast cancer can often result in poor cosmetic outcomes which can lead to long-lasting impairment of quality of life. ReFilx is a synthetic porous degradable polyurethane scaffold that has mechanical properties comparable to that of native healthy breast tissue. It has been shown in two previous porcine studies to preserve breast shape and volume over 9 months when inserted into the cavities immediately after lumpectomy. We observed minimal foreign body reaction with good integration of the host tissue while the material degraded over time. In this study, we examined the healing process of lumpectomy treated with radiation. Radiotherapy is currently a standard adjuvant therapy after lumpectomy for breast cancers; and radiation is known to affect the healing process in general. Objective: To evaluate ReFilx, as soft tissue fillers for lumpectomy cavities in combination with standard radiotherapy. Hypothesis: ReFilx will preserve breast shape and volume by supporting tissue infiltration with minimal inflammation in the presence of clinically relevant radiotherapy. Methods: 3 female Yucatan minipigs received lumpectomies carried out using electrocautery to remove normal breast tissue of approximately 2 cm diameter, after which the cavities were filled with (case) or without ReFilx (sham control) (n=3 for each condition, each pig has 12-13 breasts). 6 weeks post-implantation, 2 of the pigs received radiation directed at the right half of their bodies (6 breasts per pig) for a total dose of 42.4 Gy delivered over 15 fractions using a clinical linear accelerator. The delivered doses to target sites and the adjacent tissue were confirmed with optically stimulated luminescent dosimeters (OSLDs). A third pig was maintained as a non-irradiated control. Ultrasound examinations were performed every 3 weeks post-implantation. At week 24 and 36, samples consisted of n=3 for irradiated and non-irradiated ReFilx and sham sites for the half-irradiated pigs, and n=3 for non-irradiated ReFilx and sham sites for the non-irradiated control pig were excised by mastecomy, the tissue samples were fixed in 10% buffered formalin for subsequent histological (H&E, Masson's Trichrome) studies. Potential side effects were monitored by vital signs, pain control, wound checks, ultrasound and blood tests. Necropsies were performed at the conclusion of the study. Results: Ultrasound examination indicated no difference between ReFilx's ability to maintain breast shape and volume with or without the presence of radiation treatment, in contrast to the collapse of the sham sites by 24 weeks. Similarly, the histology of irradiated and non-irradiated ReFilx samples showed similar levels of tissue infiltration, inflammatory changes and degradation of ReFilx. There was no significant side effects observed. Conclusions: ReFilx's ability to act as a soft tissue filler for breast volume restoration post-lumpectomy does not appear to be significantly impacted by the presence of clinically relevant radiation treatment. Longer-term follow-up is currently in progress for this study. Acknowledgements: Connaught Innovation Award (University of Toronto) and Joule Innovation Fund (Canadian Medical Association).

Citation Format: Leong WL, Battiston K, Cheung F, Fulton C, Lin A, Levin W, Done S, Santerre P. The outcomes of ReFilx soft tissue filler as an immediate reconstruction technique for lumpectomy followed by radiotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-11.

Abstract P1-20-02: Incidence of hyperglycemia in non-diabetic patients with early-stage breast cancer treated with chemotherapy

Background: There are shared risk factors between breast cancer (BC) and diabetes mellitus (DM). BC treatments including chemotherapy given in combination with glucocorticoids can induce hyperglycemia and steroid related DM. Patients with DM are at increased risk of developing chemotherapy related toxicities such as chemotherapy induced peripheral neuropathy (CIPN) compared to those without DM. The incidence of hyperglycemia during chemotherapy in non-diabetic patients with early-stage breast cancer is unknown.

Methods: We performed a retrospective analysis of non-diabetic women with stage I-III breast cancer treated with chemotherapy at Columbia University Medical Center from 9/1/2016-8/31/2017 to evaluate hyperglycemia incidence during chemotherapy and up to six months after chemotherapy completion. Eligible patients were identified in the electronic health record (EHR) by ICD9 and 10 codes (ICD9 174.x and ICD10 C50.x) and a record of chemotherapy administration. Non-diabetic patients were defined by chart review as no recorded history of diabetes and no receipt of a diabetes medication in the EHR. Breast cancer stage was determined by chart review. Glucose values were recorded prior to chemotherapy, during chemotherapy, and for six-months after chemotherapy completion. We defined hyperglycemia as a glucose value of ≥200 mg/dl. Median time to hyperglycemia was also calculated.

