Abstract P2-02-07: Preoperative breast MRI and follow-up recommendations for the contralateral breast influence the rate of contralateral prophylactic mastectomy

Background: Women with breast cancer increasingly choose to undergo contralateral prophylactic mastectomy (CPM) even as the benefit of this procedure for woman at average risk for breast cancer remains uncertain. Many women with newly diagnosed breast cancer undergo pre-operative MRI for a variety of indications. Growing evidence suggests that obtaining a pre-operative MRI increases the likelihood that a patient will choose CPM. This study evaluates the relationship between a pre-operative MRI and the decision to pursue CPM, as well as the rate of contralateral MRI findings for which follow-up is recommended and the choice to undergo CPM. The pathology found in contralateral breasts in this series is also reported.

Methods: Newly diagnosed breast cancer patients were prospectively enrolled in Breast Molecular Epidemiology Resource (B-MER) observational study at the University of Iowa from April 2010 through March 2013. Prophylactic mastectomy is defined as removal of the contralateral breast within 12 months of definitive mastectomy. Univariate logistic regression was used to identify factors predictive of undergoing CPM. Recommended follow-up of the contralateral breast MRI is defined as any imaging or procedure other than immediate ultrasound evaluation.

Results: Among 134 patients (mean age 53) who underwent mastectomy, 53 (40%) underwent CPM. Univariate analysis revealed that patients undergoing CPM were more likely to have had a preoperative bilateral MRI (52%% vs. 28%, p = 0.006) and were more likely to have been given a recommendation for a follow-up test (79% vs, 40%, p = 0.007).

Univariate Analysis of Odds of Electing to Undergo CPMVariableLevelOdds ratioP-valueAge5 year0.62<.001Breast MRIYes vs No2.740.006MRI follow-up recommendationYes or No5.530.007Nodal statusPositive vs Negative0.820.581History of benign breast biopsiesNo vs Yes1.850.209Family history of breast cancerYes vs No1.160.711ER/PR statusNegative vs Positive1.830.134Triple NegativeNo vs Yes1.910.196HER2 statusPositive vs Negative2.470.066BRCA testing doneYes vs No6.04<.001BRCA results*Positive vs Negative3.120.315Tobacco everYes or No1.390.354Alcohol everYes or No1.250.544* Indeterminate and not done levels were excluded from the analysis

Univariate analysis also revealed associations between choice of CPM and younger age (p<0.001) and BRCA testing (p<0.001). In this series, CPM was not associated with nodal status, ER/PR status, history of benign breast biopsies, family history of breast cancer, BRCA result and tobacco or alcohol use, although there was a trend for association with HER2 status. Of the 53 patients who underwent CPM, one had proliferative disease with atypia, 34 had proliferative disease without atypia. A single patient had DCIS found in the contralateral breast which had not been identified on MRI.

Conclusions: The use of preoperative breast MRI and abnormal imaging findings in the contralateral breast, for which follow-up was recommended, led to a higher CPM rate. Contralateral prophylactic mastectomy rarely uncovered occult malignancy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-07.

Development and validation of a quality of life instrument for Kashin-Beck disease: an endemic osteoarthritis in China

OBJECTIVES

To develop and validate a disease-specific Quality of Life (QOL) measure for a specialized osteoarthritis (OA)-Kashin-Beck disease (KBD).

METHODS

The standard methodology used for developing QOL instruments was employed. In phase 1, initially a group of health care professionals (HCPs) and KBD patient defined the overall concept of KBDQOL. It was followed by generation of an item pool through literature review, in-depth interview of 20 KBD patients and eight KBD HCPs and four focus group discussions. In phase 2, 368 KBD patients were interviewed and the reinterview of 95 participants, 10-14 days later assessed the reproducibility of the KBDQOL instrument.

