Association of tumor necrosis factor-α and matrix metalloproteinase-3 gene variants with stroke

BACKGROUND AND PURPOSE

  There is increasing evidence that the genetic variation in the genes coding for pro-inflammatory markers and matrix metalloproteinase may play an important role in the pathogenesis of various human diseases including stroke. The aim of this study was to evaluate the association of genetic variants within the genes encoding tumor necrosis factor-α (TNF-α) and matrix metalloproteinase-3 (MMP-3), with stroke.

METHODS

  Five hundred and twenty-five ischemic stroke patients and 500 age- and sex-matched controls were included in this study. We analyzed +488 G/A polymorphism in TNF-α gene and -1612 5A/6A polymorphism in MMP-3 gene. The genotypes were determined by Amplification Refractory Mutation System PCR. The strength of association between genotypes and stroke was measured by the odds ratio with 95% confidence interval (CI) and chi-squared analysis.

RESULTS

  Allelic and genotypic frequencies of TNF-α G/A polymorphism differed significantly between patients and healthy controls (P < 0.001). A stepwise logistic regression analysis confirmed these findings (P < 0.001). Further, evaluating the association of this polymorphism with stroke subtypes, we found significant association with intracranial large artery atherosclerosis, extracranial large artery atherosclerosis, and stroke of undetermined etiology. As far as MMP-3-1612 5A/6A polymorphism is concerned, there was no significant difference in genotypic distribution and allelic frequency between the patients and healthy controls (P = 0.5 and 0.9, respectively). We tested the gene-gene interaction between TNF-α and MMP-3 genes using the logistic regression model. However, there was no evidence for a gene-gene interaction between TNF-α and MMP-3.

CONCLUSION

  TNF-α +488 G/A variant is an important risk factor for ischemic stroke in the South Indians from Andhra Pradesh, whereas MMP-3-1612 5A/6A polymorphism is not associated with stroke in the same population.

Patent ductus arteriosus device embolization

Nonsurgical closure of patent ductus arteriosus (PDA) using a duct occluder placed percutaneously is currently the first line of therapy and the success rate is quite high. Several devices are currently available. An eight year child underwent device closure of the ductus. However after deployment of the device it, became dislodged into the left pulmonary artery. Several attempts at catheter retrieval failed. The child underwent successful surgical removal of the device without cardiopulmonary bypass.

Postoperative pain after cholecystectomy: Conventional laparoscopy versus single-incision laparoscopic surgery

BACKGROUND

This study was undertaken to compare the postoperative pain after cholecystectomy done by single-incision laparoscopic surgery (SILS) versus conventional four-port laparoscopy [conventional laparoscopic surgery (CLS)]. SILS is a feasible and a promising method for cholecystectomy. It is possible to do this procedure without the use of special equipments. While there are cosmetic advantages to SILS, it is not clear whether or not the pain is also reduced.

METHODS

Patients undergoing cholecystectomy for symptomatic gallstones were offered the choice of the two methods and the first 100 consecutive patients from each group were included in this observational study. Only conventional instruments were used to keep the cost of surgery comparable. Pain scores were checked 8 hours after the surgery using visual analogue score. Student's t test was done to check the statistical significance.

RESULTS

We observed no significant difference in the pain score between the CLS and SILS (2.78 versus 2.62). The operative time (OT) was significantly lower in the CLS group (28 versus 67 minutes). Comparing the OTs of the first 50 patients undergoing SILS with the second 50 patients showed a significantly lower OT (79 versus 54 minutes). We also compared the pain score between these three groups. The second half of SILS group had a significantly lower pain score compared to the first half (2.58 versus 2.84). This group also had a lower pain score compared to conventional laparoscopy group but the difference was not statistically significant (2.58 versus 2.78).

CONCLUSION

Although there was no significant difference in the overall postoperative pain as OT decreases with surgeon's experience in single-incision laparoscopic cholecystectomy, postoperative pain at 8 hours appears to favour this method over conventional laparoscopic cholecystectomy.

