First case report of de novo ulcerative colitis developing after orthotopic liver transplantation successfully treated by granulocyte and monocyte apheresis

BACKGROUND

Immunosuppressants such as tacrolimus and cyclosporine are prescribed long-term after orthotopic liver transplantation (OLT) to prevent allograft rejection. Although these immunosuppressants are known to effectively control ulcerative colitis (UC), some post-OLT patients develop exacerbation of preexisting UC or de novo UC. Although aminosalicylates and corticosteroid courses are usually effective to treat such UC, several patients have developed uncontrollable disease and required colectomies.

CASE REPORT

We have reported a patient who developed de novo UC after OLT to treat liver cirrhosis and hepatocellular carcinoma associated with hepatitis B virus (HBV) infection. Existence of the HBV infection made us avoid to increase the corticosteroid dose or to use other immunosuppressants such as azathioprine or infliximab.

CONCLUSIONS

In this patient, granulocyte and monocyte apheresis was highly effective in terms of inducing remission of de novo UC. No adverse event was noted.

Abstract P6-06-27: Expression of ATP-binding cassette transporter C1 (ABCC1) and activated sphingosine kinase 1 in breast cancer are associated with significantly shorter disease free survival

Background and specific objectives: ATP-binding cassette (ABC) transporters are known to be multidrug resistance proteins that efflux various compounds out of cells including chemotherapeutic agents. A number of clinical trails have been conducted targeting ABCB1: however, none showed beneficial effects. The pleiotropic bioactive lipid mediator sphingosine-1-phosphate (S1P), which is generated by sphingosine kinase 1 (SphK1) inside breast cancer cells and exerts its functions by binding to its specific cell surface G-protein coupled receptors (S1PR1-5) after being exported, is now known as a key regulatory molecule in breast cancer progression. We have previously demonstrated that ABCC1 and ABCG2, but not ABCB1 export S1P out of MCF7 human breast cancer cells. We hypothesized that ABCC1 expression in the presence of S1P produced by activated SphK1 in human breast cancer is associated with poor prognosis.

Methods: We constructed a tissue microarray with 281 breast tumors from patients, and analyzed expressions of ABCB1, ABCC1, and ABCG2, activated SphK1 (pSphK1), and S1P receptor-1 (S1PR1) immunohistochemically. Breast cancer subtypes were determined by immunohistochemistry of ER, PR, and HER2. Protein expressions were correlated to clinicopathological characteristics, clinical follow-up, and pathological complete response to neoadjuvant chemotherapy. For in vitro experiments, MCF7 human breast cancer cells were transfected with ABCB1 or ABCC1 and stimulated with estradiol. Cell proliferation was analyzed by WST-8 assay.

Results: The tissue microarray was comprised of 191 luminal A (68.0%), 17 luminal B (6.0%), 27 HER2 (9.6%), and 46 triple-negative (16.4%) tumors. Activated SphK1 was highly expressed in the patients with lymph node metastasis (40.1% vs 27.3%, P = 0.037) and the pSphK1 high expression group had significantly shorter disease free survival (DFS) (P = 0.05). Eighty percent of the patients expressed S1PR1; however, there were no significant differences in prognosis. On the other hand, ABCC1 expression was associated with significantly shorter DFS (P = 0.027). ABCC1 and ABCG2, but not ABCB1, were significantly higher and more frequently expressed in aggressive subtypes. Patients with tumors expressing both pSphK1 and ABCC1 had significantly shorter DFS (P = 0.002), while patients expressing both ABCB1 and pSphK1 did not. Overexpression of ABCC1 in MCF7 cells not only increased S1P secretion, it significantly increased estradiol-dependent proliferation, compared to MCF7 cells transfected with control vector or ABCB1 (P = 0.010 and P = 0.027, respectively).

Conclusions: We have shown that ABCC1 and ABCG2 are highly expressed in aggressive breast cancer subtypes, and that co-expression of pSphK1 and ABCC1 in the tumors is associated with poor prognosis. Our results suggest that inside-out signaling of S1P via ABCC1 may play a significant role in the course of human breast cancer progression.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-27.

Abstract P2-05-06: Does the lipid mediator sphingosine-1-phosphate have a role in obesity-related cancer progression?