RESULTS

A 37 items draft instrument was devised during phase 1. Principal Component Analysis (PCA) revealed six domains: physical function, activity limitation, social support, economics, mental health, and general health. Cronbach's alphas of six domains ranged from 0.77 to 0.90. The test-retest reliability (intraclass co-relation coefficient) of six domains was satisfactory, and ranged from 0.73 to 0.90. The smallest detectable change ranged from 13.2 to 30.2 points at the individual level and from 1.4 to 3.1 points at the group level for different domains. The construct validity was adequate when co-related with the EQ-5D (spearman co-relation coefficients: 0.49-0.61) and WHOQOL-BREF (spearman co-relation coefficients: 0.53-0.68). This resulted into the final version of KBDQOL instrument having 28 items and six domains.

CONCLUSIONS

The KBDQOL is a simple and easy to use 28-item six dimensional questionnaire. The measure has been developed as a true patient-based questionnaire and demonstrates good measurement properties.

TLRs antiviral effect on hepatitis B virus in HepG2 cells

AIMS

A hepatoma cell line, HepG2, was used as a model system to detect Toll-like receptor (TLR) expression in hepatocytes and examine the antiviral effect on hepatitis B virus (HBV).

METHODS AND RESULTS

Toll-like receptor expression was detected in HepG2 cells by RT-PCR. The TLRs, which were strongly expressed in HepG2 cells, were stimulated with specific ligands. Interferon (IFN) response was evaluated poststimulation with Western blotting for signal transduction and activators of transcription-1. Furthermore, HepG2 cells were transiently transfected with wild-type HBV 1.3-fold over-length plasmid and treated with specific ligands at indicated times. Replication of HBV DNA, transcription of HBV RNA intermediate and expression of HBV antigens were respectively detected by Southern blotting, real time PCR, ELISA and Western blotting. Activation of different TLRs induced antiviral effects on HBV to varying degrees.

CONCLUSIONS

The TLRs, which were strongly expressed in HepG2 cells, could be stimulated with specific ligands. Activation of TLRs induced apparent production of antiviral cytokines such as IFN-alpha/beta and inhibited HBV lifecycle in the hepatocyte cell model.

SIGNIFICANCE AND IMPACT OF THE STUDY

Expression of TLRs in hepatocytes may be related to local immunity of liver and participate in the outcome of viral hepatitis.

TAK-285, a Novel HER2/EGFR Inhibitor, Penetrates the CNS in Rats with an Intact Blood Brain Barrier (BBB)

Background: Approximately one third of patients with HER2-overexpressing (HER2+) metastatic breast cancer develop brain metastases. Treatment options for patients whose brain metastases have progressed after radiotherapy are urgently needed. The currently approved HER2-targeted therapies, trastuzumab and lapatinib, have generally shown limited activity against brain metastases, likely due to the limited brain penetration of these drugs. Brain penetration is mediated by multiple factors including drug permeability, tissue binding, and the expression of efflux transporters (P-gp and BCRP) and their interactions with the drug. TAK-285 is a novel, orally active, dual HER2/EGFR inhibitor currently under clinical development. In this nonclinical work, we evaluated the permeability, interactions with efflux transporters, and brain penetration of TAK-285, along with lapatinib and neratinib, using in vitro and animal models.Material and Methods: The first study evaluated the permeability of TAK-285, lapatinib, and neratinib and their interactions with efflux transporters using the Caco-2 cell monolayer system in the absence or presence of efflux pump inhibitors. The second study evaluated brain penetration of TAK-285, lapatinib and neratinib after a single oral administration in rats with an intact BBB.Results: In the Caco-2 cell model, TAK-285 showed high permeability with an efflux ratio of 1.7, indicating it is not a substrate for efflux pumps. The efflux pump inhibitors LY335979 (an inhibitor of P-gp), Ko143 (an inhibitor of BCRP), and GF120918 (an inhibitor of BCRP and P-gp) had no marked effect on the efflux ratio of TAK-285, further confirming that TAK-285 is not a substrate for P-gp and BCRP. Lapatinib and neratinib showed low to medium permeability and appeared to be substrates for P-gp/BCRP in this testing system. In the rat brain penetration study, the brain-to-plasma AUC ratio for total (free and bound) TAK-285, lapatinib, and neratinib was 0.202, 0.0243, and 0.0263, respectively.Discussion: These nonclinical studies showed that, unlike lapatinib and neratinib, TAK-285 is not a substrate for the efflux transporters, P-gp and BCRP. Based on published information, all of the approved receptor tyrosine kinase inhibitors are substrates for efflux transporters. Additionally, in rats with an intact BBB, the brain-to-plasma AUC ratio for TAK-285 was substantially higher than that of lapatinib and neratinib. The AUC ratios observed in this study for lapatinib and neratinib are similar to the proportion of blood volume in the rat brain (ie, outside the CNS) relative to the total rat brain volume. This suggests the actual brain-to-plasma AUC ratio for TAK-285 in rats may be much greater than 8-fold of that of lapatinib and neratinib calculated based on these measured AUC ratios. Consequently, TAK-285 may have a unique role in the treatment of brain lesions in patients with HER2- or EGFR-dependent tumors. Furthermore, TAK-285 may not be subject to drug resistance conferred by efflux transporters.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5098.

