Abstract P5-04-08: Modeling breast cancer dormancy

Most cancer mortality results from distant metastases. The metastatic microenvironment protects ectopic tumors, these nodules are often resistant to agents that eradicate the primary mass. Although significant interventional progress has been made on primary tumors, the lack of relevant accessible model in vitro systems in which to study metastases has plagued metastatic therapeutic development – particularly among micrometastases. One third of women diagnosed with breast cancer (BC) will have metastatic disease which often presents years after a seeming cure from the primary malignancy. An in silico model of micrometastases strongly suggests that these disseminated cells are quiescent, or ‘dormant’, for long periods of time. Current models fail to recapitulate metastatic dormancy, in vivo due to issues of spontaneous metastases and rodent lifespan and in vitro due to the nascent state of organotypic organs or microphysiological systems (MPS). We hypothesize that even the most developed MPS do not allow tumors to attain dormancy due to continued stress signaling from stiff matrices and an artificial microenvironment. We use an innovative all human three dimensional liver MPS to faithfully reproduce human physiology and pathology. In the initial iteration, the liver cells are isolated from therapeutic partial hepatectomies, but as this source may be limiting, we are examining induced pluripotent stem cells (iPSC). Currently these iPSC-derived hepatocyte-like cells demonstrate cyp p450 activity and production of fibrinogen and urea through 15 days in our MPS, albeit at levels below fresh human hepatocytes; optimization protocols are underway.

In the first phase of this work we optimized the flow rate and seeding of hepatocytes with non-parenchymal cells (NPCs) from fresh human liver resections. We found that higher flow rates produced poorer tissue formation and increased stress fibers/actin filaments. We maintained functioning hepatocytes in the MPS through 15 days. Hepatocyte function and injury was measured by urea, lactate, AST, ALT, A1AT, fibrinogen and cyp p450 assays. NPCs survived through the 15 day endpoint with immunofluorescent microscopy visualizing leukocytes, endothelial cells and macrophages. The proliferative MDA MB 231 BC cell line showed preliminary evidence of growth attenuation after 12 days of culture in a subpopulation of cells in our MPS. Luminex cancer panel studies are underway with systems biology modeling to describe a communication network in the early microenvironment of micrometastases.

In parallel we are piloting hydrogel scaffolds that support tissue formation but provide a more physiologic rheology; stiff supporting materials yield an inflammatory phenotype in the NPC which forces even well-differentiated BC cells towards a mesenchymal phenotype. We found that hydrogels support hepatocytes through 15 days and incorporate cancer cells. Micropumps are also being developed by Draper Laboratories to allow for physiologic diurnal variations of hormones and nutrients to liver tissues to accurately assess dormancy and chemotherapy response. The completion of these studies will provide insights into the tumor biology of dormant micrometastases and an accessible tool for testing of therapeutics against metastatic BC in a metabolically competent system.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-04-08.

Metacognitive therapy in recurrent depression: a case replication series in Denmark

Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.

Does Metacognition Make a Unique Contribution to Health Anxiety When Controlling for Neuroticism, Illness Cognition, and Somatosensory Amplification?

Somatosensory amplification (e.g., Barsky, 1992), illness cognition (e.g., Salkovskis & Warwick, 1986), and neuroticism (e.g., Noyes et al., 2003) have all been linked to health anxiety. The first two factors are disorder specific; however, neuroticism is a general vulnerability connected to a range of disorders. In the metacognitive model (Wells, 2009), beliefs about thinking have been implicated in the development of psychopathologies, but little is known about the contribution of individual differences in metacognition to health anxiety, specifically. A cross-sectional design was employed with convenience sampling used for participant selection. Participants (N = 351) completed a questionnaire battery and the following hypotheses were tested: (a) metacognition will show a significant positive correlation with health anxiety and (b) the relationship between metacognition and health anxiety will remain significant after controlling for variables normally associated with health anxiety (i.e., neuroticism, somatosensory amplification, and illness cognition). Hierarchical multiple regression analysis were run to test hypotheses and determine the best independent metacognitive predictors. The results supported each of the hypotheses and revealed three independent metacognitive predictors of health anxiety: “negative metacognitive beliefs about uncontrollability and danger,” “beliefs about the need for thought control,” and “cognitive confidence.” Overall, this study indicates that metacognition may have an important role in health anxiety, and the clinical implications are discussed.