INTRODUCTION: Obesity, which is the number one health risk in US ranked by the CDC, is an established independent prognostic factor for breast cancer patients. While the link between obesity and elevated breast cancer mortality is well known, the underlying mechanisms are poorly understood. The pleiotropic bioactive lipid mediator sphingosine-1-phosphate (S1P) has emerged as a key regulatory molecule in cancer progression and inflammation. S1P is generated by two sphingosine kinases, SphK1 and SphK2, and exerts its functions by binding to specific G protein-coupled receptors (S1PR1-5). We have recently shown that SphK1, but not SphK2, produces S1P that is exported from breast cancer cells, mediated by the ATP-binding cassette transporter, ABCC1. Furthermore, we discovered that another S1P transporter, Spns2, is important for the lymphatic network formation in the LNs. FTY720, which after phosphorylation is a S1PR1 functional antagonist, was recently approved by FDA for multiple sclerosis. FTY720 also has been suggested to have some anti-cancer actions. Our hypothesis is that obesity up-regulates SphK1, which produces more S1P; the elevated levels of S1P in both tumor and its microenvironment stimulate breast cancer progression. FTY720 is expected to disrupt the SphK1/S1P/S1PR1 axis, which is strengthened by obesity, and to reduce cancer metastasis and prolong survival. We tested our hypothesis by utilizing animal models of breast cancer with obesity treated with FTY720.

METHODS: We utilized two different syngeneic breast cancer mouse models: 4T1-luc2 cells in BALB/c mice and E0771 cells in C57Bl/6 mice, both inoculated into mammary fat pads of mice fed with normal or high fat diet. FTY720 was given orally. Western blot, QPCR and LC-ESI-MS/MS assays were used.

RESULTS: We observed that breast tumors in obese animals expressed higher levels of SphK1 and S1P transporters, such as ABCC1 and Spns2, as compared to animals on a normal diet. The levels of S1P in the plasma of obese mice were also elevated, which appears to be a consequence of the higher production of S1P by SphK1 in the tumor and its microenvironment. Importantly, tumor progression in both models was suppressed significantly by administration of FTY720. Interestingly, the cancer progression was suppressed more efficiently in the obese mice than the lean mice. Further, LC-ESI-MS/MS analysis showed that FTY720 suppressed S1P levels not only in the blood, but also in the tumor interstitial fluid.

CONCLUSIONS: These results suggest that the S1P axis is strengthened by obesity, and has a role in cancer progression. Targeting the S1P axis with FTY720 may be useful for treating breast cancer in individuals with obesity. M.N. is a Japan Society for the Promotion of Science Postdoctoral Fellow. This work was supported by NIH grants R37GM043880, R01CA61774 (to S.S.) and R01CA160688 (to K.T.).

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-05-06.

Peristaltic hemodynamics of a new pediatric circulatory assist system for Fontan circulation using shape memory alloy fibers

Fontan procedure is one of the common surgical treatments of congenital heart diseases. Patients with Fontan circulation have single ventricle in the systemic circulation with the total cavopulmonary connection. We have been developing a pulmonary circulatory assist device using shape memory alloy fibers for Fontan circulation with total cavopulmonary connection. It consisted of the shape memory alloy fibers, the diameter of which are 100 µm. The fibers could wrap the ePTFE conduit for Fontan TCPC connection from the outside. We designed the sequential motion control system for sophisticated pulmonary hemodynamics by the pulsatile flow generation. In order to achieve pulsatile flow assistance in pulmonary arterial system, we fabricated a mechanical structure by sequential contraction of shape memory alloy fibers. Then, we developed a sequential contraction controller for the assist system, which could reproduce the wall contractile velocity at 6.0 to 20.0 cm/sec. We examined hemodynamic characteristic of its function using a mock circulatory system, which consisted of two overflow tanks representing venous and pulmonary arterial pressures in Fontan circulation. As a result, the pulmonary circulation assist device with sequential contraction could achieve effective promotion of the pulsatility in pulmonary arterial flow.

