191 ROBUST GENERATION OF NEURAL STEM CELLS FROM PIG INDUCED PLURIPOTENT STEM CELLS FOR TRANSLATIONAL NEURAL REGENERATIVE MEDICINE

The generation of pig induced pluripotent stem cells (iPSC) opened the possibility to evaluate autologous neural cell therapy as a viable option for human patients. However, it is necessary to demonstrate whether pig iPSC are capable of in vitro neural differentiation similar to human iPSC in order to perform in vitro and in vivo comparative studies. Multiple laboratories have generated pig iPSC that have been characterised using pluripotent markers such as SSEA4 and POU5F1. However, correlations of pluripotent marker expression profiles among iPSC lines and their neural differentiation potential has not been fully explored. Because neural rosettes (NR) are composed of neural stem cells, our goal was to demonstrate that NR from pig iPSC can be generated, isolated, and expanded in vitro from multiple porcine iPSC lines similar to human iPSC and that the level of pluripotency in the starting porcine iPSC population (POUF51 and SSEA4 expression) could influence NRs development. Three lines of pig iPSC L1, L2, and L3 were cultured on matrigel-coated plates in mTeSR1 medium (Stemcell Technologies Inc., Vancouver, BC, Canada) and passaged every 3 to 4 days. For neural induction (NI), pig iPSC were disaggregated using dispase and plated. After 24 h, cells were maintained in N2 media [77% DMEM/F12, 10 ng mL–1 bovine fibroblast growth factor (bFGF), and 1X N2] for 15 days. To evaluate the differentiation potential to neuron and glial cells, NR were isolated, expanded in vitro and cultured for three weeks in AB2 medium (AB2, 1X ANS, and 2 mM L-Glutamine). Immunostaining assays were performed to determine pluripotent (POU5F1 and SSEA4), tight junction (ZO1), neural epithelial (Pax6 and Sox1), neuron (Tuj1), astrocyte (GFAP), and oligodendrocyte (O4) marker expression. Line L2 (POU5F1high and SSEA4low) showed a high potential to form NR (6.3.5%, P < 0.05) in comparison to the other 2 lines L1 (POU5F1low and SSEA4low) and L3 (POU5F1low and SSEA4high) upon NI. The NR immunocytochemistry results from Line L2 showed the presence of Pax6+ and Sox1– NRs cells at day 9 post-neural induction and that ZO1 started to localise at the apical border of NRs. At day 13, NRs cells were Pax6+ and Sox1+, and ZO1 was localised to the lumen of NR. After isolation and culture in vitro, NR cells expressed transcription factors PLAGL1, DACH1, and OTX2 through 2 passages, but were not detected in later passages. However, rosette cytoarchitecture was present up until passage 7 and were still Pax6+/Sox1+. NRs at passage 2 were cryopreserved and upon thaw showed normal NR morphology and were Pax6+/Sox1+. To characterise the plasticity of NRs, cells were differentiated. Tuj1 expression was predominant after differentiation indicating a bias towards a neuron phenotype. These results demonstrate that L2 pig iPSC (POUF51high and SSEA4low) have a high potential to form NR and neural differentiation parallels human iPSC neurulation events. Porcine iPSC should be considered as a large animal model for determining the safety and efficacy of human iPSC neural cell therapies.

Elevated expression of tumour necrosis factor-α-induced protein 8 (TNFAIP8)-like 2 mRNA in peripheral blood mononuclear cells is associated with disease progression of acute-on-chronic hepatitis B liver failure

Aberrant immunity response contributes to the pathogenesis of acute-on-chronic hepatitis B liver failure. Tumour necrosis factor-α-induced protein-8 like-2 (TIPE2) is a recently identified molecular to maintain immune homoeostasis, but its role in acute-on-chronic hepatitis B liver failure (ACHBLF) is unknown. We detected TIPE2 mRNA levels in peripheral blood mononuclear cells (PBMCs) from 56 patients with ACHBLF, 60 chronic hepatitis B patients, 24 healthy controls and analysed its role in disease severity and prognosis. TIPE2 mRNA expression in patients with ACHBLF was higher than that of patients with chronic infection or healthy controls. In patients with ACHBLF, TIPE2 mRNA level was positively correlated with serum total bilirubin, international normalized ratio and model for end-stage liver disease scores. Furthermore, the level of TIPE2 mRNA was significantly higher in nonsurvivors than survivors in patients with ACHBLF. The mRNA level of TIPE2 gradually decreased week by week in survivors accompanied by recovery from patients with ACHBLF, while its expression sustained at high levels in nonsurvivors. TIPE2 mRNA level after lipopolysaccharide (LPS) stimulation ex vivo in patients with ACHBLF was higher compared with controls and patients with chronic infection. Meanwhile, cytokines ex vivo secreted were measured as a marker of immune activation. After LPS stimulation, interleukin (IL)-6 and tumour necrosis factor (TNF)-α mRNA expression were reduced in patients with ACHBLF, and a significantly negative correlation was found between TIPE2 and TNF-α mRNA levels. In conclusion, our results identified the potential role of TIPE2 in predicting disease progression and prognosis in patients with ACHBLF by negative regulating of cell-mediated immunity.