Otitis media associated with Cryptosporidium baileyi in a Saker falcon (Falco cherrug)

A 7-week-old male Saker falcon died with a history of severe refractory dyspnoea and respiratory signs. Microscopical lesions included moderate to severe lymphoplasmacytic inflammation of the middle ears, conjunctivae, third eyelids, choanae, salivary glands of the tongue, turbinates, larynx, trachea, syrinx and bronchi. The lesions were associated with variable numbers of Cryptosporidium spp., further confirmed by transmission electron microscopy and in-situ hybridization. Cryptosporidium baileyi was identified by DNA sequence analysis. C. baileyi may therefore be a cause of otitis media in raptors as it is in man. It is most likely that the middle ears of the Saker falcon acquired the infection through the eustachian tubes that originate near the pharynx in the oral cavity. This is the first description of otitis media associated with C. baileyi in a bird or a mammal except man.

Engineering dynamics of growth factors and other therapeutic ligands

Peptide growth factors and other receptor-binding cytokine ligands are of interest in contemporary molecular health care approaches in applications such as wound healing, tissue regeneration, and gene therapy. Development of effective technologies based on operation of these regulatory molecules requires an ability to deliver the ligands to target cells in a reliable and well-characterizable manner. Quantitative information concerning the fate of peptide ligands within tissues is necessary for adequate interpretation of experimental observations at the tissue level and for truly rational engineering design of ligand-based therapies. To address this need, we are undertaking efforts to elucidate effects of key molecular and cellular parameters on temporal and spatial distribution of cytokines in cell population and cell/matrix systems. In this article we summarize some of our recent findings on dynamics of growth factor depletion by cellular endocytic trafficking, growth factor transport through cellular matrices, and growth factor production and release by autocrine cell systems. (c) 1996 John Wiley & Sons, Inc.

A triphasic metacognitive formulation of problem drinking

In this paper, a triphasic metacognitive formulation of problem drinking and its implications for treatment are presented together with a summary of the evidence consistent with this approach. In the triphasic formulation during the pre-alcohol use phase, alcohol-related triggers, in the form of cravings, images, memories or thoughts, activate positive metacognitive beliefs about extended thinking, which lead to desire thinking, rumination and worry or their combination. The activation of the latter brings to an escalation of cravings and negative affect, strengthening negative metacognitive beliefs about the need to control thoughts and enhancing the likelihood of alcohol use. In the alcohol use phase, positive metacognitive beliefs about alcohol use and a reduction in metacognitive monitoring contribute to dysregulation in alcohol use. Over the course of time and as the drinking problem escalates in severity, negative metacognitive beliefs about the uncontrollability of alcohol use and alcohol-related thoughts emerge, contributing to the perseveration of dysregulated alcohol use. In the post-alcohol use phase following the activation of positive metacognitive beliefs about post-event rumination, the affective, cognitive and physiological consequences of dysregulated alcohol use become the subject of rumination. This, in turn, leads to a paradoxical increase in negative affect and alcohol-related thoughts, together with the strengthening of negative metacognitive beliefs about such thoughts. Intermittent attempts to suppress alcohol-related thoughts increase the likelihood of returning to use alcohol as a means of achieving self-regulation.

KEY PRACTITIONER MESSAGE

A metacognitive formulation of problem drinking that may aid assessment, conceptualization and treatment across the problem drinking spectrum.

Management of young onset colorectal cancer: divergent practice in the East of England

AIM

According to the revised Bethesda Guidelines, colorectal cancer (CRC) occurring under age 50 years should be screened to exclude Lynch syndrome. However, in current practice in East Anglia, tumour screening is initiated only after genetics referral, reserved for those with a strong pedigree. This study aimed to determine how many patients with young-onset CRC undergo tumour screening in hospitals in East Anglia.

METHOD

A retrospective case notes review over 5 years in four hospitals was undertaken to determine what proportion of those with young-onset CRC underwent referral for tumour screening and to assess local practices in terms of patient counselling and management.

RESULTS

One hundred and twenty-two patients were included. There was an average yearly caseload of 6-9 patients per hospital. Documented family history was rare, as was counselling concerning metachronous and extra-colonic tumour risk and CRC risk in relatives. The rate of referral for genetic testing varied from 44% to 65%. Postoperative colonoscopic surveillance was inconsistent.

CONCLUSION

Many patients with young-onset CRC are managed as sporadic cancers, without Lynch syndrome having been excluded. This may have implications for survival of patients and any affected relatives. A streamlined management algorithm for tumour screening and genetics referral is recommended.

The temporal precedence of metacognition in the development of anxiety and depression symptoms in the context of life-stress: a prospective study

According to the metacognitive theory of psychological disorder, metacognitions are vulnerability factors in predicting development of psychological symptoms. The present study investigated metacognitive factors and life stress in a prospective test of their proposed temporal precedence in the development of anxiety and depression symptoms. Participants were 172 students and adults recruited in Ankara and Bolu, Turkey. Two separate sets of hierarchical regression analyses were conducted. In these analyses, Time 2 anxiety or depression was regressed on the main and interaction effects of metacognition and stress after controlling for baseline symptom levels measured at Time 1, age, and gender. Results revealed that negative metacognitive beliefs about the uncontrollability and danger of worry significantly predicted residual change in both anxiety and depression after controlling for the negative effect of stressful life events. Furthermore, lack of cognitive confidence interacted with daily hassles to predict the change in anxiety, when the baseline level of anxiety and other individual differences were controlled. Our results support the metacognitive theory of psychopathology.