Bioavailability of sorafenib tablets administered as a liquid suspension

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Background: Sorafenib is a multikinase inhibitor currently approved by the FDA for the treatment of advanced renal-cell carcinoma (RCC) and unresectable hepatocellular carcinoma (HCC), and by the EMEA for the treatment of HCC and advanced RCC. Sorafenib is available as a tablet formulation. Some patients who are unable to swallow tablets have suspended sorafenib tablets in a liquid for ease of administration. We performed a study to assess whether this process alters the bioavailability of sorafenib. Methods: Twenty-six healthy male volunteers were enrolled. Utilizing a randomized, crossover design, subjects received either two 200-mg intact tablets (IT) with 8 ounces water, or two 200-mg tablets disintegrated over 10 minutes in 2 ounces of water (ST), with an additional 6 ounces of water swallowed as a rinse of the dosing vessel. Doses were separated by a 10- to 14-day washout period. Following each dose, blood samples were collected at designated times up to 144 hours after dosing for measurement of sorafenib plasma concentrations. Sorafenib was assayed by a validated liquid chromatography/mass spectrometry method. The pharmacokinetic parameters area under the curve (AUC), maximum concentration (Cmax) and time to Cmax (Tmax) were assessed by noncompartmental analysis. Results: Geometric mean (percentage coefficient of variation) or median results for these pharmacokinetic assessments are shown in the table. Conclusions: The pharmacokinetics of sorafenib, when administered as a liquid suspension of tablets in water, were similar to the pharmacokinetics of tablets swallowed whole.

[Table: see text]

[Table: see text]

Multiple photonic responses in films of organic-based magnetic semiconductor V(TCNE)x, x approximately 2

Concomitant photoinduced magnetic and electrical phenomena are reported for the organic-based magnetic semiconductor V(TCNE)x (x approximately 2; TCNE=tetracyanoethylene; magnetic ordering temperature Tc approximately 400 K). Upon optical excitation (457.9 nm), the system can be trapped in a thermally reversible photoexcited state, which exhibits reduced magnetic susceptibility and increased conductivity with a simultaneous change in IR absorption spectrum. The multiple photonic effects in V(TCNE)x are proposed to originate from structural changes induced by internal excitation in (TCNE)- anions, which lead to relaxation to a long-lived metastable state.

Effects of D-galactose on the expression of hippocampal peripheral-type benzodiazepine receptor and spatial memory performances in rats

The changes in spatial memory performances and the binding of hippocampal peripheral-type benzodiazepine receptor (PBR) induced by D-galactose (D-gal) were investigated in rats. The animals were randomly divided into two groups: saline-treated group and D-gal-induced aging group. All rats received 56 days of injection followed by 5 days of behavioral tests. The D-gal-induced aging rats presented significant impairment in water maze performance, compared with that in the saline-treated rats. A significant decrease in [3H]PK11195 binding in the synaptosomes from hippocampus in the D-gal-induced aging rats was observed, compared to that in the saline-treated rats. Meanwhile, the Scatchard analysis revealed that there was a decrease in Bmax, with no significant change in KD. Further analysis demonstrated that water maze performance was closely related to the PK11195 binding in all rats. These results suggest that D-gal decreased the density of PBR in hippocampal synaptosomes, which may be attributable to the progressive pathogenesis of aging in rats.