Results: We identified 82 eligible patients. The majority of patients received dexamethasone during their chemotherapy course (79 patients, 96.3%). The most frequent chemotherapy regimen was doxorubicin/cyclophosphamide and paclitaxel (32 patients, 39.0%). At baseline, 20 patients (24.4%) had a normal body mass index (BMI), 27 patients (32.9%) were overweight, and 31 patients (37.8%) were obese. Hyperglycemia occurred in 8 patients (9.8%) after initiation of chemotherapy. Among patients with hyperglycemia, the maximum blood glucose was between 200-299 mg/dl in seven patients (87.5%), and between 500-599 in one patient (12.5%). The median time to hyperglycemia was 84 days. Among patients who did not experience hyperglycemia, the maximum blood glucose was between 140-159 mg/dl in six patients (8.1%), between 160-179 mg/dl in eight patients (10.8%), and between 180-199 mg/dl in three patients (4.1%). Three patients were diagnosed with DM following chemotherapy completion.

Conclusion: Hyperglycemia occurred in almost 10% of non-diabetic patients who received chemotherapy for early-stage breast cancer. Additionally, over 30% of patients had a blood glucose of 140 mg/dl or higher after chemotherapy initiation. The impact of hyperglycemia on the development of chemotherapy related toxicities in this group is unknown. Future research is needed to identify effective interventions for glucose control during chemotherapy, and to determine if glucose control during treatment can reduce the risk of chemotherapy related toxicities, specifically CIPN.

Citation Format: Accordino MK, Lin A, Wright JD, Trivedi MS, Kalinsky K, Crew KD, Hershman DL. Incidence of hyperglycemia in non-diabetic patients with early-stage breast cancer treated with chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-20-02.

The Ultra-High-Risk for psychosis groups: Evidence to maintain the status quo

Individuals are considered Ultra-High-Risk (UHR) for psychosis if they meet a set of standardised criteria including presumed genetic vulnerability (Trait), or a recent history of Attenuated Psychotic Symptoms (APS) or Brief Limited Intermittent Psychotic Symptoms (BLIPS). Recent calls to revise these criteria have arisen from evidence that Trait, APS and BLIPS groups may transition to psychosis at different rates. Concurrently, it has become clear that the UHR status confers clinical risk beyond transition to psychosis. Specifically, most UHR individuals will not develop psychosis, but will experience high rates of non-psychotic disorders, persistent APS and poor long-term functional outcomes. Rather than focus on transition, the present study investigated whether UHR groups differ in their broader clinical risk profile by examining baseline clinical characteristics and long-term outcomes other than transition to psychosis. Four UHR groups were defined: Trait-only, APS-only, Trait+APS, and any BLIPS. Participants (N=702) were recruited upon entry to early intervention services and followed-up over a period of up to 13years (mean=4.53, SD=3.84). The groups evidenced similar symptom severity (SANS for negative symptoms, BPRS for positive and depression/anxiety symptoms) and psychosocial functioning (SOFAS, GAF, QLS) at baseline and follow-up as well as similar prevalence of non-psychotic disorders at follow-up. Our findings demonstrate that UHR groups evidence a similar clinical risk profile when we expand this beyond transition to psychosis, and consequently support maintaining the existing UHR criteria.

Proteomic signatures differentiating Bacillus anthracis Sterne sporulation on soil relative to laboratory media

