RTOG 0525: Molecular correlates from a randomized phase III trial of newly diagnosed glioblastoma

LBA2000

Background: Formalin-fixed, paraffin embedded GBM tumor tissue, adequate for conventional MGMT methylation analyses, was required for entry onto the RTOG 0525 clinical trial. Methods: Four prognostic biomarkers were evaluated on a training set of 220 retrospectively obtained GBM samples, consisting of IDH1 mutation, the glioma-CpG island methylator phenotype (G-CIMP), a microarray-based mRNA panel and a novel MGMT promoter methylation assay. For each biomarker, 2 (IDH1 and mRNA) or 3 subgroups (G-CIMP and MGMT) were defined based on associations with overall survival. All combinations (36 possible) of each of the 4 biomarker-derived subgroups were then defined and compared with survival data and then consolidated into 4 risk groups. Once created in the training set, this model was applied to the RTOG 0525 samples (n=763) for external validation. Results: Application of the molecular risk classification to RTOG 0525 samples (left table) showed a highly significant survival association (p<0.001). When compared to the recursive partitioning analysis (RPA, table on right), this composite molecular classifier better identified patients with long term survival and appears to improve resolution by revealing an additional distinct risk group. The molecular classifier was prognostic in each of the treatment arms individually. Conclusions: Four distinct biomarkers or biomarker panels were tested in GBM. These biomarkers were compared with clinical outcome in a training set to optimize a method to combine them into a classifier. This classifier was then validated on a large sample set from a large phase III clinical trial. This composite panel may represent an improvement over the existing RPA with respect to risk stratification of patients for GBM. Additionally, it has the potential to impact future clinical trial designs and provide enhanced opportunities for personalization of therapy for GBM. Support: NCI U10 CA2121661, U10 CA37422, P50 CA127001.

[Table: see text]

CCR3, CCR2A and macrophage inflammatory protein (MIP)-1a, monocyte chemotactic protein-1 (MCP-1) in the mouse hippocampus during and after pilocarpine-induced status epilepticus (PISE)

AIMS

To investigate protein and gene expressions of chemokine subtypes CCR3, CCR2A and their respective ligands macrophage inflammatory protein 1-alpha (MIP-1alpha), monocyte chemotactic protein-1 (MCP-1) in the normal mouse central nervous system (CNS) and in the hippocampus at different time points during and after pilocarpine-induced status epilepticus (PISE).

METHODS

CCR3 and MIP-1alpha protein expressions were mapped in the mouse CNS. The protein and gene expressions of CCR3 and CCR2A and their respective ligands MIP-1alpha, MCP-1 in the hippocampus were studies by immunocytochemical and quantitative real-time RT-PCR during and after PISE.

RESULTS

CCR3 and MIP-1alpha gene expression and immunopositive neurones were broadly distributed in the CNS. CCR3 and CCA2A gene and their protein expression were downregulated in the hippocampus at 1 h during PISE. The protein expression of MIP-1alpha, MCP-1 decreased but gene expression increased at 2 h during PISE. In the hilus of the dentate gyrus, significant reduction of the numbers of CCR3, CCR2A, MCP-1 immunopositive neurones occurred from 1 h during to 2 months after PISE, but the number of MIP-1alpha neurones reduced from 2 h during to 2 months after PISE. Induced expression of CCR3 at 1 week, CCR2A, MCP-1 or MIP-1alpha at 1 week and 2 months after PISE was found in reactive astrocytes. MCP-1 was also demonstrated in the blood vessels of the hippocampus at 2 months after PISE.

CONCLUSIONS

CCR3 and MIP-1alpha may play important functional roles in the mouse brain. The downregulation of CCR3, CCR2A, MIP-1alpha and MCP-1 in the hippocampal neurones at the acute stage during and after PISE may weaken the neuroprotective mechanisms. However, induced expression of MCP-1 in hippocampal blood vessel may be related to changes in permeability of the blood-brain barrier during epileptogenesis.