Sorafenib in advanced melanoma: a Phase II randomised discontinuation trial analysis

The effects of sorafenib – an oral multikinase inhibitor targeting the tumour and tumour vasculature – were evaluated in patients with advanced melanoma enrolled in a large multidisease Phase II randomised discontinuation trial (RDT). Enrolled patients received a 12-week run-in of sorafenib 400 mg twice daily (b.i.d.). Patients with changes in bi-dimensional tumour measurements <25% from baseline were then randomised to sorafenib or placebo for a further 12 weeks (ie to week 24). Patients with ⩾25% tumour shrinkage after the run-in continued on open-label sorafenib, whereas those with ⩾25% tumour growth discontinued treatment. This analysis focussed on secondary RDT end points: changes in bi-dimensional tumour measurements from baseline after 12 weeks and overall tumour responses (WHO criteria) at week 24, progression-free survival (PFS), safety and biomarkers (BRAF, KRAS and NRAS mutational status). Of 37 melanoma patients treated during the run-in phase, 34 were evaluable for response: one had ⩾25% tumour shrinkage and remained on open-label sorafenib; six (16%) had <25% tumour growth and were randomised (placebo, n=3; sorafenib, n=3); and 27 had ⩾25% tumour growth and discontinued. All three randomised sorafenib patients progressed by week 24; one remained on sorafenib for symptomatic relief. All three placebo patients progressed by week-24 and were re-started on sorafenib; one experienced disease re-stabilisation. Overall, the confirmed best responses for each of the 37 melanoma patients who received sorafenib were 19% stable disease (SD) (ie n=1 open-label; n=6 randomised), 62% (n=23) progressive disease (PD) and 19% (n=7) unevaluable. The overall median PFS was 11 weeks. The six randomised patients with SD had overall PFS values ranging from 16 to 34 weeks. The most common drug-related adverse events were dermatological (eg rash/desquamation, 51%; hand-foot skin reaction, 35%). There was no relationship between V600E BRAF status and disease stability. DNA was extracted from the biopsies of 17/22 patients. Six had V600E-positive tumours (n=4 had PD; n=1 had SD; n=1 unevaluable for response), and 11 had tumours containing wild-type BRAF (n=9 PD; n=1 SD; n=1 unevaluable for response). In conclusion, sorafenib is well tolerated but has little or no antitumour activity in advanced melanoma patients as a single agent at the dose evaluated (400 mg b.i.d.). Ongoing trials in advanced melanoma are evaluating sorafenib combination therapies.

Expression of CD158b on Peripheral Blood Lymphocytic Cell After Kidney Transplantation

OBJECTIVE

To investigate the expression of CD158b on peripheral blood lymphocytes after kidney transplantation.

METHODS

Sixty two kidney transplant patients were divided into two groups (normal group and rejection group) according to pathologic results and clinical situation. Blood samples were assessed for percentage of CD3+; CD19+; CD3-CD16/56+; CD3+CD158b+; CD19+CD158b+, and CD3-CD16/56+CD158b+ subsets.

RESULTS

The percentages of CD3+ cells preop as well as at 1 and 7 postoperative and the day acute rejection happened were 60.06 +/- 4.67, 40.43 +/- 4.11, 31.67 +/- 4.04, and 39.21 +/- 5.20, respectively. The percentages of CD3-CD16/56+ were 21.65 +/- 1.79, 33.84 +/- 5.45, 38.10 +/- 4.86, and 39.53 +/- 4.80, respectively. The percentages of CD3+CD158b+ were 1.46 +/- 0.31, 1.88 +/- 0.70, 2.03 +/- 1.04, and 0.65 +/- 0.12, respectively. The percentages of CD3-CD16/56+CD158b+ were 5.87 +/- 1.24, 3.57 +/- 0.57, 2.82 +/- 0.45, and 1.60 +/- 0.33, respectively.