The process of sporulation is vital for the stability and infectious cycle of Bacillus anthracis. The spore is the infectious form of the organism and therefore relevant to biodefense. While the morphological and molecular events occurring during sporulation have been well studied, the influence of growth medium and temperature on the proteins expressed in sporulated cultures is not well understood. Understanding the features of B. anthracis sporulation specific to natural vs. laboratory production will address an important question in microbial forensics. In an effort to bridge this knowledge gap, a system for sporulation on two types of agar-immobilized soils was used for comparison to cultures sporulated on two common types of solid laboratory media, and one liquid sporulation medium. The total number of proteins identified as well as their identity differed between samples generated in each medium and growth temperature, demonstrating that sporulation environment significantly impacts the protein content of the spore. In addition, a subset of proteins common in all of the soil-cultivated samples was distinct from the expression profiles in laboratory medium (and vice versa). These differences included proteins involved in thiamine and phosphate metabolism in the sporulated cultures produced on soils with a notable increase in expression of ATP binding cassette (ABC) transporters annotated to be for phosphate and antimicrobial peptides. A distinct set of ABC transporters for amino acids, sugars and oligopeptides were found in cultures produced on laboratory media as well as increases in carbon and amino acid metabolism-related proteins. These protein expression changes indicate that the sporulation environment impacts the protein profiles in specific ways that are reflected in the metabolic and membrane transporter proteins present in sporulated cultures.

Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up

AIM

To determine the incidence of and risk factors for psychiatric disorders in early adulthood in patients with childhood onset type 1 diabetes (T1D).

METHODS

In this retrospective-cohort study, we identified a population-based childhood onset T1D cohort and an age and sex matched (5:1) non-diabetic comparison cohort. Data linkage was used to access inpatient hospitalization data, mental health support service data, and mortality data to follow-up both cohorts into early adulthood.

RESULTS

The mean age of T1D diagnosis was 9.5 years (SD 4.1), with a mean age at end of follow-up of 26.4 years (SD 5.2, max 37.7). The diagnosis of any psychiatric disorder was observed for 187 of 1302 (14.3%) in the T1D cohort and 400 of 6422 (6.2%) in the comparison cohort [adjusted hazard ratio (HR) 2.3; 95% CI 1.9, 2.7]. Anxiety, eating, mood, and personality and behaviour disorders were observed at higher rates within the T1D cohort. Comorbid psychiatric disorders were more frequent, at the cohort level, within the T1D cohort (2-3 disorders 3.76% vs 1.56%) and service utilization was higher (15+ contacts 6.8% vs 2.8%); though these differences did not remain when restricted to only those individuals diagnosed during follow-up. A history of poor glycaemic control was associated with an increased risk of anxiety, mood, and 'any' disorder (HR ranging from 1.35 to 1.42 for each 1% increase in mean paediatric HbA1c).

CONCLUSION

Our findings highlight the need for access to mental health support services as part of routine patient care for young adults with T1D, and for better predictive tools to facilitate targeting at-risk patients with early intervention programs.

The integrity of NSSS and containment during extended station blackout for Kuosheng BWR plant

The Fukushima Daiichi accident occurring on March 11, 2011, reveals that Station Blackout (SBO) may last longer than 8 h. However, the original design may not have sufficient capacity to cope with a SBO for more than 8 h. In view of this, Taiwan Power Company has initiated several enhancements to mitigate the severity of the extended SBO. Based on the improved plant configuration, a SBO coping analysis is performed in this study to assess whether the Kuosheng BWR plant has sufficient capability to cope with SBO for 24 h with respect to maintaining the integrity of the reactor core and containment. The analyses in the Nuclear Steam Supply System (NSSS) and the containment are based on the RETRAN-3D and GOTHIC models, respectively. The flow conditions calculated by RETRAN-3D during the event are retrieved and input to the GOTHIC containment model to determine the containment pressure and temperature response. These boundary conditions include SRV flow rate, SRV flow enthalpy, and total reactor coolant system leakage flow rate.

The higher prevalence of truncal obesity and diabetes in American than Chinese patients with chronic hepatitis C might contribute to more rapid progression to advanced liver disease

BACKGROUND

Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States (US) and an emerging cause in China.

AIM

To compare the clinical characteristics of hepatitis C patients in the US and China, and factors influencing disease stage.

METHODS

Prospective study of 2 cohorts of HCV patients recruited at 1 site in the US and 3 sites in China. Standardised questionnaire on risk factors and medical history were used and diagnosis of cirrhosis and HCC was based on pre-defined criteria.

