Usual Interstitial Pneumonia Pattern in the Lower Lung Lobes as a Prognostic Factor in Idiopathic Pleuroparenchymal Fibroelastosis

BACKGROUND

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare interstitial pneumonia that is characterized by stiffness in both the upper lobes and pleura, which is evident on high resolution computed tomography (HRCT) of the chest. However, prognostic factors for IPPFE have not been identified yet.

OBJECTIVE

We aimed to investigate the clinical prognostic factors affecting survival in patients with IPPFE.

METHODS

Between April 2009 and September 2017, we enrolled 36 patients who were clinically diagnosed with IPPFE, using HRCT. These patients were classified as either short survival (dead within 12 months from the diagnosis of IPPFE) or long survival (survived for greater than 12 months) groups. We retrospectively analyzed the clinical characteristics, serum markers, pulmonary function test results, and HRCT findings.

RESULTS

Twelve patients were classified into the short survival and 24 were categorized into long survival categories. At the time of diagnosis, the incidence of coexistence of a usual interstitial pneumonia (UIP) pattern in the lower lobes on HRCT in the short survival was significantly higher than that in the long survival. Multivariate analysis revealed that a UIP pattern in the lower lobes on HRCT was the only independent variable for poor prognosis. The median survival time from diagnosis in patients with IPPFE was 24 months. Of these patients with IPPFE, the survival time with a UIP pattern was significantly shorter than in those without a UIP pattern.

CONCLUSION

Our findings suggest that a UIP pattern in the lower lobes at the time of diagnosis was an independent prognostic factor for IPPFE.

Hydrocarbon pneumonitis caused by the inhalation of wood preservative

A 69-year-old man was admitted to our hospital with acute dyspnoea, which developed after using a wood-preserving agent in an enclosed space. Burn injuries were evident on his face, neck, chest, and both upper arms. Bronchoalveolar lavage was carried out. The collected fluid resembled wood preservative. Subsequently, it was established that kerosene was a major component of the wood preservative. A diagnosis of hydrocarbon pneumonitis was established. The patient's respiratory and general findings improved with intensive care, which included mechanical ventilation. Corticosteroid was not required to aid his recovery. Aspiration and/or inhalation of hydrocarbon compounds, such as kerosene, turpentine, and gasoline, can cause acute and fatal pneumonitis. In managing cases of hydrocarbon pneumonitis, a prompt diagnosis and appropriate supportive care are important to achieve a good outcome.

Search for CP Violation in Neutrino and Antineutrino Oscillations by the T2K Experiment with 2.2×10^{21} Protons on Target

The T2K experiment measures muon neutrino disappearance and electron neutrino appearance in accelerator-produced neutrino and antineutrino beams. With an exposure of 14.7(7.6)×10^{20} protons on target in the neutrino (antineutrino) mode, 89 ν_{e} candidates and seven anti-ν_{e} candidates are observed, while 67.5 and 9.0 are expected for δ_{CP}=0 and normal mass ordering. The obtained 2σ confidence interval for the CP-violating phase, δ_{CP}, does not include the CP-conserving cases (δ_{CP}=0, π). The best-fit values of other parameters are sin^{2}θ_{23}=0.526_{-0.036}^{+0.032} and Δm_{32}^{2}=2.463_{-0.070}^{+0.071}×10^{-3}  eV^{2}/c^{4}.

Japanese guideline for the treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology which accounts for a large proportion of cases of idiopathic interstitial pneumonia. It has a very poor prognosis with a 5-year survival rate of 30% or below, and so far there has been no guideline in Japan offering an established effective therapy based on evidence. In addition to the establishment of basic therapies, there is also an urgent need to establish therapies to deal with complications, as death occurs in many cases due to acute exacerbation or comorbid lung cancer. It was therefore decided to formulate a guideline in order to promote evidence-based clinical practice, to further improve the quality of medical treatment in the clinical setting, and to allow the benefits to be enjoyed by the public.

