Role of Toll-like Receptor 4 Expressed by Fibroblasts in Allograft Fibrosis in Mouse Orthotopic Tracheal Transplantation

Development of chronic lung allograft dysfunction involves various alloimmune-independent insults including those mediated by Toll-like receptor (TLR) signaling, which is known to activate alloimmune responses. We hypothesized that TLR signaling may also contribute to the activation of fibroblasts and promoting allograft airway fibrosis. Mouse orthotopic tracheal transplants were conducted between major histocompatibility complex (MHC)-mismatched Balb/c donor and wild-type C3H or C3H-derived TLR4 mutant recipients (nonfunctional TLR4). Immunohistochemistry on day 21 showed significantly smaller alpha-smooth muscle actin (α-SMA)-positive areas in TLR4 mutant recipients than wild-type recipients (P = .01). No difference was found for CD3+ T-cell infiltration. Proliferation of alloreactive T cells derived from the recipient spleen showed no difference between TLR4 mutant and wild-type recipients in a mixed lymphocyte reaction. The effect of TLR4 signaling was examined in primary pulmonary fibroblast cultures both with lipopolysaccharide (LPS) and transforming growth factor (TGF)-β1. Stimulation with LPS significantly increased expression of α-SMA mRNA in wild-type fibroblasts cultured with TGF-β1 compared with the control without LPS (P = .001). Taken together, these findings suggest disruption of TLR signaling leads to reduced activation of fibroblasts without affecting T-cell infiltration and proliferation in this model. TLR4-mediated activation of fibroblasts may be a potentially important mechanism of allograft remodeling.

Serum cytokine concentrations, chorioamnionitis and the onset of bronchopulmonary dysplasia in premature infants

OBJECTIVE

To investigate the relationships between serum cytokine concentrations and chorioamnionitis (CAM) and CAM-related bronchopulmonary dysplasia (BPD) in premature infants.

METHODS

Serum was collected at 0 and 7 days after birth from 36 premature infants born at <32 weeks of gestation. We examined the relationships between 30 cytokine concentrations and CAM, BPD, and other perinatal factors.

RESULTS

On day 0, GM-CSF, IL-15, IL-17, IL-2, IL-2R, VEGF, and MIG concentrations were significantly higher in the CAM group (n = 17) than in the non-CAM group (n = 19). These concentrations had decreased by day 7 and were similar in both groups. The IL-12p70 concentration on day 0 was significantly lower in the BPD group (n = 16) than in the non-BPD group (n = 15). BPD incidence was similar between the CAM and non-CAM groups.

CONCLUSIONS

These data support the hypothesis that intrauterine inflammation is not a primary risk factor for BPD. The immunological environment at birth or soon after, rather than intrauterine fetal inflammation (e.g., CAM), is a primary risk factor for BPD onset in preterm infants. Decreased inflammatory responses are particularly relevant, as indicated by the relationship between BPD and low serum IL-12p70 concentrations on day 0.

Azathioprine-induced Agranulocytosis and Severe Alopecia After Kidney Transplantation Associated With a NUDT15 Polymorphism: A Case Report

BACKGROUND

Azathioprine (AZA) is the drug recommended for the continuation of immunosuppressive treatment after renal transplant in women during pregnancy.

CASE REPORT

A 37-year-old Japanese female developed agranulocytosis and severe alopecia after initiation of AZA (50 mg), used as an alternative to mycophenolate mofetil (MMF, 1000 mg) therapy in anticipation of a planned pregnancy. Within 4 days of the initiation of AZA therapy, the patient developed a high fever, leucopenia, and cranial alopecia. Genetic testing revealed a homozygous polymorphism of NUDT15 (rs116855232, NM_018283.3:c.415C>T: p.Arg139Cys), which has previously been identified as a risk factor for AZA-related complications in patients with inflammatory bowel disease.

CONCLUSION

Genetic screening for NUDT15 could contribute to the prevention of serious adverse reactions to AZA and provide the opportunity for personalized medicine. Identification of a safe alternative to MMF during pregnancy after a renal transplant is a problem to be resolved in the future.