RESULTS

One thousand nine hundred and fifty seven patients (1000 US and 957 China) were enrolled. US patients were more likely to be men (61.4% vs 48.5%), older (median age 57 vs 53 years), obese (38.4% vs 16.8%) and diabetic (21.8% vs 10.8%). A significantly higher per cent of US patients had cirrhosis (38.2% vs 16.0%) and HCC (14.1% vs 2.7%). Investigator estimated time at infection in US was 10 years earlier than in Chinese patients but US patients were more likely to have advanced disease even after stratifying for duration of infection. Study site in the US, older age, truncal obesity, diabetes and prior HCV treatment were significant predictors of advanced disease on multivariate analysis.

CONCLUSIONS

HCV patients in the US had more advanced liver disease than those in China. We speculate that underlying fatty liver disease may be a major contributor to this difference, and management of glycometabolic abnormalities should occur in parallel with anti-viral therapy to achieve optimal outcomes.

Association of Condylar Bone Quality with TMJ Osteoarthritis

The etiology and treatment of temporomandibular joint (TMJ) osteoarthritis (TMJOA) remain complex and unclear. Based on clinical observations, we hypothesized that low condylar bone quality is significantly correlated with TMJOA and explored this association in a cross-sectional study with human patients. A total of 254 postmenopausal female participants were included in this study. Radiographic findings from cone beam computed tomography (CBCT) and clinical symptoms were used to classify each TMJ data sample as healthy control ( n = 124) or TMJOA ( n = 130). Condylar bone mineral density (BMD) (computed tomography Hounsfield unit [CT HU]) and bone volume fraction (BV/TV) were measured and modeled as predictors of healthy control versus TMJOA status in multilevel logistic regression analyses. Both CT HU (adjusted odds ratio [AOR] = 0.9989, interquartile odds ratio [IOR] = 0.4206) and BV/TV (AOR= 0.8096, IOR = 0.1769) were negatively associated with TMJOA ( P = 0.049, 0.011, respectively). To assess the diagnostic performance of CT HU and BV/TV for identification of TMJOA, receiver operating characteristic (ROC) curves were plotted. The estimated areas under the curve (AUC) were 0.6622 for BV/TV alone, 0.6074 for CT HU alone, and 0.7136 for CT HU and BV/TV together. The model incorporating CT HU and BV/TV together had a significantly higher AUC than the models using BV/TV alone ( P = 0.038) or HU alone ( P = 0.021). In conclusion, we found that low condylar bone quality was significantly correlated with TMJOA development and that condylar CT HU and BV/TV can be used together as a potential diagnostic tool for TMJOA. Careful clinical evaluation of the condyle coupled with appropriate radiographic interpretation would thus be critical for the early detection of TMJOA.

Nanosecond-Pulsed DBD Plasma-Generated Reactive Oxygen Species Trigger Immunogenic Cell Death in A549 Lung Carcinoma Cells through Intracellular Oxidative Stress

A novel application for non-thermal plasma is the induction of immunogenic cancer cell death for cancer immunotherapy. Cells undergoing immunogenic death emit danger signals which facilitate anti-tumor immune responses. Although pathways leading to immunogenic cell death are not fully understood; oxidative stress is considered to be part of the underlying mechanism. Here; we studied the interaction between dielectric barrier discharge plasma and cancer cells for oxidative stress-mediated immunogenic cell death. We assessed changes to the intracellular oxidative environment after plasma treatment and correlated it to emission of two danger signals: surface-exposed calreticulin and secreted adenosine triphosphate. Plasma-generated reactive oxygen and charged species were recognized as the major effectors of immunogenic cell death. Chemical attenuators of intracellular reactive oxygen species successfully abrogated oxidative stress following plasma treatment and modulated the emission of surface-exposed calreticulin. Secreted danger signals from cells undergoing immunogenic death enhanced the anti-tumor activity of macrophages. This study demonstrated that plasma triggers immunogenic cell death through oxidative stress pathways and highlights its potential development for cancer immunotherapy.

Cannabis-induced attenuated psychotic symptoms: implications for prognosis in young people at ultra-high risk for psychosis

BACKGROUND

Cannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among individuals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between individuals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS).

METHOD

Participants were 190 UHR individuals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4-8.7 years).