Abstract PD3-1: Serial next generation sequencing (NGS) of poor prognosis luminal tumors across treatment history reveals both de novo and acquired alterations potentially associated with endocrine resistance

Cancer therapies exert selective pressure on genomically heterogeneous breast cancers and may select for alterations in genes associated with drug resistance or metastasis. We evaluated this hypothesis by comparing sequential primary, post-neoadjuvant chemotherapy, and recurrent metastatic tumor samples from 5 patients with aggressive hormone receptor positive (HR+) breast cancer.

Triplet samples (primary untreated, primary post-neoadjuvant chemotherapy, metastatic recurrence) were assessed in 5 patients with HR+ breast cancer. All patients were treated with cyclophosphamide and doxorubicin followed by paclitaxel or docetaxel, and adjuvant radiation and hormonal therapy. They all recurred during adjuvant antiestrogen treatment (12-43 months post-surgery). Metastatic sites included liver (2), ovary, brain, and pleural fluid. In these 5 tumor sets, we queried genomic alterations across 3,769 exons from 236 cancer genes using the FoundationOne™ NGS assay.

Gene amplifications were frequently discordant among the triplet biopsies; all patients showed copy number alterations and 3 of 5 patients had two or more additional gene amplifications confirmed only in the biopsy of the metastasis. ESR1 (ERa) mutations were identified in the metastatic lesions of 2/5 patients but not in the diagnostic biopsy or the post-neoadjuvant therapy mastectomy specimen; both also harbored de novo and concurrent GATA3 truncations. One of the ESR1 mutations, Y537S, is known to result in an estrogen-independent, transcriptionally active receptor. The same patient showed amplification of 11q13 genes CCND1, EMSY, and FGF19, an amplicon known to be associated with endocrine resistance. Concordant FGFR1 and ZNF703 amplifications, both at 8p12, were observed de novo in 2 other patients; these alterations have beenassociated with the luminal B subtype and resistance to antiestrogens. FGFR1/ZNF703 alterations were mutually exclusive with ESR1 mutations. The 5th tumor contained a PIK3CA ‘hot spot’ mutation in all 3 sequential biopsies. This tumor also exhibited IGF1R, IRS2, MYC and MCL1 gene amplification only in the metastasis. Overall, IGF1R amplifications were observed in 3/5 patients. In addition, amplification of ZNF217 at 20q13.2, an amplicon with known association with poor prognosis, was observed de novo in 2 patients that exhibited rapid recurrence on adjuvant therapy (12 and 17 months).

Acquired somatic alterations that deregulate ERα signaling may allow for escape from estrogen deprivation leading to treatment resistance. We speculate ESR1 mutations, rarely observed in primary breast tumors, are selected for during adjuvant hormonal treatment in aggressive HR+ breast cancer. Testing for de novo and acquired alterations throughout the clinical course of patients with ER+ cancers may identify targetable alterations, such as FGFR1 and IGF1R gene amplifications and others, against which targeted drugs are available. Studies are underway to validate these findings in additional patients with sequential samples and to investigate the function and therapeutic implications of ESR1 mutations.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD3-1.

Abstract P4-04-12: Identification of a common genotype in patients (pts) with HER2-positive, ER-negative, inflammatory breast cancer (IBC) that was primary-refractory to trastuzumab who have had 5+ years of disease control with lapatinib therapy

Background: HER2-amplified inflammatory breast cancer (IBC) that is primary-refractory to trastuzumab has a poor prognosis. The objective of this study was to describe the genotypes of the IBC obtained from 3 pts with high grade, ER-negative, HER2+ classical IBC, primary-refractory to trastuzumab, with chest wall disease, who remain with no evidence of disease (NED) on lapatinib for 5+ years.