Isolation and sequence analysis of Sox genes in the red crucian carp (Carassius carassius red variety)

Sox genes encode a family of transcription factors which are characterized by the conserved HMG domain and are involved in a diverse range of developmental processes. Using degenerate primer PCR, 7 different sequences encoding the HMG domains of Sox1, Sox9 and Sox1 1b were cloned and sequenced from genomic DNA in the red crucian carp (Carassius carassius red variety). In the case of Sox1 and Sox1 1b, we found evidence of gene duplication. In the phylogenetic tree, two paralogs of Sox1 1b (Sox1 1b1 and Sox1 1b2) fit within the clade of Sox11, especially in the Sox 1b subfamily, not in the Sox1 1a subfamily. Three Sox1 sequences (Soxl-1, Soxl-2 and Sox1-3) which shared the same amino acid sequence were identified in the red crucian carp. At the nucleotide level, Soxl-1 shared the highest sequence similarity to the zebrafish Sox1a, and Sox1-2 and Sox1-3 showed the highest similarity to the zebrafish Sox1b. The phylogenetic tree clearly demonstrated that the red crucian carp Sox1-1 clustered together with the zebrafish Sox1a, and the red crucian carp Sox1-2 and Sox1-3 with the zebrafish Sox1b. The result suggested that the red crucian carp Sox1-1, Soxl-2 and Sox1-3 were resulted from duplication of Sox1 gene rather than polymorphisms of the same gene.

Regulation of bone morphogenetic protein signalling in human pulmonary vascular development

The bone morphogenetic protein (BMP) type II receptor (BMPR-II) is predominantly expressed on the vascular endothelium in the adult lung. Although mutations in BMPR-II are known to underlie many cases of familial pulmonary arterial hypertension (FPAH), little is known regarding the expression of BMPs and their signalling pathways during normal lung development or the impact of BMPR-II mutations on endothelial cell function. We determined the cellular localization and expression levels of BMP4, BMP receptors, and activation of downstream signalling via phospho-Smad1 in a developmental series of human embryonic and fetal lungs by immunohistochemistry. The expression of BMP4 and BMP receptors was temporally and spatially regulated during lung development. BMPR-II expression correlated with phosphorylation of tissue Smad1 and was highest during the late pseudoglandular and early canalicular stage of lung development, when vasculogenesis is intense. Phospho-Smad1 expression was associated with markers of proliferation in endothelial cells. In vitro studies confirmed that BMPs 2 and 4 induced phosphorylation of Smad1/5 and pulmonary artery endothelial cell (PAEC) migration and proliferation. Adenoviral transfection of PAECs with mutant kinase-deficient BMPR-II, or siRNA knockdown of BMPR-II, inhibited Smad signalling and the proliferative response to BMP4. Our findings support a critical role for BMPs in lung vasculogenesis. Dysfunctional BMP signalling in PAECs during development may lead to abnormal pulmonary vascular development and contribute to the pathogenesis of FPAH.

A new paradigm in the management of anorectal melanoma: Trans-anal excision with sphincter preservation and sentinel node biopsy

8513

Background: Anorectal melanoma is rare and highly lethal. Historically this disease has often been treated with abdominoperineal (APR) resection and delayed groin dissection for nodal relapse. As an alternative we have investigated trans-anal excision (TAE) with sphincter preservation and lymphatic mapping with sentinel node biopsy (SNB). We compared the outcomes of this more conservative treatment plan between our institutional data (JWCI) and the Surveillance, Epidemiology and End Results (SEER) data. Methods: JWCI prospective melanoma database (1974–2006) and the SEER database (1973–2003) were searched for pts diagnosed with anorectal melanoma (n=60 vs. n=183, respectively). Treatment, types of recurrence, and survival were recorded. Survival was estimated by the Kaplan-Meier method. Results: Lymphoscintography revealed lymphatic drainage to superficial inguinal nodal basin(s) in all cases. Among JWCI pts, the proportion of pts requiring delayed lymphadenectomy was significantly lower when TAE was performed with SNB versus without SNB (10.0% vs. 58.8%; p=0.018). Among JWCI lymphadenectomy specimens, immediate lymphadenectomy for a positive SNB was associated with fewer metastatic lymph nodes than delayed lymphadenectomy for palpable nodal recurrences (1.6 vs. 2.9; p=0.029), suggesting disease progression during observation. Over the past decade, APR rates were 11.5% for JWCI pts and 43.2% for and SEER pts, (p=0.004). JWCI pts and the SEER pts had median survivals of 33 and 17 months, respectively (p=0.009). TAE versus APR did not adversely affect the survival of JWCI pts (39 vs. 23 months; p=0.010) or SEER pts (18 vs. 16 months; p=0.875). Conclusion: Lymphatic mapping with SNB accurately identified the inguinal nodal basin as the most frequently involved basin and reduced the rate of recurrence and extent of nodal involvement. In this study, the largest to analyze surgical treatment and outcomes for pts with anorectal melanoma in the United States, national TAE rates differed from those at a tertiary melanoma center. TAE did not adversely affect survival in either dataset. Therefore, TAE plus SNB is preferred when negative margins can be obtained; APR should be reserved for locally advanced tumors that cannot be removed by TAE.