CONCLUSIONS

The percentage of CD3+ cells in the normal and the rejection groups decreased significantly. The percentages of CD158b+T cells decreased significantly after acute rejection. The percentage of CD158b+NK cells decreased significantly after kidney transplantation, decreasing gradually after acute rejection. The percentage of CD158b+ total T cells decreased significantly following acute rejection. The percentage of CD3-CD16/56+CD158b+ of total NK cells decreased significantly after kidney transplantation and after acute rejection. Because few factors interfere with the expression of CD158b on NK cells, monitoring of this marker may be accurate and sensitive.

Tunable diode laser spectrometer for pulsed supersonic jets: application to weakly-bound complexes and clusters

The design and operation of an apparatus for studying infrared spectra of weakly-bound complexes is described in detail. A pulsed supersonic jet expansion is probed using a tunable Pb-salt diode laser spectrometer operated in a rapid-scan mode. The jet may be fitted with either pinhole or slit shaped nozzles, the former giving lower effective rotational temperatures, and the latter giving sharper spectral lines. Notable features of the apparatus include use of a toroidal multi-pass mirror system to give over 100 passes of the laser through the supersonic jet, use of the normal laser controller for laser sweeping during both setup and data acquisition, and use of a simple semi-automated wavenumber calibration procedure. Performance of the apparatus is illustrated with observed spectra of the van der Waals complex He-OCS, and the seeded helium clusters He(N)-OCS and He(N)-CO.

cDNA cloning and genomic structure of the duck (Anas platyrhynchos) MHC class I gene

In order to provide data for studies on disease resistance, duck MHC class I cDNA (Anpl-MHC I) was cloned from a duck cDNA library and the genome structure was investigated. Anpl-MHC I genes encoded 344-355 amino acids. The genomic organization is composed of eight exons and seven introns. Based on the genetic distance, Anpl-MHC I cDNA from six individuals can be classified into four lineages (from Anpl-UAA to Anpl-UDA). A total of 28 amino acid positions in the peptide-binding domain (PBD) showed high scores by Wu-kabat index analysis. The Anpl-MHC amino acid sequence displayed seven critical HLA-A2amino acids that bind with antigen polypeptides, and have an 83.6-88.5% amino acid homology with each lineage, a 55.2-64.6% amino-acid homology with chicken MHC class I (B-FIV21, B-FIV2, Rfp-Y), and a 40.3-42.8% homology with mammalian MHC class I. Nested PCR detected that Anpl-MHC I can be expressed in the brain, heart, kidney, intestines and bursa. Compared with the human HLA-A2 tertiary structure of the PBD, Anpl-MHC I had an insertion or deletion variation in four domains (A-D). The phlyogenetic tree appears to branch in an order consistent with accepted evolutionary pathways.

The Interferon-α Genes from Three Chicken Lines and Its Effects on H9N2 Influenza Viruses

The interferon-alpha genes from three chicken lines were cloned by a direct PCR technique, and the effects of recombinant protein expressed in a prokaryotic system on highly pathogenic H9N2 influenza viruses were investigated. The cloned ChIFN-alpha gene encoded a protein of 193 amino acids with a signal sequence of 31 amino acids and mature peptides of 162 amino acids. Comparison of ChIFN-alpha sequences, detected six amino acids substitutions at positions 50, 58, 65, 81, 181, and 183. Homology analysis indicated that ChIFN-alpha genes could be subdivided into two lineages, SH-ChIFN-alpha and WJ-ChIFN-alpha. In addition, both SH-ChIFN-alpha and WJ-ChIFN-alpha were expressed with the N-terminal 6 consecutive histidine residues in a high-level prokaryotic expression system. Recombinant chicken interferon-alpha (rChIFN-alpha) protein has anti-VSV activity of more than 1 x 10(8) U/mg. Moreover, High concentration (10,000U) of rSH-ChIFN-alpha resulted in over 40% inhibition of the H9N2 virus infection in chicken embryos (Ovo), and 100% inhibition from one day-old to five day-old chickens (Vivo). The results suggested that rChIFN-alpha is a potential agent against many Chicken viral strains.