RESULTS

A history of cannabis abuse was reported in 58% of the sample. Of these, 26% reported a history of cannabis-induced APS. These individuals were 4.90 (95% confidence interval 1.93-12.44) times more likely to transition to a psychotic disorder (p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis (p = 0.036). However, this effect was mediated by higher abuse severity among individuals with a history of cannabis-induced APS.

CONCLUSIONS

Findings suggest that cannabis use poses risk in a subpopulation of UHR individuals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR individuals.

Abstract P2-01-06: Patterns of axillary evaluation in older patients (pts) with breast cancer and impact on adjuvant therapy

Background:

Axillary lymph node status has traditionally been a key factor in informing adjuvant therapy recommendations for pts with breast cancer. With increased emphasis on tumor biology, this information may be less relevant, particularly in older populations where competing comorbidity frequently influences treatment decisions. We examined patterns of axillary surgery in older breast cancer pts and the impact axillary surgery has on treatment receipt.

Methods:

We identified women aged ≥65 with Stage I-III invasive breast cancer diagnosed during 2012-2013 from the National Cancer Data Base who did not have clinically positive nodes and underwent cancer-directed surgery. Nodal surgery type and receipt of adjuvant therapies were examined. Multivariable logistic regression was used to examine the associations of axillary surgery receipt with pt, clinical and facility factors.

Results:

Among 69,414 eligible women, 40% were aged 65-70, 42% aged 71-80 and 18% aged >80. 91% had axillary surgery (67% sentinel lymph node biopsy, 11% axillary lymph node dissection, 13% unspecified axillary surgery), and 24% of pts had pathologically positive nodes. 10% of pts (stage IIB-III) received adjuvant chemotherapy, 81% (hormone receptor positive) received adjuvant hormonal therapy, 67% (breast conservation or stage III postmastectomy) received radiation. In adjusted analyses, increasing age and neoadjuvant hormonal therapy were strongly associated with lower odds of axillary surgery. Region and mastectomy were strongly associated with higher odds of axillary surgery. The table shows variables associated with axillary surgery.

VariableAdjusted OR (95% CI) for having any axillary surgery*Age (vs. 65-70) 71-75.64 (.58-.71)76-80.34 (.31-.37)>80.08 (.07-.09)Diagnosed in 2013 (vs. 2012)1.08 (1.02-1.15)Stage (vs. II) I1.25 (1.13-1.38)III.73 (.60-.89)Grade (vs. 1) 21.22 (1.14-1.31)31.24 (1.13-1.37)HER2 status (vs. positive) Negative.83 (.73-.93)Tumor size (vs. ≤2 cm) >2-5cm1 (.91-1.11)>5cm.56 (.47-.67)Comorbidity score (vs. 0) 1.85 (.79-.92)>/=2.62 (.56-.68)Region (vs. New England)Range 1.66-2.67 (1.42-3.12)Case volume (vs. high) Low.82 (.73-.93)Medium.98 (.91-1.06)Insurance (vs. private) Uninsured.69 (.44-1.09)Medicaid.67 (.52-.86)Medicare.84 (.77-.93)Median household income ($) (vs. >46K) <30,0001.06 (.95-1.18)30,000-34,9991.11 (1.01-1.21)35,000-45,9991.08 (1.01-1.16)Neoadjuvant hormonal therapy (vs. not).49 (.42-.59)Surgery (vs. BCS) Mastectomy, no recon3.37 (3.09-3.68)Mastectomy, +recon2.76 (2.16-3.51)  *Adjusted for table variables plus race, hormone receptor status, and facility type (none significantly associated with axillary surgery)

Axillary surgery and younger age were significantly associated with receipt of adjuvant chemotherapy, radiation, and hormonal therapy.

Conclusion:

Within the NCDB, 91% of pts age ≥65 with clinically node-negative breast cancer undergo surgical staging of the axilla, and axillary surgery was associated with adjuvant therapy receipt. The impact of routine node assessment on treatment and outcome has been questioned, and further study in this population of pts is warranted.

Citation Format: Dominici LS, Sineshaw H, Jemal A, Lin A, King TA, Freedman RA. Patterns of axillary evaluation in older patients (pts) with breast cancer and impact on adjuvant therapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-06.