No significant financial relationships to disclose.

Efficacy of aminocandin in the treatment of immunocompetent mice with haematogenously disseminated fluconazole-resistant candidiasis

OBJECTIVES

The objective of this study was to compare the activity of aminocandin, a new echinocandin with broad-spectrum activity against Candida spp., with that of amphotericin B, caspofungin and fluconazole, in an immunocompetent murine model of haematogenously disseminated candidiasis caused by a fluconazole-resistant Candida albicans.

METHODS

Mice were infected with a fluconazole-resistant strain of C. albicans and treated with aminocandin 5 and 10 mg/kg intravenously (iv) once and twice weekly, amphotericin B 0.5 mg/kg iv every other day for 5 days, fluconazole 20 mg/kg orally (po) once a day for 5 days and caspofungin 0.5 mg/kg intraperitoneally (ip) once daily for 5 days.

RESULTS

Treatment with aminocandin, given iv twice a week, resulted in 100% survival. Further, the tissue fungal burden of the aminocandin group was equivalent to that of amphotericin B (administered every other day) and caspofungin (administered daily).

CONCLUSIONS

Aminocandin may be an effective addition to the arsenal of antifungal compounds for the treatment of candidiasis caused by fluconazole-resistant C. albicans.

Targeted gene therapy for breast cancer with truncated Bid

We studied the efficiency of the proapoptotic factor tBid, targeted to tumor cells using the promoters of the hTERT, Survivin and Muc1 genes, in killing breast cancer cells. tBid is the active fragment of the proapoptotic protein Bid and is generated in response to death receptor activation. When placed under control of a strong CMV promoter, tBid was highly efficient in killing breast cancer cells. When expression of tBid was driven by tumor-specific promoters, the magnitude of killing was significant in cell lines with high levels of promoter activity. For successful gene therapy with targeted tBid, it is therefore crucial to be able to predict promoter activity prior to selection of the therapeutic construct. To test whether gene expression could serve as a predictor, we correlated expression of Survivin, hTERT and Muc1 genes with the activity of the corresponding promoters in a panel of breast cancer cell lines. Expression of the Muc1 gene correlated well with the activity of its promoter and the resultant tumor cell killing. For the hTERT and Survivin promoters, however, promoter activity did not correlate well with the expression of the corresponding genes. The implications and possible mechanism of these discrepancies are discussed.

Tinea capitis in Cleveland: survey of elementary school students

BACKGROUND

Tinea capitis, a fungal infection of the scalp, is of increasing public health importance, and Trichophyton tonsurans has become the primary causative agent in North America.

OBJECTIVES

To determine the prevalence of dermatophyte-positive scalp cultures among elementary schoolchildren in Cleveland, Ohio, describe predisposing factors, and measure the antifungal susceptibility of isolates collected.

OBSERVATIONS

A total of 937 children from 8 Cleveland elementary schools were cultured for the presence of dermatophytes; 122 children (13%), all of whom were African American, had dermatophyte-positive cultures of the scalp. Sixty percent of cases were asymptomatic, indicating a carrier state. Race, scaling, and the use of anti-dandruff shampoo were associated with increased likelihood of infection. T tonsurans was the only organism isolated (except 1 Microsporum canis isolate). All isolates were susceptible to fluconazole, griseofulvin, itraconazole, and terbinafine.