Controlling methods of a newly developed extra aortic counter-pulsation device using shape memory alloy fibers

Diastolic counter-pulsation has been used to provide circulatory augmentation for short term cardiac support. The success of intra-aortic balloon pump (IABP) therapy has generated interest in long term counter-pulsation strategies to treat heart failure patients. The authors have been developing a totally implantable extra aortic pulsation device for the circulatory support of heart failure patients, using 150 µm Ni-Ti anisotropic shape memory alloy (SMA) fibers. These fibers contract by Joule heating with an electric current supply. The special features of our design are as follow: non blood contacting, extra aortic pulsation function synchronizing with the native heart, a wrapping mechanical structure for the aorta in order to achieve its assistance as the aortomyoplsty and the extra aortic balloon pump. The device consisted of rubber silicone wall plates, serially connected for radial contraction. We examined the contractile function of the device, as well as it controlling methods; the phase delay parameter and the pulse width modulation, in a systemic mock circulatory system, with a pneumatically driven silicone left ventricle model, arterial rubber tubing, a peripheral resistance unit, and a venous reservoir. The device was secured around the aortic tubing with a counter-pulsation mode of 1:4 against the heartbeat. Pressure and flow waveforms were measured at the aortic outflow, as well as its driving condition of the contraction phase width and the phase delay. The device achieved its variable phase control for co-pulsation or counter-pulsation modes by changing the phase delay of the SMA fibers. Peak diastolic pressure significantly augmented, mean flow increased (p<0.05) according to the pulse width modulation. Therefore the newly developed extra aortic counter-pulsation device using SMA fibers, through it controlling methods indicated its promising alternative extra aortic approach for non-blood contacting cardiovascular circulatory support.

Examination of mitral regurgitation with a goat heart model for the development of intelligent artificial papillary muscle

Annuloplasty for functional mitral or tricuspid regurgitation has been made for surgical restoration of valvular diseases. However, these major techniques may sometimes be ineffective because of chamber dilation and valve tethering. We have been developing a sophisticated intelligent artificial papillary muscle (PM) by using an anisotropic shape memory alloy fiber for an alternative surgical reconstruction of the continuity of the mitral structural apparatus and the left ventricular myocardium. This study exhibited the mitral regurgitation with regard to the reduction in the PM tension quantitatively with an originally developed ventricular simulator using isolated goat hearts for the sophisticated artificial PM. Aortic and mitral valves with left ventricular free wall portions of isolated goat hearts (n=9) were secured on the elastic plastic membrane and statically pressurized, which led to valvular leaflet-papillary muscle positional change and central mitral regurgitation. PMs were connected to the load cell, and the relationship between the tension of regurgitation and PM tension were measured. Then we connected the left ventricular specimen model to our hydraulic ventricular simulator and achieved hemodynamic simulation with the controlled tension of PMs.

Unique mechanisms of excitation energy transfer, electron transfer and photoisomerization in biological systems

We discuss unique mechanisms typical in the elementary processes ofbiological functions. We focus on three topics. Excitation energytransfer in the light-harvesting antenna systems of photosyntheticbacteria is unique in its structure and the energy transfer mechanism. Inthe case of LH2 of Rhodopseudomonas acidophila, the B850 intra-ringenergy transfer and the inter-ring energy transfer between B800 and B850take place by the intermediate coupling mechanism of energy transfer. Theexcitonic coherent domain shows a wave-like movement along the ring, andthis property is expected to play a significant role in the inter-ringenergy transfer between LH2's. The electron transfer in biological systemsis mostly long-range electron transfer that occurs by the electrontunneling through the protein media. There is a long-standing problem thatwhich part of protein media is used for the electron tunneling root. As aresult of our detailed analysis, we found that the global electron tunnelingroot is a little winded with a width of a few angstrom, reflecting theproperty of tertiary and secondary structures of the protein and it isaffected by the thermal fluctuation of protein structure. Photoisomerizationof rhodopsin is very unique: The cis-transphotoisomerization ofrhodopsin occurs only around the C11 = C12 bond in the counterclockwisedirection. Its molecular mechanism is resolved by our MD simulation studyusing the structure of rhodopsin which was recently obtained by the X-raycrystallographic analysis.

Serum undercarboxylated osteocalcin level increases with 48 weeks of teriparatide treatment in pre-treated elderly rheumatoid arthritis patients who use anti-resorptive drugs

AIM

The serum undercarboxylated osteocalcin (ucOC) level, a biochemical bone marker of vitamin K insufficiency, is often affected by anti-osteoporosis drugs. There have been no reports regarding the relationship between ucOC and teriparatide.