Religion and mental health: Towards a cognitive-behavioural framework

PURPOSE

Religion is frequently ignored within the clinical domain. Yet when examined, empirical evidence indicates that specific aspects of religiosity are correlated with mental health. The established associations between religious dimensions and mental health could be mediated by cognitive-behavioural mechanisms. This paper proposes a preliminary conceptual framework in which two types of cognitive and behavioural mechanisms are described, (1). generic mental models that provide a basis for guiding appraisals of life events and (2). self-regulation of thinking processes (metacognitive control).

METHOD

A critical analysis of extant literature was employed to examine support for each of the mechanisms.

DISCUSSION

Evidence supports the idea that a religious framework can serve as a generic mental model that influences appraisals and affects well-being. The benefits derived depend on the salience of the framework, level of certainty with which attributions can be accepted, and the content of the information. Evidence for the self-regulation mechanism is weaker. Although consistent with this supposition, it requires further empirical evaluation.

CONCLUSION

The relationships between religious variables and mental health may depend on cognitive-behavioural mechanisms. Developments in this area might encourage clinicians to consider further the ways in which religious variables might be utilized and assessed in therapy. However, there is a need for further efforts to incorporate religious and spiritual factors in the clinical arena.

Association between abnormal psychosocial situations in childhood, generalized anxiety disorder and oppositional defiant disorder

OBJECTIVE

Psychosocial stressors are important in the pathogenesis of most mental disorders. However, little is known about the way psychosocial stressors uniquely combine to create risk for different expressions of child and adolescent psychopathology. The purpose of this study was to determine whether core dimensions of stressful psychosocial situations are differentially associated with childhood generalized anxiety disorder and oppositional defiant disorder.

METHOD

A case-control design conducted in Trondheim (Norway) from 2002 to 2004 comparing exposure to ICD-10-defined abnormal psychosocial situations (Z-codes) among 21 children with oppositional defiant disorder (ODD) and 22 children with generalized anxiety disorder (GAD) recruited from a university outpatient clinic with 42 non-patient school controls.

RESULTS

Multigroup discriminant analysis extracted two significant dimensions within the psychosocial variables assessed. Function 1 was characterized by overprotection, parental pressures and acute life events and was associated with GAD. Function 2 was characterized by parental abuse/hostility and interpersonal stress and was associated with ODD. Both dimensions were able to correctly classify 89.7% of the cases, compared to 35.9% by chance.

CONCLUSIONS

The results indicate that specific psychosocial dimensions are differentially related to childhood GAD and ODD. This may be useful in targeting at-risk populations for preventive intervention as well as informing more accurate alignment of psychosocial resources for treatment.

Randomized, prospective, placebo-controlled trial of bosentan in interstitial lung disease secondary to systemic sclerosis

OBJECTIVE

Endothelin is implicated as a participatory pathway in systemic sclerosis (SSc). We tested this hypothesis in a 12-month trial of bosentan, a nonselective endothelin receptor antagonist, as a therapy for SSc-related interstitial lung disease (ILD).

METHOD

Patients with SSc and significant ILD were recruited to this prospective, double-blind, randomized, placebo-controlled, parallel group study. The inclusion criteria were designed to select a cohort enriched for patients with active and progressive disease. Exclusion factors included significant pulmonary hypertension. Patients with a diffusing capacity for carbon monoxide of <80% predicted and a 6-minute walk distance of 150-500 meters or a 6-minute walk distance of > or = 500 meters with a decrease in oxygen saturation received bosentan or placebo. The primary efficacy end point was a change in the 6-minute walk distance from baseline up to month 12. Secondary end points included time to death or worsening results of pulmonary function tests (PFTs). The safety and tolerability of bosentan were also assessed.

RESULTS

Among the 163 patients, 77 were randomized to receive bosentan, and 86 were randomized to receive placebo. No significant difference between treatment groups was observed for change in the 6-minute walk distance up to month 12. No deaths occurred in this study group. Forced vital capacity and diffusing capacity for carbon monoxide remained stable in the majority of patients in both groups. Significant worsening of PFT results occurred in 25.6% of patients receiving placebo and 22.5% of those receiving bosentan (P not significant).

CONCLUSION

No improvement in exercise capacity was observed in the bosentan-treated group compared with the placebo group, and no significant treatment effect was observed for the other end points. Although many outcome variables were stable, bosentan did not reduce the frequency of clinically important worsening. These data do not support the use of endothelin receptor antagonists as therapy for ILD secondary to SSc.