CONCLUSIONS

T tonsurans was the predominant dermatophyte isolated. Further multicenter studies are needed to confirm the predominance of dermatophyte-positive scalp cultures among African American children and to determine modifiable and preventable risk factors.

[Clinical research of ischemic preconditioning on lung protection]

Twenty patients, who only need to occlude main pulmonary artery underwent pulmonectomy, were randomized into two groups. Ten patients were treated with ischemic preconditioning(IP). Their main pulmonary artery was clamped for 10 minutes and released for 10 minutes(Group IP). Ten patients were not treated with ischemic preconditioning(Group C). The results showed that the content of calcitonin gene related peptide(CGRP) in Group IP was significantly higher than that in Group C after ischemic preconditioning. After lung reperfusion for 30 minutes, the value of superoxide dismutase and pulmonary vein blood oxygen tension in Group IP was significantly higher than that in Group C. It is evident that ischemic preconditioning could reduce normothermic human lung ischemia reperfusion injury. The possible mechanism is that ischemic preconditioning increases the production of endogenous CGRP.

Effects of fluconazole singly and in combination with 5-fluorocytosine or amphotericin B in the treatment of cryptococcal meningoencephalitis in an intracranial murine model

In this study we developed a highly reproducible intracranial murine model of cryptococcosis. Mice (Balb/c, 5-7 weeks old) were challenged intracranially and treated with intermediate (30 mg/kg) or high (90 mg/kg) dose fluconazole, and amphotericin B (0.75 mg/kg), administered singly or in combination with flucytosine (100 mg/kg). Survival and brain CFU analyses were performed. Effect of fluconazole prophylaxis was also determined. Our data show that the developed model mimics clinical signs of cryptococcal meningitis. In single treatment, fluconazole (30 mg/kg) was more efficacious than amphotericin B or flucytosine (P < 0.0001). Combination treatment led to significantly increased anticryptococcal activity, which was highest for high dose fluconazole + flucytosine (P < 0.0001). However, no significant difference was observed between high dose fluconazole treatment with and without flucytosine (P >0.05). Fluconazole prophylaxis led to a significant decrease in brain CFU. In conclusion, high dose fluconazole administered post-infection, or as prophylaxis, may be highly efficacious in the treatment and prevention of meningoencephalitis.

Leaf stomatal and epidermal cell development: identification of putative quantitative trait loci in relation to elevated carbon dioxide concentration in poplar

Genetic variation in stomatal initiation and density, and epidermal cell size and number were examined in a hybrid pedigree of Populus trichocarpa T. & G. and P. deltoides Marsh in both ambient ([aCO2]) and elevated ([eCO2]) concentrations of CO2. We aimed to link anatomical traits with the underlying genetic map of F2 Family 331, composed of 350 markers across 19 linkage groups. Leaf stomatal and epidermal cell traits showed pronounced differences between the original parents. We considered the following traits in the F2 population: stomatal density (SD), stomatal index (SI), epidermal cell area (ECA) and the number of epidermal cells per leaf (ECN). In [eCO2], adaxial SD and SI were reduced in the F2 population, whereas ECA increased and ECN remained unchanged. In [aCO2], four putative quantitative trait loci (QTL) with logarithm of the odds ratio (LOD) scores greater than 2.9 were found for stomatal traits on linkage group B: adaxial SI (LOD scores of 5.4 and 5.2); abaxial SI (LOD score of 3.3); and SD (LOD score of 3.2). These results imply that QTL for SI and SD share linkage group B and are under genetic control. More moderate LOD scores (LOD scores >/= 2.5) suggest QTL for SI on linkage groups A and B and for SD on linkage groups B, D and X with a probable co-locating quantitative trait locus for SI and SD on linkage group D (position 46.3 cM). The QTL in both [aCO2] and [eCO2] for adaxial SD were co-located on linkage group X (LOD scores of 3.5 and 2.6, respectively) indicating a similar response across both treatments. Putative QTL were located on linkage group A (position 89.2 cM) for both leaf size and ECN in [aCO2] and for ECA at almost the same position. The data provide preliminary evidence that leaf stomatal and cell traits are amenable to QTL analysis.