Toxicity of Heparinoids, with Special Reference to the Precipitation of Fibrinogen

To demonstrate whether the intravascular precipitation of fibrinogen is responsible for the toxicity of heparinoid, the relation between the toxicity of heparinoid in vivo and the precipitation of fibrinogen in vitro was investigated, using dextran sulfate of various molecular weights and various heparinoids.

1. There are close relationships between the molecular weight of dextran sulfate, its toxicity, and the quantity of fibrinogen precipitated.

2. The close relationship between the toxicity and the precipitation of fibrinogen found for dextran sulfate holds good for other heparinoids regardless of their molecular structures.

3. Histological findings suggest strongly that the pathological changes produced with dextran sulfate are caused primarily by the intravascular precipitates with occlusion of the capillaries.

From these facts, it is concluded that the precipitates of fibrinogen with heparinoid may be the cause or at least the major cause of the toxicity of heparinoid.

4. The most suitable molecular weight of dextran sulfate for clinical use was found to be 5,300 ~ 6,700, from the maximum value of the product (LD50 · Anticoagulant activity). This product (LD50 · Anticoagulant activity) can be employed generally to assess the comparative merits of various heparinoids.

5. Clinical use of the dextran sulfate prepared on this basis gave satisfactory results. No severe reaction was observed. However, two delayed reactions, alopecia and thrombocytopenia, were observed. These two reactions seem to come from the cause other than intravascular precipitation.

Dasatinib Suppresses TGFβ-Mediated Epithelial-Mesenchymal Transition in Alveolar Epithelial Cells and Inhibits Pulmonary Fibrosis

PURPOSE

Transforming growth factor β (TGFβ)-mediated epithelial-mesenchymal transition (EMT) of alveolar epithelial cells contributes to pulmonary fibrosis. Dasatinib (DAS), a potent and broad-spectrum tyrosine kinase inhibitor, has been widely studied as an anti-cancer agent. However, the therapeutic application of DAS for pulmonary fibrosis has not been clarified. Our purpose here is to investigate the effect of DAS on TGFβ1-induced EMT in human alveolar and bronchial epithelial cells in vitro and to evaluate the efficacy of DAS on lung fibrosis in vivo.

METHODS

TGFβ1-stimulated human alveolar epithelial (A549) and bronchial epithelial (BEAS-2B) cells were treated with or without DAS in vitro. Murine pulmonary fibrosis model was generated by injection of bleomycin (BLM).

RESULTS

A549 and BEAS-2B cells exposed to TGFβ1 underwent EMT, as indicated by downregulation of epithelial protein E-cadherin and induction of the mesenchymal proteins, fibronectin and type I and type IV collagen. These effects were dramatically suppressed by DAS treatment, which also prevented Smad2 and Smad3 phosphorylation. DAS inhibited TGFβ1-induced cell motility and migration. Furthermore, DAS administration significantly attenuated lung fibrosis in mice by histological analysis. Treatment with DAS also significantly reduced the levels of collagen and fibronectin and phosphorylation of Smad2 in the lung tissues of the murine model.

CONCLUSIONS

These findings suggest that DAS inhibited TGFβ-mediated EMT of alveolar and bronchial epithelial cells and attenuated BLM-induced lung fibrosis in mice by suppressing the TGFβ/Smad pathway. DAS may be a promising and novel anti-fibrotic agent for preventing lung fibrosis.