Depletion of serum zinc in ischemic stroke patients

The pathogenesis of a number of diseases like cardiovascular diseases, cancer and neurological disorders, has been associated with changes in the balance of certain trace elements. In this study we aimed at investigating the levels of trace elements like calcium, copper, iron and zinc, in ischemic stroke patients in comparison with healthy controls. Serum samples were collected from 256 ischemic stroke patients and 180 healthy, age and sex matched controls. Trace element levels were detected using commercially available kits and an Auto-Analyzer (ChemWell 2910, Awareness Technology, US). The concentrations of calcium, copper and iron were not significantly different in patients when compared to healthy controls. The concentration of zinc was significantly lower in stroke patients (P = 0.001) as compared to normal subjects. To conclude, patients with acute ischemic stroke have reduced levels of serum zinc. Zinc may represent an independent risk factor for stroke and therefore a possible target for prevention. Additional studies are needed to further examine the role of zinc in the pathogenesis of stroke.

Abstract P1-13-07: Standardized Immunocytological and Molecular Analysis of Tumor Cells and Mesenchymal Stromal Cells in Bone Marrow of Patients with Primary Breast Cancer

Background: Using criteria for classification of disseminated tumor cells in compliance with the publication of Fehm et al. (Cancer, Vol.107, 2006) we have reported a cytological DTC-positivity rate of 1.9% (39/2050) in patients with primary breast cancer (T1-4, N0/N+, M0/M1). However automated picture analysis revealed cytokeratin positive stroma cell types in DTC negative samples. Here we describe the cytological and molecular characterization of these mesenchymal stromal cell (MSC) types. Material and Methods: Mononuclear cells were enriched by Ficoll density-gradient centrifugation. Cytospin slides (mean 6) with 1x106 BM-cells were stained by CK antibodies 5D3 and A45-B/B3 using automated immunostainers with the APAAP-and the enhanced SA-FastRed-method. Slides were analysed by automated picture analysis with the ACIS I and ACIS II systems (ChromaVision). Plastic adherent cells (1x106) from culture passage one from 71 breast cancer patients were analysed for expression of CK19, MUC1 and EpCAM by FACS analysis. Trypsinized cells (n=100) were lysed and used for mRNA isolation and c-DNA synthesis (Qiagen®). A real-time quantitative RT-PCR approach (MESA FAST SYBR Assay, Eurogentec®) and primers selected from the UniversalProbeLibrary system (Roche AG®) was used for the determination of the markers EpCAM, survivin, CD144, CD146, CD 105, and CD271.

Results: Small cells characterized by an excentrically located small and clear nucleus were detected in 56% (486/866) of the bone marrow samples in a mean frequency of 1-2 cells per slide. However a subgroup of patients is characterized by elevated MSC levels. More than 5 MSC cells per 106 BM cells were detected in 19,7% (96/486) samples of the DTC negative group with elevated MSC levels in 5,2% NO, 6% N+ and 9% T3/T4 tumors. By molecular expression analysis of 71 bone marrow samples 8 probes (11%) were CK19 positive. Corresponding MSC cultures had significantly elevated expression levels of the markers vimentin, survivin, CD144, CD105, CD146 and CD271.

Discussion: We have identified CK positive bone marrow stroma cells in 56% of patients with primary breast cancer. Immunobead RT-PCR based on 107 BM cells can be used to eliminate this background and to increase DTC-sensitivity from 2 to 11%. Frequency and expression profile of MSC in these probes may give valuable additional information to understand in the complex interrelation of tumor cells with tumor-associated mesenchymal stromal cells, erythroblasts and endothelial cells in the process of metastasis.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-13-07.