The 3 postmenopausal pts presented with locally advanced IBC, 2 with disease extending onto the chest wall, and the third with chest wall recurrence while on adjuvant trastuzumab. Two pts were treated with preoperative trastuzumab with multiple chemotherapy agents with no response. They were then treated with preoperative lapatinib and had a clinical partial response. They underwent salvage mastectomy showing extensive residual disease, followed by chest wall/regional radiotherapy (RT), continuing on lapatinib. The third patient received preoperative AC followed by docetaxel and had extensive residual disease at mastectomy. She underwent chest wall/regional RT and then had chest wall recurrence while on adjuvant trastuzumab. She was treated with lapatinib and resection of residual chest wall disease. All 3 pts remain NED on 1250mg lapatinib daily. The 3 pts have a strong family history of breast cancer; two have known wild type germline BRCA1/2.

Methods: Following IRB-approved informed consent, targeted next generation DNA sequencing (NGS) was performed using HiSeq-2000 (Illumina) on pts’ FFPE primary IBC at a CLIA-certified laboratory, to characterize all classes of genomic alterations across 4,604 exons of 287 cancer-related genes. Phosphoprotein analysis was performed using a proprietary Reverse Phase Protein Microarray (RPMA) platform on pts's FFPE IBC to characterize the activity of the targets of anti-HER2 therapy, and their downstream pathways.

Results: In 2 pts’ IBCs NGS identified a common genotype with amplified ERBB2, mutant p53 and PIK3CA (c.3140A&gt;G_p.H1047R), homozygous deletions of both CDKN2A and CDKN2B, and truncated BRCA2 (1 pt) or PALB2 (1 pt). The third pt's FFPE residual disease from her mastectomy did not yield sufficient DNA from invasive tumor cells for sequencing and we plan to sequence DNA from her original diagnostic core biopsy. Phosphoprotein analysis of one pt's trastuzumab-refractory, lapatinib-naive IBC showed 3+ expression of HER1 (but not pHER1 Y1068 nor pHER2 Y1248), pAkt S473, pS6 ribosomal S235-236 protein (2+), p4E-BP1 S65 and Notch1. The second pt's lapatinib-treated IBC showed 3+ overexpression of only p4E-BP1 S65.

Conclusions: Pts with a common tumor phenotype who have highly durable responses with a targeted therapy may share a common tumor genotype. Two pts’ trastuzumab-refractory HER2+ IBCs that have been very durably responsive to lapatinib share p53, PIK3CA, p16 and BRCA2-related mutations, potentially enabling the prospective identification of trastuzumab-refractory IBC pts who may benefit substantially from lapatinib.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-04-12.

Observation of a charged charmoniumlike structure Zc(4020) and search for the Zc(3900) in e+e-→π+π-hc

We study e+e-→π+π-hc at center-of-mass energies from 3.90 to 4.42 GeV by using data samples collected with the BESIII detector operating at the Beijing Electron Positron Collider. The Born cross sections are measured at 13 energies and are found to be of the same order of magnitude as those of e+e-→π+π-J/ψ but with a different line shape. In the π±hc mass spectrum, a distinct structure, referred to as Zc(4020), is observed at 4.02  GeV/c2. The Zc(4020) carries an electric charge and couples to charmonium. A fit to the π±hc invariant mass spectrum, neglecting possible interferences, results in a mass of (4022.9±0.8±2.7)  MeV/c2 and a width of (7.9±2.7±2.6)  MeV for the Zc(4020), where the first errors are statistical and the second systematic. The difference between the parameters of this structure and the Zc(4025) observed in the D*D[over ¯]* final state is within 1.5σ, but whether they are the same state needs further investigation. No significant Zc(3900) signal is observed, and upper limits on the Zc(3900) production cross sections in π±hc at center-of-mass energies of 4.23 and 4.26 GeV are set.

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Z, Yanush S, Yao L, Yasu Y, Yatsenko E, Yau Wong KH, Ye J, Ye S, Yen AL, Yildirim E, Yilmaz M, Yoosoofmiya R, Yorita K, Yoshida R, Yoshihara K, Young C, Young CJS, Youssef S, Yu D, Yu DR, Yu J, Yu J, Yuan L, Yurkewicz A, Zabinski B, Zaidan R, Zaitsev AM, Zambito S, Zanello L, Zanzi D, Zaytsev A, Zeitnitz C, Zeman M, Zemla A, Zenin O, Ženiš T, Zerwas D, Zevi della Porta G, Zhang D, Zhang H, Zhang J, Zhang L, Zhang X, Zhang Z, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zibell A, Zieminska D, Zimin NI, Zimmermann C, Zimmermann R, Zimmermann S, Zimmermann S, Zinonos Z, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Measurement of jet shapes in top-quark pair events at [Formula: see text] using the ATLAS detector