Clinical features of squamous cell lung cancer with anaplastic lymphoma kinase (ALK)-rearrangement: a retrospective analysis and review

Anti-anaplastic lymphoma kinase (ALK)-targeted therapy dramatically improves therapeutic responses in patients with ALK-rearranged lung adenocarcinoma (Ad-LC). A few cases of squamous cell lung carcinoma (Sq-LC) with ALK rearrangement have been reported; however, the clinicopathological features and clinical outcomes following treatment with ALK inhibitors are unknown. We addressed this in the present study by retrospectively comparing the clinical characteristics of five patients with ALK-rearranged Sq-LC with those of patients with ALK-rearranged Ad-LC and by evaluating representative cases of ALK inhibitor responders and non-responders. The prevalence of ALK rearrangement in Sq-LCs was 1.36%. Progression-free survival (PFS) after initial treatment with crizotinib was significantly shorter in Sq-LC than in Ad-LC with ALK rearrangement (p = 0.033). Two ALK rearrangements assayed by fluorescence in situ hybridization (FISH)-positive/immunohistochemistry-negative cases did not respond to crizotinb, and PFS decreased following alectinib treatment of ALK-rearranged Sq-LC (p = 0.045). A rebiopsy revealed that responders to ceritinib harbored the L1196M mutation, which causes resistance to other ALK inhibitors. However, non-responders were resistant to all ALK inhibitors, despite the presence of ALK rearrangement in FISH-positive circulating tumor cells and circulating free DNA and absence of the ALK inhibitor resistance mutation. These results indicate that ALK inhibitors remain a reasonable therapeutic option for ALK-rearranged Sq-LC patients who have worse outcomes than ALK-rearranged Ad-LC patients and that resistance mechanisms are heterogeneous. Additionally, oncologists should be aware of the possibility of ALK-rearranged Sq-LC based on clinicopathological features, and plan second-line therapeutic strategies based on rebiopsy results in order to improve patient outcome.

Abstract P4-03-12: Effects of PI3K inhibitors on endocrine-resistant cell lines and differences in the characteristics of ER positive breast cancer cells after acquired resistance to the inhibitors

Background

Mutations in phosphatidylinositol 3-kinase (PI3K), which encodes the catalytic subunit of PI3Kα, is one of the most frequent genomic alterations and is found in about 40% of estrogen receptor (ER)-positive, HER2 negative breast cancers. PIK3CA mutations promote the growth and proliferation of cancers via activation of the PI3K/mammalian target of rapamycin pathway and can mediate resistance to endocrine therapies in breast cancer. Although several clinical trials for PI3K inhibitors (PI3Kis) in ER-positive metastatic breast cancers are ongoing, the effects of PI3Kis on endocrine-resistant breast cancers with various characteristics and definitive biomarkers of PI3Kis are unclear. Using endocrine-resistant cells established in our laboratory, we evaluated the efficacy of PI3Ki in these cell lines and identified the characteristics associated with acquired resistance to PI3Kis in endocrine-resistant cells.

Results

Long-term estrogen deprivation-resistant (EDR) cell lines and fulvestrant-resistant cell lines (MFR and TFR) were established from MCF-7 and T-47D cells in our previous studies. These cell lines showed different ER expression levels, including high expression (EDR-1), low expression (EDR-2, -3), or no expression (MFR, TFR); all of these cell lines had the same PIK3CA mutations as the parental cell lines. The pan-class1 PI3Ki buparlisib (BKM120) and α-specific PI3K inhibitor alpelisib (BYL719) inhibited the proliferation of endocrine-resistant cell lines when compared with their parental cells. Among endocrine-resistant cells, MFR cells were dramatically inhibited by PI3Kis. Colony formation assays indicated that MFR cells were more sensitive to PI3Kis than other cells lines. Next, we established PI3Ki- and everolimus-resistant cell lines from EDR-1, EDR-2, and MFR cells using BKM120, BYL719, and everolimus. Analysis of the time required to generate resistant cells showed that MFR cells required twice as long to acquire resistance compared with EDR cells. Furthermore, the time required to acquire resistance to BYL719 was shorter than that for BKM120. BYL719-resistant (BYL-R) cells were effectively inhibited by BKM120 to a degree similar to that of parental cells; however, BYL-R cells lost sensitivity to BYL719 and everolimus. Evelolimus-resistant (EVE-R) cells were also the same. In contrast, BKM120-resistant (BKM-R) cells showed less sensitivity to BKM120, BYL719, and everolimus. In other words, the pan-PI3Ki BKM120 was able to inhibit the growth of BYL-R and EVE-R cells, whereas BYL719 and everolimus were not able to inhibit BKM-R cells sufficiently. In addition, there were no changes in ER expression in EDR-1, EDR-2, and MFR cells exposed to PI3Kis for 1 h. Interestingly, ER expression on EDR-2 cells with acquired resistance to PI3Kis was increased compared with that in parental cells.