[Research on the dynamic variation and elimination of nitrite content in sauerkraut during pickling]

To investigate the dynamic variation and elimination of nitrite content in pickles and sauerkraut during pickling, green tuber growing in Fuling was selected to make semi-manufactured mustard according to the process technology. Green tuber, cabbage and cauliflower were selected as raw materials to make sauerkraut in family way. The nitrite content in pickles and sauerkraut was determined by spectrophotometry with 1-Amino-2-(a-naphthy lamine) ethoine dihydrochloride. The nitrite content in mustard was 258.8 mg/kg when 6% salt was used and pickling for 8 days; the nitrite content was 235.9 mg/kg when 15% salt was used and pickling for 15 days. There was no nitrite in mustard when pickling for 35 days. The nitrite content in the sauerkraut was 258.7 mg/kg when pickling for 6 days and no nitrite was found after 20 days. The higher nitrite content in pickle and sauerkraut could be eliminated by water. The elimination ratio was 91% for leafy sauerkraut and semi-manufactured cut mustard and only 72% for whole mustard. It was concluded that pickles and sauerkraut that pickled for enough time (for leafy vegetable more than 20 days, for tuber more than 35 days) had no harm for people to eat, The higher nitrite content in pickles and sauerkrauts could be reduced by 91% with water for several times.

Identification of a prostate-specific G-protein coupled receptor in prostate cancer

Membrane receptors coupled to heterotrimeric G-proteins play an essential role in the transmission of signals from the extracellular environment to the cytoplasm of the cell. A wide variety of external stimuli, including neurotransmitters, hormones, phospholipids, photons, odorants, taste ligands, and growth factors, can activate specific members of the G-protein coupled receptors (GPCRs). Besides essential functions in fully differentiated cells and tissues, GPCRs are also involved in embryogenesis, tissue regeneration, cell growth stimulation, and cell proliferation. In this study, we identified a novel prostate-specific G-protein coupled receptor that interacts with Galpha(12) in our yeast two-hybrid assays. The expression of the receptor protein is highly restricted to human prostate tissues using multiple-tissue Northern blot analysis, and tissue expression array. Furthermore, the expression of prostate-specific receptor is increased significantly in prostate tumors in comparison with the matched normal prostate tissues using PCR and Southern blot analysis, suggesting a potential role of this tissue-specific G-protein coupled receptor in prostate cancer development.

Interleukin 10 inhibits the rat VSMC proliferation and collagen secretion stimulated by angiotensin II

OBJECTIVE

To study the effect of interleukin 10 (IL-10) on the angiotensin II (AngII) stimulated rat VSMC proliferation and collagen secretion, and furthermore, explore its mechanism.

METHODS

On cultured VSMC of rat, 3H-thymine (3H-TdR) and 3H-proline incorporations were used to evaluate the DNA and collagen synthesis, respectively. Western blot and immunoprecipitation were applied to assay the expression and activity of focal adhesion kinase (FAK), respectively.

RESULTS

IL-10 (10(-8) approximately 10(-10) g/ml) inhibited the increase of 3H-TdR and 3H-proline incorporation as well as FAK activity, which was induced by 10(-7) mol/L AngII (P < 0.05 or P < 0.01). IL-10 also obviously downregulated the synthesis and secretion of collagen by AngII stimulated VSMC. But there was no difference in the protein expression of FAK among all the groups (P > 0.05).

CONCLUSION

IL-10 antagonizes the VSMC proliferation and collagen synthesis by regulating FAK activity stimulated by AngII.