A measurement of jet shapes in top-quark pair events using 1.8 fb-1 of [Formula: see text]pp collision data recorded by the ATLAS detector at the LHC is presented. Samples of top-quark pair events are selected in both the single-lepton and dilepton final states. The differential and integrated shapes of the jets initiated by bottom-quarks from the top-quark decays are compared with those of the jets originated by light-quarks from the hadronic W-boson decays [Formula: see text] in the single-lepton channel. The light-quark jets are found to have a narrower distribution of the momentum flow inside the jet area than b-quark jets.

Measurement of top quark polarization in top-antitop events from proton-proton collisions at √s=7 TeV using the ATLAS detector

This Letter presents measurements of the polarization of the top quark in top-antitop quark pair events, using 4.7  fb(-1) of proton-proton collision data recorded with the ATLAS detector at the Large Hadron Collider at √s=7  TeV. Final states containing one or two isolated leptons (electrons or muons) and jets are considered. Two measurements of α(ℓ)P, the product of the leptonic spin-analyzing power and the top quark polarization, are performed assuming that the polarization is introduced by either a CP conserving or a maximally CP violating production process. The measurements obtained, α(ℓ)P(CPC)=-0.035±0.014(stat)±0.037(syst) and α(ℓ)P(CPV)=0.020±0.016(stat)(-0.017)(+0.013)(syst), are in good agreement with the standard model prediction of negligible top quark polarization.

Efficacy of intravenous lidocaine versus placebo on attenuating cardiovascular response to laryngoscopy and tracheal intubation: a systematic review of randomized controlled trials

Cardiovascular response to laryngoscopy and tracheal intubation may be harmful in surgical patients with cardiovascular and cerebral diseases. The efficacy of intravenous lidocaine on attenuating the hemodynamic changes remains controversial. This systematic review aims to determine the efficacy of lidocaine versus placebo. PubMed, Embase and Cochrane Library databases were searched for relevant randomized controlled trials (RCTs). The quality of eligible RCTs was evaluated according to the modified Jadad scale. Quantitative analyses were carried out using Review Manager 5 and Stata 10. Thirty-seven trials with 1429 patients of different age groups were included in our meta-analysis. Additional lidocaine resulted in fewer changes in systolic blood pressure (SBP) (mean difference (MD) -4.32 mmHg, 95% confidence interval (CI) -6.21 to -2.43); diastolic blood pressure (DBP) (MD -4.76 mmHg, 95% CI -5.90 to -3.63); mean arterial blood pressure (MAP) (MD -2.72 mmHg, 95% CI: -3.65 to -1.80) and heart rates (HR) (MD -4.28 beats per min, 95% CI -5.83 to -2.72). Subgroup analysis showed that lidocaine was effective in both the elderly and children with the exception of failing to reduce HR in children. Exclusion of poor-quality trials did not change the favor to lidocaine. No significant publication bias across trials was found. Intravenous lidocaine helps reduce cardiovascular responses to laryngoscopy and tracheal intubation in patients of all age groups compared to placebo. Further studies are needed to clarify the effects of dosage and timing of lidocaine on hemodynamic changes.

Expression of nestin in ovarian serous cancer and its clinicopathologic significance

OBJECTIVE

Nestin has been found to be overexpressed in several human malignancies. The primary goal of this research was to investigate whether nestin expression correlates with the occurrence and development of ovarian cancer.

PATIENTS AND METHODS

Expression of nestin was evaluated by immunohistochemistry in 315 cases of various epithelial ovarian lesions as well as 52 cases of normal ovarian epithelia. The association between nestin expression and various clinical pathological parameters was analysed.

RESULTS

Immunohistochemical results showed that the positive correlation of nestin expression gradually increased from benign and borderline to malignant ovarian tumours. Nestin overexpression was associated with more advanced International Federation of Gynaecology and Obstetrics stage and higher histological grade in serous adenocarcinoma. Nestin expression was significantly associated with chemoresistance. However, there was no significant correlation between nestin expression and the age and level of CA125 in patients.

CONCLUSIONS

We propose that nestin expression might contribute to the initiation, promotion, and progression of serous ovarian carcinoma; nestin expression is associated with poor chemoresponse. It could be a potential therapeutic target in patients with epithelial ovarian carcinoma.