SUBJECTS AND METHODS

We conducted a prospective observational study of 26 female rheumatoid arthritis (RA) patients. The patients were divided into 3 groups: those who underwent a direct switch from anti-resorptive drugs to teriparatide (12 cases), those who started teriparatide without pre-treatment (5 cases), and the control patients (9 cases). The median age (interquartile range) of the patients in each group was 75 (67-77), 82 (78-84), and 69 (62-80) yr, respectively. All patients, except controls, received 48-week treatments of teriparatide. We analyzed the median 48-week changes from baseline of the serum ucOC levels with the Steel-Dwass method.

RESULTS

The median change from baseline in the direct switch group was higher than that in other groups (p<0.05).

CONCLUSIONS

The serum ucOC levels increased with treatment of teriparatide in elderly RA patients, especially when the patients received pre-treatment.

Cell dynamics in cervical loop epithelium during transition from crown to root: implications for Hertwig's epithelial root sheath formation

BACKGROUND AND OBJECTIVE

Some clinical cases of hypoplastic tooth root are congenital. Because the formation of Hertwig's epithelial root sheath (HERS) is an important event for root development and growth, we have considered that understanding the HERS developmental mechanism contributes to elucidate the causal factors of the disease. To find integrant factors and phenomenon for HERS development and growth, we studied the proliferation and mobility of the cervical loop (CL).

MATERIAL AND METHODS

We observed the cell movement of CL by the DiI labeling and organ culture system. To examine cell proliferation, we carried out immunostaining of CL and HERS using anti-Ki67 antibody. Cell motility in CL was observed by tooth germ slice organ culture using green fluorescent protein mouse. We also examined the expression of paxillin associated with cell movement.

RESULTS

Imaging using DiI labeling showed that, at the apex of CL, the epithelium elongated in tandem with the growth of outer enamel epithelium (OEE). Cell proliferation assay using Ki67 immunostaining showed that OEE divided more actively than inner enamel epithelium (IEE) at the onset of HERS formation. Live imaging suggested that mobility of the OEE and cells in the apex of CL were more active than in IEE. The expression of paxillin was observed strongly in OEE and the apex of CL.

CONCLUSION

The more active growth and movement of OEE cells contributed to HERS formation after reduction of the growth of IEE. The expression pattern of paxillin was involved in the active movement of OEE and HERS. The results will contribute to understand the HERS formation mechanism and elucidate the cause of anomaly root.

Post-menopausal women with rheumatoid arthritis who are treated with raloxifene or alendronate or glucocorticoids have lower serum undercarboxylated osteocalcin levels

BACKGROUND

Serum undercarboxylated osteocalcin (ucOC) is a biochemical bone marker of vitamin K insufficiency. It had been reported that bone resorption inhibitors tend to decrease the serum ucOC level in patients with primary osteoporosis. In rheumatoid arthritis (RA) patients, these results have never been reported.

AIM

We investigated risk factors which could change serum ucOC level in post-menopausal women with RA (no.=100).

SUBJECTS AND METHODS

Twenty patients received no bone resorption inhibitor (control), 30 received raloxifene (RLX), while 50 received alendronate (ALN). This cross-sectional study was limited to patients with low RA disease activity (Disease Activity Score-28 ≤3.2). We measured serum ucOC, and the data were analyzed by multivariable analysis, including ucOC and the other variables.

RESULTS

Scheffe's F test demonstrated a significant difference in serum ucOC levels between controls and the RLX group (p<0.01), and between controls and the ALN group (p<0.01). Serum ucOC levels were low in both treated groups. An adjusted multivariate analysis was performed for the variables: bone resorption inhibitor use, serum alkaline phosphatase, glucocorticoid dose, age, estimated glomerular filtration rate and matrix metalloproteinase 3. As a result, serum ucOC inversely correlated with bone resorption inhibitor use (p<0.01) and oral glucocorticoid dose (p<0.01), which were independent risk factors of lowering ucOC.

CONCLUSIONS

Bone resorption inhibitors and glucocorticoids were independent risk factors for lowering serum ucOC levels in post-menopausal RA patients.