Implementation of a Composite Score System for Evaluation of Circulating Tumor Cells in Blood of Breast Cancer Patients

Background: We present a highly specific immunomagnetic separation technique in combination with an improved multimarker gene panel for molecular identification and characterization of circulating breast tumor cells in blood. Here we describe the creation of a new composite score in order to manage results and avoid false positives. Methods: Blood from breast cancer patients with primary or metastatic disease was drawn into two 10mL EDTA-tubes. The high affinity antibodies BM7 (MUC1) and VU1D9 (EpCAM) were used for immunomagnetic tumor cell enrichment. Separated cells were lysed and used for mRNA isolation and c-DNA synthesis (Qiagen®). A real-time quantitative RT-PCR approach using MESA FAST SYBR Assay (Eurogentec®) and primers selected from the UniversalProbeLibrary system (Roche AG®) for the epithelial markers cytokeratin 19 (CK19), mammaglobin 1 (MG1), epithelial cell adhesion molecule (EpCAM), baculoviral IAP repeat-containing 5 (Sur), immunosuppressive CD276 (CD276), carcinoembryonic antigen-related cell adhesion molecule 5 (CEA), HER-2, aldehyde dehydrogenase 1 family, member A1 (ALDH1), hypoxia inducible factor (HIF-1alpha) and CD44 molecule (CD44) was used for tumor cell identification and characterization. The ß-actin transcript was used for internal control and matched calibrator probes containing 2 or 10 tumor cells were used for quantitative expression analysis of tumor associated genes present in blood.Results: Positivity rate was based on a score that consists of 2 different characteristics: Marker detection (ranking according to the number of positive markers, varies from 0 – negative - to 1 – positive - for each marker) in combination with the marker expression level (ranking according to the C(t) values and varies from 0 – less then 2 tumor cells – to 1 – more then 2 tumor cells). This composite score is based on the expression of CK19, MG1, EpCAM, Sur and CD276 and has a ranking from 0 to 10. Negative cases are classified with score 0 and 1, cases ranked with score 2 need retesting and finally scores above 2 indicate clearly positive patients. The additional surrogate markers CEA, HER-2, ALDH, HIF and CD44 are analysed in positive patients in order to obtain further information. In our group of metastatic breast cancer patients, 53% were classified as positive, 42% of the patients were negative and in 5% a retesting is needed. Conclusion: The results of the composite score clearly show an increase of sensitivity and specificity for this assay. The implementation of this test in the routine monitoring of patients should help us to evaluate treatment response and create individualized treatment schedules.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3015.

Implant for Augmentation of Cerebral Blood Flow Trial 1: A Pilot Study Evaluating the Safety and Effectiveness of the Ischaemic Stroke System for Treatment of Acute Ischaemic Stroke

Introduction

In rat stroke models, sphenopalatine ganglion stimulation up to 24 h after stroke onset augments cerebral blood flow, reduces infarct volume and improves neurological deficits. The ischaemic stroke system 500 has been designed to stimulate the sphenopalatine ganglion in humans.

Objectives

( 1 ) To determine the safety and tolerability of the ischaemic stroke system 500 in acute ischaemic stroke within 24 h of stroke onset. ( 2 ) To determine the effectiveness of ischaemic stroke system 500 in acute ischaemic stroke treatment.

Design/Methods

Implant for augmentation of cerebral blood flow trial-1 is a multi-national open-label study in patients of acute ischaemic stroke in the anterior circulation with National Institutes of Health Stroke Scales 7–20. The treatment initiation will be within 24 h of stroke onset. The ischaemic stroke system is implanted adjacent to the sphenopalatine ganglion via the greater palatine canal using local anaesthesia and a minimally invasive approach. The treatment protocol is constituted as 3–4 h of daily stimulation over 5–7 days. Conclusions The implant for augmentation of cerebral blood flow trial-1 will determine the safety and tolerability of the ischaemic stroke system 500 in acute ischaemic stroke as reflected by the incidence of adverse events.

Natriuretic peptides and heart failure in the patient with chronic kidney disease: a review of current evidence

Natriuretic peptides such as brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are commonly used in the diagnosis and evaluation of heart failure. However, their utility in patients with chronic kidney disease (CKD) is less clear as renal dysfunction itself can be associated with elevated concentrations of these biomarkers. Given the high prevalence of left ventricular hypertrophy and left ventricular systolic dysfunction in patients with CKD, diagnosis or exclusion of heart failure becomes important in this population. Most studies to date indicate that upward adjustment of diagnostic cut points preserves the usefulness of both BNP and NT-proBNP in the CKD patient, with similar clinical performance of each biomarker. We review the role of natriuretic peptide in heart failure in the setting of chronic renal disease.