Interleukin-10/Ceftriaxone prevents E. coli-induced delays in sensorimotor task learning and spatial memory in neonatal and adult Sprague-Dawley rats

Intrauterine infection during pregnancy is associated with early activation of the fetal immune system and poor neurodevelopmental outcomes. Immune activation can lead to alterations in sensorimotor skills, changes in learning and memory and neural plasticity. Both interleukin-10 (IL-10) and Ceftriaxone have been shown to decrease immune system activation and increase memory capacity, respectively. Using a rodent model of intrauterine infection, we examined sensorimotor development in pups, learning and memory, via the Morris water maze, and long-term potentiation in adult rats. Pregnant rats at gestational day 17 were inoculated with 1 x 10(5) colony forming units of Escherichia coli (E. coli) or saline. Animals in the treatment group received IL-10/Ceftriaxone for 3 days following E. coli administration. Intrauterine infection delayed surface righting, negative geotaxis, startle response and eye opening. Treatment with IL-10/Ceftriaxone reduced the delay in these tests. Intrauterine infection impaired performance in the probe trial in the Morris water maze (saline 25.13+/-1.01; E. coli 20.75+/-1.01; E. coli+IL-10/Ceftriaxone 20.2+/-1.62) and reduced the induction of long-term potentiation (saline 141.5+/-4.3; E. coli 128.7+/-3.9; E. coli+IL-10/Ceftriaxone 140.0+/-10). In summary, the results of this study indicate that E. coli induced intrauterine infection delays sensorimotor and learning and memory, while IL-10/Ceftriaxone rescues some of these behaviors. These delays were also accompanied by an increase in interleukin-1beta levels, which indicates immune activation. IL-10/Ceftriaxone prevents these delays as well as decreases E. coli-induced interleukin-1beta activation and may offer a window of time in which suitable treatment could be administered.

A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder

Metacognitive Therapy (MCT) and Applied Relaxation (AR) were compared in a pilot treatment trial of generalized anxiety disorder (GAD). Twenty outpatients meeting criteria for DSM-IV-TR GAD were assessed before treatment, after treatment and at 6 m and 12 m follow-up. The patients were randomized and treated individually for 8-12 weekly sessions. There was no drop-out from MCT and 10% at 6 m follow-up from AR. At post-treatment and at both follow-up points MCT was superior to AR. Standardized recovery rates for MCT at post-treatment were 80% on measures of worry and trait-anxiety compared with 10% following AR. At 6 m follow-up recovery rates for MCT were 70% on both measures compared with 10% and 20% for AR. At 12 m follow-up recovery rates for MCT were 80% (worry) and 60% (trait-anxiety) compared with 10% and 20% following AR. The recovery rates for MCT are similar to those obtained in an earlier uncontrolled trial (Wells & King, 2006). The effect sizes and standardized recovery rates for MCT suggest that it is a highly effective treatment.

An empirical test of the metacognitive model of obsessive-compulsive symptoms: replication and extension

The aim of the current study was to further investigate the role of metacognitive beliefs implicated in Wells' (1997) model of obsessive-compulsive disorder (OCD). The metacognitive domains of thought-fusion beliefs and beliefs about rituals were positively correlated with obsessive-compulsive symptoms in a community control sample (N=269) and in an OCD sample (N=57). The OCD sample had significantly more obsessive-compulsive symptoms as well as higher scores on the metacognitive constructs than the control sample. In order to perform a more stringent test of the metacognitive model of OCD and to explore the role of a third metacognitive construct, that of stop signals, a second study was conducted using a community control sample (N=304). All three metacognitive constructs were positively correlated with obsessive-compulsive symptoms. Thought-fusion beliefs and beliefs about rituals predicted obsessive-compulsive symptoms, even when controlling for worry, threat, and non-metacognitive beliefs such as perfectionism/certainty and responsibility. Results of this study provide further evidence for the importance of metacognitions in OCD.

An empirical test of the metacognitive model of obsessive-compulsive symptoms: fusion beliefs, beliefs about rituals, and stop signals

The metacognitive model of obsessive-compulsive symptoms [Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley] emphasizes three types of metacognitive knowledge in the etiology and maintenance of symptoms: thought fusion beliefs, beliefs about the need to perform rituals, and criteria that signal rituals can be stopped. We tested the model using a series of hierarchical regression analyses. Results showed that each metacognitive domain when entered in their hypothesized causal sequence explained incremental variance in two different measures of obsessive-compulsive symptoms, with worry controlled. These incremental relationships remained when non-metacognitive beliefs (e.g., responsibility and perfectionism) which have been linked to obsessive-compulsive symptoms in other theories were controlled. Results provide further support for the metacognitive model.