Low-Dose Induction Radiotherapy for Stomach Conservation in Patients with Massive Gastric Lymphoma

Low-dose induction radiotherapy was performed in 4 patients with massive gastric lymphoma in order to treat the disease without gastrectomy. Following the radiotherapy, gastric lesions had shrunk considerably without any complications. Standard chemotherapy and/or radiotherapy could then be performed safely, and stomach conservation could be achieved in all 4 patients.

Abstract P1-07-13: Obesity is associated with poor prognosis of Japanese breast cancer, especially in ER positive/HER2 negative subtype, which tendency is prominent

Introduction: Body mass index (BMI) is defined as a poor prognostic factor in breast cancer patients in western countries. Since the percentage of the overweight differs between Asian and western breast cancer patients, we do not know if breast cancer prognosis in Asia is related to obesity, the same as in western countries. Therefore, we have investigated the association between BMI and the prognosis of Japanese breast cancer patients.

Patients and Methods: This study is a retrospective analysis of the 1,924 primary Japanese female breast cancer patients with clinical stage I through III disease to have undergone surgery between January 2004 and December 2013 at the Hokkaido Cancer Center. The data of BMI were at the time of diagnosis, and stratified into 2 groups as non-Obese (BMI &lt; 25 kg/m2), Obese (BMI ≥ 25 kg/m2). The overall survival (OS) and disease-free survival (DFS) were compared between two BMI groups using the Kaplan-Meier method and Cox hazards model.

Results: The number of non-Obese group was 1,353 (70.3%) and Obese group was 571 (29.7%) of the 1,924 patients. Six hundred and thirty two patients were in premenopausal (32.8%), 1,289 were in postmenopausal (67.0%) and 3 were unknown. The median follow-up period was 73 months. Breast cancer recurred in 239 patients (12.2%), and 204 patients died. There were 110 cases of breast cancer-related death, 48 cases of non-breast cancer death, and 46 cases of unknown as the cause of death. Patients in Obese group had shown significantly poorer OS (adjusted hazard ratio (HR) = 1.68, 95% confidence interval (CI) = 0.45 to 0.79) and DFS (HR = 1.46, 95% CI = 1.16 to 1.82). As investigating by subtype analysis, a high BMI in ER positive/HER2 negative patients was associated with a significantly worse OS (HR = 2.04, 95% CI = 1.42 to 2.92) and significantly worse DFS (HR = 1.61, 95% CI = 1.23 to 2.11). On the other hand, there was no significant interaction found between the BMI and OS or DFS in ER negative/HER2 negative patients and HER2 positive patients. Subsequently, when analysis was limited to ER positive HER2 negative, there was a difference in the degree of association between obesity and prognosis due to the difference in menopause status. In premenopausal patients with ER positive/HER2 negative cancer, Obese group had significantly poorer OS (HR = 2.83, 95%CI = 1.32 to 5.88) and significantly poorer DFS (HR = 2.41, 95%CI = 1.41 to 3.99). In postmenopausal patients, Obese group patients had significantly poorer OS (HR = 1.71, 95%CI = 1.11 to 2.58) and poorer DFS (HR = 1.35, 95%CI = 0.98 to 1.86), however. The relevance was not so large compared with that in premenopausal patients.

Conclusion: Among Japanese breast cancer patients, Obese (BMI ≥ 25 kg/m2) was one of poor prognostic factors. Specifically, obesity was associated as an extremely strong prognostic factor in ER positive/HER2 negative premenopausal patients. Since hormone therapy has been practiced in almost all ER positive breast cancers, the relationship between hormonal therapy susceptibility and obesity is noticed not only in western patients but also in Asian patients.

Citation Format: Sato M, Terai S, Tachikawa H, Maeda H, Yamamoto M, Tomioka N, Watanabe K, Takahashi M. Obesity is associated with poor prognosis of Japanese breast cancer, especially in ER positive/HER2 negative subtype, which tendency is prominent [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-13.