Conclusion

Our findings showed that PI3Kis exhibited remarkable efficacy in all types of EDR cells, particularly in fulvestrant-resistant cell lines. In PI3Ki- and everolimus-resistant cell lines, BKM120 and BYL719 showed different effects, and BYL719 and everolimus may exhibit cross-resistance. Furthermore, PI3Kis were likely to change the expression of ER.

Citation Format: Tokuda E, Komatsu T, Sasaki S, Tsuboi K, Nakamura M, Iida M, Niwa T, Saito M, Hayashi S-I. Effects of PI3K inhibitors on endocrine-resistant cell lines and differences in the characteristics of ER positive breast cancer cells after acquired resistance to the inhibitors [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 P4-03-12.

Development of interstitial pneumonia during treatment with eribulin: a case report

Background

Eribulin is typically used to treat patients with advanced breast cancer, and anti-cancer agents often cause the development of interstitial pneumonia in Japanese patients with advanced cancer. However, few case reports have addressed eribulin-induced interstitial pneumonia. Herein, we report a rare case of interstitial pneumonia—specifically, organized pneumonia—during treatment with eribulin in a patient with advanced breast cancer.

Case presentation

A 52-year-old Japanese woman was diagnosed as having advanced breast cancer 3 years before the admission described in the present report. She had received eribulin as third-line chemotherapy. Five days after her second treatment with eribulin, she was admitted to our hospital with dyspnea and dry cough. Upon admission, a chest computed tomography scan showed consolidation, with air bronchograms along the bronchovascular bundle of both lower lobes. The patient’s serum levels of sialylated carbohydrate antigen Krebs von den Lungen-6 were high, as were her surfactant protein-D levels. There was no evidence of heart failure, renal failure, or infection. Based on the clinical cause, as well as on the findings of organized pneumonia, the patient was diagnosed as having interstitial pneumonia and treated with corticosteroids. After the initiation of steroid treatment, her respiratory condition and chest radiological findings improved.

Conclusions

This case reveals an association between eribulin treatment and interstitial pneumonia. To our knowledge, this is the first case report to describe eribulin-induced organized pneumonia. Clinicians should be aware that interstitial pneumonia can develop during treatment with anti-cancer agents.

Evaluation of absolute measurement using a 4π plastic scintillator for the 4πβ-γ coincidence counting method

Absolute measurement by the 4πβ-γ coincidence counting method was conducted by two photomultipliers facing across a plastic scintillator to be focused on β ray counting efficiency. The detector was held with a through-hole-type NaI(Tl) detector. The results include absolutely determined activity and its uncertainty especially about extrapolation. A comparison between the obtained and known activities showed agreement within their uncertainties.

Crystallization and vitrification of electrons in a glass-forming charge liquid

Charge ordering (CO) is a phenomenon in which electrons in solids crystallize into a periodic pattern of charge-rich and charge-poor sites owing to strong electron correlations. This usually results in long-range order. In geometrically frustrated systems, however, a glassy electronic state without long-range CO has been observed. We found that a charge-ordered organic material with an isosceles triangular lattice shows charge dynamics associated with crystallization and vitrification of electrons, which can be understood in the context of an energy landscape arising from the degeneracy of various CO patterns. The dynamics suggest that the same nucleation and growth processes that characterize conventional glass-forming liquids guide the crystallization of electrons. These similarities may provide insight into our understanding of the liquid-glass transition.