Measurement of the azimuthal angle dependence of inclusive jet yields in Pb+Pb collisions at √(sNN)=2.76 TeV with the ATLAS detector

Measurements of the variation of inclusive jet suppression as a function of relative azimuthal angle, Δφ, with respect to the elliptic event plane provide insight into the path-length dependence of jet quenching. ATLAS has measured the Δφ dependence of jet yields in 0.14 nb(-1) of √(s(NN))=2.76 TeV Pb+Pb collisions at the LHC for jet transverse momenta p(T)>45 GeV in different collision centrality bins using an underlying event subtraction procedure that accounts for elliptic flow. The variation of the jet yield with Δφ was characterized by the parameter, v(2)(jet), and the ratio of out-of-plane (Δφ~π/2) to in-plane (Δφ~0) yields. Nonzero v(2)(jet) values were measured in all centrality bins for p(T)<160 GeV. The jet yields are observed to vary by as much as 20% between in-plane and out-of-plane directions.

IL-1β strikingly enhances antigen-driven CD4 and CD8 T-cell responses

Protective immune response requires massive expansion of antigen-triggered naïve cells, extensive differentiation into effector cells, migration of effectors into the periphery, and generation of a functional memory compartment. IL-1β strikingly enhances expansion of antigen-primed CD8 and CD4 T cells in vivo. Its T-cell expansion in lymph nodes and spleen was direct, requiring that the stimulated T cells express IL-1R1. Immunization in the presence of IL-1β increases the frequency of IL-17- and IFN-γ-producing cells among primed CD4 cells and the frequency of granzyme B-expressing and IFN-γ-producing cells and of cytotoxic cells among primed CD8 cells. IL-1β-induced increase in the number of the activated CD4 and CD8 cells and augmented differentiation of the antigen-triggered T cells is very pronounced in liver and lungs. CD4 and CD8 cells primed in the presence of IL-1β display augmented cell number and enhanced cytokine production when rechallenged 2 mo after priming with antigen and lipopolysaccharide (LPS). In five in vivo models, IL-1β enhanced the protective value of weak vaccines. Preliminary analysis of in vivo gene expression in CD4 cells stimulated with IL-1β revealed that IL-1β caused gene expression changes consistent with the up-regulation of pathways involved in cell replication, cell survival, and enhanced energy metabolism. Thus, IL-1β enhances antigen-primed CD4 and CD8 T-cell expansion, differentiation, and migration to the periphery and memory, the specific functions required for generation of effective protective immune responses.

Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli

OBJECTIVE

To evaluate our early experience with endovascular revascularization in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA).

METHODS

A retrospective review was conducted of all patients who underwent endovascular revascularization for acute thromboembolic SMA occlusion from May 2005 to May 2012. Endovascular revascularization was performed using aspiration, intra-arterial thrombolysis, and adjunctive stent-placement techniques. Laparotomy was performed if the patient developed clinical signs of advanced bowel ischemia after endovascular procedure.

RESULTS

Twenty-one patients underwent endovascular revascularization for acute thromboembolic SMA occlusion. All presented with acute-onset abdominal pain. Three patients had rebound tenderness before the procedure. Computed tomography angiography revealed complete occlusion in seven cases and incomplete occlusion in 14 cases, with no evidence of free gas or bowel necrosis. The median duration from onset of symptoms to revascularization was 8.7 ± 4.1 hours (range, 2-18 hours). Completely successful endovascular revascularization occurred in six cases (aspiration alone, 3 cases; combined aspiration and urokinase, 3 cases); partial success was achieved in 15 cases (aspiration alone, 4 cases; combined aspiration and urokinase, 10 cases; and combined aspiration, urokinase, and stent placement, 1 case). Laparotomy was required in five patients, all of whom had SMA main trunk complete occlusion and required small bowel resection. The 30-day mortality for all patients was 9.5%. During a median follow-up of 26 months, 15 patients remained asymptomatic, three patients reported occasional abdominal pain, and one patient had temporary short-bowel syndrome.

CONCLUSIONS

Percutaneous revascularization is a promising alternative to surgery for acute SMA occlusion in selected patients who have no signs of advanced bowel ischemia. Early diagnosis followed by prompt endovascular intervention with close postprocedural monitoring is key. Laparotomy is indicated in patients who develop new or worsening signs of peritonism after endovascular procedure, particularly in those who had complete occlusion of the main trunk of the SMA.